Factors associated with the severity of motor impairment in children with cerebral palsy seen in Enugu, Nigeria

Abstract

Cerebral palsy (CP) is a neurodevelopmental disability. It is the most common cause of physical disability in childhood and occurs worldwide with a prevalence of 2-2.5 per 1 000 live births in the Western world. [1] The prevalence of CP in Nigeria is unknown and the rate of children attending neurology clinics in Nigeria varies broadly from 16% to 50.3%. [2-4] The University of Nigeria Teaching Hospital (UNTH), Enugu, reported CP to be the second most frequent neurological disorder seen in the paediatric neurology clinic (PNC); [2] however, there is a paucity of studies on gross motor dysfunction (GMD) in CP in Africa. The most current definition of CP is, 'CP describes a group of permanent disorders of the development of movement and posture causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behaviour, by epilepsy and secondary musculoskeletal problems. ' [5] These impairments are experienced to varying degrees and the severity of CP is based on a functional classification of these impairments. [1,5,6] There are various functional scales, with the most popular one being the Gross Motor Function Classification System (GMFCS). GMFCS quantifies a child's gross motor function (ambulatory function) into five levels of severity, ranging from walking without restrictions (level I), to total dependence for ambulation (level V). [5,6] Vasconcellos et al. [7] in Brazil reported 34.3% of the study population as ambulatory while Nordmark et al. [8] in southern Sweden reported a much higher proportion of ambulatory patients (73%). Medical research hasn't been able to explain this huge discrepancy. The aim of this study was to identify the factors that are associated with the severity of motor function, as determined by the GMFCS in children with CP in Enugu, Nigeria. Methods Study sites The study was carried out in the PNCs of the UNTH, Ituku-Ozalla, and Enugu State University Teaching Hospital (ESUTH). The UNTH is one of the first-generation teaching hospitals in Nigeria. It has multidisciplinary departments and caters for patients from predominantly the southeastern region of the country. The PNC of UNTH operates once a week and caters primarily for children who have neurological conditions and have been referred. ESUTH is a smaller and relatively new teaching hospital. Its PNC also runs once a week (on a different weekday). Sampling method This was a cross-sectional observational study. Sample selection was non-randomised and the subjects were consecutively recruited until the desired sample size was reached. Patients aged between 9 and 96 months with a diagnosis of CP were recruited. Patients with other movement disorders, physical disabilities and motor abnormalities, such as muscular dystrophies, paralytic poliomyelitis and spina bifida (myelomeningocele) were excluded. Ethical approval and consent This rese...

Aetiology and Pathophysiology of Cerebral Palsy

“…Indeed, Iloeje and Ogoke [64] in their study on severity of CP in children found a strong correlation between postnatal CNS infections and severe/non-ambulatory CP. Thus the greater contribution of postnatal CNS infections to CP causation in LMICs may in part be the reason for the relatively poorer gross motor function in children with CP from LMICs compared to their counterparts from HICs [64].…”

“…In a word, regardless of either vascular obstruction from sequestration of parasitized red blood cells in brain capillaries and venules or cytokine-mediated inflammatory injury, ultimately, cerebral malaria causes grey and white matter damage. Severe spastic bilateral CP specifically spastic quadriplegia is the expected long-term correlate of these postnatal CNS infections since they are diffuse processes with extensive brain damage [64]. Indeed, Iloeje and Ogoke [64] in their study on severity of CP in children found a strong correlation between postnatal CNS infections and severe/non-ambulatory CP.…”

“…Severe spastic bilateral CP specifically spastic quadriplegia is the expected long-term correlate of these postnatal CNS infections since they are diffuse processes with extensive brain damage [64]. Indeed, Iloeje and Ogoke [64] in their study on severity of CP in children found a strong correlation between postnatal CNS infections and severe/non-ambulatory CP. Thus the greater contribution of postnatal CNS infections to CP causation in LMICs may in part be the reason for the relatively poorer gross motor function in children with CP from LMICs compared to their counterparts from HICs [64].…”

Clinical Classification of Cerebral Palsy

“…Iloeje and Ogoke [29] in 2017 reported that the type of CP (physiology and topography), etiological factors and the number of accompanying impairments (supplemental disorders) were positively associated with the severity of gross motor dysfunction and walking ability of children with CP. In that study [29], children with spastic quadriplegic type, bacterial meningitis as etiological factor or many (five or six) accompanying impairments all had severe gross motor dysfunction and were non-ambulatory. Therefore, the other classifications may suggest functional abilities in children with CP.…”

Características clínicas de los pacientes con parálisis cerebral infantil portadores de gastrostomía atendidos en un instituto especializado de salud de Lima, Perú

“…El trastorno motor en pacientes con PCI no viene solo, suele acompañarse de alteraciones cognitivas, de lenguaje, sensoriales, y de conducta, así como problemas musculo esqueléticos y epilepsia (4,5) . El trabajo multidisciplinario es obligatorio en estos niños, por su condición neurológica y múltiples comorbilidades, e incluye equipos de pediatras, neuropediatras, traumatólogos, terapistas físicos, ocupacionales y de lenguaje (1) .…”