- Email: [email protected]
P1 – 2109 Assessment of bone mineral density disorders in children with cerebral palsy and epilepsy
S54
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
POSTERS
Cerebral palsy P1 - 2109 Assessment of bone mineral density disorders in children with cerebral palsy and epilepsy Tosun A, Erisen S, Unuvar T, Dursun S. Adnan Menderes Medical School, Department of Pediatric Neurology, Aydin, Turkey – [email protected] Objectives: The aim of this study was to evaluate bone metabolism and mineral density disorders; to determine the effect of possible risk factors including immobilization, mental retardation, calcium and vitamin D deficiency, usage of antiepileptic drugs in children with cerebral palsy-epilepsy. Material and methods: Prepubertal 30 patients with diagnosis of cerebral palsy, 54 with epilepsy and 38 with cerebral palsyepilepsy and 30 healthy children were included into the study. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), 25 OHD3, parathormone (PTH) levels were evaluated and bone mineral density (BMD) were assessed by DEXA. Presence of malnutrition was assessed with Gomez scores. Results: Severe malnutrition was detected in 11% of patients with epilepsy, 36.7% of cerebral palsy, and 44.7% of cerebral palsy-epilepsy. Higher Gross Motor Function Classification System (GMFCS) levels were associated with higher malnutrition rates (p<0.05). Serum Ca levels in cerebral palsy and epilepsy-cerebral palsy groups were detected significantly lower than epilepsy and healthy children groups (p=0.001). The lowest serum 25 OHD3 value was detected in epilepsy-cerebral palsy group (63.2%). Moreover, it was significantly lower in patients receiving more than one anticonvulsant (p<0.05). Serum 25 OHD3 value was significantly related to sunlight, serum Ca, and level of GMFCS (p<0.05). However, there was no relation between serum Ca and BMD and seasons. Abnormal BMD was found in 61 patients (50%). Osteoporosis was detected in 3.7% of patients with epilepsy, 50% of cerebral palsy, and 39.5% of cerebral palsy- epilepsy. Immobility, mental retardation, using of long duration antiepileptic drug were the main reasons for abnormal BMD. Conclusion: Cerebral palsy patients who have immobility, mental retardation, nutrition disorders and receiving antiepileptic drug have higher risk for lower BMD. Serum 25 OHD3 levels should be evaluated in such patients and they should be assessed for BMD periodically.
P2 - 1976 Clinical-imaging correlations in cerebral palsy Minciu I, Barca D, Iliescu C, Tarta-Arsene O, Craiu D. “Carol Davila” University of Medicine, Department of Neurology, Pediatric Neurology, Neurosurgery, Psychiatry - Pediatric Neurology Clinic No.II, Bucharest, Romania Introduction: Neuroimaging is important for identifying cerebral palsy (CP) etiology. Material and method: Using the CP registry, the imaging investigations correlated with clinical data of patients with diagnosis - CP admitted in Paediatric Neurology Clinic Bucharest during year 2010 were retrospectively analysed. SPCE CP classification (spastic, ataxic, dyskinetic) was used. The motor impairment severity was assessed with GMFCS. All patients underwent cerebral CT or MRI. Lesions were classified as: malformations, periventricular white matter lesions (PWML), grey matter lesions (GML), white and grey matter lesions (WGML), other, no lesion. Statistical software package and chi square test were used for data processing. Results: 379 CP children were analysed. Spastic CP forms prevailed (76.2%). Most children (>87%) with CP had neuroimaging abnormalities. WML were the most
17s (2013) S1 – S149
frequent (38.5%), followed by WGML (∼30%). PWML were correlated with spastic diparesis (p<0.001). WGML correlated with spastic hemiparesis, and GML with dyskinetic forms (p<0.001). Malformations were significantly associated with ataxic forms and spastic hemiparesis (p<0.001). We found significant correlations between WGML and the presence of epilepsy (p0.001), severe/profound mental retardation. Microcephaly was correlated with malformations, WGML and “other types of lesions” (p<0.001). Strabismus was present in 92% of the children with PWML (p<0.001). WML were correlated with GMFCS III, IV (p0.000) in our series. WGML were correlated with GMFCS I, but also V (p0.000). Conclusions: Clinical forms and comorbidities were significantly correlated with the type of imaging lesion. The lesion type was correlated with the severity of functional impairment and, most likely, the degree and extent of the lesion, which could not be measured. Therefore, the same type of lesion in terms of description resulted in slight or severe impairment. The CP registry will serve as a base for further research.
