Cerebral Palsy CDC Expert Information : Seizures, Outcome, Prevalence in Preterm Birth

Early identification is important for early treatment in children under 1500g or born between 28-31 weeks. 

Optimally, neurology can help to guide early ECI, OT, PT, ST after a specialty neurologic exam of infants at risk. A discussion of a diagnostic AND functional / rehabilitative strategy should be part of this consultation.

JR

CDC Data & Statistics for Cerebral Palsy

Prevalence and Characteristics

• Cerebral palsy (CP) is the most common motor disability in childhood. (1)
• Population-based studies from around the world report prevalence estimates of CP ranging from 1.5 to more than 4 per 1,000 live births or children of a defined age range. (2, 3, 4, 5,6)
• About 1 in 323 children has been identified with CP according to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network. [Read summary]

  [D]

• CDC tracks CP through the Autism and Developmental Disabilities Monitoring (ADDM) CP Network.
• In 2008, the ADDM CP Network included areas of Alabama, Georgia, Missouri, and Wisconsin. Based on children who were 8 years old and living in these four communities in 2008, the ADDM CP data showed that: [Read summary] [R ead Community Report ]
  • CP was more common among boys than among girls.
  • CP was more common among Black children than White children. Hispanic and White children were about equally likely to have CP.
  • Most (77.4%) of the children identified with CP had spastic CP.
  • Over half (58.2%) of the children identified with CP could walk independently.
  • Many of the children with CP also had at least one co-occurring condition—41% had co-occurring epilepsy and 6.9% had co-occurring ASD.

Walking Ability

• In 2008, 58.2% of children with CP could walk independently, 11.3% walked using a hand-held mobility device, and 30.6% had limited or no walking ability. [Read summary]

 [D] 

• According to 2006 data from the ADDM CP Network, Black children with cerebral palsy were 1.7 times more likely to have limited or no walking ability compared with White children. [Read summary]
  
• Another study found that 41% of children with CP were limited in their ability to crawl, walk, run, or play, and 31% needed to use special equipment such as walkers or wheelchairs. [Read article]

Co-Occurring Developmental Disabilities

• Almost half (41%) of the children identified with CP by the ADDM CP Network had co-occurring epilepsy. Co-occurring epilepsy frequency was highest among children with cerebral palsy who had limited or no waking ability. [Read summary]
  
• Some (6.9%) of the children identified with CP also had autism spectrum disorder (ASD). Co-occurring ASD frequency was higher among children with non-spastic CP, particularly hypotonic CP. [Read summary]
  • It is important to note that the overall identified prevalence of ASD among children in the US is about 1% (7). That means that the identified prevalence of ASD among children with CP is much higher than among their peers without CP.

 [D] 

• The ADDM site that tracks CP in metropolitan Atlanta is the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). MADDSP 2006 data show that:
  • Approximately 60% of 8-year-old children with CP had another developmental disability.
  • More than 40% of children with CP had intellectual disability, 35% had epilepsy, and more than 15% had vision impairment. Nearly 1 in 4 children with CP had both intellectual disability and epilepsy.

Risk Factors

Low Birthweight and Premature Birth

• A study in metropolitan Atlanta found that the prevalence of CP was 6.2 per 1,000 livebirths among children born weighing 1,500 to 2,499 grams (3⅓ to 5½ pounds) and 59.5 per 1,000 livebirths among children born weighing less than 1,500 grams, compared with 1.1 per 1,000 for children born weighing 2,500 grams or more. [Read article]
• In data from Europe and Australia, the prevalence of CP ranged from: (8)
  • 35.0 to 79.5 per 1,000 live births for children born at 28 to 31 weeks gestation
  • 1.1 to 1.7 per 1,000 live births for children born at 37 or more weeks gestation
• In data from Sweden, the prevalence of CP was: (8)
  • 43.7 per 1,000 live births for children born at 28 to 31 weeks gestation
  • 6.1 per 1,000 live births among children born at 32 to 36 weeks gestation
  • 1.4 per 1,000 live births for children born at 37 or more weeks gestation
• A study in Scotland found that children born as part of a multiple birth pregnancy such as being a twin were found to be almost five times more likely to have CP than children born as singletons. Part, but not all, of this increased risk is due to the fact that multiple birth children are more likely to be born prematurely or at low birthweight. [Read summary]
• A study in Denmark found that children born after in vitro fertilization (assisted conception) were 1.6 times as likely to have CP, due to the fact that they were more likely to be born prematurely or from a multiple pregnancy. [Read article]

