Epilepsy and Cerebral Palsy DOI: http://dx.doi.org/10.5772/intechopen.82804


In a European cerebral palsy study [14], MRI was performed in 351 of the 431 children with clinically assessed CP. The MRI scans showed that white matter damage of immaturity, including periventricular leukomalacia, was the most common finding (42.5%, majority born before 34 weeks), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Normal MRI findings were present in 11.7%.

MRI scan does provide useful information on the timing and extent of the lesion. Predisposing risk factors include maternal and child genetic factors in thrombophilia leading to stroke, nutritional factors, and infections during

### Figure 1.

5. Associated comorbidities

Proportion of the different types of cerebral palsy.

Neurodevelopment and Neurodevelopmental Disorder

Table 1.

have comorbidities.

6. Neuroimaging in cerebral palsy

focal findings in 17.6% of the cases [12].

correlate findings with clinical picture.

quadriplegia.

54

Besides motor disabilities, there are significant comorbid disorders of cerebral function that may appear or become severe as the child grows including intellectual disability, seizures, behavioral and emotional disorders, speech and language disorders, as well as visual and hearing impairments. Social difficulties and autism spectrum disorders are also commonly associated comorbidities [10]. In addition, many accompanying conditions such as growth failure, pulmonary disease, orthopedic problems (e.g., joint subluxations and dislocations and hip dysplasia), osteopenia, urinary disorders, sleep disturbance, and hypersalivation have been identified. Pain is common in children with CP and can significantly impact the quality of life. Children with more severe motor disabilities are also more likely to

Spastic subtypes Percentages (%) Spastic diplegia 13–25 Spastic hemiplegia 21–40 Spastic quadriplegia 20–43 Dyskinetic subtypes 12–14 Ataxic CP 4–13

These associated comorbidities occur in CP at variable rates. Pain is noted in 75% of CP subjects, intellectual disability in half of them, whereas inability to walk or hip displacement is equally seen in a third. Twenty-five percent of children with CP cannot talk, and a similar proportion carries a diagnosis of epilepsy. Behavioral disorders and urinary incontinence are equally seen in roughly 25% of subjects and sleep disorders in 20%; tube feeding is needed in little less than 10%. Blindness is

Head CT scan commonly identifies abnormalities, particularly in spastic CP.

MRI scan is an important and safe diagnostic tool to use in children with CP after

18 months in order to assess location, nature, and structure of brain lesion and

The patterns of MRI in children with cerebral palsy are as follows:

• White matter damage, observed more often in spastic diplegia and

noted in 10% of cases, with deafness being less common at a rate of 5%.

Cerebral atrophy is a frequent finding in quadriplegia, whereas infarction, porencephalic cyst, and cerebral atrophy occur equally (26.7%) in hemiplegic CP, and periventricular leukomalacia is significantly more common with diplegia. A brain abnormality seen on CT scan has been reported in 77% of the cases of hemiplegia, followed by quadriplegia (75%) and diplegia (55%) [11], while other studies showed CT abnormalities in 77.2% of patients, with bilateral atrophy in 42.1% and

> Salient MRI changes in cerebral palsy. Panel A shows a T2-weighted image with periventricular hyperintensities and undulating ventricular margins (solid arrow). This is typically seen in prematurity associated insult and commonly manifests as spastic diplegia. Panel B shows multicystic encephalomalacia (dotted line with arrow). This pattern of watershed lesions is seen commonly in term infants with ischemia/ asphyxia and manifests clinically with spastic quadriplegia. Panel C illustrates T2 hyperintensities in posterior putamen (open arrow) and thalami bilaterally (dotted line with closed arrow). This is typically seen in infants with term hypoxic ischemic encephalopathy (HIE) and manifests as dyskinetic cerebral palsy. Panel D highlights T2 hyperintensities in occipital lobe (solid arrow); characteristic of neonatal hypoglycemic insult. Panel E shows T2 hyperintensity involving bilateral globuspallidi (open arrow), a feature of kernicterus sequelae.

pregnancy and before the onset of premature labor lead to placental damage developing throughout the pregnancy. These factors predispose the infant to an increased risk of hypoxic ischemic episodes, leading to white matter damage.

between 1980 and 1996 revealed a 20-year survival in 87–94% of cases [15]. The multivariate analysis revealed that survival was related to severity of impairment, birth weight, and socioeconomic status, with the number of severe impairments

Those children who do not achieve head balance by 20 months retain primitive reflexes, have no postural reactions by 24 months, or do not crawl by approximately 5 years of age have generally poor prognosis for walking. Generally, all children with hemiplegic CP and many with athetosis or ataxia will walk. Those who walk independently do so around the age of 3; those who walk only with support may take up to 9 years. Those who do not walk by 9 years of age are unlikely to ever

Functional outcome in CP also depends on other non-motor factors. These include intelligence, physical function, ability to communicate, and personality

Besides the motor dysfunction, epilepsy is another important problem in chil-

The incidence of epilepsy in CP varies from 33 to 41% [11, 12]. The incidence

The large variation in percentages reported in the literature can be explained in part by the variable length of follow-up periods and the different average age of

Reported rates of seizures and epilepsy in CP vary significantly depending on the underlying pathology and etiology. Epilepsy occurs in 50–94% of children with CP due to diffuse cortical malformations and injuries [17, 18] and in 50% of children with CP secondary to suspected perinatal arterial ischemic stroke [19, 20]. Epilepsy occurs at a much lower frequency (26–43%) in CP and white matter injury (WMI) than in other etiologies [21–24]. The lower frequency of epilepsy and WMI is related to the lack of involvement of cortical gray matter. A recent publication [25] indicated that 25% of children with CP and WMI had seizures beyond the neonatal period with electroclinical features of the agelimited, epileptic syndromes of childhood, with favorable outcome in the majority. Very interesting findings that need to be confirmed, guiding toward better diagnostic, treatment, prognostic, and genetic issues at this early age group. Seizure onset often occurs in the first 2 years of life. Sixty-one percent of patients with CP had their seizure onset that early. Some reports indicate 36.7% [12] to 69.7% [23] of patients with seizure onset in the first year of life. The onset of epilepsy probably reflects the time of occurrence of brain damage and its

The age of seizure onset also depends on the type of CP. Over 60% of the children with quadriplegia and diplegia have seizures in their first year of life, while 60% of the children with hemiplegia had their first seizure at a later age. Children with myoclonic seizures and infantile spasms had seizure onset very early in

dren with CP. It is sometimes more disabling than the motor disorder itself.

having the greatest effect.

Epilepsy and Cerebral Palsy

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

walk, even with support [16].

10. Seizures in cerebral palsy patients

10.1 Incidence of seizures and epilepsy in CP

and type of epilepsy vary according to the type of CP.

Epilepsy is highly correlated with CP.

attributes.

studied subjects.

severity.

life [11].

57

It is not unreasonable, therefore, to assume that with increased awareness of possible preventive measures, CP could be reduced substantially, reducing as a consequence the burden on families and saving tremendous sums of money for health services. Figure 1 shows the MRI findings in CP.
