The evaluation of epilepsy and other contributing disorders in patients with cerebral palsy using the Gross Motor Function Classification System

Abstract

Objectives. Morbidity and mortality in patients with cerebral palsy are related to motor function disability, as well as other contributing disorders. The aim of this study was to evaluate the contribution of epilepsy and other disorders in cerebral palsy patients using the Gross Motor Function Classification System (GMFCS), and to determine their relationship. Methods. This study was performed in Eskişehir Osmangazi University School of Medicine, Department of Pediatric Neurology between May 2011-January 2012, with a total of 154 patients diagnosed with cerebral palsy. Epilepsy and other contributing disorders were evaluated in the patients. GMFCS was used to measure the motor function. Results. Mental retardation (89.6%), ophthalmological problems (68.2%) and epilepsy (61.0%) were the leading disorders, followed by oromotor dysfunction (48.7%), malnutrition (40.9%), orthopedic problems (38.3%), dental problems (18.8%), sleep disorders (17.5%) and hearing loss (9.1%) in cerebral palsy patients. Epilepsy, mental retardation, oromotor dysfunction and malnutrition were mostly observed in GMFCS level 5 (p<0.001). Sleep disorder and dental problems were mostly observed at level 5 (p<0.05). Epilepsy was seen more frequently in patients who had neonatal seizure history, microcephaly and mental retardation (p<0.05). Conclusions. There are correlations between the occurrence of disorders such as mental retardation, epilepsy, oromotor dysfunction, malnutrition, sleep disorders, dental problems and gross motor function levels. GMFCS levels were thought to be instructive for possible additional disorders. 

Keywords

• Cerebral palsy,Gross Motor Function Classification System,disorders,epilepsy

References

1. [1] Little WJ. On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformities. Trans Obstet Soc Lond 1862;3:293-344.
2. [2] Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol 2007;109:8-14.
3. [3] Shevell MI. The "Bermuda triangle" of neonatal neurology: cerebral palsy, neonatal encephalopathy, and intrapartum asphyxia. Semin Pediatr Neurol 2004;11:24-30.
4. [4] Surveillance of Cerebral Palsy in Europe. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002;44:633-40.
5. [5] O'Shea TM. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol 2008;51:816-28.
6. [6] Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-23.
7. [7] Dalvand H, Dehghan L, Hadian MR, Feizy A, Hosseini SA. Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study. Arch Phys Med Rehabil 2012;93:480-4.
8. [8] Shore BJ, Yu X, Desai S, Selber P, Wolfe R, Graham HK. Adductor surgery to prevent hip displacement in children with cerebral palsy: the predictive role of the Gross Motor Function Classification System. J Bone Joint Surg Am 2012;94:326-34.

9. [9] Surveillence of Cerebral Palsy in Europe: a collaboration of cerebral palsy registers. Surveillence of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 2000;42:816-24.
10. [10] Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalance of cerebral palsy in a population based study. Pediatrics 2002;110:1220-5.
11. [11] Stoknes M, Andersen GL, Elkamil AI, Irgens LM, Skranes J, Salvesen KA, et al. The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study. Eur J Paediatr Neurol 2012;16:56-63.
12. [12] Paneth N, Hong T, Korzeniewski S. The descriptive epidemiology of cerebral palsy. Clinics in Perinatology 2006;33:251-67.
13. [13] Serdaroglu A, Cansu A, Ozkan S, Tezcan S. Prevelance of cerebral palsy in Turkish children betweeen the ages of 2 and 16 years. Dev Med Child Neurol 2006;48:413-6.
14. [14] Johnson A. Prevelance and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002;44:633-40.
15. [15] Andersen GL, Irgens LM, Haagaas I, Skranes JS, Meberg AE, Vik T. Cerebral palsy in Norway: Prevalence, subtypes and severity. Eur J Paediatr Neurol 2008;12:4-13.
16. [16] Reid SM, Carlin JB, Reddihough DS. Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy. Dev Med Child Neurol 2011;53:1007-12.
17. [17] Towsley K, Shevell MI, Dagenais L; REPACQ Consortium. Population-based study of neuroimaging findings in children with cerebral palsy. Eur J Paediatr Neurol 2011;15:29-35.
18. [18] Aksu F. Nature and prognosis of seizures in patients with cerebral palsy. Dev Med Child Neurol 1990;32:661-8.
19. [19] Kułak W, Sobaniec W, Kubas B, Walecki J, Smigielska-Kuzia J, Bockowski L, et al. Spastic cerebral palsy: clinical magnetic imaging correlation of 129 children. J Child Neurol 2007;22:8-14.
20. [20] Sellier E, Uldall P, Calado E, Sigurdardottir S, Torrioli MG, Platt MJ, et al. Epilepsy and cerebral palsy: characteristics and trends in children born in 1976-1998. Eur J Paediatr Neurol 2012;16:48-55.
21. [21] Singhi P, Jagirdar S, Khandelwal N, Malhi P. Epilepsy in children with cerebral palsy. J Child Neurol 2003;18:174-9.
22. [22] Frampton I, Yude C, Goodman R. The prevalence and correlates of specific learning difficulties in a representative sample of children with hemiplegia. Br J Educ Psychol 1998;68:39-51.
23. [23] Zafeiriou DI, Kontopoulos EE, Tsikoulas I. Characteristics and prognosis of epilepsy in children with cerebral palsy. J Child Neurol 1999;14:289-94.
24. [24] Didden R, Korzilius H, van Aperlo B, van Overloop C, de Vries M. Sleep problems and daytime problem behaviours in children with intellectual disability. J Intellect Disabil Res 2002;46:537-547.
25. [25] Singhi PD, Ray M, Suri G. Clinical spectrum of cerebral palsy in north India-an analysis of 1,000 cases. J Trop Pediatr 2002;48:162-6.
26. [26] von Wendt L, Rantakallio P, Saukkonen AL, Tuisku M, Mäkinen H. Cerebral palsy and additional handicaps in a 1-year birth cohort from northern Finland--a prospective follow-up study to the age of 14 years. Ann Clin Res 1985;17:156-61.
27. [27] Murphy CC, Yeargin-Allsopp M, Decouflé P, Drews CD. Prevalence of cerebral palsy among ten-year-old children in metropolitan Atlanta, 1985 through 1987. J Pediatr 1987;123:13-20.
28. [28] Del Giudice E, Staiano A, Capano G, Romano A, Florimonte L, Miele E, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain Dev 1999;21:307-11.
29. [29] Erkin G, Culha C, Ozel S, Kirbiyik EG. Feeding and gastrointestinal problems in children with cerebral palsy. Int J Rehabil Res 2010;33:218-24.
30. [30] Dormans JP, Copley LA. Musculoskeletal impairmen ts. In: Dor mans JP, Pellegrino L, Paul H, editors. Caring for children with cerebral palsy. A team approach. Baltimore (MD): Brookes Co;1998:125-41.
31. [31] Dormans J, Copley LA. Orthopaedic approaches to treatment. In Caring for children with cerebral palsy: A team approach. Dormans JP, PellegrinoL, Paul H. Brookes Publishing Co: Baltimore; 1998:143-68.