Nature And Prognosis Of Seizures In Patients With Cerebral Palsy

Aksu, Fuat

doi:10.1111/j.1469-8749.1990.tb08426.x

Cited by 64 publications

(36 citation statements)

References 11 publications

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“…When the type of CP has not been identified, generalized seizures, usually considered to have started from a focal abnormality, are those usually reported. 7,16 West syndrome was diagnosed in 28% and Lennox-Gastaut syndrome in 18% of 174 children with CP attending an epilepsy clinic. 16 Clearly, children with CP are liable to experience many types of seizures and epilepsy syndromes.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…7,16 West syndrome was diagnosed in 28% and Lennox-Gastaut syndrome in 18% of 174 children with CP attending an epilepsy clinic. 16 Clearly, children with CP are liable to experience many types of seizures and epilepsy syndromes. Some of these may not be readily accommodated in a formal classification system.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…15 In a study involving patients who were attending a seizure clinic, epilepsy was noted in 16% of first-degree relatives of those with CP, and 8% of relatives of control individuals with epilepsy, but no physical disability. 16 Secondary generalized epilepsies were found in the relatives of those with CP; whereas, in those without CP, primary generalized seizures predominated. It seems probable that the secondary generalized epilepsies and the CP are symptomatic of genetically determined, heritable conditions in at least some of these cases, and that this may be so more often than is usually appreciated.…”

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confidence: 99%

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Epilepsy in cerebral palsy

Wallace

2001

Develop Med Child Neuro

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The heightened risk of epilepsy in cerebral palsy (CP) was recognized by Freud more than 100 years ago. 1 His descriptions of the characteristics of the seizures indicate his appreciation of their essentially symptomatic nature. Much more recently, the importance of epilepsy as an adverse factor for cognitive function in children with hemiplegic CP has been highlighted. 2 The possibility that subclinical seizure discharges may add to cognitive problems requires particular attention in any child whose abilities may be already impaired secondary to structural brain abnormalities. Nevertheless, it is important to recognize that the motor difficulties, and any intellectual disabilities, as well as complicating seizures, are likely to stem from the same underlying pathology. EpidemiologyIn the general childhood population, the prevalence of epilepsy is between 3 and 6 per 1000. 3 Overall, epilepsy occurs in between 15 and 55% of children and adults with CP. 1,48 If learning disability* coexists, the risk to children with CP is much higher, rising to 71%. 4 Epilepsy is more common in some forms of CP than others. Although Paine 1 found children with tetra-or triplegic CP to be among the least likely to have epilepsy, other authors 4, 9, 10 showed at least 50%, and up to 94% 9 to be affected. In hemiplegic CP, at least one-third, and up to a half in some series, 1,4,6,11,12 have continuing seizures. With spastic or ataxic diplegia, the risk is somewhat lower at 16 to 27%. 4,6,10,13 With the exception of reports from Germany and Sweden, that show much higher frequencies, 10 epilepsy is noted to complicate dystonic/dyskinetic CP in about one-quarter of cases; 4, 6, 14 and seems to be only rarely associated with pure ataxic CP. 4, 14 Thus, those cerebral palsies with possibly the more cortical pathologies seem most likely to be complicated by epilepsy. Predisposing factorsThese can be considered under three main headings: genetic factors and pre-, and perinatal events. In addition, postnatal causes of CP, such as non-accidental or accidental head injuries and postencephalitic states may also be associated with epilepsy. In CP, information on the role of inherited predisposition to epilepsy is sparse in unselected populations. Curatolo and colleagues selected patients with CP, partial epilepsies, and learning difficulties on the bases of either structural lesions demonstrable on neuroimaging, or the presence of conditions likely to be secondary to pre-or perinatal asphyxia. Of these patients, the surprisingly high figure of 73% of their first-degree relatives were found also to have epilepsy; when compared with control individuals, those patients with prenatal pathology were 22 times as likely, and those with later pathology 14.5 times as likely as control individuals to have affected first-degree relatives. 15 In a study involving patients who were attending a seizure clinic, epilepsy was noted in 16% of first-degree relatives of those with CP, and 8% of relatives of control individuals with epilepsy, but no physical disa...

