Pediatric Cerebral Palsy Patients Research Articles

Corrective Efficacy of Calcaneal Lengthening Osteotomy for Planovalgus Deformity in Cerebral Palsy Patients.

Introduction Planovalgus deformity is common in children with spastic cerebral palsy (CP), particularly spastic diplegia and spastic quadriplegia. It results from muscle imbalance over the immature foot skeleton, leading to hindfoot valgus, forefoot abduction, and joint subluxation. Surgical interventions, like calcaneal lengthening osteotomy (CLO), are frequently employed to correct this deformity, but objective guidelines for its use in CP patients are lacking. Material and methods This retrospective cohort study examined the efficacy of CLO in correcting plano valgus deformity in pediatric CP patients at the Pediatric Orthopedic Unit of Christian Medical College (CMC) in Vellore, India. Data from patient records and radiographs were collected, including demographics, pre- and postoperative angles, and surgical details. Statistical analysis was performed to assess changes in angles and associations with various factors. Results After the surgery, there was a notable enhancement in the calcaneal pitch, lateral talo-first metatarsal angle, and naviculocuboid overlap, as shown by the CLO results. However, tibiocalcaneal angles did not show significant changes. Associations were observed between age, Gross Motor Function Classification System (GMFCS) level, additional surgeries, and postoperative angle corrections. Conclusion CLO shows promise in correcting plano valgus deformity, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up is crucial to monitor correction durability. Specific radiographic angles provide insights into CLO's biomechanical effects, but study limitations warrant caution in interpretation. CLO effectively corrects plano valgus deformity in pediatric CP patients, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up and further research are needed to optimize management strategies and enhance understanding of surgical outcomes.

Trends in Botulinum Neurotoxin Utilization for Lower Limb Spasticity Management in Pediatric Cerebral Palsy Patients in South Korea: Impact of Insurance Coverage

Trends in Botulinum Neurotoxin Utilization for Lower Limb Spasticity Management in Pediatric Cerebral Palsy Patients in South Korea: Impact of Insurance Coverage

Neuroimaging patterns of anatomical features in pediatric cerebral palsy patients at Ayder Hospital, Mekelle, Ethiopia

Neuroimaging patterns of anatomical features in pediatric cerebral palsy patients at Ayder Hospital, Mekelle, Ethiopia

Fifteen Years of Spinal Fusion Outcomes in Children With Cerebral Palsy: Are We Getting Better?

Retrospective multicenter study. We reviewed 15-year trends in operative factors, radiographic and quality of life outcomes, and complication rates in children with cerebral palsy (CP)-related scoliosis who underwent spinal fusion. Over the past two decades, significant efforts have been made to decrease complications and improve outcomes of this population. We retrospectively reviewed a multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020. We evaluated baseline and operative, hospitalization, and complication data as well as radiographic and quality of life outcomes at a minimum 2-year follow-up. Mean estimated blood loss and transfusion volume declined from 2.7±2.0L in 2008 to 0.71±0.34L in 2020 and 1.0±0.5L in 2008 to 0.5±0.2L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97% (all, P <0.01). Unit rod and pelvic fusion use declined from 33% in 2008 to 0% in 2020 and 96% in 2008 to 79% in 2020, respectively (both, P <0.05). Mean postoperative intubation time declined from 2.5±2.6 to 0.42±0.63 days ( P< 0.01). No changes were observed in preoperative and postoperative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays. Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively did not change significantly over the study period. Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period. Over the past 15 years of CP scoliosis surgery, surgical blood loss, transfusion volumes, duration of postoperative intubation, and pelvic fusion rates have decreased. However, the degree of radiographic correction, the rates of surgical and medical complications (including infection), and health-related quality of life measures have broadly remained constant.

