Cases Of Spastic Cerebral Palsy Research Articles

A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy.

This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed. The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension. SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR.

Therapeutic Effect of Botulinum Toxin a on Children with Spastic Cerebral Palsy: Meta-analysis

To systematically evaluate the clinical effect of botulinum toxin A (BXT-A) on children with spastic cerebral palsy. All clinical randomized controlled trials (RCTs) of BXT-A in children with spastic cerebral palsy were collected from the database establishment to April 20, 2021. Meta-analysis was performed on the extracted data using Review Manager 5.4 and R 4.0 software. A total of 21 studies met the inclusion criteria, including 1357 cases of spastic cerebral palsy and 704 cases in the BTX-A+ rehabilitation group. Meta-analysis results showed that: MAS score [MD=-0.83, 95%CI (-0.86, -0.80), Z=51.03, P<0.05] and GMFM-88 score [MD=5.50, 95%CI (4.40, 6.59), Z=9.85, P<0.05] in BTX-A+ rehabilitation treatment group, GMFM-D score [MD=8.51, 95%CI (5.24, 11.78), Z=5.09, P<0.05], GMFM-E score [MD=8.44, 95%CI (5.16, 11.72), Z=5.04, P<0.05], CSS score [MD=-1.86, 95%CI (-3.07, -0.66), Z=3.03, P<0.05], PRS score [MD=0.85, 95%CI (0.26, 1.44), Z=2.83, P<0.05] were better than the rehabilitation treatment group in these aspects, and the diversity between the two groups was statistically (P<0.05). BTX-A can effectively enhance motor function, and is an effective method for the treatment of children with spastic cerebral palsy.

Cerebral palsy: comorbidities, the second hidden side

Background: Cerebral palsy (CP) is the most common group of permanent disorders of motor impairment resulting from injury in the developing brain which are accompanied by comorbidities. Moreover, it has been observed that because of physical disabilities, the underlying comorbidities are neglected. The study aimed to assess the co-morbidities in children suffering from cerebral palsy in Kolhapur district.Methods: The cross-sectional study was conducted among children suffering from cerebral palsy and presenting to Department of Paediatrics (n=250), D. Y. Patil Medical College, between October 2018 to October 2019. Detailed history with clinical examination were recorded in a pre-designed performa. The patients were classified according to the physiological and topographical classification. Data was analyzed using R software version 3.6.1. Variables were represented using frequency distribution, (p&lt;0.05).Results: Of the total participants (n=250), male predominance was observed (n=140); with age range of 1-18 years. Common form of cerebral palsy was spastic type (n=140; 56%). Most common type among spastic CP was diplegia (n=96; 38%). Children were suffering from speech abnormality in spastic CP cases (n=65). Among spastic hemiplegic cases all the children were suffering from intellectual disability (n=3).Conclusion: Thus, it can be concluded that the motor impairment in just the top notch, the actual disability is the underlying co morbidities.

Umbilical cord arterial blood gas analysis in term singleton pregnancies: a retrospective analysis over 11 years.

ObjectiveGiven that the large volume of data on cord arterial blood gas analysis (ABGA) have been rarely addressed in Korean population, we aimed to examine the incidence, associated factors, and neonatal outcomes in cases of low cord pH, and investigate the incidence of cerebral palsy (CP).MethodsFrom data of all consecutive term singleton pregnancies delivered in our institution from 2006 to 2016 (n=15,701), cases with cord ABGA (n=14,221) available were included. We collected information on maternal clinical characteristics and delivery outcomes and also examined neonatal and infant outcomes, including neonatal intensive care unit (NICU) admission and CP, in cases with low cord pH, defined as a pH <7.1.ResultsRates of low Apgar scores at 1 minute (<4) and 5 minutes (<7) were 0.6% (n=79) and 0.4% (n=58), respectively. Rates of cord pH <7.2, <7.1, and <7.0 were 7.1% (n=1,011), 1.1% (n=163), and 0.3% (n=38), respectively. Among cases with low cord pH, 30.1% (n=49/163) were admitted to the NICU and 11.0% (n=18/163) required ventilator support. Ultrasonography of the brain was performed in 28.8% (n=47/163), with abnormal findings observed in 27.7% (n=13/47). Among cases with low cord pH, 1.8% (n=3/163) were subsequently diagnosed with CP, including 2 cases of spastic CP and 1 of ataxic CP.ConclusionAlthough low cord pH was a relatively frequent finding observed in 1 out of every 87 cases, hypoxic-ischemic encephalopathy-related CP was found in only 1 out of 7,111 term singleton deliveries over 11 years in our institution.

