Chapter 15 - Epidemiology of cerebral palsy
Section snippets
Definition and classification
Cerebral palsy (CP) is the most common cause of motor disability in childhood, affecting about two per 1000 live born children. It comprises a group of conditions, heterogeneous in causation and manifestations. The most recent definition of CP, including the naming of some accompanying impairments, was put forward by the participants at an international workshop on the definition and classification of CP, in Washington in July 2004 (Bax et al., 2005):
Cerebral palsy (CP) describes a group of
Prevalence: overall trends
Cerebral palsy epidemiology is important as an indicator of hazards, relevant to maternal, perinatal, and neonatal care. Prevalence of CP is monitored by numerous registers across the world. The overall prevalence of CP appears to have been fairly stable over the years, although major changes may have occurred in the various subtypes (Surveillance of Cerebral Palsy in Europe, 2002, Cans et al., 2008). Perinatal and neonatal mortality have decreased (Fig. 15.2), and maternal, perinatal, and
Trends by birthweight and gestational age
Lower birthweight is correlated with higher CP rate, 48.4 per 1000 in children with a birthweight below 1500 g compared to 1.1 per 1000 in children with a birthweight of more than 2500 g in a recent European report (European Perinatal Health Report, 2008). In a survey including 16 centers of the SCPE, a decreasing trend in prevalence was shown among very low-birthweight children, mainly due to a decrease in the bilateral spastic CP subtype (Platt et al., 2007) (Fig. 15.3).
There is a large
Multiple birth
A four times higher risk for CP for multiple births as compared to singletons has been reported from large studies in Australia and the USA as well as from Europe (Scher et al., 2002, Topp et al., 2004). In the former study, an increased risk was seen in surviving twins whose co-twin had died or had CP, while in the latter study, the increased risk was mainly related to the higher risk of preterm birth in multiples.
Intrauterine growth deviation
Growth deviation, both small for gestational age and large for gestational age in singletons and in twins born after 32 weeks of gestation, is also linked to an increased risk for CP (Jarvis et al., 2003). Deviant intrauterine growth is also associated with more severe disability and male sex. In twins born before 32 weeks of gestation, only small for gestational age was associated with a higher risk for CP (Jarvis et al., 2005, Glinianaia et al., 2006).
Trends in motor severity and CP subtypes
The changes in severity of motor impairment over time are very small. About 60% of the children with CP learn to walk unaided (Himmelmann et al., 2006). The mean proportion of children unable to walk was 28% in children born 1976–1996 in Europe with very little variance within the time period. Walking ability is strongly correlated to CP subtype: 3% of children with unilateral spastic CP, 10% of the children with ataxia, 43% of those with bilateral spastic CP, and 59% of the children with
Accompanying impairments
In more than half of the children with CP, there are accompanying impairments, which may override the motor impairment in some. Screening for these conditions should be part of the evaluation of a child with CP. The occurrence of accompanying impairments like epilepsy, impaired vision, and learning disability (mental retardation) is correlated to the severity of the motor impairment (Himmelmann et al., 2006, Venkateswaran and Shevell, 2008, Pueyo et al., 2009). Communication and feeding may
Survival in cerebral palsy
Survival in individuals with CP is related to severity of motor impairment and accompanying impairments. Blair found intellectual disability to be the strongest predictor of mortality in a survey of birth years 1958–1994, while severe motor impairment primarily increased early mortality (Blair et al., 2001). However, CP may well be associated with full life expectancy.
References (29)
- et al.
Epidemiology of cerebral palsy
Semin Fetal Neonatal Med
(2006) - et al.
Epidemiology of cerebral palsy. Symposium: Special needs
Paediatr Child Health
(2008) - et al.
Cerebral palsy and intrauterine growth in single births: European Collaborative Study
Lancet
(2003) - et al.
Trends in cerebral palsy among infants of very low birthweight (< 1500 g) or born prematurely (< 32 weeks) in 16 European centres: a database study
Lancet
(2007) - et al.
Neuropsychologic impairment in bilateral cerebral palsy
Pediatr Neurol
(2009) - et al.
Proposed definition and classification of cerebral palsy
Dev Med Child Neurol
(2005) - et al.
Neuroimpairments, activity limitations and participation restrictions in children with cerebral palsy
Dev Med Child Neurol
(2002) - et al.
Probability of walking in children with cerebral palsy in Europe. Surveillance of Cerebral Palsy in Europe
Pediatrics
(2008) - et al.
Life expectancy among people with cerebral palsy in Western Australia
Dev Med Child Neurol
(2001) - et al.
Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy
Dev Med Child Neurol
(2007)
Behaviour in children with cerebral palsy with and without epilepsy
Dev Med Child Neurol
The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability
Dev Med Child Neurol
Euro-Peristat project in collaboration with SCPE, EUROCAT&EURONEOSTAT
Intrauterine growth and cerebral palsy in twins: a European multicenter study
Twin Res Hum Genet
Cited by (34)
Early Detection of Cerebral Palsy Using Sensorimotor Tract Biomarkers in Very Preterm Infants
2019, Pediatric NeurologyCitation Excerpt :Cerebral palsy (CP) is the most common physical disability in children and a lifelong disorder that can worsen without treatment.1,2 Infants born extremely preterm have a 50-fold higher risk of CP than infants born at term.2 In most clinical settings, the average age at diagnosis of CP is typically two years or beyond, despite the etiologic role brain injury or abnormal brain development play in the development of CP.3,4
Earliness in the diagnosis of cerebral palsy in the city of Kinshasa
2019, Motricite CerebraleCerebral palsy
2018, Handbook of Clinical NeurologyCitation Excerpt :Major surgical intervention in childhood is common, with single-event multilevel orthopedic procedures to address progressive musculoskeletal pathology, including tendon lengthening, tendon transfers, rotational osteotomies, and joint stabilization procedures (McGinley et al., 2012). Although around 60% of individuals are able to walk independently or with aids when entering adulthood (Himmelmann, 2013), walking ability commonly deteriorates in early and middle adulthood with many individuals describing worsening or loss of walking ability (Morgan and McGinley, 2014). A recent systematic review of gait in adults found most studies reported walking decline in around 30% of participants (Morgan and McGinley, 2014).