Clinical and Inflammatory Factors Influencing Constipation and Quality of Life in Cerebral Palsy

Abstract

Introduction: Intestinal constipation is a clinical consequence, secondary to neuromotor disturbances, which acts on subjects with cerebral palsy (CP). The aim of this study was to investigate the factors influencing constipation and the quality of life (QOL) of CP subjects. Materials and methods: We recruited a total of 63 subjects aging from 5-17 years with spastic CP who received physical rehabilitation. The subjects were divided into two groups including with and without constipation. Subjects were assigned into one of the 4 groups (G1-4) based on the prevalence of 1) CP and 2) Constipation. Subjects were assigned as CP with constipation (G1), CP without constipation (G2), and controls without CP with constipation (G3) and without CP and without constipation (G4). Subject demographics, use of antiepileptic drugs (AEDs), motor function, caregiver priorities and child health index of life with disabilities (CPCHILD) were included. In addition to medical metadata, a subset of subjects was evaluated for oral and systemic inflammation through gingival bleeding and serum cytokine levels (TNF-alpha, IL-1 beta, IL-6, IL-8, IL-10) respectively. Statistical significance was evaluated by ANOVA One-Way (parametric data) and Kruskal Wallis (non-parametric data). Results: A significant relationship was found between the type of medication and constipation. Subjects taking GABA and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Additionally, quality of life was directly correlated with constipation; subjects in G1 presented the lower mean score of CPCHILD (49.0 SD13.1) compared to G2 (71.5 SD 16.7) when compared to G3 (88.9 SD 7.5), and G4 (95.5 SD5.0) (P < 0.01). Inflammation was more severe for patients in G1 (P < 0.001). There were no differences among groups regarding gender (P = 0.332) and age (P = 0.292). Conclusions: Our results suggest that constipation was mostly affected by the use of certain antiepileptic drugs, namely GABA. This showed a direct detrimental effect on CP quality of life, which was influenced by inflammatory cytokines and the dosage and type of AEDs.