A clinico-epidemiological study of cerebral palsy in western Rajasthan

Abstract

INTRODUCTIONCerebral palsy (CP) is one of the leading causes of disability in children. Incidence of cerebral palsy varies from one to six per thousand live births. Besides handicapping a child, it causes considerable psychological and social trauma to the parents and financial burden to family and community. A cure for cerebral palsy (CP) has not yet been discovered, hence, a ABSTRACT Background: Cerebral palsy (CP) is one of the leading causes of disability in children. Incidence of cerebral palsy varies from one to six per thousand live births. Besides handicapping a child, it causes considerable psychological and social trauma to the parents and financial burden to family and community. A cure for cerebral palsy (CP) has not yet been discovered, hence, a need for primary prevention of disease. But unfortunately, the etiology of cerebral palsy is poorly understood thereby eluding a definitive prevention strategy. Methods: All cases of non-progressive neurological disorder in the age group of 0-9 years were enrolled in the present study. Thorough and complete Obstetric history including antenatal, natal and post-natal were recorded. Woodside scale is used for assessment of neurodevelopment and a complete anthropometric measurement, physical examination including detailed Central Nervous System and all neuroimaging and EEG were recorded. Severity of cerebral palsy was assessed according to Minear's classification. Statistical analysis was done by standard statistical methods. Results: Majority of patients were males (78.26%) as compared to females. The mean age of male patients was 2.04±1.53 years and females was 3.67±3.14 years. Spastic type of CP was most common (93.47%), followed by mixed (4.34%) and atonic (2.17%) type. Quadriplegic CP was the most common (76.75%), followed by diplegia (11.62%) amongst the spastic variety. Risk factors found are maternal pyrexia (17.39%), home vaginal delivery (58.70%), birth asphyxia (67.39%), Neonatal seizures (39.13%) other factors being icterus neonatorum (13.04%) and meconium aspiration syndrome (13.04%), ICH (10.86%), septicemia (8.69%) and renal failure (4.34%). Majority of the patients (78.26%) had class III and IV functional impairment. Cortical atrophy was the most commonly (71.73%) seen abnormality on neuroimaging with CT-scan. Epilepsy was present in 47.82% patients. Conclusions: Cerebral palsy along with its associated dysfunctions definitely disturbs the routine of children's life as well as family life. We have to go a long way before something definitive can be done for these children and their families.

Clinical profile of cerebral palsy: a study from multidisciplinary clinic at tertiary care centre

“…9 So, authors presume that in Bihar may be more male CP attending the apex centre for treatment as of in western Rajasthan in a study by Makwana M et al 2017. 10 Maximum numbers of patients at presentation were in the age group of 2-5 years (40%) followed by in less than 2years (32.85%) which is nearly similar to other study by Makwana et al on 46 patients. 10 78.5% cases born as normal delivery, 70 % children had delayed cry after birth and 61.50% children required Admission in NICU.…”

“…10 Maximum numbers of patients at presentation were in the age group of 2-5 years (40%) followed by in less than 2years (32.85%) which is nearly similar to other study by Makwana et al on 46 patients. 10 78.5% cases born as normal delivery, 70 % children had delayed cry after birth and 61.50% children required Admission in NICU. This is nearly similar to the Indian studies by done by Sharma et al, Anwar S et al and Singhi et al [11][12][13] This may be attributed to poor antenatal check-up, fewer 1 or 2 USG in antenatal check-up.…”

“…As authors see there is 100% hospital delivery in contrast to one recently published study shown about 60% home delivery from western Rajasthan but status of antenatal and perinatal care is not clear. 10 But studies particularly from developed countries like Nelson and Ellenberg, Nelson and Grether have found that perinatal asphyxia is a much less frequent cause of Cerebral Palsy. 14,15 This may be due to lesser patient load, increased availability of specialist, better perinatal care and in developed country than ours.…”

Male sex preponderance in cerebral palsy

“…In a study by Mohan Makwana et al, conducted at Department of Pediatrics, Regional Institute of Maternal and Child Health, Umaid Hospital for Women and Children, Dr. S.N. Medical College, Jodhpur they showed the male: female ratio was 78.26% and 21.73% respectively [12] . In a study by Nabanita Das et al Across-sectional epidemiological study conducted in Inpatient and Out Patient Department of Pediatrics in GMCH, Composite Regional Centre (CRC) and Sishu Sarothi, Spastics society of Assam showed in their study that 63 out of 100 cases were boys with a boy/girl ratio of 1.7:1 [13] .…”

Factors Influencing the Utilization of Physiotherapy Services Among the Children with Cerebral Palsy at Protibondhi Seba-O-Sahajjo Kendro in Bangladesh

“…A cross-sectional study was carried out at protibondhi seba-o-sahajjo kendro (PSOSK) from the fourteen (14) different districts and Upazila in Bangladesh. 225 participants were assigned randomly.…”