Aetiology and comorbidities of cerebral palsy in a developing country

Background: Cerebral palsy (CP) is a common disabling condition of movement and posture causing activity limitation arising from a static injury to the developing brain. Common risk factors for cerebral palsy in Africa include severe birth asphyxia, kernicterus and neonatal infections. This study is aimed at determining the aetiology and comorbidities associated with cerebral palsy in our environment.Methods: All children with CP presenting to the Paediatric Neurology clinic of the University of Calabar Teaching Hospital whose parent gave consent were recruited into the study. The biodata of the children and that of the parent’s/ care givers were obtained. A detailed pregnancy and delivery history, neonatal history, seizures during first three years of life and developmental mile stones was documented.Results: Seventy children with CP were recruited into the study of which 46 (65.7%) were males and 24 (34.3%) females. Majority of the children were from low social class and products of home, church or TBA’S delivery where supervision is poor. Severe birth asphyxia and CNS infections are the commonest identified risk factors. Spastic quadriplegic CP is the dominant type of CP followed by spastic hemiplegia. There is a significant statistical relationship between the aetiology and the type of CP. Epilepsy (60%) speech defect (42.9%) and microcephaly (40%) are the predominant comorbidities seen in the study. Cortical atrophy and ventricular dilatation are predominant CT findings in contrast to periventricular leukomalecia seen in developed countries.Conclusions: Majority of the patients with CP in this study are from low social class and were delivered in places with poor obstetrics care. Improved perinatal care through an adequate social support system may reduce the burden of the disease.

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Known risk factors and co-morbidities in 100 cases of cerebral palsy in a neurology follow-up clinic

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v6i1.29083 ◽

2016 ◽

Vol 6 (1) ◽

pp. 44

Author(s):

Mohammed Mahbubul Islam ◽

Kazi Ashraful Lslam ◽

Regina Bilquise ◽

Shaheen Akhter ◽

Md. Mizanur Rahman ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cerebral Palsy ◽

Perinatal Care ◽

Birth Asphyxia ◽

Child Neurology ◽

Common Risk Factor ◽

Speech Problem ◽

Medical University

Background: Cerebral palsy (CP) is a major cause of crippling in children. Several antenatal, natal and post natal factors for CP like birth asphyxia and pretenn & LBW deliveries were identified.Objective: To see the presence of known risk factors of CP and co-morbidities in our setting. Methods: ln this study 100 cases of cerebral palsy attending the child neurology out-patient department Bangabandhu Sheikh Mujib Medical University (BSMMU) were evaluated with special attention to risk factors of CP. Full evaluation was done to find out co-morbidities. Results: Birth asphyxia (49%) was the most common risk factor. Mental retardation; speech problem and seizure were common co-morbidities. Conclusion: As birth asphyxia is common risk factor of cerebral palsy, it may be reduced by improving perinatal care.

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Clinical profile of childhood epilepsy in Nigerian children seen in a tertiary hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172658 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1138 ◽

Cited By ~ 1

Author(s):

Komomo Ibor Eyong ◽

Emmanuel E. Ekanem ◽

Asindi A. Asindi ◽

Torty Chimaeze

Keyword(s):

