Cerebral palsy and sex differences in children: A narrative review of the literature

Romeo, Domenico M.; Venezia, Ilaria; Pede, Elisa; Brogna, Claudia

doi:10.1002/jnr.25020

Cited by 13 publications

(8 citation statements)

References 67 publications

(242 reference statements)

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“…In CP, women are more tolerant of brain damage than men. This conclusion is consistent with the results of some clinical investigations and animal experiments ( 28 , 29 ). This phenomenon can also be explained by the concept of canalization put forward by Waddington.…”

Section: Discussionsupporting

confidence: 93%

Predicting the brain age of children with cerebral palsy using a two-dimensional convolutional neural networks prediction model without gray and white matter segmentation

Zhang

Yan²,

Mutalifu³

et al. 2022

Front. Neurol.

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BackgroundAbnormal brain development is common in children with cerebral palsy (CP), but there are no recent reports on the actual brain age of children with CP.ObjectiveOur objective is to use the brain age prediction model to explore the law of brain development in children with CP.MethodsA two-dimensional convolutional neural networks brain age prediction model was designed without segmenting the white and gray matter. Training and testing brain age prediction model using magnetic resonance images of healthy people in a public database. The brain age of children with CP aged 5–27 years old was predicted.ResultsThe training dataset mean absolute error (MAE) = 1.85, r = 0.99; test dataset MAE = 3.98, r = 0.95. The brain age gap estimation (BrainAGE) of the 5- to 27-year-old patients with CP was generally higher than that of healthy peers (p < 0.0001). The BrainAGE of male patients with CP was higher than that of female patients (p < 0.05). The BrainAGE of patients with bilateral spastic CP was higher than those with unilateral spastic CP (p < 0.05).ConclusionA two-dimensional convolutional neural networks brain age prediction model allows for brain age prediction using routine hospital T1-weighted head MRI without segmenting the white and gray matter of the brain. At the same time, these findings suggest that brain aging occurs in patients with CP after brain damage. Female patients with CP are more likely to return to their original brain development trajectory than male patients after brain injury. In patients with spastic CP, brain aging is more serious in those with bilateral cerebral hemisphere injury than in those with unilateral cerebral hemisphere injury.

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Section: Discussionsupporting

confidence: 93%

Predicting the brain age of children with cerebral palsy using a two-dimensional convolutional neural networks prediction model without gray and white matter segmentation

Zhang

Yan²,

Mutalifu³

et al. 2022

Front. Neurol.

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“…Risk factors for cerebral palsy are related to asphyxia, prematurity, infection/inflammation, and genetic disorders. These risk factors have the potential to affect brain development regardless of gender, but several studies report a higher male gender prevalence, with a male/female sex ratio of 1.3-1.4:1.2 (10,11). The prevalence of malnutrition in this study was 75.3% (41.2% malnutrition and 34.1% malnutrition).…”

contrasting

confidence: 51%

Clinical Profile and Vitamin D Status of Cerebral Palsy Children at Haji Adam Malik Hospital Medan

Yusnita,

H.Saing,

Buana Nasution

2024

IJRP

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Cerebral palsy (CP) is a disorder of motor function and posture, due to impaired brain development. Children with CP are at risk of experiencing vitamin D deficiency due to reduced mobility, low vitamin D intake, and use of anti-epileptic drugs. Vitamin D deficiency can cause hypocalcemia and reduce bone mineral density, osteopenia, and rickets so that it can result in pathological fractures even with only minor injuries. Monitoring vitamin D levels, early identification, and appropriate vitamin D supplementation are important in reducing the risk of injury and fracture in PS children. This study aims to determine the clinical profile of children with cerebral palsy and their vitamin D status. Methods: A descriptive study of children with cerebral palsy aged 2 to 6 years at the Neuro-pediatric outpatient clinic at H. Adam Malik Hospital, Medan from November 2022 to April 2023. Primary data was obtained from interviews and examination of serum vitamin D levels. Secondary data was obtained from medical records. Results: Eighty-five CP children were included in this study, 51.8% were boys and 48.2% were girls. The mean age of the subjects was 3.48 years, 34.1% of the subjects experienced malnutrition. The etiology of CP mainly occurs in the perinatal period (66.7%). Most subjects had spastic type (75.3%), with GMFCS grade V being the most common type (34.1%). Most of the subjects (57.6%) had epilepsy and were using anti-epileptic drugs. The majority of subjects had vitamin D deficiency status (56.5%). Conclusion:The clinical profile of cerebral palsy children at Haji Adam Malik Hospital Medan showed that most CP occurred during the perinatal period. Spastic type is the most common type of CP, most CP children experience epilepsy and vitamin D deficiency.

