- Email: [email protected]
O32 – 1912 Brain volume reduction in young adults with perinatal hypoxic-ischaemic encephalopathy
S10
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
ness was present in 65%. Focal deficits, confusion and severe disturbance of consciousness were more common in ADEM than in IE. Seizures occurred more often in HSV encephalitis. Focal deficits were more typical of VZV. CSF was abnormal in 85, EEG in 93%. Severe diffuse dysfunction occurred more often in ADEM than in IE. Periodic changes, focal and paroxysmal changes were more typical of HSV than of other etiologies. MRI was abnormal in 96% of ADEM and 53% of IE cases examined. 58% of all and 79% of ADEM patients required intensive care. HSV patients were more likely to require intensive care and for a longer duration, than patients with other etiologies. Mortality rate was 3%. Sequelae (26%) occurred more often after ADEM, following severely disturbed consciousness, seizure(s), severe diffuse dysfunction, focal, paroxysmal and periodic changes of the EEG and abnormal MRI. 14% developed epilepsy. Relapses occurred in 1 HSV and 2 ADEM patients. The most important predictors of unfavourable outcome were: ADEM, HSV-etiology, severely disturbed consciousness, focal seizures, paresis, pyramidal signs, paroxysmal EEG changes, cortical, subcortical abnormal signal on MRI. Conclusion: This large series of paediatric encephalitis patients is unique in terms of the high-ratio of successful epidemiological workup and of the correlations found between the acute phase and the outcome.
O30 - 1893 Guillain-Barré syndrome in UK children: H1N1 vaccinations, preceding infections and clinical features Verity C. Addenbrookes Hospital, Cambridge, UK – [email protected] Objectives: To identify all new cases of Guillain-Barré syndrome (GBS) or Fisher syndrome (FS) in United Kingdom (UK) children in the 2 years following September 2009 and determine the proportion that was temporally associated with recent infections, with pandemic H1N1 (2009) strain influenza vaccination or with seasonal influenza vaccination. To report the clinical features of these cases. Material and methods: A prospective UK-wide epidemiological study using the British Paediatric Surveillance Unit (BPSU) system, including all children aged ≤16 years meeting the Brighton Collaboration criteria for GBS or FS. Results: We identified 112 children with GBS (66 boys and 46 girls) and 3 boys with FS in 2 years. The annual incidence rate of GBS in our patients <15 years old was 0.45/100,000, similar to other countries. Infection preceded the onset of symptoms in all but 20 of the 115 GBS/FS cases. In England 7 GBS cases received H1N1 (2009) vaccination and 3 others received seasonal vaccination within 6 months of symptom onset: no more than expected by chance. Most GBS cases were too weak to walk (90/112) and most (80) received intravenous immunoglobulin. 13 of the 112 GBS cases needed ventilation. About a third of GBS children had dysautonomia. 114/115 recovered sufficiently to go home. Conclusions: In 1976 a national immunization programme against swine influenza in the United States was discontinued because GBS was associated with vaccination. However we found that the majority of GBS and FS cases were temporally associated with previous infections, with no evidence of a temporal link with pandemic H1N1 (2009) strain vaccination in children. The outcome for GBS and FS after 6 months was better than reported in adult studies. Acknowledgements: Thanks to notifying paediatricans and the BPSU. Department of Health (DH) grant 019/0047: views expressed are not necessarily those of the DH.
17s (2013) S1 – S149
Parallel session 6: Cerebral palsy Chairs: Florian Heinen and Bernard Dan
O31 - 1568 Neonatal neuroimaging predicts recruitment of contralesional corticospinal tracts following perinatal brain injury van der Aa NE, Verhage CH, Groenendaal F, Vermeulen RJ, de Bode S, van Nieuwenhuizen O, de Vries LS. Department of Neonatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands – [email protected] Objectives: Unilateral perinatal brain injury may result in recruitment of ipsilateral projections originating in the unaffected hemisphere and development of unilateral spastic cerebral palsy (USCP). The aim was to assess the predictive value of neonatal neuroimaging following perinatal brain injury for recruitment of ipsilateral corticospinal tracts. Methods: Neonatal magnetic resonance imaging and cranial ultrasound scans of 37 children (20 males, 17 females; median [range] gestational age 36 wk+4 [26+6–42wk+5] and birthweight 2312 ([770–5230]) g with unilateral perinatal arterial ischaemic stroke (n=23) or periventricular haemorrhagic infarction (n=14) were reviewed and scored for involvement of the corticospinal trajectory. Hand function was assessed using the Assisting Hand Assessment (AHA) and Transcranial Magnetic Stimulation (TMS) was performed (age range 7years and 4 months –18 years and 7 months) to determine the type of cortical motor organisation (normal, mixed or ipsilateral). Neuroimaging scores were used to predict TMS patterns. Results: Eighteen children developed USCP (49%), with ipsilateral corticospinal tract projections in 13 children (8 mixed, 5 ipsilateral). AHA scores decreased with increased ipsilateral projections. Asymmetry of the corticospinal tracts seen on neonatal MRI was predictive of development of USCP and recruitment of ipsilateral tracts (positive and negative predictive value of 73% and 91%). Conclusion: Neonatal neuroimaging can predict recruitment of ipsilateral corticospinal tracts. Early knowledge of the expected pattern of cortical motor organisation will allow early identification of children eligible for early therapy.