Cerebral Palsy ◽

Mental Retardation ◽

Age At Onset ◽

Central Nervous System Infection ◽

Birth Asphyxia ◽

Sub Saharan Africa ◽

Cns Infection ◽

Seizure Type ◽

P Value ◽

Neurology Clinic

Background: Epilepsies are the most common conditions encountered in most paediatric neurology clinics in many parts of the developing world. In sub-Saharan Africa epilepsies are secondary, reflecting persistently high risks at birth, and the adverse neurological sequelae of CNS infections during and beyond childhood. The study was designed to determine the clinical pattern of childhood epilepsies, probable aetiologies and associated comorbidities of the disease children.Methods: The study was conducted within an 18 months period among children having established epilepsy attending the Neurology Clinic of University of Calabar Teaching Hospital (UCTH). The children and or care givers were interviewed by the authors and the following data were obtained and recorded in a questionnaire; bio data, age at onset of seizure. History was obtained to determine the possible cause of the seizure, type of epilepsy and associated comorbidities. The data obtained was analysed with SPSS version 20. P-value <0.05 was considered significant.Results: Of the one hundred eighty children seen with various neurological morbidities during the study period, one hundred and seven had epilepsy which constitutes 59.4%. Generalized tonic clonic epilepsy was the commonest type of epilepsy found in 66 (61.1%) of the children with epilepsy, followed by simple partial and myoclonic epilepsy in 18.5% and 6.5% respectively. Severe birth asphyxia was responsible was the commonest identifiable cause of epilepsy in 19 (17.8%) of cases while central nervous system infection accounted for 14 (13.1%). Cerebral palsy was the commonest comorbidity in 20 (18.6%) followed by mental retardation in 17 (15.9%) of the children.Conclusions: The study showed epilepsy to be the commonest neurological presentation among children presenting at the paediatric neurology clinic of our facility. Primary generalised tonic clonic epilepsy was the commonest type of epilepsy seen, followed by simple partial seizures. Cerebral palsy and mental retardation were the main associated comorbidities. Birth injuries mainly severe birth asphyxia and CNS infection were the major causes of epilepsy in our study. In conclusion, epilepsy is the commonest neurological morbidity in our environment, limited facilities and resources still militate against identifying the actual aetiology in most children with the disease. Effort should be intensifying to eradicate the preventable causes of the disease.

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Clinical features and aetiology of cerebral palsy in children from Cross River State, Nigeria

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-317932 ◽

2020 ◽

Vol 105 (7) ◽

pp. 625-630 ◽

Cited By ~ 1

Author(s):

Roseline Duke ◽

Chimaeze Torty ◽

Kennedy Nwachukwu ◽

Soter Ameh ◽

Min Kim ◽

...

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Low Income ◽

Management Strategies ◽

Birth Asphyxia ◽

Population Based ◽

System Level ◽

Middle Income ◽

Cross River State ◽

Level 1

ObjectiveThere are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria.DesignA population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4–15 years were clinically assessed for CP.ResultsThe estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1–3 and 88 (22.7%) of level 4–5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP.ConclusionThe profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.

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Cerebral palsy risk factors: international experience

E3S Web of Conferences ◽

10.1051/e3sconf/202015908006 ◽

2020 ◽

Vol 159 ◽

pp. 08006

Author(s):

Raushan Issayeva ◽

Aigerim Aliakparova ◽

Symbat Abzaliyeva ◽

Gulzhan Kassenova ◽

Gulnara Tashenova

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Birth Asphyxia ◽

Population Based ◽

Hereditary Diseases ◽

Surveillance Programs ◽

Exact Etiology ◽

Common Risk Factors ◽

Real Picture ◽

Post Infectious

This review article aims to outline several risk factors for the Cerebral Palsy (CP) development worldwide. CP is the most prevalent disabling condition in children that imposes a significant socio-economical responsibility on the system of the health care. Despite a solid body of extant research, the exact etiology of CP remains unknown. There are several risk factors that may be triggering CP development at pre-, intra- and postnatal periods, particularly, gestational age, birth weight, mother's health, placental abnormalities, thrombophillia, asphyxia, brain ischemia and multiple pregnancies. According to extant literature, the majority of CP cases develop within antenatal period in high-income countries. Contrastingly, in developing countries, there is a slightly higher proportion of a postnatally acquired CP cases linked to post-infectious brain damage following meningitis, septicaemia, as well as other conditions, such as malaria. However, these studies were of a small size and not case-controlled or population-based, which significantly curtails the results and underestimating the real picture. With very small number of survivors of early preterm, common risk factors identified to be the maternal rhesus allergenic immunization and birth asphyxia, or hereditary diseases, such as dehydrogenase of glucose-6-phosphate (G6PD) deficiency and encephalopathy of subsequent bilirubin. According to standardized data from international surveillance programs, important risk factors are strongly associated with CP development in most countries.

