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Epilepsy and drug-resistant epilepsy in children with cerebral palsy: A retrospective observational study
Fatma Hanci1, Sevim Türay2, Mustafa Dilek3
1Division of Child Neurology, Department of Pediatrics, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
Insights
Children with cerebral palsy face a high risk of epilepsy, particularly those with motor or speech impairments, hearing loss, or neonatal seizures. However, these factors did not significantly increase the risk of developing drug-resistant epilepsy (DRE).
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Cerebral palsy (CP) is frequently associated with epilepsy, posing significant challenges in pediatric care.
- Understanding risk factors for epilepsy and drug-resistant epilepsy (DRE) in children with CP is crucial for effective management and prognosis.
Purpose of the Study:
- To identify specific risk factors associated with the development of epilepsy in children diagnosed with cerebral palsy.
- To investigate risk factors contributing to the development of drug-resistant epilepsy (DRE) in this pediatric population.
Main Methods:
- Retrospective analysis of 229 pediatric patients diagnosed with cerebral palsy between November 2016 and November 2019.
- Examination of medical histories, clinical, laboratory, and radiological findings, including electroencephalograms (EEGs).
Main Results:
- Epilepsy was present in 52.4% of patients; DRE was observed in 27.9%.
- Risk factors for epilepsy included motor/speech impairment, hearing impairment, neonatal seizures, psychiatric comorbidity (e.g., autism spectrum disorder), microcephaly, quadriplegic CP, and abnormal EEG findings.
- No significant risk factors were identified for the development of DRE when comparing these factors.
Conclusions:
- Children with cerebral palsy exhibit high rates of comorbid epilepsy.
- Specific clinical and demographic factors are associated with increased epilepsy risk, but not necessarily DRE.
- Normal EEG findings or only background rhythm abnormalities in neonates with seizures may indicate a favorable prognosis for non-development of DRE.
Purpose:
The objective of this study was to determine risk factors for epilepsy and drug-resistant epilepsy (DRE) development in children with cerebral palsy.
Method:
Two hundred twenty-nine patients presenting to the pediatric neurology clinic and diagnosed as having cerebral palsy between November 2016 and November 2019 were included in the study. Medical histories and clinical, laboratory, and radiological findings were examined retrospectively from patient records in the hospital data system.
Results:
Girls represented 103 patients (45%) and boys 126 (55%). The patients' mean age was 8.39 ± 4.54 years. Epileptic seizures were present in 120 (52.4%) patients and drug-resistant seizures in 64 (27.9%). The risk of epilepsy was significantly higher in patients with motor or speech impairment, with hearing impairment, or undergoing first seizure in the neonatal period. We also observed a higher risk of epilepsy in patients with psychiatric comorbidity, particularly autism spectrum disorder. The risk of epilepsy was also higher in patients with microcephaly or quadriplegic cerebral palsy and in patients with focal and generalized epileptiform abnormality on electroencephalograms (EEGs). However, no significant difference was identified when all these factors were evaluated in terms of the risk of developing DRE.
Conclusion:
Patients with cerebral palsy have high comorbid epilepsy rates. We think that the risk of epilepsy may be higher in patients undergoing first seizure in the neonatal period, with microcephaly, with quadriplegic type cerebral palsy, and with additional psychiatric comorbidity. The rate of DRE development was very low in patients with normal EEG findings or with only background rhythm abnormalities on first EEGs during neonatal seizures. This may be regarded as a good prognostic factor for nondevelopment of DRE.
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