Function and neuroimaging in cerebral palsy: a population-based study

Authors

  • KATE HIMMELMANN,

    1. Department of Paediatrics, Institute of Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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  • PAUL UVEBRANT

    1. Department of Paediatrics, Institute of Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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  • This article is commented on by Hoon and Stashinko page 482 of this issue.

  • North American usage: mental retardation.

Dr Kate Himmelmann at Department of Paediatrics, Institute of Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. E-mail: kate.himmelmann@vgregion.se

Abstract

Aim  The aim of this population-based study was to describe function in cerebral palsy (CP) in relation to neuroimaging.

Method  Motor function, accompanying impairments, and neuroimaging (86 by magnetic resonance imaging, 74 by computed tomography) were studied in 186 children born in western Sweden between 1999 and 2002 (96 males, 90 females; age range at data collection 4–8y).

Results  Forty per cent of the children had unilateral spastic CP, 39% bilateral, 16% dyskinetic CP, and 5% ataxia. Fifty-one per cent were in level I of the Gross Motor Function Classification System (GMFCS), 14% in level II, 3% in level III, 11% in level IV, and 22% level V. Forty per cent of the children were in level I of the Manual Ability Classification System 19% were in II, 9% at III, 8% in IV, and 24% in level V. Seventy-six per cent of the children with white-matter lesions were in GMFCS levels I and II, whereas 67% with basal ganglia lesions were in levels IV and V. Learning disability* (45%), epilepsy (44%), and visual impairment (17%) were most common in children with brain maldevelopment, and cortical/subcortical or basal ganglia lesions. Speech was impaired in 49% of the children, absent in 30%, and 6% had a neuropsychiatric diagnosis. Compared with children born between 1991 and 1998, the numbers of those in GMFCS level I increased (p=0.007), as did those with epilepsy (p=0.015).

Interpretation  Neuroimaging improves the understanding of the neuroanatomical basis for function in CP. Type and severity of motor impairment and accompanying impairments are related to the timing of lesions.

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