1 - Physical Therapy and Rehabilitation Dept., Hospital Dr Fernando Fonseca;
2 - Research Center, Centro Hospitalar de Lisboa Central;
3 - Physical Therapy and Rehabilitation Dept., Hospital Dr Fernando Fonseca;
4 - Centro 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 - Paediatric Neurology Dept., Hospital D. Estefânia, CHLC.
* on behalf of the National Surveillance of Cerebral Palsy in Portugal among 5-year-old Children,Federação das Associações Portuguesas de Paralisia Cerebral (FAPPC) and Surveillance of Cerebral Palsy in Europe (SCPE)
- VI Jornadas Internacionais de Neonatologia / XLIV Jornadas Nacionais de Neonatologia, 5-6 Novembro 2015, Évora (comunicação oral)
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 pediatric 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.