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Hemiparetic cerebral palsy: clinical pattern and imaging in prediction of outcome
P Humphreys1, S Whiting, B Pham
1Department of Pediatrics, and the Thomas Chalmers Center, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Clinical assessment and brain imaging both predict outcomes in hemiparetic cerebral palsy (HCP). Imaging showing cortical pathology strongly predicts cognitive deficits and epilepsy in HCP patients.
Area of Science:
- Neurology
- Pediatrics
- Medical Imaging
Background:
- Hemiparetic cerebral palsy (HCP) presents as arm-dominant or leg-dominant forms, with varying associated neurological deficits.
- Epilepsy and cognitive impairments are more prevalent in arm-dominant HCP, linked to cortical/subcortical lesions.
- Routine imaging is suggested for assessing etiology and predicting outcomes in children with HCP.
Purpose of the Study:
- To compare the predictive values of clinical assessment versus imaging studies for epilepsy and cognitive disabilities in HCP.
- To determine the relative importance of clinical patterns and radiological findings in predicting HCP outcomes.
Main Methods:
- Prospective follow-up of 41 consecutive HCP patients.
- Utilized clinical assessment and neuroimaging (primarily CT scans) to evaluate patients.
- Monitored for the development of recurrent seizures and academic difficulties.
Main Results:
- Arm-dominant HCP (48.8%) showed large arterial infarcts or cysts; leg-dominant (34.1%) showed periventricular leukomalacia.
- Both arm-dominant hemiparesis and cortical pathology on imaging predicted cognitive deficits.
- Imaging evidence of cortical pathology was a powerful predictor of epilepsy (OR 80.7).
Conclusions:
- Both clinical pattern and radiological findings in HCP are predictive of patient outcomes.
- Absence of cortical pathology on imaging is particularly predictive of no epilepsy.
- Combined clinical and imaging evaluations are recommended for comprehensive HCP patient assessment.
Background:
Hemiparetic cerebral palsy (HCP) is described as having two main forms: arm-dominant, associated with large cortical/subcortical lesions; leg-dominant, associated with lesions of central white matter. Epilepsy and cognitive deficits are common in the former pattern and rare in the latter. Some authors have recommended routine imaging studies in children with HCP as an assessment of etiology and a predictor of outcome. The present study compares the relative values of clinical analysis and imaging in predicting epilepsy and cognitive disabilities.
Methods:
Forty-one consecutive patients with HCP underwent careful clinical assessment and imaging studies (primarily computed tomography) and were followed prospectively for the development of recurrent afebrile seizures and academic difficulties.
Results:
Twenty of the 41 patients (48.8%) were arm-dominant, 14/41 (34.1%) leg-dominant, and 7/41 (17.1%) proportional (arm = leg). The principal imaging findings were: arm-dominant patients - large arterial infarcts, porencephalic cysts, brain malformations; leg-dominant - periventricular leukomalacia; proportional - porencephaly. Arm-dominant hemiparesis and radiologic evidence of cortical pathology were both predictive of cognitive deficits (odds ratios 14.2 [95% CI 2.6, 75.8] and 5.7 [95% CI 1.4. 22.3] respectively). For the development of epilepsy, both evaluation techniques were again predictive, with imaging findings of cortical pathology being particularly powerful (clinical pattern OR 18.0 [95% CI 3.0, 107.7]; imaging OR 80.7 [95% CI 8.5, 767.3]).
Conclusions:
In this study, the clinical pattern of HCP and the radiological findings were both predictive of outcome, with absence of cortical pathology on imaging being particularly predictive for the absence of epilepsy. While the clinical pattern, in isolation, appears helpful in predicting outcome, our results suggest that both evaluation tools have important roles to play in the evaluation of HCP patients.