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Published on: November 20, 2015
Outcome of hemiplegic cerebral palsy born at term depends on its etiology
Yukihiro Kitai1, Kazuhiro Haginoya2, Satori Hirai1
1Department of Pediatric Neurology, Morinomiya Hospital, Japan.
Insights
Periventricular venous infarction (PVI) is the leading cause of term-born hemiplegic cerebral palsy (HCP). Etiology impacts initial signs and outcomes, with PIS generally showing better results than cerebral dysgenesis.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Hemiplegic cerebral palsy (HCP) affects motor function on one side of the body.
- Understanding the underlying causes and their impact on development is crucial for targeted interventions.
Purpose of the Study:
- To investigate the causes of HCP in term-born children.
- To explore the relationship between specific etiologies and clinical outcomes in HCP.
Main Methods:
- Retrospective analysis of MR images and clinical data from 156 children with HCP.
- Classification of etiologies into perinatal ischemic stroke (PIS) and cerebral dysgenesis (CD).
- Detailed comparison of functional outcomes across different PIS subtypes (PVI, MCAI, DGMI) and CD.
Main Results:
- Perinatal ischemic stroke (PIS) was the most common etiology (68%), with venous infarction (PVI) more frequent than arterial infarction.
- PVI presented with later motor asymmetry and lower limb involvement.
- Children with PIS generally exhibited earlier walking, better intellectual development, and less epilepsy compared to those with cerebral dysgenesis.
Conclusions:
- Periventricular venous infarction (PVI) is the predominant cause of term-born HCP.
- The specific etiology of HCP significantly influences initial clinical signs and long-term functional outcomes.
- Identifying the etiology aids in predicting developmental trajectories and managing HCP.
Objectives:
To elucidate the etiology and its relationship to the outcomes of hemiplegic cerebral palsy (HCP).
Participants And Methods:
MR images and outcomes of 156 children with HCP born at term and older than three years were investigated in two major centers for cerebral palsy in Japan. Etiologies were classified into perinatal ischemic stroke (PIS), cerebral dysgenesis (CD), and others. PIS was divided into periventricular venous infarction (PVI) and two types of arterial infarction; middle cerebral artery infarction (MCAI) and deep gray matter infarction (DGMI). Initial signs and the time of presentation were investigated among the three types of PIS. As functional outcomes, laterality of paresis, age at initial walk, affected hand's function, intellectual development, and occurrence of epilepsy were compared among all the four types.
Etiology:
PIS was found in 106 children (68%), while CD accounted for 28 (18%). Among PIS, venous infarction was more common than arterial infarction (62:44).
Outcomes:
PVI revealed later presentation of motor asymmetry and more involvement of lower extremity as the initial sign among PIS groups. Only MCAI showed right-side predominance in laterality of paresis. DGMI related to better intellectual development and PVI showed lower occurrence of epilepsy, while there was no significant difference in affected hand's function among the four groups. PIS groups showed significantly earlier attainment of independent walk, better intellectual development, and lower occurrence of epilepsy than CD.
Conclusions:
PVI was the most common cause of HCP born at term, and the etiology closely related to the initial signs of hemiplegia and overall outcomes.