Risk factors for 90-day readmission and prolonged length of stay after hip surgery in children with cerebral palsy

ObjectiveSpastic hip dysplasia is a common complication of cerebral palsy in children, and surgical intervention is usually warranted. While current literature has primarily analyzed single institution outcomes, this study utilized a national database to describe readmission rates and factors correlated with readmission for children with cerebral palsy undergoing hip surgery in order to treat this population more effectively. MethodsThis study queried the Nationwide Readmissions Database (2014–2018) for pediatric patients with cerebral palsy who underwent hip surgery. Patient demographics, pre-operative comorbidities, length of stay (LOS), treatment complications, and readmission data were collected for each patient and analyzed with inferential statistics. ResultsOf the 1225 patients included, the average age was 9.3 ± 3.8 years and 42.8% were female. Approximately 26.3% patients had a prolonged LOS (≥5 days) and 14.2% patients required readmission within 90-days of surgery. Medical complications, cardiac arrhythmias, and iron deficiency anemia were all significantly associated with elongated LOS as well as 90-day readmission. Patients with Medicaid were more frequently associated with an inpatient medical complication and the overall complication rate was 5.5%. ConclusionsWhile current literature has analyzed common risk factors and complications associated with hip surgery in the pediatric cerebral palsy patient, this study identifies a national readmission rate (14.2%) as well as preoperative comorbidities associated with readmission within 90-days and/or elongated LOS. Notably, complications are more frequently associated with patients using Medicaid. These results further exemplify the importance of equitable access to care and thorough selection of pediatric cerebral palsy patients appropriate for hip surgery.

Effectiveness of Serial Casting Alone and in Combination with Botulinum Neurotoxin in Pediatric Spastic Cerebral Palsy Patients

Purpose This study evaluated the changes in gait of pediatric cerebral palsy patients after serial casting alone and serial casting in conjunction with botulinum neurotoxin treatments. Methods Retrospective data of 31 children were investigated. Sixteen children were treated with serial casting combined with BoNT injection and 15 children were treated only with serial casting treatment. GAITRite was used to collect velocity, cadence, swing %, stance %, step length, stride length, and step time parameters to compare the outcomes of the treatments. Results Combined treatment group unaffected side swing % showed a statistically significant difference at completion (M = 35.16 ±1.21; M = 32.46 ± 1.38; t (15) = 2.12, p = 0.049). Unaffected side stance % at pre-intervention was statistically different for serial casting only and the combined treatment groups (M = 61.69± 0.73; M = 64.88±1.20; t (14) = -2.273, p = 0.039). Pre- and post-intervention hemiplegic side swing % comparison was statistically significant for the serial casting only group (M = 40.87± 0.57; M = 42.39±0.79, t (14) = -0.151, p = 0.032). The baseline velocity of the combined treatment group was slower than the serial casting-only group (88±11.2 vs. 107±14.4 (cm/s), p=0.007). Conclusions This investigation suggests that for patients, who have poor ambulation quality, abnormal spatiotemporal gait parameters, and significant spasticity at pre-intervention, BoNT in conjunction with serial casting is more effective for improving ambulation quality. Serial casting can be used in conjunction with botulinum neurotoxin, which is efficient in muscle morphology and function regulation by reducing spasticity.

RIESGO DE DEFICIENCIA DE VITAMINA D EN PACIENTES PEDIÁTRICOS CON PARÁLISIS CEREBRAL QUE RECIBEN NUTRICIÓN ENTERAL DOMICILIARIA

