By: Maura Toner
Photo from www.shutterstock.com
Cerebral Palsy is a group of neurological disorders that affect both motor and developmental skills. Cerebral palsy most commonly affects movement in different parts of the body, often causing problems with gait, muscle tone, and coordination in movement. The Centers for Disease Control and Prevention estimates about 1 in 345 children in the US are diagnosed with cerebral palsy. CP is caused by damage to the fetal or infant brain, specifically the cerebrum, and is most commonly caused by bacterial or viral infection, hemorrhaging in the brain, head injuries, asphyxia (lack of oxygen to the brain), and prenatal exposure to drugs and alcohol.
According to a study by the National Center on Birth Defects and Developmental Disabilities, spastic cerebral palsy is the most prevalent form of CP, making up about 77% of all cases. Individuals experience high muscle tone and jerky movements, which are caused by motor cortex damage. The various types and symptoms of cerebral palsy are as follows:
| Type | Prevalence | Damage | Common signs |
| Spastic Cerebral Palsy | 77% | Motor cortex, pyramidal tract | Abnormal walking, Jerky reflexes, Permanently tightened muscles/joints, Localized body stiffness |
| Athetoid Cerebral Palsy | 2.6% | Basal Ganglia and/or cerebellum | Involuntary movement in face, torso, limbs, Feeding issues, Posture issues, Stiffness in body |
| Ataxic Cerebral Palsy | 2.4% | Cerebellum | Tremors, Reduction in muscle tone, Difficulty speaking, Issues with depth perception |
| Hypotonic Cerebral Palsy | 2.6% | Cerebral cortex | Low muscle tone/floppy muscles, Lack of head control, Lack of balance |
| Mixed Cerebral Palsy | 15.4% | More than one area of damage | Multisymptomatic, effects multiple areas of the brain |
(Cerebral Palsy Guide, 2021)
Epidemiology
Studies have shown the heightened risk of epilepsy in patients with cerebral palsy, especially in children. 3-6 per 1000 children are diagnosed with epilepsy, yet epilepsy occurs at a much more frequent rate among children and adults with cerebral palsy, 15-55%. If a CP patient has an accompanying learning disability, the risk of epilepsy rises to 71.4%. It must be noted that the prevalence of epilepsy varies with each form of CP; however, it is likely that the motor and intellectual difficulties that are seen with patients in cerebral palsy and epileptic seizures stem from the same underlying pathology.
Cerebral Palsy and Epilepsy
Nearly half of children with cerebral palsy, especially those with limited mobility, will also be diagnosed with epilepsy. Of all types of CP, Quadriplegic spastic cerebral palsy has the highest proportion of patients with epilepsy but there is an association throughout all types of CP. The reason for positive correlation between epilepsy and cerebral palsy is hypothesized to be brain injury. CP stems from a brain injury before, during, or after birth and this injury increases the likelihood for abnormal brain activity to trigger a seizure. It is also important to note that some hypothesized causes of epilepsy overlap with the causes of cerebral palsy, further indicating the correlation between the two: low oxygen levels, head injuries, infections like meningitis, and abnormal substance levels. As research is being conducted further to discover the link (if any) between CP and epilepsy, one thing is clear: there is a strong correlation between the two that likely has to do with shared pathology or cerebral damage.
Treatment & Promising Studies
A recent study in the Official Journal of the American Academy of Pediatrics shows promise in treating CP patients’ seizures. In the article, “Seizures in Children with Cerebral Palsy and White Matter Injury,” researchers found that children with cerebral palsy generally experience the same types of seizures as children that are developing normally. It was also found that the seizures in children with CP occur infrequently and respond very well to medicine, an outcome very optimistic for deriving treatment plans in the future. It appears that cerebral palsy patients that experience seizures will generally find medicine effective, and they will likely outgrow seizures as they develop into adulthood. Most interestingly, the study conducted MRI scans to study the patients’ brains and look for links between epilepsy and CP. White matter injury, the most common type of injury in CP patients, was used to classify patients for the study. Of these patients, one in five experienced seizures that fit a recognized epilepsy syndrome. As of today, the classification for these epilepsy syndromes does not account for children with brain injury, however the study raises an argument that it should. Thus, building evidence suggests that brain injury does not necessarily imply lifelong or directly related seizures, shedding an optimistic light on curing seizures in children with cerebral palsy.
Resources:
Cerebral Palsy Guide (2021). Cerebral Palsy and Epilepsy. Cerebral Palsy Guide. Retrieved from: https://www.cerebralpalsyguide.com/cerebral-palsy/coexisting-conditions/epilepsy/
Cooper, M., Mackay, M., Fahey, M., Reddihough, D., Reid, S., Williams, K., and Harvery S. (2017). Seizures in Children with Cerebral Palsy and White Matter Injury. Pediatrics 147(5), e20162975. Retrieved from: https://doi.org/10.1542/peds.2016-2975
Cooper, M. and Mackay, M. (n.d.) Understanding more about Cerebral Palsy and Seizures. Murdoch Children’s Research Institute. Retrieved from: https://www.mcri.edu.au/users/murdoch-childrens-media/blog/understanding-more-about-cerebral-palsy-and-seizures
Proctor, R.N., K. (2021). What is Cerebral Palsy. Cerebral Palsy Guide. Retrieved from: https://www.cerebralpalsyguide.com/cerebral-palsy/
Wallace, S.J. (2001). Epilepsy in Cerebral Palsy. Developmental Medicine and Child Neurology, 43(10), 713-7. Retrieved from: https://search.proquest.com/docview/195581562?pq-origsite=gscholar&fromopenview=true
