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Seizures in Children With Cerebral Palsy and White Matter Injury
Monica S Cooper1,2,3, Mark T Mackay1,2,3, Michael Fahey4
1The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Seizures in children with cerebral palsy (CP) due to white matter injury (WMI) often present as common childhood epilepsy syndromes. Most children outgrow these seizures, indicating a generally favorable prognosis for seizure control.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder.
- White matter injury (WMI) is a significant cause of CP, particularly in preterm infants.
- Seizure disorders are a frequent comorbidity in children with CP.
Purpose of the Study:
- To determine the prevalence of seizure disorders in children with CP resulting from WMI.
- To characterize the specific epileptic syndromes and their evolution in this population.
- To understand the long-term outcomes of seizures in children with CP and WMI.
Main Methods:
- A population-based cohort study reviewed brain MRI and medical records of children with CP and WMI.
- Included were 166 children with isolated WMI, with 87 born preterm.
- Seizure details were gathered from medical records, interviews, and EEG review.
Main Results:
- 25% of children (41/166) experienced seizures beyond the neonatal period.
- Common syndromes included West syndrome, febrile seizures, and focal epilepsies, many of which were outgrown.
- 14 children showed evolution between epileptic syndromes, with 80% seizure-free at last follow-up.
Conclusions:
- Seizure disorders in children with CP due to WMI typically manifest as age-limited childhood epileptic syndromes.
- The majority of these seizure disorders have a favorable outcome, with most children becoming seizure-free.
- These findings are crucial for effective counseling and guiding pharmacological treatment strategies.
Objective:
The goal of this study was to describe the prevalence, syndromes, and evolution of seizure disorders in children with cerebral palsy (CP) due to white matter injury (WMI).
Methods:
For this population-based cohort study, brain MRI scans and medical records were reviewed in children in the Victorian Cerebral Palsy Register born between 1999 and 2006 recorded as having WMI. Children were excluded if they had features of an undiagnosed syndrome, associated cortical malformation or injury, or no medical contact in the preceding year. Included were 166 children with CP and isolated WMI due to presumed vascular insufficiency or hemorrhage; 87 were born preterm. Seizure and CP details were obtained from medical records and interviews, and EEG recordings were reviewed.
Results:
Forty-one children (25%) had seizures beyond the neonatal period. Four children had West syndrome, which resolved with treatment. Thirteen children had febrile seizures that they outgrew. Thirty children had focal epilepsy with seizure manifestations and EEG discharges typical of early-onset childhood occipital epilepsy or childhood epilepsy with centrotemporal spikes; 23 have outgrown these seizures. Two children had idiopathic generalized epilepsy; it was ongoing in 1 child. Fourteen children had evolution from 1 epileptic syndrome to another. At last follow-up (median age, 12.7 years; minimum age, 9.7 years), 80% had not had a seizure for >2 years.
Conclusions:
The electroclinical features of seizure disorders associated with CP and WMI are those of the age-limited, epileptic syndromes of childhood, with favorable outcome in the majority. The findings have important implications for counseling and drug treatment.
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