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Section: Predisposing Factorsmentioning

confidence: 99%

Section: Predisposing Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

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Epilepsy in cerebral palsy

Wallace

2001

Develop Med Child Neuro

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“…The term cerebral palsy (CP) applies to any individual with motor disturbance since the neonatal period caused by various aetiologies including hypoxic-ischaemic encephalopathy. Epilepsy occurs in 10% to 60% of patients with CP, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] which is higher than the prevalence of 0.3% to 0.8% in the general population. 16,17 In one study, seizures could eventually be controlled with antiepileptic drugs (AEDs) in 70% of children with epilepsy, 18 whereas the seizure remission (complete seizure control under AED medication) proportion in patients with CP is reported to range between 5.2% and 75.3%.…”

mentioning

confidence: 99%

“…16,17 In one study, seizures could eventually be controlled with antiepileptic drugs (AEDs) in 70% of children with epilepsy, 18 whereas the seizure remission (complete seizure control under AED medication) proportion in patients with CP is reported to range between 5.2% and 75.3%. [1][2][3][4][5][7][8][9][10]12,13,15,[19][20][21] Some articles have reported epilepsy resolution (no seizure relapse after termination of AEDs) proportions between 5.2% and 86.6% in patients with CP. [1][2][3]10,15,19 The variation in these remission and resolution proportions results, at least partly, from the different proportions of causative aetiologies and the different follow-up periods among the studies: for example, there was a higher remission proportion (75.3%) in 69 patients with CP, including 59 (85.5%) with perinatal aetiologies, 3 and a lower remission proportion (14%) in 57 patients with a short mean follow-up of 5 years 10 months (Table SI, online supporting information).…”

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confidence: 99%

Long‐term prognosis of epilepsy in patients with cerebral palsy

Tsubouchi

Tanabe²,

Saito

et al. 2019

Develop Med Child Neuro

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Aim To assess the long‐term natural course and prognosis of epilepsy in patients with cerebral palsy (CP). Method We retrospectively collected data for 72 patients (36 males, 36 females) with CP who had epilepsy who visited our institutions between 1980 and 2015. The data from medical records, electroencephalography (EEG), and neuroimaging findings were reviewed. Time‐to‐event statistical analyses were performed to analyse the remission outcome and the Cox regression model was used for multivariate analyses. Results Median age at onset of epilepsy was 2 years 0 months, and 17 years 0 months at the latest follow‐up. In total, 34 patients (47%, 0.043 per person‐year) achieved seizure remission at a median age of 11 years 0 months. Favourable factors for seizure remission included older age, motor disability being able to roll over/crawl but not able to sit, intellectual disability with an IQ between 36 and 70, normal findings on neuroimaging, and CP type other than spastic quadriplegia. In multivariate analysis, spastic quadriplegia was found to be associated with continued seizure activity. Antiepileptic drugs could be discontinued without relapse in 10 patients at a median age of 16 years 6 months, occurring 11 years 6 months after the onset of epilepsy. The drugs were terminated if the patient was aged at least 10 years and had perinatal causative aetiology and normalization or amelioration of epileptiform discharges on EEG. Interpretation The remission rate of epilepsy in CP increases up to young adulthood, and termination of antiepileptic drugs can be considered in selected cases at older ages. What this paper adds The remission rate of epilepsy in cerebral palsy increases up to 20 years after onset. In some cases, antiepileptic drugs (AEDs) can be terminated without relapse. Older age, perinatal aetiology, and improvement on electroencephalography are favourable factors for terminating AEDs.

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Seizure Remission and Antiepileptic Drug Discontinuation in Children With Tuberous Sclerosis Complex

Sparagana¹,

Delgado²,

Batchelor³

et al. 2003

Arch Neurol

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The proportion of children with TSC and epilepsy who achieve seizure remission is small. Nevertheless, some do attain seizure remission, and AEDs may be successfully discontinued. Mild cerebral involvement is a general clinical marker for seizure remission. The relapse rate in those who have undergone a trial of discontinuation of AED therapy is comparable with the rate in the general pediatric population with epilepsy.

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Nature And Prognosis Of Seizures In Patients With Cerebral Palsy

Cited by 64 publications

References 11 publications

Epilepsy in cerebral palsy

Epilepsy in cerebral palsy

Long‐term prognosis of epilepsy in patients with cerebral palsy

Seizure Remission and Antiepileptic Drug Discontinuation in Children With Tuberous Sclerosis Complex

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