Effect of Botulinum Toxin Injection in Treatment of Upper Limb Spasticity in Childhood Cerebral Palsy: A Systematic Review

Abstract Cerebral palsy (CP) is the most common cause of childhood disability globally. It manifests in restricted functional mobility and impacts the quality of life negatively. Botulinum toxin injections are widely used to manage limb spasticity in children with cerebral palsy. In the upper limbs of CP children intramuscular botulinum toxin-A has been used to manage pre and post-operative pain, facilitate nursing and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity.. This review aims at providing the evidence for effect of botulinum toxin-A injections to manage upper limb spasticity in spastic cerebral palsy cases. The literature extraction process yielded 15 articles for inclusion in this review. After reviewing these articles we concluded that botulinum toxin-A had a positive effect on the degree of spasticity, motor functions and cosmetic appearance of the injected upper limb but its effect increased by addition of another regimen as O.T.,P.T, casting or splintage.

Two Patients with Spastic Cerebral Palsy Complicating Cervical Spondylotic Myelopathy：Not Only Athetoid Type

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

Spectrum of clinical profile, co-morbidities and parental burden of cerebral palsy children in a tertiary care centre

Background: The cerebral palsy is the most common cause of severe physical disability in childhood. The developmental disabilities are a group of disorders differentiated by the pattern of delay among developmental streams. The four streams of development include language, problem solving, motor and social. Cerebral palsy (CP) is a disorder of development in which motor function abnormalities are a key feature. Severity varies from mild to severe. Cerebral palsy is a very challenging disability for parents and professionals. Cerebral palsy is a heterogeneous group of persistent disorders of movement and posture caused by non-progressive defects or lesions of immature brain, is the most common cause of childhood disability. The incidence of CP is 2 to 2.5 per thousand live births. During the past twenty years, there have been increases in the incidence and prevalence of CP that may be related to improved documentation of cases, advances in neonatal care and other factors.Methods: This study is a cross-sectional study. A total of 100 Cerebral Palsy cases were studied in Neuro-developmental clinic, in BMC and RI.Results: Clinical profile of our study shows 74% Spastic cerebral palsy cases (of which 38% were quadriparetic, 31% were diplegic and 5% were hemiparetic), 19% of Hypotonic CP, 1% of Dystonic CP and 6% of Mixed CP cases. Co morbidities in the form of Mental retardation was seen in 94%, feeding problem 64%, visual problems in 39%, seizure disorder in 39%, hearing problems in 18%, behavioral problems 16% of cases.Conclusions: Perinatal asphyxia was important preventable cause of cerebral palsy. Majority of cerebral palsy children were of spastic type. Mental retardation, feeding problem, hearing and vision impairment and seizures were major co morbidities in children with cerebral palsy. Nuclear type of family and high number of co morbidities of the disabled child correlated significantly with higher caregiver burden.

Power Spectral Analysis of EEG as a Potential Marker in the Diagnosis of Spastic Cerebralpalsycases

The detection and diagnosis of various neurological disorders are performed using different medical devices among which electroencephalogram (EEG) is one of the most cost effective technique. Though significant progress had been made in the analysis of EEG for diagnosis of different neurological disorders, yet detection of cerebral palsy (CP) is not quite clear. This study was performed to analyze the EEG power spectrum density (PSD) of spastic CP and normal children to find if any significant EEG patterns could be used for early detection of CP. Twenty children participated in this study out of which ten were spastic CP and other ten were normal healthy children. EEG of all the participants was recorded from C3 C4 and F3 F4 regions following montage 10-20 system. The artifact-free EEG signals of 15 minutes duration was extracted for spectral analysis using Fast Fourier Transformation (FFT) algorithm in MATLAB and power density spectrum (PSD) was plotted. The PSD revealed high intensity power peak at frequency of 50Hz and smaller at 100 Hz, which was consistent for all healthy subjects. In case of spastic CP children, high intensity peak at 100Hz were prominent and smaller peak was observed at 50Hz. The high intensity 100Hz peak observed in the PSD of spastic CP patients demonstrated that this tool can be used for early detection of spastic CP.

