1- Centro de Investigação, Centro Hospitalar de Lisboa Central, Lisboa
2- Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian, Lisboa
3- Departamento de Medicina Física e Reabilitação, Hospital Dr. Fernando Fonseca, Amadora
4- Programa Nacional Vigilancia 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
6th International Congress of Union of European Neonatal & Perinatal Societies, 2016
Introduction. Magnetic resonance imaging (MRI) may help ascertain the prognosis and aetiology of cerebral palsy (CP). In some children with CP, MRI is normal. The epidemiology of children with CP and normal MRI is described.
Methods. Nested case-cohort study based on data from active surveillance of 5-years-old children with CP born in 1996-2010. SCPE definitions, functional classifications (GMFCS, BMFM, MACS, IQ, vision, hearing, communication) and MRI classification of paediatric MRI based on the predominant pattern were used. Chi-squared test and Odds Ratios were calculated.
Results. From 1532 reported cases, 1459 children residing in Portugal at age 5 were considered. Neuroimaging was reported in 1095 (75%), MRI was performed in 944 (65%) and a report was available for classification in 732 (50%). The sample included 56.5% born at term, 77.5% with spastic CP (51% bilateral), 8.3% post-neonatal CP. MRI predominant patterns were: Congenital anomaly (A) 14.6% (107), White matter lesion (B) 39.5% (289), Grey matter lesion (C) 29.1% (213), Miscellanea (D) 9.3% (68) and Normal (E) 7.5% (55). The typical 5-year-old child with CP and normal MRI was male, born at term, normal Apgar score, no early neonatal seizures or epilepsy later on, presenting bilateral spastic CP, scoring levels I-II/V for most functional classifications, no sight or hearing impairment, IQ<50 and in regular pre-school. Normal MRI was present in 28% of cases of ataxic, 15% of dyskinetic, 15% of unclassified and 5% of spastic CP. The Odds for having CP and normal MRI were significantly higher for males, those born at term, those having bilateral or predominately non-spastic CP (higher if ataxic CP), an identified post-neonatal cause and no sight impairment.
Conclusions. MRI may be normal in 7.5% of 5-year-old children with CP, the proportion being much higher if CP is predominately non-spastic. The odds for normal MRI are higher in those born at term and when a post-neonatal cause was identified.
Palavras Chave: cerebral palsy, MRI, prognosis, aetiology