1- Departamento de Medicina Física e Reabilitação, Hospital Dr. Fernando Fonseca, Amadora
2- Centro de Investigação, Centro Hospitalar de Lisboa Central, Lisboa
3- Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian, Lisboa
4- Programa Nacional Vigilância Paralisia Cerebral
5- Serviço de Imagiologia, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
6- Sociedade Portuguesa de Pediatria do Neurodesenvolvimento
7- Escola Superior de Saúde, Universidade de Aveiro
8- Serviço de Neurologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
28th Annual Meeting of the European Academy for Child Disability, 2016
Background and Aims. Magnetic resonance imaging (MRI) is an important tool in the characterization of cerebral palsy (CP). The function and morbidity of children with CP are described according to their MRI.
Methods. Cross-sectional study based on active surveillance data of 5-years-old children born in Portugal in 2001-2006, reported to the National Surveillance of Cerebral Palsy in Portugal. SCPE definitions, functional classifications (GMFCS, BMFM, MACS, IQ, vision, hearing, communication) and MRI classification of paediatric MRI based on the predominant pattern (Krägeloh-Mann et al.) were used. Chi-squared test and relative risks were calculated.
Results. In 1107 children, MRI was performed in 613 and a report was available for classification in 494 (17 deceased before 5yoa were excluded). The sample included 58% born at term, 81.7% with spastic CP (66.4% bilateral), 7.4% had post-neonatal CP. The predominant MRI pattern was: Congenital anomaly (A) 14.2% (70), White matter lesion (B) 37.7% (186), Grey matter lesion (C) 32.2% (145), non-classified 10.1% (50) and Normal 7.9% (39). Highly significant differences on functional severity assessments and prevalence of morbidities were found. Overall, the best outcomes were found in children with pattern B MRI. Comparing levels IV-V with levels I-II, patterns B vs. C had a RR = 0.62 [95%CI 0.473-0.822] for GMFCS and 0.42 [95%CI 0.311-0.571] for BFMF, a RR of IQ<50 0.61 [95%CI 0.464-0.803] and for epilepsy, a RR = 0.69 [95%CI 0.531-0.906]. Among the patterns most predominant in children born a term, a RR = 1.29 [95%CI 1.037-1.602] for epilepsy if pattern A vs. C. Conclusions. Major morbidity and function in children with CP are strongly associated with the predominant patterns found in MRI. Early MRI may be a useful aid for prediction of later outcomes.
Palavras Chave: cerebral palsy, MRI