O32 - 1912 Brain volume reduction in young adults with perinatal hypoxic-ischaemic encephalopathy Bregant T, Rados M, Vasung L, Zadnik V, Derganc M, Evans AC, Neubauer D, Kostovic I. Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia – [email protected] Objectives: A severe form of perinatal hypoxic-ischaemic encephalopathy (HIE) carries a high risk of perinatal death and severe neurological sequellae while in moderate and mild HIE only discrete cognitive disorders may occur. Imaging biomarkers for long term outcome in children with perinatal HIE are not known. Material and methods: MR imaging (3T Magnetom Trio Tim, Siemens) was performed in a cohort of 14 young adults (9 males, 5 females, mean age 22.1±0.7 years) with a history of mild or moderate perinatal HIE defined by Sarnat and Sarnat criteria. The control group consisted of healthy participants (9 males, 5 females, mean age 22.8±0.7 years). Volumetric analysis was done after the MR images processing using a fully automated CIVET pipeline. We measured gyrification indexes, total brain volume, volume of white and grey matter, and cerebrospinal fluid. We measured volumes, thickness and area of the cerebral cortex in the frontal, parietal, temporal, occipital lobe, and of the cingulated and parahippocampal gyrus, isthmus cinguli, and insula. Results: The HIE patient group showed smaller absolute volumetric data. Statistically significant (p<0.05) reductions of
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
gyrification index in the right hemisphere, of cortical areas in the right temporal lobe and parahippocampal gyrus, of cortical volumes in the right temporal lobe and of cortical thickness in the right isthmus of the cingulate gyrus were found. Comparison between the healthy group and the HIE group of the same gender showed statistically significant changes in the male HIE patients, where a significant reduction was found also in whole brain volume; left parietal, bilateral temporal, and right parahippocampal gyrus cortical areas; and bilateral temporal lobe cortical volume. Conclusions: Our analysis showed general total brain volume reduction in HIE patients with predilection changes in the temporal lobes and parahippocampal gyrus.
O33 - 2123 Visual spatial perceptual profiles in children with developmental coordination disorder or in very premature children with cerebral palsy Gonzalez Monge S. Praticien Hospitalier, Lyon, France – [email protected] The visual-spatial function appears to be particularly sensitive to neuro-cognitive developmental disorders. This emphasizes the clinical importance of using tools to specifically test the visuospatial function during development. The aim of our study was to compare the visual spatial perceptual profiles in two groups of children with Developmental Coordination Disorder (DCD) or with Cerebral Palsy (CP) (i e without or with early cerebral lesions). We selected two groups of children aged 8 to 12 years old. Ten children were identified as having DCD following DSMIV-TR criteria and a score below the 5% cut-off point on M-ABC-2 (Movement Assessment Battery for Children-Second Edition) and ten children with following criteria: diagnosis of Spastic Diplegia (SD), gestational age at birth was inferior to 33 weeks, diagnosis of Periventicular Leukomalacia documented by brain MRI. Each child had a full-scale IQ-score above 70 on WISC-IV (Wechsler Intelligence Scale for Children-Fourth Edition) and a low score on block design test (Perceptual Reasoning Index). All children were assessed with the DTVP-2 (Developmental Test of Visual Perception-Second Edition) measuring visual perceptual skills (NMVPQ, Non Motor Visual Perceptual Quotient) and visual motor integration nskills (VMIQ, Visual Motor Integration Quotient). In 8 out of 10 very premature children with SD, concerning the DTVP profile, the VMIQ was lower than the NMVPQ and concerning MRI data, these children presented a posterior parietal white matter (or dorsal stream) involvement. The same DTVP’s profile was obtained in 5 out of 10 children identified as having DCD and these results suggest that the dorsal stream could be involved, in the same way, in a neurocognitive developmental disorder without identified cerebral lesion. To conclude, the comparison of both neurocognitive developmental disorders could shed light on neuroanatomical bases of visual spatial perceptual impairment in children.
