Determining risk factors of epilepsy at childern with cerebral palsy in retrospective study

ABSTRACT DETERMINING RISK FACTORS OF EPILEPSY AT CHILDERN WITH CEREBRAL PALSY IN RETROSPECTIVE STUDY Objective: At Ege University Faculty Of Medicine, Department Of Pediatrics, Department Of Pediatric Neurology, between 2008-2015, 116 non-epileptic children with cerebral palsy (group 1) and 118 epileptic children with cerebral palsy (group 2) has been studied and to determine risk factors of epilepsy at children with cerebral palsy, case data of these groups compared to each other retrospectively. Materials and Methods: Demographical values, physical examination, existing laboratory values (cranial ultrasonography (USG), cranial computerized tomography (CT), cranial magnetic resonance imaging (MRI)), type/types of seizures, findings of EEG, type of epileptic syndrome and medications of patients took are analyzed and epileptic and non-epileptic groups are compared according to these variables. Data of this study is analyzed via IBM SPSS 17.0 program. At analysis, ki-square, t-test and logistic regression analyze has been used for defining statistics. Values with p<0,05 are considered as statistically significant. Results: %39,7 of group 1 with 116 patient were female and %60,3 of it were male. %42,4 of group 2 with 118 patient were female and %57,6 of it were male. Mean value of age at group 1 was 101,5 month old and group 2 was 115,5 month old. %17,2 of group 1 are children who has parents from same lineage and this value is %19,5 at group 2. Seizure history is found similar between first degree relatives of groups. Birth via caesarean section (C/S) is found %48,1 at group 1 and %57,6 at group 2. Gestational age of group 1 was 38 weeks and group 2 was 38,5 weeks. Mean value of birth weight of group 1 was 2765 gram and group 2 was 2940. Pre/peri/postnatal risk factors of these groups were similar. Mean value of newborn intensive care unit period and mechanic ventilation usage rate were similar between groups. 20 in group 1, 45 in group 2, neonatal convulsion cases have been recorded. When we compare groups according to types of seizures in neonatal period, focal clonic and generalized tonic seizures recorded significantly frequently in group 2. Basal rhythm of neonatal EEG was abnormal at %23,5 of group 1 and %64,7 of group 2. At least one antiepileptic agent was used at discharging patients from neonatal intensive care unit in group 1 by %80 and group 2 by %93,3. No difference found between groups in terms of imaging systems (USG, CT, MRI) findings. When we look at 6th month EEG screening results, %94,4 of group 1 had normal basal rhythm meanwhile %68,5 of group 2 had normal basal rhythm. Spastic bilateral (tetraplegic) type, which is most common CP type, has been seen %36,2 in group 1 and %55,9 in group 2. Spastic unilateral type, which is 2nd most common CP type, has been seen similar between group 1 and 2. Spastic bilateral diplegic type has been seen %32,8 in group 1 and %16,9 in group 2. Mean age to start epilepsy is 6months in group 2. Most common seizure type seen in group 2 was generalized type seizures with %46,6. Focal and/or secondary generalized seizure types were %39. 9 epileptic case (%10,1) had infantile spasms. Screening EEG basal rhythm finding were normal in %70,3 at new epileptic cases. 7 cases had West syndrome meanwhile 2 cases had West syndrome first, but then clinical presentation shifted towards Lennox Gastaut Syndrome. Anti-epileptical treatment stopped at %7,6 of group 2, others keep using at least one anti-epileptic medication. Even with multiple anti-epileptic medication, %20,3 of group 2 developed resistant type epilepsy. Periventricular leukomalacia detected similar amounts between 2 groups in cranial MRI scanning. Cerebral atrophy, cerebral anomalies and hydrocephaly are seen in group 2 significantly more. Intracranial hemorrhage and ischemia are seen at %9,8 of group 1 and %4,7 of group 2. When we check problems that co-exist with CP in all cases, we saw that sight problems, mental retardation and microcephaly are significantly more at group 2. Risk multipliers of these problems are 3 times for sight problems, 4 times for mental retardation and 3,8 times for microcephaly. Hearing problems incidence were similar between these 2 groups. Conclusion: These factors are found clinically significant for epilepsy in cerebral palsy children (p<0.05): • Seizure history in neonatal period • Focal clonic or generalized tonic type seizure history in neonatal period • Abnormal findings at basal activity of EEG in neonatal period • Using antiepileptic agent at discharging patients from neonatal intensive care unit • Existing bilateral spastic (tetraplegic) cerebral palsy • Epileptic activity in 6th month screening EEG • Existing cerebral atrophy , hydrocephaly, and cerebral anomaly in neuroimaging systems • Sight problems • Microcephaly • Mental retardation KEYWORDS: Cerebral palsy, epilesy