Introduction: Malnutrition and micronutrient deficiencies are frequent complications in patients with cerebral palsy (CP). Objective: to analyze the levels of vitamin D (VitD) in CP patients receiving Home Enteral Nutrition (HEN). Material and Methods: Retrospective analytical cross-sectional study. CP patients, from 2 to 18 years old, with measured VitD at the end of winter 2021, were included. The following study variables were analyzed: sex, age, disability by Gross Motor Scale (GMS), nutritional status, antiepileptic drugs, formula, VitD intake, volume, access route, basal energy expenditure (BEE), according to Schofield P/T. They were grouped: Group I (GI VitD ≥ 30 ng/ml) GII (VitD ≤ 29 ng/ml). Results: 34 CP patients were included, 15 female (44.11 %), mean age 10.87 years (SD 4.78), all grade V (GMS). The mean BMI Z score (WHO) was -1.33 (SD 3.14). EN was daily in all, 33 due to gastrostomy and 1 due to SNG. The average contribution 1270 Kcal (DS243), 1.16 (Kcal received according to Schofield). The formulas provided 80 % of the VitD requirement. VitD blood levels showed: 16 patients (47 %) ≥ 30 ng/ml and 18 (52 %) ≤ 29 ng/ml. 14 (41.17 %) were deficient and 4 insufficient (11.76 %). 59 % (20) of the patients received anticonvulsant medication. No significant differences were found between G1 and G2 for sex, age, BMI Z score, VitD intake, calories received/GMB and anticonvulsant medication. Conclusion: The high percentage of pediatric CP patients with suboptimal levels of Vit D shows that it is a population at risk and suggests the need for systematic check-up for adequate prevention and treatment. Key words: Cerebral Palsy; Nutrition; Vitamin D; Home Enteral Nutrition.

Pelvic radiography as a non-invasive screening tool for hiatal hernia in children with cerebral palsy.

The diagnosis of hiatal hernia (HH), causing severe gastroesophageal reflux disease and complications in children with cerebral palsy (CP) is cumbersome because invasive investigations are required for diagnosis. Hip displacement, one of the most common complications in children with CP, can be diagnosed with a simple pelvic radiograph. This study aimed to evaluate the association between the severity of hip displacement and HH and the diagnostic accuracy of Reimers’ hip migration percentage (MP) on pelvic radiography in assessing the presence of HH. A total of 52 children with CP (27 boys, 25 girls; mean age, 6.3 years; range, 0.6–17.4 years) who underwent esophagogastroduodenoscopy, upper gastrointestinal series and pelvic radiography between March 2013 and February 2020 were recruited. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were evaluated and statistically analyzed. HH was defined as ≥ 2 cm proximal displacement of the gastroesophageal junction identified in esophagogastroduodenoscopy or upper gastrointestinal series, and MP was calculated by evaluating the pelvic radiograph. Of the 52 children enrolled in this study, HH was diagnosed in 18 children (34.6%). When the patients were classified and analyzed according to the MP result, HH was observed in 10%, 26.7%, and 70.6% in MP <33%, MP 33%–39%, and MP > 40% groups, respectively (P < .001). The optimal MP cutoff of 36.5% distinguished pediatric CP patients with HH from those without HH with a sensitivity of 78%, specificity of 68%, a positive predictive value of 56.0%, and a negative predictive value of 85.2%, respectively. The application of MP and the severity of hip displacement, which can be easily measured by simple radiography, may be useful and reliable in screening for detecting HH in children with CP. Retrospectively registered. This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2007-627-106).

Grice extra-articular subtalar fusion for spastic pes planovalgus.

A pes planovalgus deformity, an unstable foot deformity, affects the gait of children with cerebral palsy (CP). Treatments, including subtalar fusion, were proposed. The Grice procedure maintains foot stability, but bone graft non-union poses a challenge. This study aimed to identify the rate and factors related to post-operative bone graft non-union. Thirty-one paediatric CP patients (age, 8.9 ± 1.8 years) who underwent the Grice procedure (53 feet) using ipsilateral tibial bone grafts were reviewed. Pre-operative gross motor function classification system (GMFCS) classes were class 1 in five, 2 in five, 3 in 14, and 4 in seven patients. Standing foot radiographs were assessed for signs of non-union, and parameters (talocalcaneal and talar declination angles and talar head uncovering index) measured pre-operatively, post-operatively, and at the most recent evaluation were compared. Factors associated with bone graft non-union were analysed by regression analysis. P < 0.05 was considered statistically significant. Degenerative changes in hindfoot joints were evaluated by Bargon's criteria. At the average follow-up evaluation at 5.4 ± 4.3 years, the GMFCS class was improved or was maintained in 29/31 patients. Post-operative radiographic measurements were restored and were maintained over the follow-up period (P < 0.001). A total of 14/53 feet (26%) had non-union. The pre-operative lateral talocalcaneal angle (OR 1.08, p = 0.04) and follow-up duration (OR 1.18, p = 0.03) were identified in univariate analysis as potential factors related to non-union but were not confirmed in a multivariate model. Hindfoot joints in most feet showed mild degenerative changes. Grice subtalar fusion in patients with a higher pre-operative lateral talocalcaneal angle might lead to bone graft non-union.

Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy.

Planovalgus foot (PVF) in cerebral palsy (CP) tends toward progression and rigidity in adolescence, especially in patients with greater functional impairment. Deformity at the talonavicular joint justifies the use of talonavicular arthrodesis as a corrective surgical technique. This study aims to assess patient or caregiver functional satisfaction and radiographic outcomes of talonavicular arthrodesis for PVF in CP patients with assisted ambulation in the long-term. Retrospective comparative study of level III and level IV pediatric CP patients who underwent talonavicular arthrodesis for PVF between 1999 and 2010 as part of multilevel surgery and with a minimum follow-up of 10 years. Radiologic correction at 10 years was compared with preintervention values, and functional impact at 10 years was measured by the foot function index (FFI); correlation between radiologic measurements and FFI were obtained, and complications were recorded. Forty-nine PVFs in 25 patients with CP (72% level III and 28% level IV) were included; 52% were male. The patients had a median age of 12 years at the time of surgery (range: 11 to 15) and 23 years at the time of the study (21 to 26). Significant (P<0.01) pre-post radiologic improvements were obtained in Meary angle (37.86±10.7/8.37±5.5 degrees), calcaneal pitch (3.20±8.1/13.22±5.6 degrees), lateral talocalcaneus angle (42.18±12.1/25.29±2.9 degrees), Moreau-Costa-Bartani angle (167.04±8/146.12±7.1 degrees), talus-first metatarsal angle (27.92±13.9/9.69±4.4 degrees), anteroposterior talocalcaneal angle (37.61±7.4/22.61±2.4 degrees), and talus coverage angle (37.04±11.11/2.45±2.5 degrees). At 10 years postoperatively, functional outcome measured with the FFI was satisfactory (33.9±15.2%) and the mean maximum pain was 3.04; 56% of cases had mild pain. All patients were able to wear an ankle-foot orthosis and 8 no longer needed the device. A significant correlation was found between the talofirst metatarsal angle and the FFI (P=0.024). There were 8% of cases with screw protrusion and 14% presented pseudarthrosis, most of them asymptomatic. The adequate functional outcome, as well as the persistence of long-term radiologic correction and acceptable number of complications, enables us to recommend talonavicular arthrodesis as an alternative treatment to consider in level III and level IV CP patients with PVF. Level III-retrospective comparative study.

POSC100 Healthcare Resource Utilization and Costs in Pediatric Cerebral Palsy Patients with Spasticity: A Matched Cohort Analysis

Cerebral palsy (CP) is a major cause of serious disability for children. Prevalence estimates for CP range from 1-4 per 1,000 live births worldwide. Spasticity is a common complication, occurring in approximately 80% of pediatric CP patients. This analysis evaluated incremental healthcare resource utilization (HCRU) and costs in pediatric patients with CP and spasticity (cases) versus pediatric CP patients without spasticity (controls) over a 1-year period.

Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study.

Introduction Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country. Objective To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019. Methods An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27. Results Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31–68.88), central nervous system infections (AOR: 0.02, 95% CI: 0–0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03–0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15–161.73). Conclusion Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes.

Feeding difficulties are common in children with cerebral palsy (CP). The goal of this study was to examine pediatric CP patients undergoing gastrostomy tube (G tube) placement and assess the association between patient characteristics and weight after 3 months, 6 months, and 1 year. This was a retrospective study of all pediatric patients with CP who received a G tube placement between April 2014 and December 2017 at a single institution. Bivariate analysis was used to examine association between patient characteristics and the primary outcome of improvement in weight Z score at 3, 6, and 12 months. Of 63 patients who received a G tube, 81% had an increase in Z score at 3 months, 44% at 6 months, and 64% at 12 months. By 12 months, factors associated with a positive Z score change included moderate and severe malnutrition, lack of prior G tube, and fewer comorbidities. The majority (69.8%) of patients experienced complications. Seven (11%) patients died, with only 1 death related to G tube placement. The use of G tubes in CP patients resulted in an increase in an improvement in nutritional status for the majority of patients over the course of a year. Although most complications were minor, patients had a high complication rate and frequently visited the emergency department, highlighting the need for standardized education and follow-up among this patient population.