O34 - 1931 Innovative application of the motion graph deviation indexes for the quantification of the pre-post BTX – a upper limb movement changes Darras N, Vanezis T, Tziomaki M, Pasparakis D, Papavasiliou A. Elepap Gait Analysis and Motion Analysis Center, Athens, Greece – [email protected] The kinematic assessment of upper limb function requires the examination of a variety of tasks; this produces a very large set of data that is difficult to clinically analyze. We aimed to apply a new method that simplifies and enhances the quantitative assessment of upper limb performance pre and post Botulinum Toxin A (BTX-A) injection; this method has been previously
17s (2013) S1 – S149
S11
used in Gait Analysis and produces Motion Graph Deviation Indexes (MGDIs) that enable the examiner to summarize and directly compare graph information from different parameters and motions. Methods: Twenty Typically Developing subjects (age = 14.2±6.6) were used for creating the Normal graphs. One patient with dystonia and two with spasticity were assessed pre and four weeks post BTX-A application. All subjects completed four “reach to grasp” and four gross motor tasks. The examiners were blind regarding injection sites and procedures. Kinematic calculations were based on the recommendations of the International Society of Biomechanics. MGDIs were calculated. Motion Indexes (MI) and Graph Indexes (GI) were created from the average MGDIs, representing the subject’s deviation at a specific motion and at each graph respectively. Finally the Global Upper Limb Deviation Index was calculated from the averaged MI’s demonstrating the overall subject deviation and four Body Level Indexes averaging the MGDIs of the Head-Trunk, Shoulder, Elbow and Wrist graphs of all motions. Pre-Post BTX-A index differences were calculated. The results were used to identify the Body Levels that showed changes on the Pre-Post BTX-A indexes. Results: The use of the four Body Level Indexes enabled the prediction of the areas that BTX-A was injected with 70–100% accuracy. Conclusion: This Upper Limb assessment protocol and the application of MGDIs were sensitive in recording and identifying the movement changes after BTX-A treatment.
O35 - 1861 Cerebral visual impairment and cerebral palsy: two sides of the same coin? Fazz E, Galli J, Micheletti S, Rossi A, Franzoni A. Civil Hospital Brescia Ð, Italy – [email protected] Aim: the Cerebral Visual Impairment (CVI) (neurological disorder caused by damage to or malfunctioning of the retrogeniculate visual pathways) has been recognised as an important part of clinical manifestations in Cerebral palsy (CP). CP and CVI share a common origin; the literature shows that 60–70% of children with CP also have CVI. We set out to describe CVI in children with CP. A further aim was to establish whether different types of CP are associated with different patterns of visual involvement. Methods: 129 patients with CP and CVI underwent an assessment protocol including neurological examination, developmental (Griffiths Mental Development Scales50) and/or cognitive assessment (Wechsler Scales of Intelligence51), neuro- ophthalmological evaluation (using the Hirschberg Test of corneal reflexes 42), the Cover Test and the Paliaga Test 43 to detect strabismus; Teller Acuity Cards 44, Lea Symbols 45 or letter optotypes to evaluate visual acuity; Hiding Heidi Low Contrast “Face” Test 46 to determine contrast sensitivity; using a semirigid screen covered with black and white square patterns in front of the infant’s face to test the optokinetic nystagmus 47, evaluating the behavioural reactions to the kinetic perimetry to assess the visual field 48 and Lang Stereotest 49 to verify stereopsis) and neuroradiological investigations. Results: Visual dysfunction in diplegia was characterised mainly by refractive errors (75% of cases), strabismus (90%), abnormal saccadic movements (86%), reduced visual acuity (82%). The subjects with hemiplegia showed strabismus (71%), refractive errors (88%); oculomotor involvement was less frequent (59%). This group had the largest percentage of patients with altered visual field (64%). Children with tetraplegia showed a severe neuro-ophthalmological profile, characterised by ocular abnormalities (98%), oculomotor dysfunction (100%) and reduced visual acuity (98%). Interpretation: Neuro-ophthalmological disorders are a main symptom in CP, associated with a distinct neuro-ophthalmological profile. Early and careful neuro-ophthalmological assessment of children with CP is essential for an accurate diagnosis and for personalised rehabilitation tools.
