Serebral Palsili Çocuklarda Epilepsinin Klinik Özellikleri ve Olası Risk Faktörleri: Üçüncü Basamak Merkez Deneyimi

Öz

Amaç: Bu çalışmada serebral palsili (SP) çocuklarda klinik özellikler ile epilepsi gelişiminde olası risk faktörlerinin ve epilepsi prognozunun değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: 2019-2022 yılları arasında SP tanısı ile takip edilen toplam 145 çocuk hasta değerlendirilmiştir. Olguların demografik bilgileri, prenatal/perinatal öyküsü, SP etiyolojisi ve tipi, motor ve bilişsel fonksiyonlardaki bozukluğun derecesi, nöbet tipi, nörogörüntüleme ve elektroensefalografi (EEG) bulguları hastane kayıtlarından retrospektif olarak toplanmıştır. Olgular epilepsisi olan ve epilepsisi olmayan SP hastaları olmak üzere iki gruba ayrılmıştır. Çalışma değişkenleri bu iki grup arasında ve ayrıca dirençli epilepsi ile kontrollü epilepsi grupları arasında karşılaştırılmıştır.

Bulgular: Olguların 91'i (%63) erkek, 54'ü (%37) kız ve ortalama yaşı 11.1±4.2 yıl (3-18 yaş) idi. Toplam 107 (%73.7) olguda epilepsi mevcuttu ve bunların %40.1'i dirençli epilepsi idi. Epilepsi grubunda en sık SP tipi tetraplejik SP idi (p=0.028). Term gebelik, ≥2500 g doğum ağırlığı ve neonatal nöbet öyküsü epilepsili SP grubunda anlamlı olarak daha fazla idi (sırasıyla p=0.03, 0.01 ve 0.03). Dirençli epilepsi grubunda tetraplejik SP tipi (%50) ve ağır zihinsel yetersizlik (%56) görülme oranı kontrollü epilepsi grubuna göre daha yüksekti.

Sonuç: Serebral palsili hastalarda epilepsi gelişiminin öngörülmesinde olası risk faktörlerinin belirlenmesi, yüksek riskli hastaların yakın izlemi açısından önemlidir. Serebral palsili çocuklarda komorbid epilepsinin erken tanımlanması ve tedavisine özellikle dikkat edilmelidir.

Anahtar Kelimeler

• serebral palsi
• epilepsi
• risk faktörleri
• dirençli epilepsi
• pediatrik

Clinical Characteristics and Possible Risk Factors of Epilepsy in Children with Cerebral Palsy: A Tertiary-Center Experience

Öz

Objective: The aim of this study was to evaluate the clinical characteristics of children with cerebral palsy (CP) and to investigate possible risk factors and prognosis of epilepsy in children with cerebral palsy (CP) with a special emphasis on drug-resistant epilepsy (DRE).

Materials and Methods: A total of 145 pediatric patients who were followed up with a diagnosis of CP between 2019 and 2022 were evaluated. Demographic features, prenatal/perinatal history, etiology and type of CP, degree of impairment in motor and cognitive functions, seizure type, neuroimaging, and electroencephalography (EEG) findings were obtained retrospectively from hospital records. The patients were divided into two groups: CP patients with epilepsy and patients without epilepsy. Study variables were compared between these two groups and also between DRE and controlled epilepsy groups.

Results: There were 91 (63%) boys and 54 (37%) girls with a mean age of 11.1 ± 4.2 years (3-18 years). Epilepsy was present in 107 (73.7%) cases and 40.1% of them had refractory epilepsy. Epilepsy was most common in the tetraplegic form of CP (p=0.028). Term gestation, birth weight of ≥2500 g, and history of neonatal seizures were significantly higher in patients with epilepsy (p=0.03, 0.01, and 0.03, respectively). Children with DRE were more likely to have tetraplegic CP (50%) and severe intellectual disability (56%).

Conclusion: Determination of potential risk factors is important in predicting the development of epilepsy in patients with CP, as it may provide closer follow-up of patients at high risk. Particular attention should be paid to the early identification and treatment of comorbid epilepsy in children with CP.

