Risk factors, additional problems and prognosis in patients with cerebral palsy

Risk Factors, Additional Problems and Prognosis in Patients with Cerebral Palsy Introduction and Aim: Cerebral palsy (CP) is one of the most common neurodevelopmental disorders in childhood. Antenatal, perinatal or postnatal risk factors may play a role in the etiology. Recently, it is thought that metabolic and genetic causes also play a role in the etiology. In addition to motor disorders, many problems can accompany to CP and these problems are important in the prognosis of the disease. In our study, we aimed to determine the risk factors, additional problems and their frequency to predict the prognosis and to determine the factors affecting the prognosis in patients with CP. Materials and Methods: 264 patients with CP who were followed up between January 1, 2015 and December 31, 2020 at Istanbul University, Istanbul Faculty of Medicine, Department of Child Health and Diseases, Department of Pediatric Neurology were included in our study. Patients' age, gender, gestational age, delivery type, birth weight, CP type, CP etiology, CP risk factors, gross motor function classification system (GMFCS) levels, magnetic resonance imaging (MRI) findings, treatments, additional problems, mortality, the age of head control, sitting without support, and walking without support were recorded retrospectively. Patients with and without a diagnosis of epilepsy were compared in terms of their gender, gestational age, birth weight for gestational age, presence of multiple pregnancy, neonatal convulsion, GMFCS level, MRI findings and CP type. The distribution of CP type, the age of head control, sitting without support, and walking without support were evaluated according to the GMFCS level of the patients. The relationship between epilepsy, refractory epilepsy and neonatal convulsions with GMFCS level was investigated. Results: A total of 264 patients, 168 (63.6%) male and 96 (36.4%) female, were included in our study. The mean age of the patients was 6.6±3.5 years. The mean gestational age of the patients was 35.7±4.5 weeks, 57.2% were term, 42.8% were preterm. In our study group, 95.8% of the patient had spastic CP, 3.8% had dyskinetic CP, and 0.4% had ataxic CP. 28.8% of the patients were GMFCS level 5, 23.1% were GMFCS level 1, 18.2% were GMFCS level 4, 15.9% were GMFCS level 2 and 14% were GMFCS level 3. Dominant white matter damage was the most common MRI finding in 41.3% of the patients, while 27.3% of the patients had dominant gray matter damage, 17.8% had mixed lesions, and 5.3% had malformations. MRI was normal in 8.3% of the patients. Epilepsy was the most common accompanying problem in 56% of the patients. Refractory epilepsy was present in 21.9% of the patients. Strabismus was detected in 31.4% of patients, respiratory problems in 25.8%, hearing problems in 11.7%, scoliosis in 11.4%, and hip dislocation in 6.1%. When patients with and without a diagnosis of epilepsy were compared, the probability of developing epilepsy was found to be statistically significantly higher in term-born children (p=0.036), in patients with SGA (p=0.026), in patients with neonatal convulsions (p=0.000), in patients with GMFCS level 5 (p=0.000), in patients with mixed lesions with MRI findings (p=0.000), in spastic quadriplegic type CPs (p=0.000). The probability of developing epilepsy was found to be statistically significantly lower in patients with a history of multiple pregnancy (p=0.015). The relationship between epilepsy, refractory epilepsy, neonatal convulsion history and GMFCS level was evaluated. 41.9% of patients with epilepsy, 58.6% of patients with refractory epilepsy, and 55.8% of patients with a history of neonatal convulsions were level 5, and the probability of these patients to be GMFCS level 5 was found to be statistically significantly higher (p=0.000, p=0.000, p=0.000 respectively). Conclusion: Cerebral palsy is a definition that covers different clinical manifestations, especially in the predominance of motor symptoms, resulting from antenatal, perinatal or postnatal risk factors. Evaluation of the risk factors and accompanying problems can be helpful to predict the expected prognosis and useful for improving prognosis with early treatment modalities. Keywords: Cerebral palsy, risk factors, additional problems, prognosis