engleski

Time of onset of brain lesion and motor outcome in children with cerebral palsy in Croatia

Purpose of this study was to analyze relationship between time of onset of lesion (gestational age), type of lesionwith type of CP and functional outcome. Data collected in Croatian register of children with CP, from 2004-2006. was analyzed, containing birth and health status, CP type and subtype, gross motor classification system (GMFCS), bimanual fine motor function (BFMF), classification of MRI and neonatal ultrasound imaging resultsand accompanying impairments.171 children with confirmed diagnosis of CP, with dominant clinical features and MRI imaging were included. Children with present syndromes, congenital anomalies were excluded. 92, 4% of children were classified as spastic type, 6, 4% dyskinetic, and 1, 1% as ataxia. 63, 2% of children had the ability of walking, while 36, 8% were classified as dependent on mobility devices or other peoples help. Significant difference between children with spastic and dyskinetic type was found: spastic CP have better motor outcome (measured by GMFCS) results than dyskinetic and lower gestational age (34, 3weeks comparing to 37, 8 weeks in dyskinetic CP). In spastic group, children classified as bilateral type had worse outcome in GMFCS than unilateral and were born significantly earlier (33, 1weeks comparing to 36, 5 weeks).Considering time of onset of lesion, children were classified in three groups: 30, 5% children were born as early preterm (GA 24-31 weeks), 31, 1% as late preterm (GA 32-37 weeks) and 38, 4% were born at term (GA 38-41 weeks). We found that early preterm children have significantly worse gross motor outcome (GMFCS) than children born at term, but there was no difference in fine motor function.Classification of MRI results showed that 58, 9% of children had predominant white matter injury, 11, 6% were classified as predominant grey matter injury, 9, 82% had brain maldevelopments (such as lissencephaly, pachygyria, polymicrogyria, or scizencephaly), 11, 6% had miscellaneous changes on MRI and 8% were classified as normal MRI. We found that children with predominant gray matter injury have significantly higher GA than children with white matter injury (34, 1comparing 38, 2).There is a significant difference in time of onset of injury of white matter ("early 3rd trimester patterns") that occurs earlier, comparing to gray matter injury ("late 3rd trimester patterns") that occurs at term, with significant impact on gross motor outcome in observed group.

lesion onset ; brain ; motor outcome ; cerebral palsy ; Croatia

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