Serebral palsili çocuklarda oküler problemler [Ocular problems in children with cerebral palsy]

Abstract

Objectives: The aim of this study is to evaluate eye problems in children with cerebral palsy in our region. Materials and Methods: 90 patients which was diagnosed as cerebral palsy, treated and followed up in Pediatric Neurology Department of Mustafa Kemal University, were included to this study. The history was taken, and a physical examination was performed to determine the etiology of the disease and type of SP. All of the patients were underwent a detailed ophthalmological examination including visual acuity, refractive error, amblyopia, strabismus, nystagmus and fundus examination. Results: Totally 90 patients, 51 male and 39 female, were included to the study. When the etiologic factors were evaluated, the asphyxia was seen in 33.3% of the patients. The most common type of cerebral palsy was spastic quadriplegia at the rate of 43.3%. Eye problems were detected in 60% of our cases. Of this, 54.4% were refractive errors, 35.6% were strabismus, and 22.2% were optic nerve pathologies. Amblyopia was found in 11.1% of cases. Although strabismus is more common in spastic diplegia type of cerebral palsy, there was no statistically significant difference Conclusion: In conclusion, eye problems are common in children with cerebral palsy. Therefore, we recommend routine eye examination in these patients due to be beneficial in reducing the detection and communication difficulties.

Keywords

• Cerebral palsy, refractive error, strabismus, optic atrophy

Serebral palsili çocuklarda oküler problemler

Abstract

Amaç: Bu çalışmadaki amacımız bölgemizdeki serebral palsili çocuklarda göz problemlerinin sıklığını ve çeşitliliğini tespit etmektir. Gereç ve yöntem: Çalışmaya Mustafa Kemal Üniversitesi Çocuk Nöroloji polikliniğinde takip ve tedavisi yapılan serebral palsi tanısı almış 90 hasta alındı. Hastalığın etyolojisi ve serebral palsi tipini belirlemek için öykü alındı ve fizik muayene yapıldı. Tüm hastalara görme keskinliği, kırma kusuru, ambliyopi, şaşılık, nistagmus ve göz dibi muayenesini içeren ayrıntılı oftalmolojik muayene yapıldı. Bulgular: Çalışmaya 51\'i erkek, 39\'u kız olmak üzere toplam 90 hasta alındı. Etiyolojik faktörler incelendiğinde olguların %33,3\'de asfiksi görüldü. En sık görülen serebral palsi tipi %43,3 oranında spastik quadripleji idi. Olgularımızın %60\'ında göz problemleri tesbit edildi. Bunun %54,4\'nü kırma kusurları, %35,6\'sını şaşılık, %22,2\'sini optik sinir patolojileri oluşturmaktaydı. Ambliyopi olguların %11,1\'inde görüldü. Serebral palsinin spastik dipleji tipinde şaşılık daha fazla görülmesine rağmen, istatistiksel olarak anlamlı farklılık yoktu. Sonuç: Sonuç olarak serebral palsili çocuklarda göz problemleri sık görülmektedir. Bu nedenle, hastaların algılama ve iletişim güçlüklerini azaltmada faydalı olacağından rutin göz muayenesi öneriyoruz.

Keywords

• Serebral palsi, refraksiyon kusuru, şaşılık, optik atrofi.

References

1. Morris C. Definition and classification of cerebral palsy: a historical perspective. Dev Med Child Neurol Supply 2007;109(1):3-7.
2. Cans C. Surveillance of cerebral palsy in Europe: a collabora- tion of cerebral palsy surveys and registers. Dev Med Child Neurol 2000;42(12):816-24.
3. Bax MC. Terminology and classification of cerebral palsy. Dev Med Child Neurol 1964;6:295-7.
4. Bax MC, Goldstein M, Rosenbaum P, et al. Proposed defi- nition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571-76.
5. Nelson KB, Grether JK. Causes of cerebral palsy. Curr Opin Pediatr 1999;11(6):487-91.
6. Stanley FJ. The aetiology of cerebral palsy. Early Hum Dev 1994;36(2):81-8.
7. Minear WL. A classification of cerebral palsy. Pediatrics 1956;18(5):841-52.
8. Crothers B, Paine RS. The natural history of cerebral palsy. Cambridge: Harvard University Press 1959.

