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Investigators from Charité University Medicine, Berlin, Germany, conducted a retrospective study to evaluate the association between cause and clinical phenotype in children diagnosed with cerebral palsy (CP). For the study, they reviewed the medical records of children with CP seen at their institution between 2015 and 2017. Head MRI and chromosome testing were used to evaluate the etiology of CP, with possible causes including chromosomal aberrations, brain malformation, hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), neonatal stroke, cerebral hemorrhage, hydrocephalus, and infection. Some children had multiple causes identified. Components of phenotype included clinical description, risk factors, and comorbidities. Clinical description encompassed type of CP (unilateral spastic, bilateral spastic, and dyskinetic) and motor function, as classified using the Gross Motor Function Classification System (GMFCS). Multiple risk factors related to perinatal events, prematurity, and pregnancy were examined. The association between comorbidities, such as visual defects and epilepsy, and cause of CP also were evaluated. Differences in clinical description, risk factors, and comorbidities among children with different causes for their CP were assessed using chi-square tests; approximately 200 statistical comparisons were performed.
Data were analyzed on 384 children with a mean age of 10.6 years; 63.3% were male. A possible cause for CP was identified in 296 patients (77.1%). Identified causes of CP included PVL (33.6% of cases), intracerebral hemorrhage (32%), hydrocephalus (24.2%), HIE (20.3%), infection (23.9%), neonatal stroke (7.6%), brain malformations (11.2%), and chromosomal aberrations (2.3%). Overall, 62.3% of children had bilateral spastic CP, 33.7% unilateral spastic CP, and 3.4% dyskinetic CP. The most common comorbidities were visual impairment (49%) and epilepsy (29.9%). Among study patients, 53.9% were born prematurely, 17.7% were multiple births, and cardiotocography (CTG) was abnormal in 11.2% of births. Children with chromosomal aberrations as the cause of their CP had significantly worse gross motor function based on GMFCS scores (P = 0.004) and were more likely to have epilepsy (P = 0.04) than those with other causes. Patients with CP because of HIE also had worse gross motor function (P <0.001), were more likely to have dyskinetic CP (P = 0.01), more likely to have abnormal CTG (P = 0.003), and more likely to be delivered by emergency caesarean section (P <0.001). The most distinguishing feature of children with CP caused by PVL was a higher rate of premature birth (P = 0.001). Those with neonatal stroke had significantly better gross motor function (P = 0.03), were more likely to have unilateral spastic CP (P <0.001), and were less likely to have been born prematurely (P <0.001).
The authors conclude that the clinical phenotype of children with CP is associated with the cause.
Dr Candee has disclosed no...
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