Epilepsy in children with cerebral palsy: a data linkage study

Hospitalizations in Children With Optic Nerve Hypoplasia and Septo-Optic-Pituitary Dysplasia

BACKGROUND AND OBJECTIVES

Optic nerve hypoplasia (ONH) causes congenital impaired vision. The diagnosis of septo-optic-pituitary dysplasia (SOD) is made when ONH occurs in conjunction with hypopituitarism or absent septum pellucidum or abnormal corpus callosum. Our objectives were to describe differences in hospitalisation rates, length of hospital stay (LOS), and the primary reasons for hospitalisations among children with ONH/SOD in comparison to controls.

METHODS

A population-based retrospective study with a case-control design was conducted. Cases were 124 ONH/SOD patients (mean age: 13 years, SD: 7.2 years), matched to 620 unrelated population-based controls (mean age: 12.4 years, SD: 7.2 years) on area of residence, year of birth, and sex. Non-parametric statistics were used to test for differences between cases and controls on number of hospital admissions, crude rates of admissions, and LOS. Relative rates (RR) with 95% confidence intervals (CIs) were estimated. Primary (most responsible) diagnoses were described for hospitalisations.

RESULTS

ONH/SOD cases had the highest percentage of hospitalisations (26.6%-32.3%) in comparison to the control group (10.2%-12.6%), especially in the SOD subgroup with hypopituitarism (42.9%-54.3%) who were also at risk of multiple hospitalisations. ONH/SOD cases had a significantly higher crude hospitalisation rate in comparison to the control group (RR range:2.3-2.8, 95% CI range:1.6-4.2), and was highest in infants < 1-year-old and in the SOD subgroup with hypopituitarism. The median LOS was significantly higher in ONH/SOD cases in comparison to the controls [median (interquartile range):7-8 (3-21) versus 3-4 (2-9) days respectively, p ≤ 0.004]. Diseases of the respiratory system were the primary reasons for hospitalisation in all groups, but they were highest in the ONH/SOD group accounting for 25.3% of their hospitalisations versus 9.5% in the unrelated controls.

CONCLUSION

Children with ONH/SOD have a higher rate of hospitalisation and LOS in comparison to controls, especially in the SOD subgroup with hypopituitarism. Diseases of the respiratory system were primarily responsible for hospitalisations in all groups, but disproportionately affected the ONH/SOD group.

Cerebral palsy: potential risk factors and functional status among children under three years, a case-control study in northwest Iran

BACKGROUND

Cerebral palsy (CP) is one of the most common motor-postural disorders in childhood. It occurs due to impairment in the developing brain-before, during, or after birth-and has a significant burden on the public health system. This study aimed to investigate the potential risk factors and detect the associated CP-related disorders.

METHODS

This case-control study was conducted on 46 children with CP and 175 matched healthy children less than three years old who referred to the Children's Hospital, Tabriz, Iran in 2022. Then, a checklist related to the mother's medical history during current and previous pregnancies, a questionnaire related to perinatal factors of the newborn, types of CP, concurrent disorders, the Gross Motor Function Classification System (GMFCS), and Age and Stage Questionaire (ASQ) were completed. Data was analyzed using Statistical Package for the Social Sciences) SPSS(-21 software by descriptive and analytical statistics consisted of Chi-square, Independent t-test, and Binary logistic regression.

RESULTS

Finally, 35 children with CP and 122 healthy children completed the study and were analyzed. The mean (standard deviation: SD) age of children in the CP group was 15.3 (6.2) and in the healthy group was 14.4 (6.6) months (p = 0.635). Spastic CP (82.9%) was the common type, and the most common prevailing form of the involved limb was quadriplegia (54.3%). The severity of the functional disorder in 39.3% of CP cases was at levels 4 and 5 (severe form). The most prevalent comorbidities were inability to walk (31.4%), speech delay (22.9%), epilepsy (11.4), and strabismus (8.6%). Children with CP had abnormal development in gross motor (82.9%), problem-solving (68.6%), personal-social (65.7%), fine motor (60%), and communication (54.3%). Moreover, duration of pregnancy (p = 0.023), birth weight lower than 2500 g (p = 0.002), problems in the current pregnancy [adjusted odds ratio (aOR) [95% CI]: 3.06 (1.87 to 8.54); p = 0.013] and problems in previous pregnancy ([aOR (95% CI): 4.8 (1.6 to 14.2); p = 0.005) were potential risk factors.

CONCLUSION

Due to accompanying movement, vision, and speech problems, especially high developmental disorders in children with CP, necessary measures to prevent the identified risk factors are very important.

Prevalence of cerebral palsy comorbidities in China: a systematic review and meta-analysis

Objectives

This systematic review aimed to comprehensively understand the comorbidity of cerebral palsy (CP) in China.

Methods

We searched through databases in both Chinese and English until December 2022 to gather cross-sectional studies on the comorbidity of CP in China. After two reviewers independently screened the articles, collected the data, and assessed the bias risk, a meta-analysis was conducted using the Stata 17.0 software.

