Abstracts

RATIONALE: At the end of this activity the participants should be able to discuss the etiology and response to therapy of seizures occuring with cerebral palsy in children .
METHODS: A search of a patient data base of 527 children with seizures followed in an academic pediatric neurology practice from December 1999 to April 2002 was made to identify children with both seizures and cerebral palsy (CP). All seizure types occuring at any time in life were included. CP was defined as a fixed motor deficiet with onset early in life. An identified brain abnormality or insult was considered the cause of both the seizures and CP, and classified as either Intrauterine-Developmental, Secondary to Prematurity, Perinatal, Postnatal or Unexplained. Response to therapy of seizures was considered Excellent if a daily anti-epileptic drug (AED) was not prescribed, Good if only one AED was currently prescribed, Moderate if two AEDs were prescribed, and Poor if three AEDs were prescribed.
RESULTS: A total of seventy-four children were identified with both seizures and CP. Causes of CP and seizures in this patient group were: 19 Intrauterine-Developmental which includes cerebral anomalies, congentital hydrocephalus, TORCH infection, intrauterine stoke or Tuberous Sclerosis; 19 Postnatal which includes central nervous system infection with meningitis or encephalitis, toxic-metabolic, or trauma; 18 Seconday to Prematurity from intraventricular hemorrhage or periventricular leukomalacia; 11 Perinatal which includes hypoxic ischemic encephalopathy from abruptio placenta or meconium aspiration and neonatal stroke; and 7 Unexplained. Moderate to Severe mental retardation was present in 42 of the 74 patients and was considered a co-morbid sign and not a cause for CP or seizures.
Response to therapy for the 74 children was Excellent in the 16 children who received no daily AED; Good in 27 children receiving one AED; Moderate in 22 children receiving two AEDs, and Poor in 9 children receiving three AEDs. Prescription or use of a seizure rescue medication (either an oral or rectal benzodiazepine) was not consistently recorded in the data base to use as a measure for therapeutic response.
CONCLUSIONS: In 74 children with both seizures and cerebral palsy a cause was identified in most, 67 (91%) of patients. In this patient sample causes were about evenly distributed amoung Intrauterine-Developmental (26%), Prematurity (24%), and Postnatal (26%) events with fewer caused by Perinatal (15%) or Unexplained (9%). Over half of children with seizures and cerebral palsy, 42 of 74 (57%) had an excellent to good response to therapy requiring zero or only one daily AED.
In children with both seizures and cerebral palsy, an evaluation into etiology and an attempt to optimize therapy is indicated.