Epilepsy and Cerebral Palsy
Source: Hadjipanayis A, et al. Epilepsy in patients with cerebral palsy. Dev Med Child Neurol 1997;39:659-663.
Cerebral palsy (cp), defined as a non-progressive disorder of movement and posture due to a defect or lesion of the immature brain, is well known to be associated with an increased risk of epilepsy. Cerebral palsy (like epilepsy) has many defineable causes, but the majority of cases are idiopathic, and only 10-15% of cases attributable to perinatal events. Most cases of CP seen today are one of three varieties: spastic diplegia, spastic hemiplegia, or spastic quadriplegia (SD, SH, or SQ). Less commonly seen are children who are athetoid, ataxic, or who have a mixture of spastic and other features.
The focus article by Hadjipanayis et al seeks to characterize epileptic seizures seen in children with various types of cerebral palsy. The authors examined 323 children with CP seen in one of five clinics in Athens, Greece, over a two-year period. The spastic varieties of CP accounted for more than 90% of the cases. These were about equally divided among SD, SH, and SQ. Epilepsy (defined as 2 or more unprovoked seizures, neither neonatal nor febrile) developed in 42% of patients with CP, as compared to only 0.7% in their healthy siblings. Also, patients with IQs above 70 had a much lower (29%) incidence of epilepsy than in those with IQs below 50 (71%).
Considerable differences were observed among patients with different varieties of CP. Patients with SD had the lowest incidence (27%) among the various groups, significantly lower than patients with SH (47%) or SQ (50%). As might be predicted, most patients with SH (73%) displayed predominantly focal seizures, whereas generalized seizures dominated in the SD and SQ groups. More than 95% of patients with SQ had a first seizure before age 4, whereas only 50% of patients with SH displayed a first seizure by age 4.
COMMENTARY
When neurologists counsel parents of children with CP, they should be told of the high risk of future epilepsy; a general figure of about 40% would seem to follow from the current study. Among patients with SH, the risk might be lowerapproximately 25%but still much higher than the general population. When dealing with a child with SQ, parents can be told that if the child does not develop epilepsy by age 5, his chances of developing seizures are not much higher than the general population; such statements cannot be made in children with spastic hemiplegia. rt
Which of the following is a true statement?
a. Cerebral palsy is associated with an increased risk of epilepsy as compared to the general population but only among patients who also have mental retardation.
b. If a child with spastic quadriplegia does not display epilepsy by age 5, the child’s lifetime risk is probably not much higher than the general population.
c. The most common seizure type among patients with spastic hemiplegia is generalized tonic-clonic seizures.
d. The median age of onset of seizures in children with spastic quadriplegia is later than in children with spastic hemiplegia.
e. Intelligence quotient is not relevant in attempting to determine future risk of epilepsy in a child with cerebral palsy.
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