9. Black P. Visual disorders associated with cerebral palsy. Br J Ophthalmol 1982;66(1): 46-52.
10. Pennefather PM, Tin W. Ocular abnormalities associated with cerebral palsy after preterm birth. Eye 2000;14(1):78-81.
11. Berk A, Özturk A, Yaman A. Serebral palsili çocuklarda göz problemleri. TOD dergisi 2010;40(4):209-16.
12. Ferziger NB, Nemet P, Brezner A, Feldman R, Galili G, Zivotofsky AZ. Visual assessment in children with cerebral palsy: implementation of a functional questionnaire. Dev Med Child Neurol 2011;53(5):422-8.
13. Yüksel A, Yalcın E. Serebral paralizili cocuklarda epilepsi insidans, konvulsiyon tipleri, elektroensefalografi ve krani- al tomografi anomali sıklığının araştırılması. T Klin Pediatri 1993;2(1):14-9.
14. Güven A, Deda G, Karagül U, Uysal S. Serebral palsi: 61 ol- gunun değerlendirilmesi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 1999;52(1):13-7.
15. Duman Ö, İmad FM, Kızılay F, Yücel İ, Balkan S, Haspolat Ş. Serebral palsili hastaların işlevsel kapasitelerine göre gör- me sorunlarının değerlendirilmesi. Çocuk Sağlığı ve Hasta- lıkları Dergisi 2005;48:130-5.
16. McDonald AD. Cerebral palsy in children of very low birth weight. Arch Dis Child 1963;38:579-88.
17. İpek B, Ecevit C, İpek I, Kocabaş O, Kavaklı T, Ozturk A. The evaluation of 371 cases with Cerebral Palsy between January 1984 and December 2004. Journal of Neurological Sciences 2007;24:270-9.
18. Grether JK, Cumminis SK, Nelson KB. The California cere- bral palsy project. Pediatr Perinat Epidemiol 1992;6(3):339- 51.
19. Buckley E, Seaber JH. Dyskinetic strabismus as: a sign of cerebral palsy. Am J Ophthalmol 1981;91(5):652-7.
20. Robinson RO. The frequency of other handicaps in children with cerebral palsy. Dev Med Child Neurol 1973;15(3):305- 12.
21. Crofts BJ, King R, Johnson A. The contribution of low birth weight to severe vision loss in a geographically defined pop- ulation. Br J Ophthalmol 1998;82(1):9-13.
22. Dowdeswell HJ, Slater AM, Broomhall J, Tripp J. Visual deficits in children born at less than 32 weeks’ gestation with and without major ocular pathology and cerebral damage. Br J Ophthalmol 1995;79(5):447-52.
23. Cumurcu T, Cumurcu HB, Erkorkmaz Ü, Yardım H. Se- rebral Palsili Çocuklarda Göz Bulguları. Fırat Tıp Dergisi 2007;12(1):48-52.
24. Lo Cascio GP. A study of vision in cerebral palsy. Am J Op- tom 1977;54(5):332-7.
25. Sobrado P, Suarez J, Garcia-Sanchez FA, Uson E. Refractive errors in children with cerebral palsy, psycomotor reterda- tion and other non-cerebral palsy neuromotor disabilities. Dev Med Child Neurol 1999;41(6):396-403.
26. Ghasia F, Brunstrom J, Gordon M, Tychsen L. Frequency and severity of visual sensory and motor deficits in children with cerebral palsy: Gross motor function classification scale. In- vest Ophthalmol Vis Sci 2008;49(2):572-80.
27. Kozeis N, Anogeianaki A, Mitova DT, Anogianakis G, Mitov T, Klisarova A. Visual function and visual percep- tion in cerebral palsied children. Ophthalmic Physiol Opt 2007;27(1):44-53.
28. Katoch S, Devi A, Kulkarni P. Ocular defects in cerebral palsy. Indian J Ophthalmol 2007;55:154-6.
29. Lagunju IA, Oluleye TS. Ocular abnormalities in children with cerebral palsy. Afr J Med Sci 2007;36(1):71-5.
30. Breakey AS. Ocular findings in cerebral palsy. Arch Ophthal- mol 1995;53(6):852-6.
31. Jethani J. Ocular defects in cerebral palsy. Indian J Ophthal- mol 2007;55(5):397.
32. O’Keefe M, Kafil-Hussain N, Flitcroft I, Lanigan B. Ocular significance of intraventricular hemorrhage in premature in- fants. Br J Ophthalmol 2001;85(3):357-9.
33. Dineen JT, Hendrickson AE. Age-correlated differences in the amount of retinal degeneration after striate cortex lesions in monkeys. Invest Ophthalmol Vis Sci 1981;21(5):749-52.
34. Herbin M, Boire D, The´oret H, Ptito M. Transneuronal de- generation of retinal ganglion cells in early hemispherecto- mized monkeys. Neuroreport 1999;10(7):1447-52.
35. Ruberto G, Salati R, Milano G, et al. Changes in the optic disc excavation of children affected by cerebral visual im- pairment: a tomographic analysis. Invest Ophthalmol Vis Sci 2006;47(2):484-8.
36. Scheiman MM. Optometric findings in children with cerebral palsy. Am J Optom Physiol Opt 1984;61(5):321-3.
37. Jakobson L, Hellstrom A, Flodmark O. Large cups in normal sized optic discs-a variant of optic nerve hypoplasia in chil- dren with periventricular leukomalacia. Arch Ophthalmol 1997;115(10):1263-9.
38. Nacitarhan S. Merkezimize başvuran Güneydoğu Anadolu bölgeli serebral palsili çocukların sosyoekonomik ve demog- rafik özellikleri. Dicle Tıp Dergisi, 2005;32(1):13-9.