10.2 Risk factors for seizures in patients with CP

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.

Hence, neonatal seizure history in CP is a significant risk factor for both epilepsy

Family history of epilepsy is associated with a 5.5 times higher risk of epilepsy in

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

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

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

Patients with CP and epilepsy have lower intelligence levels compared with CP alone; the patients with paroxysmal abnormalities in the EEG had lower intelligence

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

The risk of epilepsy is inversely proportional to the Apgar scores of term babies, both at 5 and 10 minutes. This is significant even with relatively minor reductions in

Low Apgar scores were also recognized as risk factors for epilepsy in the general

No relationship has been found between the risk of epilepsy development and gestational age [31]. In a study where 173 patients were categorized according to their birth weight as appropriate for gestational age (76.9%), small for gestational age (12.1%), and large for gestational age (11%), they found no correlation between

However, other studies reveal that low birth weight and prematurity increase the risk of epilepsy development in patients with CP [12, 37, 39]. These studies assessed Apgar scores and determined that premature babies have lower Apgar scores; they suggested that the increased risk of epilepsy development among pre-

All types of epileptic seizures can be seen in patients with CP. Focal impaired awareness (complex partial) and focal to generalized tonic-clonic are the most

development and poor epilepsy prognosis.

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

trained in epilepsy witness the events only rarely.

levels and learning disabilities [34].

both cognitive deficit and epilepsy.

these scores [35].

10.3 Types of seizures

59

10.2.4 Apgar score and risk of seizures in CP patients

birth weight and risk of epilepsy development [38].

mature babies was actually related to low Apgar scores.

population in some other studies [36, 37].

higher in patients with CP who have mental retardation [32, 33].

10.2.2 Family history of epilepsy

patients with CP [31].

Epilepsy and Cerebral Palsy

10.2.3 Mental retardation

multiple seizure types.

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

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 patients.

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

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 the various percentages.

Other studies revealed that epilepsy was found in 54% of quadriparetic, 34–60% of hemiparetic, 27% of diparetic, and 23–26% of dystonic CP patients [26, 27].

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

## 10.2.1 Neonatal seizures

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

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].


### Table 2.

Type of CP as a risk factor for seizures.

Hence, neonatal seizure history in CP is a significant risk factor for both epilepsy development and poor epilepsy prognosis.
