García Ron A, González Toboso R M, Bote Gascón M, de Santos M T, Vecino R, Bodas Pinedo A
Unidad de Neuropediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Madrid, Spain.
Unidad de Neuropediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Madrid, Spain.
Neurologia (Engl Ed). 2023 Jan-Feb;38(1):35-40. doi: 10.1016/j.nrleng.2019.12.006. Epub 2021 Nov 23.
Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life.
We conducted a descriptive, cross-sectional, open-label study of out-patients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS).
Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores.
This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.
消化系统疾病是脑瘫（CP）患儿最常见的合并症之一。本研究旨在探讨CP患者的营养状况、吞咽困难按运动障碍程度的患病率，以及消化系统疾病对生活质量的影响。
我们对马德里地区一家三级医院的CP门诊患者进行了一项描述性、横断面、开放标签研究，采用结构化访谈，使用饮食能力分类系统（EDACS）对吞咽困难进行分类。我们收集了人口统计学和人体测量数据，并分析了吞咽困难严重程度与用粗大运动功能分类系统（GMFCS）测量的功能状态之间的相关性。
我们的样本包括44名患者（65.9%为男孩），平均（标准差）年龄为9.34（5）岁，平均BMI为18.5（4.9）。43%的患者存在安全和效率限制（EDACS水平>II）。安全和效率限制与更广泛的运动受累（60%有四肢瘫）、更多样化的临床表现（87%有混合形式）和更差的功能能力（100%处于GMFCS V级）相关。随着EDACS和GMFCS评分升高，对营养状况的影响增加。
这是首次对西班牙CP儿童和青少年代表性样本中EDACS量表的有用性进行研究。我们的研究结果强调了在这些患者中筛查吞咽困难的重要性，无论运动障碍程度如何，以及早期治疗以预防潜在后果的必要性：营养不良（生长发育受损、微量营养素缺乏、骨质减少等）、微误吸或可能使患者神经状态恶化的反复感染。
