Patterns and Prognosis of Epileptic seizures in Children with Cerebral Palsy

Abstract

ABSTRACT: BACKGROUND:Cerebral palsy (CP) is the result of non-progressive damage to the developing brain and consists of a number of clinical neurological syndromes of heterogeneous etiology. Epilepsy is known to have a higher association with cerebral palsy; 15–60% of children with cerebral palsy have been reported to have epilepsy.OBJECTIVE:This study was performed to determine and assess the characteristics of cerebral palsy and explore the relationship between type of cerebral palsy and patterns of epileptic seizures and to determine the associated factors, nature and prognosis of epilepsy in children with cerebral palsy.PATIENTS AND METHODS:Design:A prospective, hospital-based, case-control study.Setting: RaparinPediatric Teaching Hospital, Rizgary Teaching Hospital-Neurology Department and Helina Handicap Care Centre during the period of January 2013- July 2015, Erbil, KRG, Iraq.PATIENTS: One hundred and twelve children had CP and seizures were studied (group1). Two control groups included 70 children had CP without seizures (group2), and 50 children had seizures without CP (group3).The following data were ascertained: Type of CP, pattern of seizures, age, gender, age at onset of seizures, mode of delivery, history of hypoxic ischemic encephalopathy in the neonatal period, neonatal seizures, history of status epilepticus, family history of seizures, developmental delay, EEG data, image findings, use of anti-epileptic drugs, seizures control and seizures outcome. Children with febrile convulsion were excluded from this study. RESULTS: Spastic tetraplegia wasthe most common type of CP (29.46%, 35.71%) in group 1 and 2 respectively.Generalized tonic, clonic or tonic clonic seizures were the most common types of seizures in both groups. Unlike those who had epilepsy without CP,themajority; 57(50.89%) of patients who had epilepsy and CPdeveloped seizures in the first year of life. Twenty eight percent of caseswith epilepsy and cerebral palsy, and 88% of cases with epilepsies alone showed good seizure control by antiepileptic therapy. Children who had epilepsy and CPhad a higher frequency of; neonatal seizures44 (39.28%), developmental delay98 (87.5), abnormal brain CT scan 91(81.25%) and family history of seizures47 (41.69%). Large number of patients who had epilepsy and CP 81(72.32%) needed poly therapy while majority ofthose who had epilepsy without CP needed single therapy 60(90%).CONCLUSION: Cerebral palsy is associated with a higher incidence of seizure disorders, whichin a majority has its onset in the first year life.Brain imaging showed abnormal pathology in most affected children and needed poly therapy and even difficult to control.