P3 - 1961 Development of a clinical algorithm for children with toe-walking Wacks M, Sen S, Varghese K, Watson D, Mankad K, O’Driscsoll M, Kinali M. Paediatric Neurology Chelsea and Westminster Hospital NHS Foundation Trust, United Kingdom – [email protected] Background: Toe-walking is a common presentation within Paediatric Neurology and Neurodevelopmental services. Children under 2 years may toe-walk until an independent gait has been established. Although beyond this age, idiopathic toe-walking occurs, it is a diagnosis of exclusion and warrants assessment to exclude conditions such as cerebral palsy, autism, and neuromuscular diseases. Objectives: 1. Establish the epidemiology of toewalkers within a large single centre paediatric cohort. 2. Establish an association between toe-walking and other diagnoses. 3. Establish the diagnostic yield of MRI brain and spine in toe-walkers in those with and without additional neurological signs/symptoms. 4. Develop an appropriate clinical algorithm for screening of children presenting with toe-walking. Method: We plan to identify children who toe-walk who were seen within Neurology and Neurodevelopmental services in Chelsea and Westminster Hospital from 2009 to April 2013. A retrospective pilot study was carried out of 60 randomly selected children who attended the Neurodevelopmental Services between 2009 and 2013 using the search criteria “Toe Walking”; reviewing their clinic letters, assessment reports and investigations. Results of pilot: Out of 60 case notes reviewed, 12 children had definite histories of toewalking. Of these, 4 had cerebral palsy, 3 had global developmental delay, 2 had autism, 1 had a specific speech and language disorder, 1 had no underlying diagnosis and 1 only had a single audiology review. Four of the 12, had an MRI brain and spine; 3 had normal imaging and 1 had subtle cerebral changes which were thought to unrelated to the toe- walking. Conclusion: The pilot study demonstrated that 12 children (20%) toe-walked. These 12 children showed a significant association with cerebral palsy, autism, speech and language development and global developmental delay. A retrospective study of a larger cohort is currently in progress to produce data allowing the above aims to be met.
P4 - 1946 Quadriplegia following minor trauma in a three year old child with Chiari-I malformation – a management challenge Nabialek T, Kaliaperumal C, Leonard J, Flanagan M. Temple Street Children’s University Hospital, Dublin, Ireland – [email protected] Introduction: Spinal cord injuries following minor trauma are
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
POSTERS
Cerebral palsy P1 - 2109 Assessment of bone mineral density disorders in children with cerebral palsy and epilepsy Tosun A, Erisen S, Unuvar T, Dursun S. Adnan Menderes Medical School, Department of Pediatric Neurology, Aydin, Turkey – [email protected] Objectives: The aim of this study was to evaluate bone metabolism and mineral density disorders; to determine the effect of possible risk factors including immobilization, mental retardation, calcium and vitamin D deficiency, usage of antiepileptic drugs in children with cerebral palsy-epilepsy. Material and methods: Prepubertal 30 patients with diagnosis of cerebral palsy, 54 with epilepsy and 38 with cerebral palsyepilepsy and 30 healthy children were included into the study. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), 25 OHD3, parathormone (PTH) levels were evaluated and bone mineral density (BMD) were assessed by DEXA. Presence of malnutrition was assessed with Gomez scores. Results: Severe malnutrition was detected in 11% of patients with epilepsy, 36.7% of cerebral palsy, and 44.7% of cerebral palsy-epilepsy. Higher Gross Motor Function Classification System (GMFCS) levels were associated with higher malnutrition rates (p<0.05). Serum Ca levels in cerebral palsy and epilepsy-cerebral palsy groups were detected significantly lower than epilepsy and healthy children groups (p=0.001). The lowest serum 25 OHD3 value was detected in epilepsy-cerebral palsy group (63.2%). Moreover, it was significantly lower in patients receiving more than one anticonvulsant (p<0.05). Serum 25 OHD3 value was significantly related to sunlight, serum Ca, and level of GMFCS (p<0.05). However, there was no relation between serum Ca and BMD and seasons. Abnormal BMD was found in 61 patients (50%). Osteoporosis was detected in 3.7% of patients with epilepsy, 50% of cerebral palsy, and 39.5% of cerebral palsy- epilepsy. Immobility, mental retardation, using of long duration antiepileptic drug were the main reasons for abnormal BMD. Conclusion: Cerebral palsy patients who have immobility, mental retardation, nutrition disorders and receiving antiepileptic drug have higher risk for lower BMD. Serum 25 OHD3 levels should be evaluated in such patients and they should be assessed for BMD periodically.