Anahtar Kelimeler

• cerebral palsy
• epilepsy
• risk factors
• refractory epilepsy
• pediatric

Kaynakça

1. 1. Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat 2020;16:1505-18.
2. 2. Cooper MS, Mackay MT, Dagia C, Fahey MC, Howell KB, Reddihough D, et al. Epilepsy syndromes in cerebral palsy: varied, evolving and mostly self-limited. Brain 2022;24:awac274. doi: 10.1093/brain/awac274.
3. 3. Sadowska M, Sarecka-Hujar B, Kopyta I. Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy. Brain Sci 2020;10:481.
4. 4. Bhati P, Sharma S, Jain R, Rath B, Beri S, Gupta VK, et al. Cerebral Palsy in North Indian Children: Clinico-etiological Profile and Comorbidities. J Pediatr Neurosci. 2019;14:30-5.
5. 5. Pavone P, Gulizia C, Le Pira A, Greco F, Parisi P, Di Cara G, et al. Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity. Children 2020 31;8:16.
6. 6. Palisano RJ, Cameron D, Rosenbaum PL, Walter SD, Rusell D. Stability of the gross motor function classification system. Dev Med Child Neurol 2006;48: 424–8.
7. 7. Himmelmann K, Horber V, Sellier E, De la Cruz J, Papavasiliou A, Krageloh-Mann I. Neuroimaging Patterns and Function in Cerebral Palsy-Application of an MRI Classification. Front Neurol 2021;11:617740.
8. 8. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58:512–21.

9. 9. Mert GG, Incecik F, Altunbasak S, Herguner O, Mert M, Kiris N, et al. Factors affecting epilepsy development and epilepsy prognosis in cerebral palsy. Pediatr Neurol 2011;45:89–94.
10. 10. Karatoprak E, Sözen G, Saltık S. Risk factors associated with epilepsy development in children with cerebral palsy. Childs Nerv Syst 2019;35:1181–7.
11. 11. Gürkan F, Gökben S, Serin HM, Yılmaz S, Aktan G, Tekgül H. Determining risk factors of epilepsy in children with cerebral palsy: a retrospective study. J Pediatr Res 2018;5:76-81.
12. 12. Hanci F, Türay S, Dilek M, Kabakuş N. Epilepsy and drug-resistant epilepsy in children with cerebral palsy: A retrospective observational study. Epilepsy Behav 2020;112:107357.
13. 13. Bearden DR, Monokwane B, Khurana E, Baier J, Baranov E, Westmoreland K, et al. Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities. Pediatr Neurol 2016;59:23–9.
14. 14. Zelnik N, Konopnicki M, Bennett-Back O, Castel-Deutsch T, Tirosh E. Risk factors for epilepsy in children with cerebral palsy. Eur J Paediatr Neurol 2010;14:67–72.
15. 15. Abdel Maksoud YH, Suliman HA, Eisayed Abdulsamea S, Mohamed Kamal N, Al-Shokray AH, Ibrahim AO, et al. Risk Factors of Intractable Epilepsy in Children with Cerebral Palsy. Iran J Child Neurol 2021;15:75–87.
16. 16. KA Saini L Gunasekaran PK., Singh P, Sahu JK, Sankhyan N, Sharma R, et al. The Profile of Epilepsy and its characteristics in Children with Cerebral Palsy. Seizure 2022;101:190–6.
17. 17. Szpindel A, Myers KA, Ng P, Dorais M, Koclas L, Pigeon N, et al. Epilepsy in children with cerebral palsy: a data linkage study. Dev Med Child Neurol 2022;64:259-65.
18. 18. Singhi P, Jagirdar S, Khandelwal N, Malhi P. Epilepsy in children with cerebral palsy. J Child Neurol 2003;18:174–9.
19. 19. Tokatly Latzer I, Blumovich A, Sagi L, Uliel-Sibony S, Fattal-Valevski A. Prediction of Drug-Resistant Epilepsy in Children With Cerebral Palsy. J Child Neurol 2020;35; 187–94.