Region Västra Götaland, Habilitation and Health, Gothenburg, Sweden.
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Dev Med Child Neurol. 2021 Jul;63(7):839-845. doi: 10.1111/dmcn.14871. Epub 2021 Mar 27.
To determine if walking ability and presence of intellectual disability and epilepsy change from childhood to 50 years of age in individuals with cerebral palsy (CP), and if such changes are related to age, sex, or CP subtype.
This was a population-based follow-up study of 142 adults born from 1959 to 1978 (82 males, 60 females; mean age 48y 4mo, range 37-58y; 44% unilateral, 35% bilateral, 17% dyskinetic, and 4% ataxic CP) listed in the CP register of western Sweden. We compared childhood data with a follow-up assessment in 2016.
At follow-up, walking ability had changed significantly (p<0.001). The proportion of participants walking without aids had decreased from 71% to 62%, and wheelchair ambulation increased from 18% to 25%. Walking ability was related to subtype (p=0.001), but not to age, sex, pain, fatigue, or body mass index. The proportion classified as having intellectual disability had increased from 16% to 22% (p=0.039) and the proportion with epilepsy from 9% to 18% (p=0.015). Of those with childhood epilepsy, 46% were seizure-free without medication.
Walking ability and the presence of intellectual disability and epilepsy had changed significantly since childhood. Life-long access to specialized health care is warranted for re-evaluation of impairments, treatment, and assistance. What this paper adds Changes in impairments in individuals with cerebral palsy (CP) over time are related to CP subtype. After 50 years, walking ability in CP may have deteriorated or improved. Intellectual disability in CP may not always be detected in early childhood assessments. Epilepsy in CP may develop after childhood or may be outgrown.
确定脑瘫患者的步行能力以及智力障碍和癫痫的存在是否会从儿童期持续到 50 岁，并探讨这些变化是否与年龄、性别或脑瘫类型有关。
这是一项基于人群的随访研究，共纳入了 1959 年至 1978 年出生的 142 名成年人（男性 82 名，女性 60 名；平均年龄 48 岁 4 个月，范围 37-58 岁；44%为单侧脑瘫，35%为双侧脑瘫，17%为痉挛型脑瘫，4%为共济失调型脑瘫），他们均在瑞典西部的脑瘫登记处注册。我们将这些患者的儿童时期数据与 2016 年的随访评估结果进行了比较。
在随访时，患者的步行能力发生了显著变化（p<0.001）。无需辅助工具步行的患者比例从 71%下降到 62%，而需要轮椅助行的患者比例从 18%上升到 25%。步行能力与脑瘫类型有关（p=0.001），但与年龄、性别、疼痛、疲劳或体重指数无关。智力障碍的患者比例从 16%上升到 22%（p=0.039），癫痫的患者比例从 9%上升到 18%（p=0.015）。在患有儿童期癫痫的患者中，46%在无需药物治疗的情况下癫痫发作已得到控制。
自儿童期以来，脑瘫患者的步行能力以及智力障碍和癫痫的存在已经发生了显著变化。为了对残疾、治疗和辅助措施进行重新评估，脑瘫患者需要终身获得专业医疗保健。本文的创新点：脑瘫患者的随时间推移的损伤变化与脑瘫类型有关。50 岁以后，脑瘫患者的步行能力可能会恶化或改善。在儿童早期评估中，脑瘫患者的智力障碍可能并不总是被发现。脑瘫患者的癫痫可能会在儿童期之后出现，也可能会自行缓解。