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Is Cerebral Palsy Changing in High Resource Settings? Data From the Quebec Cerebral Palsy Registry

Journal of Child Neurology ◽

10.1177/0883073819845272 ◽

2019 ◽

Vol 34 (10) ◽

pp. 567-573

Author(s):

Aristides Hadjinicolaou ◽

Pamela Ng ◽

Xun Zhang PhD ◽

Louise Koclas ◽

Céline Lamarre ◽

...

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Perinatal Care ◽

Developed Countries ◽

Birth Cohorts ◽

Phenotypic Profile ◽

High Resource ◽

Using Data ◽

Associated Risk Factors ◽

Over Time

Advances in maternal and perinatal care in developed countries have led to improved health outcomes for children. These changes may have impacted the profile of children with a cerebral palsy (CP) and groups at risk for CP over time. Using data from the Canadian CP Registry, the objectives of this retrospective cohort study were to describe the profile of children with CP in Quebec born between 1999 and 2010 and identify possible temporal variation in CP risk factors and phenotypic profile. Our sample consisted of 662 children with CP in Quebec. No change in profile or associated risk factors was observed across the birth cohorts 1999 to 2010. Prematurity remains the largest risk factor for CP in Quebec, and children with CP have multiple comorbidities that contribute to overall CP burden. CP registries offer a unique platform to study spectrum disorders and their longitudinal changes over time.

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Etiology, outcomes and co-morbidities among cerebral palsy children attending tertiary care hospital, India: a prospective study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20191437 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1023

Author(s):

N. Dushyanth Subramaniam ◽

Antony Jenifer ◽

Uma Devi L. ◽

Suresh P.

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cerebral Palsy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Birth Asphyxia ◽

Care Hospital ◽

Maternal Risk ◽

Prolonged Labour ◽

History Of

Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36±30 months. Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP.

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A clinico-epidemiological study of cerebral palsy in western Rajasthan

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172065 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1146

Author(s):

Mohan Makwana ◽

Harish Kumar Mourya ◽

Saroj Mourya ◽

B. D. Gupta ◽

Ratan Lal Bhati ◽

...

Keyword(s):

Cerebral Palsy ◽

Financial Burden ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Cortical Atrophy ◽

Anthropometric Measurement ◽

Class Iii ◽

Social Trauma ◽

Male Patients ◽

The Mean

Background: Cerebral palsy (CP) is one of the leading causes of disability in children. Incidence of cerebral palsy varies from one to six per thousand live births. Besides handicapping a child, it causes considerable psychological and social trauma to the parents and financial burden to family and community. A cure for cerebral palsy (CP) has not yet been discovered, hence, a need for primary prevention of disease. But unfortunately, the etiology of cerebral palsy is poorly understood thereby eluding a definitive prevention strategy.Methods: All cases of non-progressive neurological disorder in the age group of 0-9 years were enrolled in the present study. Thorough and complete Obstetric history including antenatal, natal and post-natal were recorded. Woodside scale is used for assessment of neurodevelopment and a complete anthropometric measurement, physical examination including detailed Central Nervous System and all neuroimaging and EEG were recorded. Severity of cerebral palsy was assessed according to Minear's classification. Statistical analysis was done by standard statistical methods.Results: Majority of patients were males (78.26%) as compared to females. The mean age of male patients was 2.04±1.53 years and females was 3.67±3.14 years. Spastic type of CP was most common (93.47%), followed by mixed (4.34%) and atonic (2.17%) type. Quadriplegic CP was the most common (76.75%), followed by diplegia (11.62%) amongst the spastic variety. Risk factors found are maternal pyrexia (17.39%), home vaginal delivery (58.70%), birth asphyxia (67.39%), Neonatal seizures (39.13%) other factors being icterus neonatorum (13.04%) and meconium aspiration syndrome (13.04%), ICH (10.86%), septicemia (8.69%) and renal failure (4.34%). Majority of the patients (78.26%) had class III and IV functional impairment. Cortical atrophy was the most commonly (71.73%) seen abnormality on neuroimaging with CT-scan. Epilepsy was present in 47.82% patients.Conclusions: Cerebral palsy along with its associated dysfunctions definitely disturbs the routine of children's life as well as family life. We have to go a long way before something definitive can be done for these children and their families.

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