Vol. 16/007, nr 3 3
Epilepsy in cerebral palsy. Comprehensi�e questionnaire research
Comprehensi�e questionnaire research
Comprehensi�e questionnaire research
performed in three different pro�inces in poland
padaczka w mózgowym porażeniu dziecięcym. Badania populacyjne na podstawie wyników
z trzech województw
1
Maria Mazurkiewicz-Bełdzińska,
1Marta Szmuda,
1Agnieszka Matheisel,
2Janusz Wendorff,
3Anna Gniadkowska-Nowakowska
1
Departament of Developmental Neurology, Chair of Neurology, Medical University of Gdańsk, Poland
2Department of Pediatric Neurology, Polish Mother’s Memorial Hospital Research Institute, Łodź
3County of Kielce Children’s Epilepsy Outpatient Centre
STRESZCZENIE
Wprowadzenie. Współwystępowanie mózgowego porażenia
dziecięcego (MPD) i padaczki jest częstym zjawiskiem i wymaga szczególnej uwagi ze strony neurologów dziecięcych. W ostat-nich latach dokonał się znaczny postęp w leczeniu padaczki oraz zwiększyła się znacznie liczba dostępnych na rynku leków prze-ciwpadaczkowych, co pozwoliło na dobór optymalnej metody leczenia u pacjentów z MPD. Cel pracy. Określenie częstości występowania padaczki oraz sposobu jej leczenia u pacjentów z MPD w trzech regionach Polski. Materiał i metody. Badaniem objęto 1115 dzieci z rozpoznaną padaczką i współistniejącym MPD pozostających pod opieką trzech poradni neurologicznych dla dzieci (w Gdańsku, Łodzi i Kielcach). Rodzaj padaczki, a także metody i skuteczność jej leczenia zostały poddane ana-lizie. Grupę kontrolną stanowiły dzieci z izolowaną padaczką.
Wyniki. Padaczka występowała u 178 (16%) pacjentów z
MPD. W tej grupie przeważały napady częściowe złożone wtór-nie uogólnione (62%), ponadto występowały napady toniczne (22%), częściowe złożone (20%), miokloniczne (10%), atypowe napady nieświadomości (8%). Większość dzieci z MPD była leczona kwasem walproinowym (74%) i karbamazepiną (41%). Benzodiazepiny stosowano statystycznie częściej u dzieci z padaczką i współistniejącym MPD niż w grupie z izolowaną padaczką. Sukces terapeutyczny (zmniejszenie liczby napadów o co najmniej 75%) osiągnięto u 54,6% pacjentów (z tego u 89% stosowano monoterapię) – odsetek ten był znacząco niższy niż w grupie dzieci z izolowaną padaczką. Wnioski. Padaczka często występuje u dzieci z MPD. Skuteczność leczenia prze-ciwpadaczkowego w tej grupie jest niższa niż w grupie dzieci z izolowaną padaczką.
Słowa kluczowe: padaczka, porażenie mózgowe, leczenie
padaczki, dzieci
ABSTRACT
Introduction: Children with cerebral palsy (CP) often suffer from
associated neurological problems and the association between CP and epilepsy is considered to be an important issue. In last years advantages in epilepsy treatment have been made (sev-eral new antiepileptic drugs have been introduced). Aim of
study: Determination of the prevalence of CP among children
with epilepsy in the group of patients embraced by the care of developmental neurology out-patient clinic in three provinces in Poland as well as determination of major types of antiepileptic treatment. Materials and Methods: The study group consisted of 1115 consecutive patients presented in outpatients’ child-neurology clinics in three province-cities in Poland (Gdansk, Lodz and Kielce). We isolated the group of patients with CP and analysed their type of epilepsy and type of received treatment as well as overall response rate for treatment comparing those results with non-CP epilepsy group. Results: Among 1115 patients with epilepsy – 178 had CP (16%). Children with CP had mostly secondarily generalized seizures (62%), tonic sei-zures (22%), complex partial seisei-zures (20%), myoclonic seisei-zures (10%), atypical absence seizures (8%). Majority of CP children were treated with valproic acid (74%), than carbamazepine (41%). Interestingly statistically significant more children with CP than with “pure” epilepsy were treated with benzodi-azepines. The success rate (more than 75% of seizure reduc-tion) was 54.6% (89% on monotherapy), this was significantly less that in isolated epilepsy group. Conclusions: Epilepsy is a serious co-morbidity in children with CP. There are several factors which need to be considered when starting treatment, especially that the effectiveness of AEDs treatment seems to be less effective in children with CP.
