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Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India
Maya Viswanath1, Ruchika Jha1, Ankita Dilip Gambhirao1
1Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India.
Insights
Children with cerebral palsy (CP) experience a high burden of comorbidities, particularly visual and cognitive impairments. Early identification and management of these co-occurring conditions are crucial for improving outcomes in children with CP.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Cerebral palsy (CP) is a complex neurological disorder affecting children.
- Comorbidities are common in children with CP, impacting their overall health and development.
- Understanding the spectrum and characteristics of these co-occurring impairments is essential for comprehensive care.
Purpose of the Study:
- To describe the prevalence of comorbidities in children diagnosed with cerebral palsy (CP).
- To identify characteristics associated with different types of impairments in children with CP.
- To inform strategies for managing the multifaceted needs of children with CP.
Main Methods:
- A cross-sectional study was conducted at a tertiary care referral center in India.
- 384 children aged 2-18 years with confirmed CP diagnosis were enrolled.
- Data collected included risk factors, clinical evaluations, and investigations (neuroimaging, genetic/metabolic workup).
Main Results:
- High prevalence of comorbidities was observed, including visual impairment (93.2%), cognitive impairment (88.8%), and epilepsy (64%).
- Drug-resistant epilepsy affected 42.4% of participants.
- Hemiparetic and diplegic CP, along with lower Gross Motor Function Classification System scores, predicted fewer co-occurring impairments.
Conclusions:
- Children with CP face a significant burden of comorbidities that escalate with functional impairment.
- Preventive measures targeting CP risk factors are needed.
- Organized resources are required for timely identification and management of co-occurring impairments in CP.
Objective:
To describe the comorbidities in children with cerebral palsy (CP) and determine the characteristics associated with different impairments.
Design:
Cross-sectional study.
Setting:
Tertiary care referral centre in India.
Patients:
Between April 2018 and May 2022, all children aged 2-18 years with a confirmed diagnosis of CP were enrolled by systematic random sampling. Data on antenatal, birth and postnatal risk factors, clinical evaluation and investigations (neuroimaging and genetic/metabolic workup) were recorded.
Main Outcome Measures:
Prevalence of the co-occurring impairments was determined using clinical evaluation or investigations as indicated.
Results:
Of the 436 children screened, 384 participated (spastic CP=214 (55.7%) (spastic hemiplegic=52 (13.5%); spastic diplegia=70 (18.2%); spastic quadriplegia=92 (24%)), dyskinetic CP=58 (15.1%) and mixed CP=110 (28.6%)). A primary antenatal/perinatal/neonatal and postneonatal risk factor was identified in 32 (8.3%), 320 (83.3%) and 26 (6.8%) patients, respectively. Prevalent comorbidities (the test used) included visual impairment (clinical assessment and visual evoked potential)=357/383(93.2%), hearing impairment (brainstem-evoked response audiometry)=113 (30%), no understanding of any communication (MacArthur Communicative Development Inventory)=137 (36%), cognitive impairment (Vineland scale of social maturity)=341 (88.8%), severe gastrointestinal dysfunction (clinical evaluation/interview)=90 (23%), significant pain (non-communicating children's pain checklist)=230 (60%), epilepsy=245 (64%), drug-resistant epilepsy=163 (42.4%), sleep impairment (Children's Sleep Habits Questionnaire)=176/290(60.7%) and behavioural abnormalities (Childhood behaviour checklist)=165 (43%). Overall, hemiparetic and diplegic CP and Gross Motor Function Classification System ≤3 were predictive of lesser co-occurring impairment.
Conclusion:
CP children have a high burden of comorbidities, which increase with increasing functional impairment. This calls for urgent actions to prioritise opportunities to prevent risk factors associated with CP and organise existing resources to identify and manage co-occurring impairments.
Trial Registration Number:
CTRI/2018/07/014819.
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