A Tale of Two Cerebral Palsies.

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.