Characteristics and challenges of epilepsy in children with cerebral palsy : a population-based study

Infantile cerebral palsy (CP) is a chronic neurological disorder comprising heterogeneous subtypes with different clinical symptoms. Structural epilepsy is a common comorbidity, but its prevalence varies greatly between the different CP subtypes. The aim of the present retrospective study was to determine the prevalence and specific characteristics of epilepsy in a population-based CP cohort and to correlate them with different disease-specific and sociodemographic factors. For this purpose, data from the CP register of western Sweden was used. All children born between January 2003 and December 2006 in the county of Västra Götaland in Sweden with confirmed diagnosis of CP were included. Data was manually extracted from the medical records at two predefined time periods, i.e., at the age of 9,0-12,0 years and at the age of 13,0-16,0 years. Of the 140 children initially identified in the registry, two had already deceased before reaching the second inclusion date, leaving a total number of 138 patients (98,6%) in the cohort (43,5% female, 56,5% male). An epilepsy diagnosis was present in 42,8% (n = 59) of patients. Predictive factors for the development of epilepsy were the presence of dyskinetic CP, a positive history of neonatal seizures, a more severe mental or motor disability and the presence of a comorbid autism spectrum disorder. Children with dyskinetic CP were also more likely to have infantile spasms, continuous spike-and-wave discharges during sleep, and status epilepticus compared to other CP subgroups. Almost all patients with epilepsy received anti- seizure monotherapy (45,7%) or polytherapy (45,7%); only 8,5% report of patients did not receive epilepsy-specific therapy. An age of > 2,0 years at epilepsy diagnosis, female gender and imaging evidence of an isolated white matter damage was associated with a more benign course of epilepsy. In summary, epilepsy is a common complication in children with CP, especially in those with a dyskinetic type. Based on this population-based retrospective cohort analysis, further predictive factors for the development of epilepsy as well as for its further complicative or refractory course could be developed. These results may help to improve the care of children with CP and comorbid epilepsy in the future.