ISSN 1817-1745
Journal of Pediatric Neurosciences • Volume 10 • Issue 2 • April - June 2015 • Pages 93-***
1990
Journal of Pediatric Neurosciences Official Journal of Indian Society for Pediatric Neurosurgery www.pediatricneurosciences.com Volume 10 / Issue 2 / Apr-Jun 2015
Original Article Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India Vykuntaraju K. Gowda, Anil Kumar1, Sanjay K. Shivappa1, Praveen Kumar Srikanteswara2, Shivananda1, M. S. Mahadeviah1, M. Govindraj1, Premalatha Ramaswamy1 Departments of Pediatrics Neurology and 1Pediatrics, Indira Gandhi Institute of Child Health, 2Department of Neurology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Address for correspondence: Dr. Vykuntaraju K. Gowda, Bangalore Child Neurology and Rehabilitation Center, HANS Complex, 8/A 1st Main 1st Cross, Manuvana, Near Adhichunchanagiri Choultry, Vijayanagar, Bengaluru - 560 040, Karnataka, India. E-mail:
[email protected]
ABSTRACT Introduction: Cerebral palsy (CP) is the most common physical disorder of children. Causes like jaundice and birth injury though are decreasing; complications resulting from the survival of low birth weight babies are replacing some of the older etiologies. Hence, this study was planned. Objectives: The objective was to study the clinical patterns, predisposing factors, and co-morbidities in children with CP. Materials and Methods: The present study is a hospital based prospective study conducted from January 2012 to January 2013 in children presenting to neurodevelopmental clinic at a tertiary care teaching hospital in India. Hundred cases with clinical features suggestive of CP were included in the study. Cases were evaluated by history, clinical examination, and necessary investigations. Results: Results of the study showed 81% of spastic, 12% of hypotonic, 5% of dystonic, and 2% of mixed CP cases. The mean age of presentation was 2 year, 2 month, and male to female ratio of 1:2. Pregnancyinduced hypertension (PIH) was the most common antenatal complication observed in 6%. Four percent had neonatal sepsis and 19% were born premature. Associated co-morbidities were mental retardation (55%), seizure disorder (46%), visual problems (26%), hearing problems (19%), and failure to thrive (47%). Discussion: Sex distribution observed in our study was male to female ratio of 1.2, which was comparable with a multicenter study in Europe. PIH was observed in 6% of cases, which was comparable with prior studies. Birth asphyxia was observed in 43% of cases. Eighty-one percent of the cases constituted a spastic variety of CP which was comparable to other studies. Conclusion: Perinatal asphyxia was the important etiological factor. We found preventable intranatal causes (60%) and antenatal causes (20%) forming a significant proportion. Co-morbidities were significantly observed in our study. Key words: Cerebral palsy, clinical profile, co-morbidities, predisposing factors, South India
Introduction The developmental disabilities are a group of disorders differentiated by the pattern of delay among the developmental Access this article online Quick Response Code:
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DOI: 10.4103/1817-1745.159191
108 / Journal of Pediatric Neurosciences / Volume 10 / Apr-Jun / 2015
streams. The four streams of development include language, problem solving, motor, and social. Cerebral palsy (CP) is a disorder of development in which motor function This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact:
[email protected] Cite this article as: Gowda VK, Kumar A, Shivappa SK, Srikanteswara PK, Shivananda, Mahadeviah MS, et al. Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India. J Pediatr Neurosci 2015;10:108-13.
Gowda, et al.: Cerebral palsy
abnormalities are the key features. It is the most common physical disorder in children first described by William John Little in 1861. Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behavior, epilepsy, and by secondary musculoskeletal problems.[1-10] The definition and classification of CP, April 2006 document is offered for international consensus and adoption, with the intent of providing a broad spectrum of audience with a common conceptualization about CP.[5] Because of the wide variety of causes of CP, the exact numbers from different studies do not completely match. However, there is a remarkable similarity in the prevalence across the world, from Sweden in the 1980s with a prevalence of 2.4 per 1000[11] and 2.5 per 1000 in the early 1990s,[12] 2.4 per 1000 from Malta,[13] 2.5 per 1000 from Finland,[14] and 1.6 per 1000 in China.[15] Considering the difficulty in making a specific diagnosis, and especially finding mild cases, these numbers probably reflect much more variation in counting than clear differences in prevalence. Ravn et al. reported the total CP birth prevalence has been significantly decreasing since the birth period 1983–1986 with 3.0 per 1000 live births until the period 1995–1998 with 2.1 per 1000 live births. The overall decrease was seen in preterm infants (