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
ness was present in 65%. Focal deficits, confusion and severe disturbance of consciousness were more common in ADEM than in IE. Seizures occurred more often in HSV encephalitis. Focal deficits were more typical of VZV. CSF was abnormal in 85, EEG in 93%. Severe diffuse dysfunction occurred more often in ADEM than in IE. Periodic changes, focal and paroxysmal changes were more typical of HSV than of other etiologies. MRI was abnormal in 96% of ADEM and 53% of IE cases examined. 58% of all and 79% of ADEM patients required intensive care. HSV patients were more likely to require intensive care and for a longer duration, than patients with other etiologies. Mortality rate was 3%. Sequelae (26%) occurred more often after ADEM, following severely disturbed consciousness, seizure(s), severe diffuse dysfunction, focal, paroxysmal and periodic changes of the EEG and abnormal MRI. 14% developed epilepsy. Relapses occurred in 1 HSV and 2 ADEM patients. The most important predictors of unfavourable outcome were: ADEM, HSV-etiology, severely disturbed consciousness, focal seizures, paresis, pyramidal signs, paroxysmal EEG changes, cortical, subcortical abnormal signal on MRI. Conclusion: This large series of paediatric encephalitis patients is unique in terms of the high-ratio of successful epidemiological workup and of the correlations found between the acute phase and the outcome.
O30 - 1893 Guillain-Barré syndrome in UK children: H1N1 vaccinations, preceding infections and clinical features Verity C. Addenbrookes Hospital, Cambridge, UK – [email protected] Objectives: To identify all new cases of Guillain-Barré syndrome (GBS) or Fisher syndrome (FS) in United Kingdom (UK) children in the 2 years following September 2009 and determine the proportion that was temporally associated with recent infections, with pandemic H1N1 (2009) strain influenza vaccination or with seasonal influenza vaccination. To report the clinical features of these cases. Material and methods: A prospective UK-wide epidemiological study using the British Paediatric Surveillance Unit (BPSU) system, including all children aged ≤16 years meeting the Brighton Collaboration criteria for GBS or FS. Results: We identified 112 children with GBS (66 boys and 46 girls) and 3 boys with FS in 2 years. The annual incidence rate of GBS in our patients <15 years old was 0.45/100,000, similar to other countries. Infection preceded the onset of symptoms in all but 20 of the 115 GBS/FS cases. In England 7 GBS cases received H1N1 (2009) vaccination and 3 others received seasonal vaccination within 6 months of symptom onset: no more than expected by chance. Most GBS cases were too weak to walk (90/112) and most (80) received intravenous immunoglobulin. 13 of the 112 GBS cases needed ventilation. About a third of GBS children had dysautonomia. 114/115 recovered sufficiently to go home. Conclusions: In 1976 a national immunization programme against swine influenza in the United States was discontinued because GBS was associated with vaccination. However we found that the majority of GBS and FS cases were temporally associated with previous infections, with no evidence of a temporal link with pandemic H1N1 (2009) strain vaccination in children. The outcome for GBS and FS after 6 months was better than reported in adult studies. Acknowledgements: Thanks to notifying paediatricans and the BPSU. Department of Health (DH) grant 019/0047: views expressed are not necessarily those of the DH.
17s (2013) S1 – S149
Parallel session 6: Cerebral palsy Chairs: Florian Heinen and Bernard Dan
O31 - 1568 Neonatal neuroimaging predicts recruitment of contralesional corticospinal tracts following perinatal brain injury van der Aa NE, Verhage CH, Groenendaal F, Vermeulen RJ, de Bode S, van Nieuwenhuizen O, de Vries LS. Department of Neonatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands – [email protected] Objectives: Unilateral perinatal brain injury may result in recruitment of ipsilateral projections originating in the unaffected hemisphere and development of unilateral spastic cerebral palsy (USCP). The aim was to assess the predictive value of neonatal neuroimaging following perinatal brain injury for recruitment of ipsilateral corticospinal tracts. Methods: Neonatal magnetic resonance imaging and cranial ultrasound scans of 37 children (20 males, 17 females; median [range] gestational age 36 wk+4 [26+6–42wk+5] and birthweight 2312 ([770–5230]) g with unilateral perinatal arterial ischaemic stroke (n=23) or periventricular haemorrhagic infarction (n=14) were reviewed and scored for involvement of the corticospinal trajectory. Hand function was assessed using the Assisting Hand Assessment (AHA) and Transcranial Magnetic Stimulation (TMS) was performed (age range 7years and 4 months –18 years and 7 months) to determine the type of cortical motor organisation (normal, mixed or ipsilateral). Neuroimaging scores were used to predict TMS patterns. Results: Eighteen children developed USCP (49%), with ipsilateral corticospinal tract projections in 13 children (8 mixed, 5 ipsilateral). AHA scores decreased with increased ipsilateral projections. Asymmetry of the corticospinal tracts seen on neonatal MRI was predictive of development of USCP and recruitment of ipsilateral tracts (positive and negative predictive value of 73% and 91%). Conclusion: Neonatal neuroimaging can predict recruitment of ipsilateral corticospinal tracts. Early knowledge of the expected pattern of cortical motor organisation will allow early identification of children eligible for early therapy.