Key words: epilepsy, cerebral palsy, antiepileptic treatment,
Neurologia Dziecięca 36
Cerebral palsy �C�� �s a ���-pr�gress�ve d�s�rder, caused by perma�e�� bra�� damage a� early s�age �f devel�pme��. �a��e��s w��h C� prese�� a var�e�y �f symp��ms a�d ab��rmal���es, �ha� crea�es all ��ge�her charac�er�s��c �eur�l�g�cal sy�dr�mes �f he�-er�ge�e�us e���l�gy. M�veme�� d�s�rders are �f�e� acc�mpa��ede���l�gy. M�veme�� d�s�rders are �f�e� acc�mpa��ed. M�veme�� d�s�rders are �f�e� acc�mpa��ed by decrease �� c�g����ve fu�c����s, s�gh� �r hear��g �mpa�rme�� a�d speech delay. Cl���cal p�c�ure �s freque��ly ass�c�a�ed w��h prese�ce �f ep�lepsy. Acc�rd��g �� �he w�rld-w�de l��era�ure, ep�-lepsy ex�s�s �� ab�u� 15 �� 60 [1] �r eve� 90% [2] pa��e��s w��h d�ag��sed C�. Tha� pa��e��s c��s���u�es ab�u� 0.5–1% �f ge�eral p�pula����. The freque�cy �f ep�lepsy var�es am��g d�ffere�� �ypes �f C� – h�gher �� spas��c quadr�pleg�a a�d �he l�wes� �� spas��c d�pleg�a a�d dys����c C� [3, 4]. Acc�rd��g �� Gururaj [1], C� ep�lepsy c��s���u�es ab�u� 10–20% �f all ep�leps�es. H�wever, �here �s s��ll ��� e��ugh ep�dem��l�g�cal da�a �� c��f�rm �ha� per-ce��age.
C�rrec� d�ag��s�s c��f�rm��g c�ex�s�e�ce �f b��h �eur�l�g�-cal c��d�����s �� ch�ldre� �s par��cularly valuable, as ipso facto pr�v�des a p�ss�b�l��y �f pr�mp� pharmac�l�g�cal �r �eur�surg�cal �rea�me�� �mpleme��a����. I� �s h�ghly s�g��f�ca�� �� pa��e��s, wh� ��� ��ly suffer fr�m phys�cal a�d me��al �mpa�rme�� c���ec�ed w��h �he prese�ce �f C�, bu� als� are a� r�sk �f escala�ed c�urse �f ep�lepsy. M�re�ver, �he age �f se��ure ��se� �s c��s�derably l�wer �� c�mpar�s�� �� ch�ldre� w��h �s�la�ed ep�lepsy, as well as �he m����herapy �s c�mm��ly f�u�d �� be ��effec��ve [5].
The a�m �f �h�s s�udy was �� ver�fy �he prevale�ce �f C� �� ver�fy �he prevale�ce �f C� am��g ch�ldre� w��h ep�lepsy �� �he gr�up �f pa��e��s embraced by �he care �f devel�pme��al �eur�l�gy �u�-pa��e�� cl���c �� �hree pr�v��ces �� ��la�d as well as de�erm��e maj�r �ypes �f a���ep�-lep��c �rea�me��.
Maj�r��y �f �he sc�e���f�c research are c��duc�ed �� �umer�-cally l�w gr�ups �f pa��e��s a�d �hey d� ��� def��e u�equ�v��umer�-cally �he ��c�de�ce, �he c�urse a�d pr�g��s�s �f ep�lepsy �� ch�ldre� w��h C�. There are als� ��� e��ugh da�a de�erm����g appr�pr�a�e �rea���g pr�cedures �� �hese pa��e��s.
F�r �h�s reas��, �he f�ll�w��g s�udy was perf�rmed �� char-ac�er��e �he p�pula���� �f ch�ldre� w��h c��curre�� C� a�d ep�-lepsy w��h a regard �� appl�ed �rea�me�� �gr�up 1�. C���r�l gr�up c��s�s�ed �f ch�ldre� w��h �s�la�ed ep�lepsy �gr�up 2�. A spec�al a��e����� was pa�d �� se��ure ��se�, �e��a�al se��ures, freque�cy �f par��cular se��ures �ypes, me�h�ds �f �rea�me��, as well as pres-e�ce �f me��al re�arda����.
We bel�eve �ha� �ur a�alys�s, c��duc�ed �� �he �umer�cally large gr�up �f pa��e��s, represe��s rel�able charac�er�s��cs �f C� ch�ldre� w��h c�ex�s���g ep�lepsy a�d als� c��s���u�es a� �bjec-��ve rev�ew �f ac�ually appl�ed me�h�ds �f �rea�me�� �� ��la�d. We bel�eve �ha� �h�s s�udy w�ll c���r�bu�e �� s�a�dard��a���� �f a���ep�lep��c �herapy �� �he �eares� fu�ure a�d w�ll all�w �� �b�a�� cred�ble ep�dem��l�g�cal da�a �ha� w�ll e�able early d�ag��s�s �f ep�lepsy �� ch�ldre� w��h C�.