P2 - 1976 Clinical-imaging correlations in cerebral palsy Minciu I, Barca D, Iliescu C, Tarta-Arsene O, Craiu D. “Carol Davila” University of Medicine, Department of Neurology, Pediatric Neurology, Neurosurgery, Psychiatry - Pediatric Neurology Clinic No.II, Bucharest, Romania Introduction: Neuroimaging is important for identifying cerebral palsy (CP) etiology. Material and method: Using the CP registry, the imaging investigations correlated with clinical data of patients with diagnosis - CP admitted in Paediatric Neurology Clinic Bucharest during year 2010 were retrospectively analysed. SPCE CP classification (spastic, ataxic, dyskinetic) was used. The motor impairment severity was assessed with GMFCS. All patients underwent cerebral CT or MRI. Lesions were classified as: malformations, periventricular white matter lesions (PWML), grey matter lesions (GML), white and grey matter lesions (WGML), other, no lesion. Statistical software package and chi square test were used for data processing. Results: 379 CP children were analysed. Spastic CP forms prevailed (76.2%). Most children (>87%) with CP had neuroimaging abnormalities. WML were the most
17s (2013) S1 – S149
frequent (38.5%), followed by WGML (∼30%). PWML were correlated with spastic diparesis (p<0.001). WGML correlated with spastic hemiparesis, and GML with dyskinetic forms (p<0.001). Malformations were significantly associated with ataxic forms and spastic hemiparesis (p<0.001). We found significant correlations between WGML and the presence of epilepsy (p0.001), severe/profound mental retardation. Microcephaly was correlated with malformations, WGML and “other types of lesions” (p<0.001). Strabismus was present in 92% of the children with PWML (p<0.001). WML were correlated with GMFCS III, IV (p0.000) in our series. WGML were correlated with GMFCS I, but also V (p0.000). Conclusions: Clinical forms and comorbidities were significantly correlated with the type of imaging lesion. The lesion type was correlated with the severity of functional impairment and, most likely, the degree and extent of the lesion, which could not be measured. Therefore, the same type of lesion in terms of description resulted in slight or severe impairment. The CP registry will serve as a base for further research.
P3 - 1961 Development of a clinical algorithm for children with toe-walking Wacks M, Sen S, Varghese K, Watson D, Mankad K, O’Driscsoll M, Kinali M. Paediatric Neurology Chelsea and Westminster Hospital NHS Foundation Trust, United Kingdom – [email protected] Background: Toe-walking is a common presentation within Paediatric Neurology and Neurodevelopmental services. Children under 2 years may toe-walk until an independent gait has been established. Although beyond this age, idiopathic toe-walking occurs, it is a diagnosis of exclusion and warrants assessment to exclude conditions such as cerebral palsy, autism, and neuromuscular diseases. Objectives: 1. Establish the epidemiology of toewalkers within a large single centre paediatric cohort. 2. Establish an association between toe-walking and other diagnoses. 3. Establish the diagnostic yield of MRI brain and spine in toe-walkers in those with and without additional neurological signs/symptoms. 4. Develop an appropriate clinical algorithm for screening of children presenting with toe-walking. Method: We plan to identify children who toe-walk who were seen within Neurology and Neurodevelopmental services in Chelsea and Westminster Hospital from 2009 to April 2013. A retrospective pilot study was carried out of 60 randomly selected children who attended the Neurodevelopmental Services between 2009 and 2013 using the search criteria “Toe Walking”; reviewing their clinic letters, assessment reports and investigations. Results of pilot: Out of 60 case notes reviewed, 12 children had definite histories of toewalking. Of these, 4 had cerebral palsy, 3 had global developmental delay, 2 had autism, 1 had a specific speech and language disorder, 1 had no underlying diagnosis and 1 only had a single audiology review. Four of the 12, had an MRI brain and spine; 3 had normal imaging and 1 had subtle cerebral changes which were thought to unrelated to the toe- walking. Conclusion: The pilot study demonstrated that 12 children (20%) toe-walked. These 12 children showed a significant association with cerebral palsy, autism, speech and language development and global developmental delay. A retrospective study of a larger cohort is currently in progress to produce data allowing the above aims to be met.
P4 - 1946 Quadriplegia following minor trauma in a three year old child with Chiari-I malformation – a management challenge Nabialek T, Kaliaperumal C, Leonard J, Flanagan M. Temple Street Children’s University Hospital, Dublin, Ireland – [email protected] Introduction: Spinal cord injuries following minor trauma are