Evaluation of Anxiety, Depression and Burden on Caregivers of Children with Cerebral Palsy

ABSTRACT In this study, we investigated the relationship of demographic variables with mental disorders generally encountered by the caregivers. The cohort includes 109 caregivers (38.53 ± 9.62 year-old) of pediatric cerebral palsy patients (1–18 year-old) taken more than 3 months of caregiving. Data were obtained via face-to-face interviews and a 13-questioned survey followed by a statistical correlation with Zarit-Caregiver-Burden-Scale (Zarit-CBS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II scores (BDI-II). BAI scores were lower in the case of collaborative caregiving (p = .034) and a better financial status (p = .045) but higher in families having more than 1 disabled child (p = .019). Zarit-CBS scores were significantly higher in caregiving mothers with older age (p = .027) and lower in families having only 1 disabled child (p = .025). Mental disorders related to caregiving are dependent on the burden directed on the caregivers and having collaboration decreases anxiety. Medical assistance should be provided to caregivers showing signs of a mental disorder.

Quantification and Monitoring of the Effect of Botulinum Toxin A on Paretic Calf Muscles of Children With Cerebral Palsy With MRI: A Preliminary Study.

Background: Muscles from patients with cerebral palsy (CP) are often spastic and form contractures that limit the range of motion. Injections of botulinum toxin A (BTX) into the calf muscles are an important treatment for functional equinus; however, improvement in gait function is not always achieved. BTX is also used to test muscle weakening for risk evaluation of muscle lengthening surgery. Our aim was to assess the effect of BTX over time on calf muscle properties in pediatric CP patients with MRI.Material and Methods: Six toe-walking CP patients (mean age 11.6 years) with indication for lengthening surgery were prospectively enrolled and received BTX injections into the gastrocnemius and soleus muscles. MRI scans at 3T of the lower legs and clinical examinations were performed pre-BTX, 6 weeks (6w), and 12 weeks (12w) post-BTX. A fat-suppressed 2D multi-spin-echo sequence was used to acquire T2 maps and for segmentation. Fat fraction maps were calculated from 3D multi-echo Dixon images. Diffusion tensor imaging (DTI) with a 2D echo-planar imaging (EPI) sequence yielded maps of the mean apparent diffusion coefficient (ADC) and of the fractional anisotropy (FA). Hyperintense regions of interest (ROIs) on the T2-weighted (T2w) images at 6w were segmented in treated muscles. Mean values of T2, fat fraction, ADC, and FA were calculated in hyperintense ROIs and in reference ROIs in non-treated muscles.Results: Hyperintensity on T2w scans and increased T2 (group mean ± standard deviation: 35 ± 1 ms pre-BTX, 45 ± 2 ms at 6w, and 44 ± 2 ms at 12w) were observed in all patients at the injection sites. The T2 increase was spatially limited to parts of the injected muscles. FA increased (0.30 ± 0.03 pre-BTX, 0.34 ± 0.02 at 6w, and 0.36 ± 0.03 at 12w) while ADC did not change in hyperintense ROIs, indicating a BTX-induced increase in extracellular space and a simultaneous decrease of muscle fiber diameter. Fat fraction showed a trend for increase at 12w. Mean values in reference ROIs remained unchanged.Conclusion: MRI showed limited spatial distribution of the BTX-induced effects in pediatric CP patients. It could be a promising non-invasive tool for future studies to test BTX treatment protocols.

