Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and cognitive impairment: a population-based
Kristina Ahlin1, Bo Jacobsson1,2, Staffan Nilsson3
1Department of Perinatal Center, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Insights
This study found that low birthweight, brain maldevelopment, and neonatal infection are linked to accompanying impairments in cerebral palsy (CP). Neuroimaging patterns correlate with the timing of these antecedents, offering insights into CP development.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Cerebral palsy (CP) often presents with accompanying impairments like cognitive deficits and epilepsy.
- Understanding the antecedents and neuroimaging patterns associated with these impairments is crucial for early intervention and management.
- Previous research has explored various factors contributing to CP, but the link to specific co-occurring conditions requires further investigation.
Purpose of the Study:
- To explore antecedents of accompanying impairments in children with cerebral palsy.
- To investigate the relationship between these antecedents and specific neuroimaging patterns.
- To determine if factors beyond motor impairment are associated with cognitive impairment and/or epilepsy in CP.
Main Methods:
- A population-based study included 309 children with cerebral palsy born at term between 1983 and 1994.
- Prepartum, intrapartum, and postpartum variables were analyzed in children with and without accompanying impairments (cognitive impairment and/or epilepsy).
- Neuroimaging patterns were assessed and correlated with identified antecedents using data from the cerebral palsy register of western Sweden and obstetric/neonatal records.
Main Results:
- Children with CP and accompanying impairments had higher rates of low birthweight, brain maldevelopment at birth, and neonatal infection.
- Neuroimaging revealed increased prevalence of maldevelopment, cortical/subcortical lesions, and basal ganglia lesions in this group, while white matter injury was less common.
- Cerebral maldevelopment was linked to prepartum antecedents, whereas lesions in cortical/subcortical areas and basal ganglia were associated with intrapartum and postpartum events.
Conclusions:
- No factors beyond those related to motor impairment were found to be associated with epilepsy and cognitive impairment in cerebral palsy.
- The timing of antecedents is critical for the development of cerebral palsy with accompanying impairments.
- Neuroimaging patterns support the hypothesis that the timing of antecedents influences the development of specific CP characteristics and associated impairments.
Introduction:
Antecedents of accompanying impairments in cerebral palsy and their relation to neuroimaging patterns need to be explored.
Material And Methods:
A population-based study of 309 children with cerebral palsy born at term between 1983 and 1994. Prepartum, intrapartum, and postpartum variables previously studied as antecedents of cerebral palsy type and motor severity were analyzed in children with cerebral palsy and cognitive impairment and/or epilepsy, and in children with cerebral palsy without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analyzed. Data were retrieved from the cerebral palsy register of western Sweden, and from obstetric and neonatal records.
Results:
Children with cerebral palsy and accompanying impairments more often had low birthweight (kg) (odds ratio 0.5, 95% confidence interval 0.3-0.8), brain maldevelopment known at birth (p = 0.007, odds ratio ∞) and neonatal infection (odds ratio 5.4, 95% confidence interval 1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (odds ratio 7.2, 95% confidence interval 2.9-17.2), cortical/subcortical lesions (odds ratio 5.3, 95% confidence interval 2.3-12.2) and basal ganglia lesions (odds ratio 7.6, 95% confidence interval 1.4-41.3) were more common, wheras white matter injury was found significantly less often (odds ratio 0.2, 95% confidence interval 0.1-0.5). In most children with maldevelopment, the intrapartum and postpartum periods were uneventful (p < 0.05). Cerebral maldevelopment was associated with prepartum antecedents, whereas subcortical/cortical and basal ganglia lesions were associated with intrapartum and postpartum antecedents.
Conclusion:
No additional factor other than those related to motor impairment was associated with epilepsy and cognitive impairment in cerebral palsy. Timing of antecedents deemed important for the development of cerebral palsy with accompanying impairments were supported by neuroimaging patterns.