Disruption of Blood and Oxygen Supply to the Developing Brain

• Ischemic stroke, when a blood clot blocks a blood vessel in the brain, is recognized to cause brain damage that can result in CP. It can occur in the developing fetal brain during pregnancy or shortly after birth. [Read summary]
• Disruption of the oxygen supply during birth (birth hypoxia) has been estimated to account for less than 10% of CP cases. [Read summary]

Infection Among Mothers

• Infection of the placental membranes (chorioamnionitis) or other signs of infection (blood infection in the mother or fever during labor) have been associated with an increased risk of CP for children born full-term. [Read article], [Read summary]
• Chorioamnionitis has been found to account for 12% of spastic CP among children born full-term and 28% of CP among children born prematurely. [Read article]
• Maternal genitourinary infection has been associated with an increased risk of CP among children born prematurely or at low birthweight. [Read article] 

Other Factors

• Birth defects of the central nervous system (brain) were found to be more common among children with CP than among those without CP. [Read summary]
• Data from metropolitan Atlanta showed that about 10% to 15% of CP was acquired in the early years of a child’s life. The most frequent causes were brain injuries from motor vehicle crashes or falls, and infections (such as meningitis). [Read article], [Read summary]

More HERE

In Brain-Injured Children, Early Gesturing Predicts Language Delays

ScienceDaily (Mar. 26, 2010) — About 1 in 4,000 infants has a brain injury known as pre- or perinatal brain lesions, mainly as a result of stroke, with risk factors involving both mothers and babies. Children with early brain lesions that affect one side of the brain often take longer to reach early language milestones; these delays normalize for many but persist for some. New research has found that children's gesturing at 18 months can identify those children who will have these later language delays.

Researchers at the University of Chicago carried out the work, which can be found in the March/April 2010 issue of the Child Development journal.

The study looked at gestures such as pointing or waving goodbye in 11 18-month-olds as a way of predicting later vocabulary delays. The researchers considered gesture because recent studies have found it to be a good predictor of later language abilities in typically developing children. The children's language comprehension was tested when they were 30 months old.

The researchers found that gesturing at 18 months (but not early speech) predicted which children with lesions had vocabulary delays a year later. The results suggest that gesture may be a tool for diagnosing persistent language delay in children with brain lesions.

These findings have both diagnostic and therapeutic implications, according to the authors of the study, Susan C. Levine, Stella M. Rowley Professor of Psychology, and Susan Goldin-Meadow, Beardsley Ruml Distinguished Service Professor, both in the Department of Psychology, Comparative Human Development, and the Committee on Education at the University of Chicago....

summary article here

abstract here

Early Gesture Predicts Language Delay in Children With Pre- or Perinatal Brain Lesions

"Does early gesture use predict later productive and receptive vocabulary in children with pre- or perinatal unilateral brain lesions (PL)? Eleven Children with PL were categorized into 2 groups based on whether their gesture at 18 months was within or below the range of typically developing (TD) children. Children with PL whose gesture was within the TD range developed a productive vocabulary at 22 and 26 months and a receptive vocabulary at 30 months that were all within the TD range. In contrast, children with PL below the TD range did not. Gesture was thus an early marker of which children with early unilateral lesions would eventually experience language delay, suggesting that gesture is a promising diagnostic tool for persistent delay."

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2009.01413.x/abstract