Clinical Associations and Predictors of Epilepsy in Children with Cerebral Palsy: A Population Based Study
Abstract number :
2.121
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2021
Submission ID :
1825541
Source :
www.aesnet.org
Presentation date :
12/1/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:43 AM
Authors :
Nimra Feroz, BAMSc - The University of Sydney; Katarina Ostojic, Bsc – Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health; Russell Dale, PhD – The Children’s Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; Sarah McIntyre, PhD – 2. Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia; Elizabeth Barnes, BSc – 3. Department of Statistics, University of Sydney, The Children's Hospital at Westmead, Sydney, NSW, Australia; Iona Novak, PhD – 2. Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia; Nadia Badawi, PhD – 2. Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia; Simon Paget, FRACP – 4. Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia; Mary-Clare Waugh, FRACP – 4. Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia; Deepak Gill, FRACP – 6. Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia; Kavitha Kothur, PhD – 6. Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
Rationale: Epilepsy is a common comorbidity accounting for 30-50% of children with cerebral palsy (CP). Epilepsy negatively affects motor, cognitive function, education, behaviour, and quality of life in children with CP. The associations between seizures and CP are poorly understood. Most of the previous studies are hospital-based with a small number of patients and there is significant heterogeneity in clinical associations and epilepsy characterisation depending on the population selected.
Objective: We aimed to investigate the predictive factors and clinical associations for epilepsy in children with CP using a population-based study.
Methods: Children with a diagnosis of CP born between 2003 to 2015 (inclusive) were identified from the NSW/ACT CP Register. Information on CP motor type and topography, etiological timing of the injury, gestational age, birth weight, sex, birth plurality, level of neonatal care, Gross Motor Function Classification System (GMFCS) level, Manual Abilities Classification System (MACS) level, and associated impairments (intellectual, speech, vision and hearing) was retrieved from the NSW/ACT CP Register. The profile of children with CP and epilepsy at the age of 5 years was compared to those with CP without epilepsy.
Results: A total of 2299 children with CP were identified, of whom 604 (26.3%) had epilepsy at age 5 years,1203 (52.3%) did not have epilepsy, 109 (4.7%) had epilepsy resolved by the age of 5 years, and for 383 (16.7%) their epilepsy status was unknown and were excluded from further analysis. Children with predominant spastic quadriplegia (53.2%) and dyskinetic CP (50.7%) had higher proportions of epilepsy compared to spastic hemiplegia (24%) and spastic diplegia (11.7%) (p < 0.0001). On univariate analysis, term gestational age (OR 2.7, 95% CI 2.1-3.7), severe motor disability functioning at GMFCS level IV-V (OR 6.0, 4.8-7.7), MACS level IV-V (OR 8.3, 6.3-10.9), intellectual impairment (OR 9.0, 95% CI 6.9-11.7), any vision impairment (OR 4.4, 95% CI 3.5-5.4), and speech impairment (OR 6.8, 95% CI 5.1-9.2) were strongly associated with the presence of epilepsy at the age of 5 years (p < 0.0001). Following multivariate analysis, term gestational age, MACS levels IV-V, intellectual impairment, and vision impairment were found to be independent associations for the presence of epilepsy in children with CP.
Conclusions: Our study highlights important clinical associations/predictors of epilepsy in children with CP using population-based data. This knowledge supports counselling of families and careful medical surveillance.
Fig 1: The clinical associations for the presence of epilepsy using population-based registry: Term gestational age, spastic quadriplegia, dyskinetic CP, higher motor impairment, presence of intellectual and vision impairment were associated with higher prevalence of epilepsy in CP.
Abbreviations: GMFCS (Gross Motor Function Classification System) and MACS (Manual Ability Classification System)
Funding: Please list any funding that was received in support of this abstract.: Cerebral Palsy Alliance.
Clinical Epilepsy