Spastic Cerebral Palsy at Age 5 has Better Functional Outcome in Extreme Prematurity than in Term Children

Background and aim: Cerebral palsy (CP) is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain (SCPE). Spastic CP is the most common clinical type and the disorders of the development of the premature brain are the most frequent cause. Do the functional outcomes in 5-years-old children with spastic CP differ depending on their gestational age? Methods: Data from 5-years-old children born in 2001 were analysed (National Surveillance of Cerebral Palsy in Portugal). SCPE definitions and functional classifications (GMFCS, BMFM, IQ, vision, hearing) were used, as well as the Portuguese scales for assessment of communication (as producer), feeding ability and drooling control. Spastic CP cases were selected. Children born with gestational age ≤ 28 weeks were compared with those born at term (≥37 weeks) using non-parametric statistical tests. Results: From 171 spastic cases among 209 CP children, 117 were included: 88 born at term and 29 born ≤ 28 weeks. Spastic CP was bilateral in 70% of the term children and 90% of those born ≤28 weeks. Including every type of spastic CP, those born ≤ 28 weeks scored significantly better for communication and drooling control only. Comparing only children with bilateral spastic CP, those born ≤ 28 weeks scored significantly better in every item but vision and hearing. Conclusion: Bilateral spastic CP children born ≤ 28 weeks have significantly better function than their counterparts born at term.

The Influence of Gestational Age on Severity of Impairment in Spastic Cerebral Palsy

To investigate the association between severity of impairment and gestational age in unilateral and bilateral spastic cerebral palsy, and to determine whether the influence of gestational age is independent of deviations from optimal birth weight. The study group was a United Kingdom cohort of 4772 cases of spastic cerebral palsy born between 1960 and 1997, with information on birth demographics and severity of impairment. Generalized additive models were used to determine the proportions of cases severely impaired, by gestational age, and to determine whether gestational age or deviations from optimal birth weight better predicts severity of impairment. For unilateral spastic cerebral palsy, the proportions of severe impairments did not vary with gestational age. In contrast, for bilateral spastic cerebral palsy, the proportions of severe motor or cognitive impairments increased with increasing gestational age (e.g., from 20% to 50% between weeks 30 and 40 for cognitive impairment). For spastic cerebral palsy, gestational age is at least as good as deviation from optimal birth weight in predicting severity. The severity of impairment increases with increasing gestational age in bilateral spastic cerebral palsy. This suggests differing etiologies in term and preterm infants and supports the theory that the developing brain is better able to compensate after a cerebral insult.

Intrauterine Growth and Spastic Cerebral Palsy II. The Association With Morphology at Birth

Abstract This study tests the hypothesis that children with spastic cerebral palsy had different birth morphologies, defined in terms of their weight, length, head circumference, ponderal index and length to head circumference ratio, from that of the normal liveborn population. An earlier study showed a highly significant association of spastic cerebral palsy with low birthweight for gestational age in infants over 34 weeks gestation at delivery. This analysis defines morphological measurements as “abnormal’ if not within the 10th-90th percentile ranges of appropriate total liveborn populations. The proportions with combinations of such measurements in 104 cases of spastic cerebral palsy from a population register of cerebral palsy are compared with those in a total liveborn population. Categories of ‘abnormal’ measurements associated with increased risk contained 44.4% of cases in excess of the proportion observed in the total population. More than half these excess cases were short for their gestation (suggesting size deficits originating before the 3rd trimester) and tended to have more severe forms of cerebral palsy. A further excess of 7.4% of cases had a head circumference above their 90th percentile: these generally developed mild cerebral palsy.

Intrauterine growth and spastic cerebral palsy II. The association with morphology at birth

This study tests the hypothesis that children with spastic cerebral palsy had different birth morphologies, defined in terms of their weight, length, head circumference, ponderal index and length to head circumference ratio, from that of the normal liveborn population. An earlier study showed a highly significant association of spastic cerebral palsy with low birthweight for gestational age in infants over 34 weeks gestation at delivery. This analysis defines morphological measurements as “abnormal’ if not within the 10th-90th percentile ranges of appropriate total liveborn populations. The proportions with combinations of such measurements in 104 cases of spastic cerebral palsy from a population register of cerebral palsy are compared with those in a total liveborn population. Categories of ‘abnormal’ measurements associated with increased risk contained 44.4% of cases in excess of the proportion observed in the total population. More than half these excess cases were short for their gestation (suggesting size deficits originating before the 3rd trimester) and tended to have more severe forms of cerebral palsy. A further excess of 7.4% of cases had a head circumference above their 90th percentile: these generally developed mild cerebral palsy.

Long-term results of posterior functional rhizotomy.

The long-term results (2–7 years) of posterior functional rhizotomy (personal technique) in 80 cases of spastic cerebral palsy are presented. The lack of recurrencies, the minimal side effects, the effective improvement of spasticity in all cases, the actual suprasegmental improvement suggest posterior functional rhizotomy for the treatment of spastic cerebral palsy, associated with a physiotherapeutic rehabilitative treatment and orthopedic corrective treatment.