Department of Paediatrics, Copenhagen University Hospital, Hillerød, Denmark.
Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Acta Paediatr. 2019 Oct;108(10):1850-1856. doi: 10.1111/apa.14806. Epub 2019 Apr 21.
We aimed at describing clinical findings in children with dyskinetic as compared to bilateral spastic cerebral palsy (CP).
Data were extracted from the Danish nationwide CP register. Participants were born in 1999-2007 and were 5-6 years at ascertainment.
The total number of CP cases was 1165 of which 92 had dyskinetic and 540 bilateral spastic CP. Prevalence of dyskinetic CP was 0.16 per 1000 live births. In participants with dyskinetic compared to bilateral spastic CP, there was more frequently an Apgar level less than five at five minutes (22.7% vs. 11.2%) and neonatal seizures (43.5% vs. 28.5%), but less respiratory deficiency, hyperbilirubinaemia and sepsis. Impairment based on gross motor function classification was more severe in dyskinetic CP (level III-V 90.0% vs. 66.0%). In dyskinetic CP, there was a high rate of reduced developmental quotient (68.1%), visual impairment (39.3%) and epilepsy (51.6%). Basal ganglia lesions were more prevalent in dyskinetic compared to bilateral spastic CP (27.7% vs. 12.8%).
Cases of dyskinetic CP had overlapping clinical features with cases of bilateral spastic CP, but differed significantly in several perinatal risk factors. The children with dyskinetic CP had experienced more peri- or neonatal adverse events, and neurodevelopmental impairment was severe.
本研究旨在描述与双侧痉挛性脑瘫(CP)相比,不随意运动型脑瘫患儿的临床特征。
数据来自丹麦全国性脑瘫登记处。参与者于 1999 年至 2007 年出生,在确定时年龄为 5-6 岁。
CP 总病例数为 1165 例,其中不随意运动型 CP 92 例,双侧痉挛性 CP 540 例。不随意运动型 CP 的患病率为每 1000 例活产儿中 0.16 例。与双侧痉挛性 CP 相比,不随意运动型 CP 组中存在更多的新生儿在 5 分钟时 Apgar 评分低于 5 分(22.7% vs. 11.2%)和新生儿癫痫发作(43.5% vs. 28.5%),但呼吸功能不全、高胆红素血症和败血症较少。不随意运动型 CP 组的粗大运动功能障碍严重程度更高(III-V 级 90.0% vs. 66.0%)。在不随意运动型 CP 中,发育商降低的发生率较高(68.1%)、视力障碍(39.3%)和癫痫(51.6%)。基底节病变在不随意运动型 CP 中比双侧痉挛性 CP 更常见(27.7% vs. 12.8%)。
不随意运动型 CP 病例与双侧痉挛性 CP 病例具有重叠的临床特征,但在几个围产期危险因素方面存在显著差异。不随意运动型 CP 患儿经历了更多围生期或新生儿不良事件,神经发育损伤严重。