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A Tale of Two Cerebral Palsies
Victoria D'Amours1, Nafisa Husein1, Michael Shevell2
1Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada.
Insights
Children with cerebral palsy (CP) born in low-middle-income countries (LMICs) exhibit a more severe phenotype, including greater functional impairments and comorbidities, compared to those born in high-income countries (HICs). This difference is linked to distinct etiologies and brain injury patterns, highlighting the need for targeted interventions in LMICs.
Area of Science:
- Neurology
- Pediatrics
- Global Health
Background:
- Cerebral palsy (CP) understanding is limited in low- and middle-income countries (LMICs).
- This study compares CP phenotypes, severity, and etiologies in children born in LMICs versus high-income countries (HICs).
Purpose of the Study:
- To describe and compare the phenotype, severity, and etiologic profile of children with CP born in LMICs versus HICs.
- To identify differences in CP presentation and contributing factors between these settings.
Main Methods:
- Retrospective cross-sectional study of children with CP assessed over five years (2020-2024).
- Data extracted from hospital records, classifying children by birth location (LMIC or HIC).
- Pearson chi-square analyses compared CP subtype, etiology, MRI findings, functional impairments, and comorbidities.
Main Results:
- LMIC children were more likely to have spastic quadriparetic or dyskinetic CP.
- Deep gray matter injury on MRI and severe functional impairments (GMFCS/MACS IV-V), cognitive disability, and sensory deficits were more common in LMIC children.
- Intrapartum asphyxia or kernicterus were significantly more likely etiologies in LMIC-born children.
Conclusions:
- Children from LMICs present with a substantially more severe CP phenotype, characterized by greater functional impairments and comorbidities.
- This severe phenotype is linked to a greater degree of deep gray matter injury, resulting from an altered etiologic profile.
- Findings offer insights into CP in LMICs, suggesting targets for preventative strategies and anticipating increased service needs for migrant populations in HICs.
Background:
There is limited understanding of cerebral palsy (CP) in low-middle-income countries (LMICs). This retrospective cross-sectional study aims to describe and compare the phenotype, severity and etiologic profile of children with CP born either in a LMIC or high-income country (HIC) assessed in a single setting.
Methods:
Data from consecutive children with CP initially assessed by a single neurologist over a 5-year interval (2020-2024 inclusive) were extracted from hospital records. Children were classified into one of two groups based on location at birth (HIC or LMIC). Pearson chi-square analyses compared the two CP populations along the following characteristics: CP subtype, etiology, magnetic resonance imaging finding, functional impairments, and comorbidities.
Results:
Eighty-nine Canadian (HIC) born and 48 LMIC born children met inclusion criteria. LMIC children were significantly (P < 0.01) more likely to have spastic quadriparetic or dyskinetic CP, magnetic resonance imaging signs of deep gray matter injury, Gross Motor Function Classification System/Manual Ability Classification System level IV-V functional severity or cognitive disability and be nonverbal, deaf or cortically blind than a child born in a HIC. Intrapartum asphyxia or kernicterus was significantly (P < 0.01) more likely as an etiology in LMIC born children.
Conclusions:
Children from LMICs have a substantially different CP phenotype. This phenotype is markedly more severe with respect to functional impairments and comorbidities. This likely reflects a significantly greater degree of deep gray matter injury that is the consequence of an altered etiologic profile. These results provide greater insight into the profile of CP in LMICs offering specific targets for preventative strategies. Greater service needs for children with CP derived from migrant populations in HICs can be expected.
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