Abstracts

RATIONALE: To study the spectrum of epilepsy in children with cerebral palsy (CP) and to find out whether there is any significant difference between those children with CP who have epilepsy versus those who do not.
METHODS: 105 consecutive children with CP and active epilepsy, between 1-14 years of age were studied prospectively. A cross sectional study of 452 consecutive registered cases of CP was also done to find the incidence of seizures. Detailed history and examination including neuro-developmental assessment, an EEG and CT Scan were done in all cases. The social quotient (SQ) was assessed using the Vineland Social Maturity Scale. A control group of age matched children with CP but no epilepsy was also studied for comparison of SQ. Epilepsy was classified according to the ILAE classification. Descriptive statistics, chi square and student t test were used for subgroup differences. Correlation and multiple regression analysis were used to compare variables of subtypes of CP and find relation between IQ and other variables.
RESULTS: Of the 452 children, 160 (35.4%) had epilepsy. The maximum incidence of 66% was seen in children with Spastic Hemiplegia (SHP) followed by quadriplegia (SPQ) (42.6%) and diplegia (SPD)(15.8%). Seizures were less common in dystonic (DYS), Hypotonic (HYPO) and Mixed (MIX) CP.
Of the 105 children, 65 were males, 45 were females; 40 (38%) had history of birth asphyxia. The mean age of onset of seizures was 18.9 months; 64 (60.95%) had seizure onset before one year of age. Children with myoclonic seizures (p [lt]0.05) and infantile spasms (p[lt]0.01) had seizure onset significantly early in life as compared to those with generalized tonic-clonic seizures.Types of seizures in different types of CP are shown in [dsquote][Table-1][dsquote].Seizures were controlled in 45 (58.1%) children , polytherapy was required in 40; of these 65% had CT abnormalities. Seizure control was achieved in 74% patients with normal to borderline SQ as compared to 48.7% with SQ less than 70. SQ values had a positive correlation with age of onset of seizures (p [lt] 0.01) and with better control of seizures(p[lt]0.01).
CONCLUSIONS: Epilepsy occurs in more than a third of patients with CP and is commonest in spastic hemiplegia and quadriplegia. Seizure onset is mostly in infancy. While generalized tonic clonic seizures are commonest, myoclonic jerks are seen in about one fourth of cases. Seizures are more common and more difficult to control in children with low intelligence.[table1]