10.5 Neuroimaging in cerebral palsy with epilepsy

Children with CP and epilepsy appear to have abnormal brain imaging more often. It is not surprising that a trend toward the occurrence of epilepsy was found in children with gray matter insult (primarily cerebral infarcts), rather than in children with white matter lesions. In addition, cerebral atrophy was also reported more frequently in CP complicated by epilepsy [31], reaching statistical significance in the study of Gururaj et al. [40]. A possible explanation for the association of


## Table 4.

EEG abnormality and type of CP.

frequent seizure types. Some syndromes, such as infantile spasms, West, and

Generalized epilepsy is the predominant form of epilepsy in CP. Generalized seizures have been reported in 36.8%, followed by focal (partial) seizures in 33%, West syndrome in 15.6%, and myoclonic jerks in 10.6%. Absence seizures are

In another study of patients with both CP and epilepsy, the following seizure types were observed: 44.6% experience focal to generalized tonic-clonic, 41.1%

Lennox-Gastaut syndromes, are particularly frequent.

Figure 2.

Table 3.

60

Types of seizures in subtypes of CP [11].

Epileptic syndromes in 41 children with cerebral palsy.

Neurodevelopment and Neurodevelopmental Disorder

usually of the atypical type reported in 3.3–6.7% [3].


10.6 Seizure control

Epilepsy and Cerebral Palsy

DOI: http://dx.doi.org/10.5772/intechopen.82804

requiring polytherapy.

reduce further CP prevalence.

63

More than 50% of seizures in patients with CP are fairly controlled. Seizures in patients with hemiplegic CP achieve better control (75%) than those with quadriplegic and diplegic CP (50%); one study reported seizure control in children with CP in nearly two-thirds [4]. Seizure control was achieved with monotherapy in the majority of cases. Polytherapy was required in half, one-third, and one-fourth of cases with diplegic, quadriplegic, and hemiplegic CP, respectively, although this difference did not reach statistical significance. In another study by Hadjipanayis et al., children with spastic hemiplegia (35%) and tetraplegia (28%) were more likely to require polytherapy compared to patients with spastic diplegia (11%) [3]; however, the differences were not statistically significant [3]. Not surprising, polytherapy was required more often in children with infantile spasms and myoclonic seizures. All other seizure characteristics also were more severe in the group requiring polytherapy. In addition, a trend was noted for the following: seizures began earlier, and CT and EEG abnormalities were more often present in children

The rate of CP has remained static for decades, at between 2 and 2.5 cases for every 1000 live births, due to abnormalities of the developing fetal or infantile brain resulting from a variety of causes. In a recent publication, however, Hollung et al. reported that the prevalence of CP declined for children born in Norway from 2.62 per 1000 in 1999 to 1.89 in 2010, and in addition a substantial improvement in the severity of clinical characteristics with a decrease in the proportion of children with severe motor impairments, epilepsy, intellectual disability, and difficult to understand or no speech was observed. They attributed this improvement to the better obstetric and neonatal care the first decade of the twenty-first century [43]. In general, however, methods that have been implemented, such as continuous electronic monitoring of the fetus in labor, have not had the anticipated benefits. Many neuroprotective strategies have failed. In premature infants, an increase in survival without a decrease in prevalence added more healthy citizens but also more disabled children to the population. As a consequence in recent years, efforts have focused on prevention, cure, early diagnosis, and early intervention in an attempt to

Approximately one-half of all new cases of cerebral palsy arise from the group of neonates born prematurely (< 30 weeks gestation) that are at risk for long-term neurodevelopmental problems, with almost one-half having motor, cognitive, and/ or language impairments, a rate much higher than their term peers [44]. For many children, however, the cause of cerebral palsy is unclear. There are many known risk factors that affect the fetal and neonatal developing brain leading to cerebral palsy, and some of them can be prevented. Risk factors for congenital CP include infection during pregnancy (toxoplasmosis, rubella, cytomegalovirus, and herpes can infect the womb and placenta, leading to brain damage in the fetus), abuses of alcohol or drugs during pregnancy, smoking, exposure to toxic chemicals, multiple gestations, and infertility treatments that have an increased risk in preterm delivery and multiple gestations and certain medical conditions such as diabetes, high blood pressure, abnormal thyroid function, sexually transmitted infections, and eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). Placental infarctions are most likely to be identified in the births of infants who will in the

10.7 Cerebral palsy: recommendation and future directions

### Table 5.

Imaging findings in patients with cerebral palsy only and with cerebral palsy and epilepsy.

atrophy and epilepsy is the fact that in many cases atrophy presents the end result of prenatal or perinatal global ischemia with extensive neuronal damage.

Intraventricular hemorrhage was identified as a significant risk factor for the development of neonatal seizures [41]. In patients with neonatal seizures, cerebral dysgenesis and intraventricular hemorrhage proved to be predictors for poor outcome [29].

Brain imaging in children with CP and epilepsy shows frequently abnormal findings. In children with CP and epilepsy, cerebral atrophy is more often reported [31, 40]. Atrophy is the consequence of prenatal and perinatal ischemia; this will lead to an extensive neuronal damage which may be the cause of the seizures. A significant risk factor for the development of neonatal seizures was found with intraventricular hemorrhage [41]. Cerebral dysgenesis and intraventricular hemorrhage were found to be predictors of poor outcome in patients with neonatal seizures [29].

The effect of imaging abnormalities in CP remains controversial. In one study, an MRI abnormality was noted in 86.7% of patients, and the abnormal finding variable in the MRI did not significantly affect the epilepsy development and seizure outcome.

In other studies the range of abnormal findings in MRI was reported as 84– 88% [42]. Cerebral infarct is found by neuroimaging to be an abnormality that significantly affects seizure outcome in epileptic patients with CP [4]. Table 5 shows the imaging findings in patients with CP and epilepsy and CP without epilepsy.
