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Epilepsy in children with cerebral palsy
1Department of Pediatrics and Physical Medicine and Rehabilitation, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital and Indian Agricultural Statistics Research Institute, New Delhi, India. gudu@ndf.vanl.net.in
Insights
Children with cerebral palsy and epilepsy often have severe, difficult-to-control seizures. Quadriparesis, mental retardation, and myoclonic epilepsy predict a poor response to anti-epileptic drugs (AEDs).
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Cerebral palsy (CP) frequently co-occurs with epilepsy, posing significant management challenges.
- Understanding the clinical profile and epilepsy characteristics in children with CP is crucial for optimizing treatment.
Purpose of the Study:
- To investigate the clinical features of children suffering from both cerebral palsy and epilepsy.
- To identify clinical predictors associated with the response to anti-epileptic drugs (AEDs) in this population.
Main Methods:
- A prospective, hospital-based follow-up study included 85 children with CP and epilepsy (excluding neonatal seizures).
- Data collected included seizure classification (ILAE), EEG, neuroimaging, and clinical assessments over a minimum 12-month follow-up.
- Multivariate analysis was employed to determine predictors of AED response.
Main Results:
- Perinatal factors were the primary cause in 72.3% of cases.
- Quadriparesis was the most common motor deficit (64 cases), often associated with mental retardation (80.9%).
- Generalized epilepsy was predominant, particularly in quadriparesis patients who frequently required multiple AEDs. Poor AED response was linked to quadriparesis, microcephaly, mental retardation, and myoclonic epilepsy.
Conclusions:
- Epilepsy in children with cerebral palsy is typically severe and challenging to manage.
- Clinical factors such as quadriparesis, mental retardation, and myoclonic epilepsy are significant predictors of poor response to anti-epileptic drug therapy.
Abstract:
This article deals with the clinical profile of children with cerebral palsy and epilepsy, and to study the clinical predictors of response to anti-epileptic drugs. It is a prospective hospital based follow-up study. All the children who presented with cerebral palsy and history of seizure (other than neonatal seizures) over a period of one year were included. Seizures were classified according to ILAE classification. An EEG was obtained in all cases. Neuroimaging was done in all patients. Eighty-five patients were studied and followed for minimum of 12 months. Perinatal factors accounted for 62 (72.3%) cases. The motor deficits seen were quadriparesis (n = 64), hemiplegia (n = 12) and diplegia (n = 9). Associated mental retardation was seen in 80.9% patients with quadriparesis. A predominance of generalised epilepsy was seen with generalised tonic clonic seizures (32.9%) followed by mycolonic seizures (30.6%) and localisation related epilepsy (24.7%). The patients with quadriparesis were more likely to have generalised epilepsy and 52.4% of them required two or more anti-epileptic drugs for control of seizures. Patients with hemiplegia had localisation related epilepsy in 83.3% of cases. On multivariate analysis presence of quadriparesis, microcephaly, mental retardation and myoclonic epilepsy were found to predict the poor response to AED. Epilepsy in patients with cerebral palsy is of severe nature and difficult to control. Presence of quadriparesis, mental retardation and myoclonic seizures was predictive of poor response to anti- epileptic drugs.