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

Assessment of the Different Modalities of Treatment in Paediatric Cerebral Palsy Patients

Background: To assess the effects of injection of citicoline in combination with physiotherapy versus physiotherapy alone, to advance the functional outcome in paediatric patients with cerebral palsy. Subjects &amp; Methods: A total of 150 paediatric patients diagnosed with cerebral palsy were incorporated into the study. The average age of the patient included in the study was found to be 36 months. All the patients enrolled in the study were referred to the paediatric neurological department. Results: The mean age of the patient was 36 10 months. Out of the 150 total patients, 60% were boys and 40% were girls. When the percentage of improvement was compared between the groups, the study group was established to be statistically significant. (P = 0.02). Conclusion: Citicoline is efficient and secure in the treatment of gross motor function combination with physiotherapy in patients with cerebral palsy. Physical therapy is frequently the first move in managing cerebral palsy.

Assessment of adult patients with cerebral palsy.

Objectives The aim of this study was to evaluate health problems, accommodation, and mobility of adult patients with cerebral palsy (CP). Patients and methods Between September 2018 and September 2019, a total of 70 adult CP patients (37 males, 33 females; mean age 29.4±10.2 years; range, 19 to 68 years) who were admitted to our clinic were included. Accommodation, education status, mental state, comorbidities, spasticity, contracture, deformity, and mobility of the patients were evaluated. Results Of the patients, 24.3% were diplegic, 21.4% were hemiplegic, 32.9% were tetraplegic, 15.7% were dyskinetic, and 5.7% had mixed form of CP. Among the patient, 38.6% had normal mental ability and 21.4% had severe mental retardation. A total of 92.9% of the patients were living with their family, 85.7% were unemployed, 10% were illiterate, and 21.4% had no health problems. Speech disorder was the most common health issue in 52.9% of the patients. Other health concerns included sensory problems, epilepsy, bladder/intestinal problems, nutritional problems, and respiratory and skin problems. The ratio of pain was 31.4%. Mild deformity was present in 54.3% of the patients, 43.7% were wheelchair-dependent, and 25.7% were Gross Motor Function Classification System (GMFCS) Level V. Conclusion Recognition and understanding health problems and living conditions of adult patients with CP would be useful both in determining the treatment goals of pediatric CP patients and in improving the quality of life of adult CP patients.

Clinical and Radiological Outcomes of Subtalar Arthroereisis for Management of Planovalgus Foot in Children With Cerebral Palsy: 3-Year Follow-up

Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The results showed statistically significant improvement in both radiological and clinical data as well as patient's symptoms and parent's satisfaction. Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. Therapeutic, Level IV.

Neuroimaging patterns of anatomical features in pediatric cerebral palsy patients at Ayder hospital, Mekelle, Ethiopia.

BackgroundNeuroradiological studies have greatly improved the knowledge and diagnoses of cerebral palsy with its underlying pathology, types and accompanying changes in brain morphology. However, there is no published study on cerebral palsy neuroimaging patterns in Ethiopia.MethodsRetrospective chart and neuroimaging reviews were conducted among pediatric patients, who attended Ayder Comprehensive Specialized Hospital between January 2016 and August 2019, fulfilling the study criteria. The magnetic resonance images and computed tomography scans reviewed by a neuroradiologist and/or pediatric neurologist were included. Data was collected using a structured checklist and analyzed using SPSS statistical software version 22. Results were represented using tables, graphs and images.ResultsThe median age at neuroimaging was 2 years. There were more males (54.5%) than females (45.5%) with a male: female ratio of 1.2:1. Majority of the patients had magnetic resonance (81.8%) as opposed to computed tomography scans (18.2%). Most of the patients (69.7%) had been born at term with spastic quadriplegia (33.3%) found to be the leading type of cerebral palsy. 30.3% of the patients had normal neuroimaging studies whereas 69.7% had neuroimaging abnormalities. Anomalies included pathologies of the white matter (18.2%), basal ganglia (15.2%), cortex and lobes (27.3%), corpus callosum (6.1%), lateral ventricles (12.1%), cysts (18.2%) and cerebellum (3%), respectively. Other findings were seen in 45.5% of the patients.ConclusionSevere forms of cerebral palsy (spastic quadriplegia) were most common with majorly cortical and subcortical brain involvement.