Last modified: 2014-04-03
Abstract
Objective: To evaluate the clinical profile, aetiological factors and co-morbidities of hemiplegic cerebral palsy (CP) in North Indian children
Design: Retrospective cohort study.
Method: A total of 185 children with hemiplegic CP registered over the last ten years at our rehabilitation center were reviewed.
Results: Common presenting problems were global developmental delay (89%), speech difficulties (13.5%), seizures (32%) and behavioral problems (8%). Majority of the children were males (64%), in 1-2 years age-group, first-borns (46%) and from low socio-economic status (56%). Antenatal problems were noted in 30% of mothers; commonly pregnancy-induced hypertension (12%) and antepartum hemorrhage (4%). Most of the children were born at term (88%), by institutional vaginal delivery (82%). The cause of hemiplegic CP was congenital (73%), acquired central nervous system insults (11%) or both (16%). Neonatal problems included birth asphyxia (38%), low birth weight (25%), neonatal seizures (10%), sepsis (15%) and neonatal jaundice (19%). Common co-morbidities were seizures (42%), intellectual impairment (35%), microcephaly (51%) and behavioral abnormalities (18%). Commonest seizure type was generalized (14%) followed by focal (11%), myoclonic (10%) and infantile spasms (7%), whilst no seizures were noted in 58%. Neuroimaging was done in 85% of children; common findings included diffuse cerebral atrophy (15%), infarct (15%), hypoxic-ischemic changes (12%) and brain malformations (10%), periventricular leukomalacia (6%), unilateral ventriculomegaly (3.8%) whilst normal in 19%.
Conclusion: Hemiplegic CP can be very disabling due to associated co-morbidities. Comprehensive evaluation and early management may limit the degree of disability