Last modified: 2018-09-09
Abstract
Introduction: Spastic cerebral palsy is the commonest physiological type in literature and data comes mainly from the developed countries where prematuriy is a common. In developing countries like India, the leading causes of cerebral palsy are birth asphyxia, infections and hyperbilirubinemia and hence the physiological type of CP is likely to be different. However the data from our country is scant.
Methods: 103 consecutive patients attending pediatric neurology OPD were evaluated in detail using an ojective tool Hypertonia assessment tool (HAT) by two qualified pediatric neurologists. Based on the predominant tone, the cases were classified as spastic, dyskinetic, hypotonic and mixed. The type of cerebral palsy was correlated with perinatal details and neuroimaging findings.
Results: Out of 103 children, predominant dykinetic CP was seen in 54 (52.4%), predominant spastic CP in 30 (29.1%) and mixed (dyskinetic+spastic) CP in 19 (18.4%). The most common cause for predominant type of CP was perinatal asphyxia (61%) followed by neonatal jaundice/hypoglycemia (14.8%); for spastic CP was prematurity (56.7%) followed by perinatal asphyxia (30%); for mixed CP, the main cause was perinatal asphyxia (63.2%), followed by neuroinfection (15.8%). The main neuroimaging finding in predominant dyskinetic CP was basal ganglia involvement followed by parieto-occipital gliosis, where as in spastic CP it was periventricular leucomalacia. In mixed CP, there was multicystic encephalomalacia.
Conclusions: Dyskinetic cerebral palsy either as predominant type or along with spasticity is the most common physiogical type of cerebral palsy in India and is mostly due to birth asphyxia, hyperbilirubinemia, hypoglycemia and infections.