MATERIAL AND METHODS
There were ���ally 1115 cases ��cluded �� �he s�udy. All �f �he pa��e��s were a��e�d��g �� �he �u�pa��e��s’ devel�pme��al �eu-r�l�gy cl���cs �� ��e �f �he 3 cl���cal s��es: �� Gda�sk, Łódź �r K�elce. Every pa��e�� suffered fr�m ep�lepsy a�d v�s��ed ped�a�r�c �eur�l�g�s� fr�m 1st Ja�uary �� 31st December 2005. Am��g �he
gr�up �f ep�lep��c pa��e��s we �de���f�ed �he s�udy gr�up �gr�up 1� a�d �he c���r�l gr�up �gr�up 2�. The s�udy gr�up c��s�s�ed
�f 178 pa��e��s w��h c��curre�� C� a�d ep�lepsy. The c���r�l gr�up c�mpr�sed �f 937 ch�ldre� suffer��g fr�m ep�lepsy w��h�u� a�y ��her �eur�l�g�cal def�c��s. The age �f pa��e��s ra�ged fr�m 9 m���hs �� 18 years. The da�a were c�llec�ed �� �he bas�s �f ques�����a�res, c�mple�ed by pa��e��s, pare��s �r legal represe�-�a��ves a�d ped�a�r�c �eur�l�g�s�s dur��g �he c���r�l v�s��s fr�m Ja�uary �� December 2005. The quer�es �� �he ques�����a�res referred �� fam�ly h�s��ry, ma�� d�seases, resul�s �f �eur�l�g�cal exam��a����, me�h�ds a�d �u�c�me �f appl�ed a���ep�lep��c �rea�-me��. �elec�ed de�a�ls, �ha� were s�a��s��cally a�aly�ed, referred �� age, ge�der, �e��a�al c��vuls���s, se��ure ��se�, �ype �f ep�lep-��c se��ures, a���ep�lepep�lep-��c �herapy, �u�c�me �f appl�ed �rea�me��, class�f�ca���� �f �he C�, me��al re�arda����.
Ob�a��ed resul�s were s�a��s��cally a�aly�ed a�d c�mpared. The�, �he pr��c�pal d�ffere�ces be�wee� gr�up 1 a�d gr�up 2 were �s�la�ed. A spec�al a��e����� was pa�d �� se��ure �ype, se�-�ure ��se�, me�h�ds a�d effec�s �f appl�ed �rea�me��.
Def������� �f �e��a�al c��vuls���s descr�bes �he c��vuls���s dur��g �he f�rs� 30 days �f l�fe.
Types �f ep�lep��c se��ures were def��ed acc�rd��g �� �he I��er�a����al League Aga��s� Ep�lepsy rev�sed class�f�ca���� fr�m 1989 year. Ep�lep��c se��ures �� pa��e��s w��h C� ca� �ake ma�y f�rms. Due �� �he fac� �ha� �hey may be d�ff�cul� �� d�s���-gu�sh fr�m ��v�lu��ary �r s�ere��yp�c m�veme��s, brea�h-h�ld��g spells, swall�w��g ab��rmal���es, vas�vagal sy�c�pes a�d ��her ���-ep�lep��c par�xysmal d�s�rders c�ex�s���g w��h C� [20]. Ep�-lep��c se��ure was rec�g���ed ��ly �� c��d�����s �ha� were u�am-b�gu�us a�d d�d ��� ar�use a susp�c��� �f ���-ep�lep��c �a�ure.
G��d se��ure c���r�l was def��ed by 75% �r m�re reduc���� �� �umber �f se��ures �� a per��d �f 3 m���hs. �e��ure-free per��d �f 3 m���hs was a���her parame�er measured �� b��h gr�ups �f patients.
Class�f�ca���� �f C� ��cluded: spas��c quadr�pleg�a �spas��c��y ��v�lv��g all f�ur l�mbs w��h ��v�lveme�� �f �he arms be��g m�re marked �ha� �r equal �� �ha� �f �he legs�, spas��c d�pleg�a �spas��c-��y �f �he l�wer ex�rem���es w��h a var�able bu� lesser ��v�lveme�� �f �he upper l�mbs�, spas��c hem�pleg�a �spas��c��y �f �he arm a�d leg �� ��e s�de�, ex�rapyram�dal, a�ax�c a�d m�xed �ype ���clud-��g spas��c a�d ex�rapyram�dal ma��fes�a����s� [6, 7].
