10.2.3 Mental retardation

10.2 Risk factors for seizures in patients with CP

Neurodevelopment and Neurodevelopmental Disorder

in diparetic CP, and 2.5 years in hemiparetic CP [21].

predictive for future development of epilepsy [11, 29].

CP that is mainly athetoid.

the various percentages.

10.2.1 Neonatal seizures

Table 2.

58

Type of CP as a risk factor for seizures.

patients.

Family history, structural abnormalities (primarily brain atrophy and gray matter involvement), neonatal seizure, low Apgar scores, and mental retardation are significant risk factors for the development of epilepsy in patients with CP.

CP patients with spastic quadriplegia or acquired hemiplegia are more prone to seizures, whereas seizures are less common in mild symmetric spastic diplegia and

The mode of delivery, the relative birth weight, head circumferences, and the presence of consanguinity are not known to be risk factors for epilepsy in these

In a study of 452 patients with CP and 160 patients with both CP and epilepsy [11], the incidence of epilepsy among patients with hemiparetic CP was 65.9%, compared to 42.6% in patients with quadriparetic CP and 15.8% in patients with paraparetic CP. The different levels and degrees of brain damage may account for

Other studies revealed that epilepsy was found in 54% of quadriparetic, 34–60%

The age at onset of seizures might differ depending on the type of CP. Carlsson et al. reported the seizure onset of age as 6 months in quadriparetic CP, 12 months

Neonatal seizures represent a strong predictor for the development of epilepsy. A strong association of neonatal seizures with epilepsy was reported in the Collaborative Perinatal Project (NCPP) of the NIH summarizing 54,000 singleton pregnancies between 1959 and 1966 [28]. Subsequently, additional retrospective studies provided clear evidence that in children with CP neonatal seizures were strongly

Neonatal seizure history in patients with CP is a risk factor for epilepsy development. In addition, the outcome for seizure control was negatively affected by this history, and patients with neonatal seizure history are 3.3 times more likely to have poor epilepsy prognosis than those who had no neonatal seizure history [30].

of hemiparetic, 27% of diparetic, and 23–26% of dystonic CP patients [26, 27].

Risk factors for the development of epilepsy are shown in Table 2.

Mental retardation is more frequently observed in CP patients with seizures than in those without seizures, and severe mental retardation is more likely in those with multiple seizure types.

In patients with CP and mental retardation, the diagnosis of epilepsy presents unique challenges. Generally, patients are unable to describe the epileptic events themselves, parents may not recognize subtle seizure manifestations, and persons trained in epilepsy witness the events only rarely.

Mental retardation is frequently observed in patients with both CP and epilepsy compared to patients with CP only. In addition, the risk of epilepsy development is higher in patients with CP who have mental retardation [32, 33].

Patients with CP and epilepsy have lower intelligence levels compared with CP alone; the patients with paroxysmal abnormalities in the EEG had lower intelligence levels and learning disabilities [34].

Mental retardation is most common in quadriplegic CP, followed by hemiplegic CP. On the contrary, almost half of diplegic CP and 60% of children with dystonic CP have normal to borderline intelligence, which again correlates well with the type and location of brain damage. Mental retardation is associated with earlier age of onset, increased frequency, and treatment-resistant seizures [11]. This might represent an underlying severity of brain injury that is responsible for the severity of both cognitive deficit and epilepsy.