Results

A total of 73 articles were included. Of these, 16 articles reported total comorbidity, with a prevalence of 79.7% (95% CI: 73.8-85.7%); 56 articles reported epilepsy, with a prevalence of 17.9% (95% CI: 15.4-20.4%); 48 articles reported intellectual disability, with a prevalence of 58.0% (95% CI: 51.8-64.3%); 32 articles reported speech disorders, with a prevalence of 48.0% (95% CI: 41.6-54.4%); 41 articles reported hearing disorders, with a prevalence of 17.2% (95% CI: 13.0-21.4%); and 35 articles reported vision disorders, with a prevalence of 23.1% (95% CI: 16.3-29.8%). The topographical type of CP was the primary source of heterogeneity in the prevalence of epilepsy. Diagnostic criteria for CP, clinical type of CP, GMFCS, publishing time, and topographical type of CP were the primary sources of heterogeneity in the prevalence of intellectual disability. Clinical type of CP and topographical type were the primary sources of heterogeneity in the prevalence of speech disorders. Finally, the region was the primary source of heterogeneity in the prevalence of hearing disorders.

Conclusion

The prevalence of comorbidities in CP is high in China. Comorbidities are related to the characteristics, severity, and risk factors of brain insult and have a particular relationship with regional economic development and medical and health levels.

Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis

OBJECTIVE

To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups.

METHOD

We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias.

RESULTS

Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP.

CONCLUSION

Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.

Characteristics and Challenges of Epilepsy in Children with Cerebral Palsy-A Population-Based Study

The aim of this population-based study was to describe the prevalence and characteristics of epilepsy in children with cerebral palsy (CP), focusing on antiseizure medication (ASM) and seizure outcome. Findings were related to CP type, gross motor function and associated impairments. Data on all 140 children with CP born in 2003-2006 were taken from the CP register of Western Sweden. Medical records were reviewed at ages 9-12 and 13-16 years. In total 43% had a diagnosis of epilepsy. Epilepsy was more common in children with dyskinetic CP, who more often had a history of infantile spasms, continuous spike-and-wave during sleep and status epilepticus. Neonatal seizures, severe intellectual disability, severe motor disability and autism were associated with a higher risk of epilepsy. Many children were on polytherapy, and valproate was frequently used, even in girls. At age 13-16 years, 45% of the children with epilepsy were seizure free for at least one year. Onset after 2 years of age, female sex and white matter injury were associated with good seizure outcome. Despite the risk of relapse, reduction or discontinuation of ASM could be an option in selected cases. It is important to optimize ASM and to consider the possibility of epilepsy surgery.

Safety Profile and Lack of Immunogenicity of IncobotulinumtoxinA in Pediatric Spasticity and Sialorrhea: A Pooled Analysis

IncobotulinumtoxinA, a pure botulinumtoxinA formulation, is free of accessory proteins. This analysis provides pooled safety data from phase 3 trials of children/adolescents (2-17 years), investigating incobotulinumtoxinA for the treatment of spasticity associated with cerebral palsy (at doses ≤20 U/kg (max. 500 U) per injection cycle (IC) for ≤6 ICs; three trials) or sialorrhea associated with neurologic disorders (at total doses of 20-75 U per IC for ≤4 ICs; one trial) for ≤96 weeks. Safety endpoints included the incidences of different types of treatment-emergent adverse events (TEAEs) and immunogenicity. IncobotulinumtoxinA dose groups were combined. Of 1159 patients (mean age 7.3 years, 60.4% males) treated with incobotulinumtoxinA, 3.9% experienced treatment-related TEAEs, with the most common being injection site reactions (1.3%) (both indications), muscular weakness (0.7%) (spasticity), and dysphagia (0.2%) (sialorrhea). Two patients (0.2%) experienced a treatment-related treatment-emergent serious adverse event, and 0.3% discontinued the study due to treatment-related TEAEs. No botulinumtoxinA-naïve patients developed neutralizing antibodies (NAbs) after incobotulinumtoxinA. All children/adolescents with known pre-treatment status and testing positive for Nabs at final visit (n = 7) were previously treated with a botulinumtoxinA other than incobotulinumtoxinA. IncobotulinumtoxinA was shown to be safe, with very few treatment-related TEAEs in a large, diverse cohort of children/adolescents with chronic conditions requiring long-term treatment and was without new NAb formation in treatment-naïve patients.

Frequência de comorbidades em crianças com paralisia cerebral de diferentes níveis de função motora grossa

ResumoIntrodução: A paralisia cerebral (PC) é uma desordem predominantemente motora, no entanto, pode estar associada a outras disfunções, que também impactam a funcionalidade das crianças. Objetivo: Documentar a frequência das comorbidades em crianças com PC nos diferentes níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). Métodos: Estudo observacional, descritivo, de corte transversal. Foram coletados dados de 70 crianças com diagnóstico de PC, que recebiam tratamento fisioterapêutico em Belo Horizonte e na região metropolitana, por meio de entrevistas, e realizada análise descritiva e quantitativa. Resultados: As comorbidades mais frequentes foram as limitações do uso das mãos e dos braços, deficiências de continência urinária e fecal, deficiências da voz e da fala, deficiências de comportamento limitação para andar e epilepsia. Um número maior de comorbidades foi encontrado em crianças com maior comprometimento da função motora grossa. Conclusão: Profissionais da saúde devem observar com atenção a ocorrência das comorbidades na PC, proporcionando intervenções para preveni-las ou tratá-las, melhorando a funcionalidade desses indivíduos.