1-Paediatric Neurology Dept., Hospital D. Estefânia, CHLC;
2-Research Center, Centro Hospitalar de Lisboa Central;
3-Physical Therapy and Rehabilitation Dept., Hospital Dr Fernando Fonseca;
4-Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian, Santa Casa da Misericórdia de Lisboa;
5-Neuroradiology Department, CHLC;
6-Portuguese Society of Neurodevelopment Paediatrics;
7-Escola Superior de Saúde, University of Aveiro;
8-On behalf of Programa de Vigilância Nacional de Paralisia Cerebral aos 5 Anos de Idade em Portugal (PVNPC5A), Federação das Associações Portuguesas de Paralisia Cerebral (FAPPC) and Surveillance of Cerebral Palsy in Europe (SCPE).
- 11th European Paediatric Neurology Society Congress. 27-30 Maio 2015, Vienna, Austria (comunicação oral)
Background and Aims. The Portuguese Surveillance of Cerebral Palsy at Age 5 (PVNPC5A) is a population-based national registry, affiliated to SCPE. Children with cerebral palsy (CP) and stroke registered in the PVNPC5A are described.
Methods. Cross-sectional analysis of 5-years-old children born on 1996-1997 and 2001-2009, registered in the PVNPC5A with positive diagnosis of stroke or suggestive MRI report. Common SCPE definitions, classifications and tools were used. CP type was given by the predominant clinical features.
Results. Among 1332 registered children, 85 stroke cases were identified (MRI mentioned in 70), 47 with ischemic middle cerebral artery stroke (55%). Stroke was mentioned in 9.8% of the CP cases (annual range 3.3-14.5%). There was no gender predominance (48 males, 56.5%) but of born at term (62), singletons (71) and adequate for gestational age (60) children. A perinatal or neonatal cause is mentioned in 61 cases, 15 had seizures on the first 72 hours after birth and 31 cases were admitted to the NICU. CP was spastic in 84 cases (1 case was dystonic), unilateral in 71 (right-sided in 47); in 12 cases 4 limbs were affected (8 term born children). GMFCS was levels I-II in 86%, BFMF 77%, MACS 72%, feeding ability 81%, verbal expression 79% and drooling control 81%; IQ<70 in 35% (21% IQ<50; 81% with associated epilepsy). Active epilepsy was reported in 32 cases (39%). Six children had no early inclusive education. None of the 4 major severity parameters (GMFCS IV-V, epilepsy, IQ<70, subvision) was present on 60% of the children (vs. 30% children with CP without stroke).
Conclusions. BS causes circa 10% of CP cases in Portugal. Despite most of the cases having high functional unilateral spastic CP, an important proportion of cases is severely affected. Prevention and treatment of paediatric BS contributes to the prevention of CP.