O32 - 1912 Brain volume reduction in young adults with perinatal hypoxic-ischaemic encephalopathy Bregant T, Rados M, Vasung L, Zadnik V, Derganc M, Evans AC, Neubauer D, Kostovic I. Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia – [email protected] Objectives: A severe form of perinatal hypoxic-ischaemic encephalopathy (HIE) carries a high risk of perinatal death and severe neurological sequellae while in moderate and mild HIE only discrete cognitive disorders may occur. Imaging biomarkers for long term outcome in children with perinatal HIE are not known. Material and methods: MR imaging (3T Magnetom Trio Tim, Siemens) was performed in a cohort of 14 young adults (9 males, 5 females, mean age 22.1±0.7 years) with a history of mild or moderate perinatal HIE defined by Sarnat and Sarnat criteria. The control group consisted of healthy participants (9 males, 5 females, mean age 22.8±0.7 years). Volumetric analysis was done after the MR images processing using a fully automated CIVET pipeline. We measured gyrification indexes, total brain volume, volume of white and grey matter, and cerebrospinal fluid. We measured volumes, thickness and area of the cerebral cortex in the frontal, parietal, temporal, occipital lobe, and of the cingulated and parahippocampal gyrus, isthmus cinguli, and insula. Results: The HIE patient group showed smaller absolute volumetric data. Statistically significant (p<0.05) reductions of
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
gyrification index in the right hemisphere, of cortical areas in the right temporal lobe and parahippocampal gyrus, of cortical volumes in the right temporal lobe and of cortical thickness in the right isthmus of the cingulate gyrus were found. Comparison between the healthy group and the HIE group of the same gender showed statistically significant changes in the male HIE patients, where a significant reduction was found also in whole brain volume; left parietal, bilateral temporal, and right parahippocampal gyrus cortical areas; and bilateral temporal lobe cortical volume. Conclusions: Our analysis showed general total brain volume reduction in HIE patients with predilection changes in the temporal lobes and parahippocampal gyrus.
O33 - 2123 Visual spatial perceptual profiles in children with developmental coordination disorder or in very premature children with cerebral palsy Gonzalez Monge S. Praticien Hospitalier, Lyon, France – [email protected] The visual-spatial function appears to be particularly sensitive to neuro-cognitive developmental disorders. This emphasizes the clinical importance of using tools to specifically test the visuospatial function during development. The aim of our study was to compare the visual spatial perceptual profiles in two groups of children with Developmental Coordination Disorder (DCD) or with Cerebral Palsy (CP) (i e without or with early cerebral lesions). We selected two groups of children aged 8 to 12 years old. Ten children were identified as having DCD following DSMIV-TR criteria and a score below the 5% cut-off point on M-ABC-2 (Movement Assessment Battery for Children-Second Edition) and ten children with following criteria: diagnosis of Spastic Diplegia (SD), gestational age at birth was inferior to 33 weeks, diagnosis of Periventicular Leukomalacia documented by brain MRI. Each child had a full-scale IQ-score above 70 on WISC-IV (Wechsler Intelligence Scale for Children-Fourth Edition) and a low score on block design test (Perceptual Reasoning Index). All children were assessed with the DTVP-2 (Developmental Test of Visual Perception-Second Edition) measuring visual perceptual skills (NMVPQ, Non Motor Visual Perceptual Quotient) and visual motor integration nskills (VMIQ, Visual Motor Integration Quotient). In 8 out of 10 very premature children with SD, concerning the DTVP profile, the VMIQ was lower than the NMVPQ and concerning MRI data, these children presented a posterior parietal white matter (or dorsal stream) involvement. The same DTVP’s profile was obtained in 5 out of 10 children identified as having DCD and these results suggest that the dorsal stream could be involved, in the same way, in a neurocognitive developmental disorder without identified cerebral lesion. To conclude, the comparison of both neurocognitive developmental disorders could shed light on neuroanatomical bases of visual spatial perceptual impairment in children.
