Several factors, including maternal infection during pregnancy, very preterm birth, and certain findings on brain MRI scans were correlated with cerebral palsy, according to a study in the October 4 issue of JAMA.
Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Additional information about the causes of CP could help identify preventive strategies, according to background information in the article.
Martin Bax, D.M., F.R.C.P.C.H., of Imperial College London and Chelsea & Westminster Hospital, London, and colleagues examined the correlates of CP in a population sample and compared clinical findings with information available from MRI brain scans. The study included 585 children with CP who were born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan at 18 months of age or later. The research was conducted at eight European study centers (North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland).
The researchers found that 39.5 percent (158 of 400) of the mothers reported an infection during the pregnancy, including 19.2 percent who reported a urinary tract infection and 15.5 percent who reported taking antibiotics during the pregnancy. Fifty-one children (12 percent) were known to be from a multiple pregnancy, with 48 from a twin pregnancy and 3 from a triplet pregnancy. This compares with a population rate of multiple pregnancy of about 1.5 percent. In addition, 235 children (54 percent) were born at term, whereas 47 children (10.9 percent) were very preterm (born less than 28 weeks gestation), 69 (16 percent) were born between 28 and 31 weeks, and 79 (18.3 percent) were born between 32 and 36 weeks gestation. Emergency cesarean deliveries were performed in 32.3 percent of births.
Among children with clinical evaluation, 351 (81.4 percent) had a brain MRI scan assessed for the study. The scans showed that white-matter damage of immaturity (brain areas affected due to not being fully developed) was the most common finding (42.5 percent). Only 11.7 percent of these children had normal MRI findings. There were good correlations between the MRI and clinical findings.
"Not only do MRI scans help reveal the pathologic basis of the condition but, also, the findings have strong correlations with clinical findings. This may be useful in helping parents, clinicians, and others involved in the care of children with CP to understand the nature of the children's condition and to predict their needs in the future. Therefore, all children with CP should have an MRI scan," the authors write.
"We think it is not unreasonable to assume that with increased awareness of possible preventive measures, over the next decade the rate of CP could be reduced substantially, thus reducing the burden on families and saving tremendous sums of money for health services," the researchers conclude.
(JAMA. 2006;296:1602-1608. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Ongoing funding for this study is provided by the Castang Foundation, having been initiated by the Little Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Complexity of the Cerebral Palsy Syndromes
In an accompanying editorial, Michael E. Msall, M.D., of the University of Chicago Pritzker School of Medicine, University of Chicago Comer Children's and LaRabida Children's Hospitals, Chicago, comments on the study by Bax and colleagues.
"The key translational question is how to use advances in maternal-fetal medicine, neonatology, and developmental neuroscience to describe the best explanatory mechanisms for children with a CP syndrome. Most important is how to use the best science to understand potential pathways that would decrease the functional severity of CP."
"With respect to ongoing management, a long-term whole-child focus that optimizes health, developmental, and functional outcomes, community participation, and family well-being is in order. In this way, an informed and compassionate science for children with neurodisability can be developed." (JAMA. 2006;296:1650-1652. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Financial disclosures - none reported. Please see the editorial for information on funding/support.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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