Etiological and clinical evaluation of patients with spastic tetraplegic form of cerebral palsy

Objective: To evaluate the etiology, associated problems, fre¬quency of epilepsy and the factors which affect antiepileptic therapy in children with spastic tetraplegia.
Methods: A total of 270 consecutive patients (60%males) aged 41-190 months (mean 68) with spastic tetraplegia were retrospectively studied. Type and frequency of epilepsy, EEG finding, cranial MRI finding and etiology of spastic tetraple¬gia were analysed.
Results: Follow up period ranged 15 and 35 months (mean 24 months). The % 54.5 of cerebral palsy were evaluated as spastic tetraplegia, hi the etiology the reasons were found as follow: prenatal in 33 patients, postnatal in 39 patients, peri¬natal ini47 patients. The most, frequent cranial MRI finding was cortical lesions (45.5 %). The frequency of epilepsy was 38 % in spastic tetraplegia. In 65 % of the epileptic patients, the onset age of epilepsy was under I year of age, and generalized convulsions were the most common type. Neona¬tal seizures and cranial cortical lesions associated with a hig¬her incidence of epilepsy. Regarding response to antiepileptic therapy there was not apparently any relationship between control of the seizure and the onset age of the epilepsy and the gender of the patients.
Conclusion: Epilepsy in spastic tetraplegia can be predicted if seizures occur in the neonatal period and if there is cort ical lesion in cranial MRI

Serebral palsinin spastik tetraparezik formunda etiolojik ve klinik deðerlendirme

Amaç: Spastik tetraplejide etiolojik faktörleri, eþlik eden sorunlarý, epilepsi sýklýðýný epilepsi tedavisine etkili faktörleri incelemek
Metod: Spastik tetrapleji tanýsý almýþ ve yaþlarý 41-190 ay (ortalama 68) arasýnda deðiþen 270 hastada (%60’ý erkek) etiolojik faktörler, epilepsi sýklýðý, epilepsi türü, kranial man¬yetik rezonans görüntüleme ve EEG bulgularý retrospektif olarak deðerlendirildi.
Bulgular: Hastalarýn izlem süresi ¡5 ay - 35 ay (ort. 24 ay) arasýnda deðiþmekteydi. Serebral palsili hastalarýn % 54.5 spastik tetrapleji tanýsý aldý. Etiolojik faktörler deðerlendiðinde 33 hastada prenatal, 39 hastada postnatal, 147 hastada perinatal risk faktörleri saptandý. Spastik tetrapleji olgularý¬nýn kranial görüntülemelerinde kortikal lezyoýýlar en sýk rastlanan bulgu idi (%45.5). Olgularýmýzýn % 3S‘unda epilepsi saptandý. Býý olgularýn % 65’inde nöbetler bir yaþýndan önce baþlamýþtý ve en sýk jeneralize türde konvülsiyonlar saptan¬mýþtý. Yenidoðan konviilsiyonu ve kranial kortikal lezyonu olan grupta epilepsi insidensi yüksek bulundu. Antikonvülsif tedaviye yanýl ve epilepsinin ortaya çýkýþ yaþý ve hastanýn cinsiyeti arasýnda belirgin bir iliþki saptanmadý.
Sonuç: Çalýþma grubunda yer alan spastik tetraplejik hastalarda yenidoðan döneminde konvülsiyon ve kranial kortikal lezyonu olmasý epilepsi geliþme sýklýðýný artýrdýðý görülmektedir.