Epidemiology of Cerebral Palsy: A Review

The complex aetiology of cerebral palsy

Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.

Clinical Experience with Autologous M2 Macrophages in Children with Severe Cerebral Palsy

Stem cell-based therapy is considered to be a new approach for the treatment of cerebral palsy (CP). Given the potent anti-inflammatory activity and high regenerative potential of M2 macrophages, these cells may be an alternative source for cell transplantation. To evaluate the safety and efficacy of autologous M2 macrophages, we conducted a pilot clinical trial in 21 children with severe CP. The primary outcome measure was safety, which included assessment of mortality of any cause, immediate adverse reactions, and serious adverse effects and comorbidities during 5-year follow-up. The secondary outcome measure was functional improvement in Gross Motor Function Measure (66-item GMFM) test, Peabody Developmental Motor Scale-Fine Motor (PDMS-FM) test, Ashworth scale, MRC scale, and an easy-to-understand questionnaire for evaluation of cognitive functions in our modification. Intradural injection of M2 cells (in mean dose of 0.8 × 106/kg) into the lumbar spinal area did not induce any serious adverse events. No cases of mortality, psychomotor worsening, exacerbation of seizures, and long-term comorbidities, including tumors, were observed during a 5-year follow-up. After 3 months, GMFM score increased from 13.7 ± 7.8 to 58.6 ± 14.6, PDMS-FM score improved from 0.76 ± 0.42 to 5.05 ± 0.97, and the Ashworth score decreased from 3.8 ± 0.21 to 3.3 ± 0.24. Along with gross and fine motor function enhancement, an improvement of cognitive activity (from 1.62 ± 0.41 to 4.05 ± 0.64, according to questionnaire assessment) and reduction of seizure syndrome were registered as well. The neurological improvements did not diminish during the 5-year follow-up period. The data obtained suggest that cell therapy based on M2 macrophages is safe, does not induce early adverse effects and long-term comorbidities, and is accompanied with a significant improvement of motor and cognitive activities in severe CP patients. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.

A prospective comparative study of the aetiology of cerebral palsy and epilepsy in a one-year birth cohort from Northern Finland

The one-year birth cohort from Northern Finland comprises 12 058 children, representing 96% of all live births in 1966 in the two northernmost provinces of Finland, Oulu and Lapland. Only 14 children, 1.2 per thousand, were lost during the follow-up to 14 years of age, in which data were collected prospectively on development, mortality and morbidity using questionnaires and registers. When all 47 children with cerebral palsy fulfilling the criteria of the Little Club of London (1959) were included, a prenatal risk factor was detected in 13 infants (27.7%) and a perinatal one in 25 children (53.2%), whereas 9 children (19.1%) represented an untraceable form of this disorder. There were 208 children with epilepsy, among which 18 (8.7%) had a prenatal risk factor, 38 (18.2%) a perinatal one, 33 (15.9%) a postnatal one, and 119 (57.2%) no identifiable risk factor. Among the 11 320 healthy children in the cohort alive at 14 years of age, there were 992 (8.8%) with risk factors for cerebral palsy and epilepsy. The relative risk attached to these aetiological factors was lower for epilepsy than for cerebral palsy.

Prognosis for low-birthweight infants up to the age of 14: a population study

A birth cohort of 12,058 infants was followed up to 14 years of age. Cerebral palsy, epilepsy, severe hearing defects, mental retardation and educational subnormality all had a higher incidence among the 411 children with a low birthweight (less than 2500 g). 6 per cent of the total cohort had educational problems with or without some other neurological handicap, and there was a higher prevalence among low-birthweight infants. 1.5 per cent had a handicap but normal school performance. Children with birthweight 1500 to 2499 g had a significantly higher percentage of handicaps than those of heavier birthweight. All the neurological handicaps were more common among boys than girls, but only in mental subnormality was there a marked difference. Height at 14 years was significantly less among low-birthweight children.

Prevalence and disabilities in 4 to 8 year olds with cerebral palsy

A register of children born between 1970 and 1979 in the South East Thames Regional Health Authority, and diagnosed as having pre-, peri-, and postnatal cerebral palsy, was set up between 1978 and 1981. We report the 527 children born between 1970 and 1974 for whom ascertainment is virtually complete. The estimated prevalence was 2.2 per 1000, with 7.4% multiple births, and 58% boys. Birthweight distribution is as expected, with 35% weighing less than 2500 g at birth. Parental permission for release of detailed medical information was sought, and the clinicians responsible gave us data on the type of cerebral palsy; details of impairments, disabilities, and anticipated future prospects; and an opinion on the probable timing of the cause. There was a high incidence of orthopaedic defects which must represent a considerable use of resources, although the prevalence of hearing and vision defects suggested that some of these may be undetected.

Prevalence of cerebral palsy in the biracial population of Copiah County, Mississippi

As part of a door-to-door survey of major neurological disorders, the prevalence of cerebral palsy was ascertained in the institutionalized and non-institutionalized biracial population of Copiah County, Mississippi. The over-all prevalence ratio was 212 per 100,000 inhabitants. For whites, as for blacks, males had a higher prevalence ratio than females. For both sexes, blacks had a higher prevalence ratio, but the race difference was not striking. Prevalence ratios declined with age. Other findings are presented on clinical features and degree of disability.

Prediction of the development of cerebral palsy from perinatal risk factors

Perinatal data of 29 cerebral palsy (CP) children and 237 control children were analyzed to identify etiological and predictive factors for cerebral palsy. Obstetrical and neonatal factors associated with CP in the low-birth-weight group were sex (male) and place of birth, and in the normal-birth-weight group they were prolonged delivery, meconium staining of the amniotic fluid, an Apgar score of less than 4 at 1 minute, the first respiration occurring only after 3 minutes, and the first cry taking place after 7 minutes. The following neonatal signs and symptoms were strongly associated with CP in the both birth weight groups; convulsion, hypotonia, hypertonia, absence of the Moro reflex, tremor, and apnea. A linear discriminant function was developed from the above neonatal signs and symptoms. The use of three factors, convulsion, hypotonia, and apnea efficiently discriminated between the CP and control children and they would be used as good predictive factors for cerebral palsy.