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“…However, after stratifying by sex, male infants had imprecisely elevated CP risk associated with ambient PM 2.5 exposure in the early and middle pregnancy, while female infants were at higher CP risk in early pregnancy. The sex-specific difference in susceptible windows could be due to the sexually dimorphic susceptibility to specific CP subtypes which may have different vulnerable periods in utero but may also reflect the increased uncertainty in the weekly effect estimates . Nevertheless, the underlying mechanism of this male predominance and the sex difference in the windows of susceptibility warrant research to understand the underplay of genetic, hormonal, and environmental factors.…”

Section: Discussionmentioning

confidence: 99%

“…The sex-specific difference in susceptible windows could be due to the sexually dimorphic susceptibility to specific CP subtypes which may have different vulnerable periods in utero but may also reflect the increased uncertainty in the weekly effect estimates. 38,39 Nevertheless, the underlying mechanism of this male predominance and the sex difference in the windows of susceptibility warrant research to understand the underplay of genetic, hormonal, and environmental factors. Some underlying mechanisms may help explain the findings.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Exposure to Ambient Air Pollution and Cerebral Palsy

Zhang,

Hu,

Talarico

et al. 2024

JAMA Netw Open

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ImportanceAir pollution is associated with structural brain changes, disruption of neurogenesis, and neurodevelopmental disorders. The association between prenatal exposure to ambient air pollution and risk of cerebral palsy (CP), which is the most common motor disability in childhood, has not been thoroughly investigated.ObjectiveTo evaluate the associations between prenatal residential exposure to ambient air pollution and risk of CP among children born at term gestation in a population cohort in Ontario, Canada.Design, Setting, and ParticipantsPopulation-based cohort study in Ontario, Canada using linked, province-wide health administrative databases. Participants were singleton full term births (≥37 gestational weeks) born in Ontario hospitals between April 1, 2002, and March 31, 2017. Data were analyzed from January to December 2022.ExposuresWeekly average concentrations of ambient fine particulate matter with a diameter 2.5 μm (PM2.5) or smaller, nitrogen dioxide (NO2), and ozone (O3) during pregnancy assigned by maternal residence reported at delivery from satellite-based estimates and ground-level monitoring data.Main outcome and measuresCP cases were ascertained by a single inpatient hospitalization diagnosis or at least 2 outpatient diagnoses for children from birth to age 18 years.ResultsThe present study included 1 587 935 mother-child pairs who reached term gestation, among whom 3170 (0.2%) children were diagnosed with CP. The study population had a mean (SD) maternal age of 30.1 (5.6) years and 811 745 infants (51.1%) were male. A per IQR increase (2.7 μg/m3) in prenatal ambient PM2.5 concentration was associated with a cumulative hazard ratio (CHR) of 1.12 (95% CI, 1.03-1.21) for CP. The CHR in male infants (1.14; 95% CI, 1.02-1.26) was higher compared with the CHR in female infants (1.08; 95% CI, 0.96-1.22). No specific window of susceptibility was found for prenatal PM2.5 exposure and CP in the study population. No associations or windows of susceptibility were found for prenatal NO2 or O3 exposure and CP risk.Conclusions and relevanceIn this large cohort study of singleton full term births in Canada, prenatal ambient PM2.5 exposure was associated with an increased risk of CP in offspring. Further studies are needed to explore this association and its potential biological pathways, which could advance the identification of environmental risk factors of CP in early life.

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Cerebral palsy and sex differences in children: A narrative review of the literature

Cited by 13 publications

References 67 publications

Predicting the brain age of children with cerebral palsy using a two-dimensional convolutional neural networks prediction model without gray and white matter segmentation

Predicting the brain age of children with cerebral palsy using a two-dimensional convolutional neural networks prediction model without gray and white matter segmentation

Clinical Profile and Vitamin D Status of Cerebral Palsy Children at Haji Adam Malik Hospital Medan

Prenatal Exposure to Ambient Air Pollution and Cerebral Palsy

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