O34 - 1931 Innovative application of the motion graph deviation indexes for the quantification of the pre-post BTX – a upper limb movement changes Darras N, Vanezis T, Tziomaki M, Pasparakis D, Papavasiliou A. Elepap Gait Analysis and Motion Analysis Center, Athens, Greece – [email protected] The kinematic assessment of upper limb function requires the examination of a variety of tasks; this produces a very large set of data that is difficult to clinically analyze. We aimed to apply a new method that simplifies and enhances the quantitative assessment of upper limb performance pre and post Botulinum Toxin A (BTX-A) injection; this method has been previously
17s (2013) S1 – S149
S11
used in Gait Analysis and produces Motion Graph Deviation Indexes (MGDIs) that enable the examiner to summarize and directly compare graph information from different parameters and motions. Methods: Twenty Typically Developing subjects (age = 14.2±6.6) were used for creating the Normal graphs. One patient with dystonia and two with spasticity were assessed pre and four weeks post BTX-A application. All subjects completed four “reach to grasp” and four gross motor tasks. The examiners were blind regarding injection sites and procedures. Kinematic calculations were based on the recommendations of the International Society of Biomechanics. MGDIs were calculated. Motion Indexes (MI) and Graph Indexes (GI) were created from the average MGDIs, representing the subject’s deviation at a specific motion and at each graph respectively. Finally the Global Upper Limb Deviation Index was calculated from the averaged MI’s demonstrating the overall subject deviation and four Body Level Indexes averaging the MGDIs of the Head-Trunk, Shoulder, Elbow and Wrist graphs of all motions. Pre-Post BTX-A index differences were calculated. The results were used to identify the Body Levels that showed changes on the Pre-Post BTX-A indexes. Results: The use of the four Body Level Indexes enabled the prediction of the areas that BTX-A was injected with 70–100% accuracy. Conclusion: This Upper Limb assessment protocol and the application of MGDIs were sensitive in recording and identifying the movement changes after BTX-A treatment.
O35 - 1861 Cerebral visual impairment and cerebral palsy: two sides of the same coin? Fazz E, Galli J, Micheletti S, Rossi A, Franzoni A. Civil Hospital Brescia Ð, Italy – [email protected] Aim: the Cerebral Visual Impairment (CVI) (neurological disorder caused by damage to or malfunctioning of the retrogeniculate visual pathways) has been recognised as an important part of clinical manifestations in Cerebral palsy (CP). CP and CVI share a common origin; the literature shows that 60–70% of children with CP also have CVI. We set out to describe CVI in children with CP. A further aim was to establish whether different types of CP are associated with different patterns of visual involvement. Methods: 129 patients with CP and CVI underwent an assessment protocol including neurological examination, developmental (Griffiths Mental Development Scales50) and/or cognitive assessment (Wechsler Scales of Intelligence51), neuro- ophthalmological evaluation (using the Hirschberg Test of corneal reflexes 42), the Cover Test and the Paliaga Test 43 to detect strabismus; Teller Acuity Cards 44, Lea Symbols 45 or letter optotypes to evaluate visual acuity; Hiding Heidi Low Contrast “Face” Test 46 to determine contrast sensitivity; using a semirigid screen covered with black and white square patterns in front of the infant’s face to test the optokinetic nystagmus 47, evaluating the behavioural reactions to the kinetic perimetry to assess the visual field 48 and Lang Stereotest 49 to verify stereopsis) and neuroradiological investigations. Results: Visual dysfunction in diplegia was characterised mainly by refractive errors (75% of cases), strabismus (90%), abnormal saccadic movements (86%), reduced visual acuity (82%). The subjects with hemiplegia showed strabismus (71%), refractive errors (88%); oculomotor involvement was less frequent (59%). This group had the largest percentage of patients with altered visual field (64%). Children with tetraplegia showed a severe neuro-ophthalmological profile, characterised by ocular abnormalities (98%), oculomotor dysfunction (100%) and reduced visual acuity (98%). Interpretation: Neuro-ophthalmological disorders are a main symptom in CP, associated with a distinct neuro-ophthalmological profile. Early and careful neuro-ophthalmological assessment of children with CP is essential for an accurate diagnosis and for personalised rehabilitation tools.