�rese�ce �f me��al re�arda���� was s�a�ed �� �he bas�s �f psy-ch�l�g�cal �r pedag�g�cal d�ag��s�s.
The �bjec��ves �f �he s�udy were expla��ed �� �he pare��s �r legal represe��a��ves �f ch�ldre� whe� p�ss�ble a�d als� a� ��f�rmed c��se�� was �b�a��ed. ��a��s��cal a�alys�s us��g Ch�-square a�aly-s�s, s�ude�� �-�es� a�d Ma��-Wh���ey �es� was perf�rmed. The level p<0.05 was c��s�dered as �he cu�-�ff value f�r s�g��f�ca�ce.
RESULTS
A ���al �f �he 1115 pa��e��s were ��cluded �� �he s�udy. There were 178 �16%� ch�ldre� w��h C� a�d c��curre�� ep�lepsy �gr�up 1�, a�d 937 �84%� ch�ldre� w��h �s�la�ed ep�lepsy �gr�up 2�. Ge�der pr�p�r���� �f g�rls �� b�ys �� �he wh�le s�ud�ed p�pula���� was 520:595 �0.87�, respec��vely, �� �he gr�up 1 �� was 81:97 �0,83� a�d �� �he gr�up 2 �he pr�p�r���� was 439:498 �0.88�. The age �f pa��e��s �� gr�up 1 ra�ged fr�m 10 m���hs �� 17 years �mea�: 6.7 years� a�d �� �he gr�up 2 ra�ged fr�m 9 m���hs �� 18 years �mea� age: 5.4 years�.
Occurre�ce �f par��cular �ypes �f C� �� �he s�udy gr�up �s prese��ed �� �able I.
Vol. 16/007, nr 3 37 Table I. Incidence of CP types in children from the study group
CP classification Incidence (%) Spastic quadriplegia 41 Spastic diplegia 39 Spastic hemiplegia 15 Extrapyramidal type 2 Ataxic type 1 Mixed type 2
Ne��a�al c��vuls���s were �bserved �� 20 �11%� pa��e��s �� gr�up 1 a�d 49 �5.2%� pa��e��s �� gr�up 2. Al�h�ugh �he perce�-�age was �w� ��mes h�gher �� ch�ldre� w��h C� a�d ep�lepsy �ha� �� �he c���r�ls, �� pr�ved �� be s�a��s��cally ��� s�g��f�ca��.
Me��al re�arda���� �ccurred m�re freque�� �� �he s�udy gr�up 1. I� was es��ma�ed a� 80% �144 pa��e��s� versus 24% �225 pa��e��s� �� �he gr�up 2. Th�s pr�p�r���� was assessed as s�a��s��cally s�g��f�-ca�� �p<0.05�. ��m�lar resul�s are c��f�rmed �� �he l��era�ure [7, 8]. There was a s�r��g c�rrela���� be�wee� early se��ure ��se� a�d c�ex�s�e�ce �f ep�lepsy a�d C� �p<0.05�. The mea� age was evalua�ed a� 1.2 year �f l�fe. �e��ure ��se� �� ep�lep��c ch�ldre� w��h�u� �eur�l�g�cal def�c��s was es��ma�ed a� 4.2 years. Table II. Profile of patients with isolated epilepsy and concurrent CP
Group 1 Group 2 Number of patients 178 (16%) 937 (84%) Girls/Boys ratio 81/97 (0.83) 439/498 (0.88) Mean age 6.7 5.4 Neonatal convulsions 20 (11%) 49 (5.2%) Mental retardation 144 (80%) * 225 (24%)
Age of onset of epilepsy 1.2 4.2
* p<0.05
The h�ghes� ��c�de�ce �f ep�lepsy was �bserved am��g pa��e��s wh� prese��ed spas��c quadr�pleg�a �41%�, a�d �he l�wes� was prese�� �� a�ax�c C� �8%�. H�wever, �here was �� s�ra�gh� s�a��s��cal c�rrela���� be�wee� �he c��cre�e �ype �f C� a�d �he ep�lepsy. The spec�f�c ��f�rma���� �� ��c�de�ce �f ep�-lepsy am��g d�ffere�� �ypes �f C� �s dem��s�ra�ed bel�w. Table III. Incidence of epilepsy among different types of CP
Type of CP Incidence of epilepsy (%)
Spastic quadriplegia 73 (41%) Spastic diplegia 30 (17%) Spastic hemiplegia 23 (13%) Extrapyramidal 16 (9%) Ataxic 14 (8%) Mixed 22 (12%)
�r�mar�ly ge�eral��ed ����c-cl���c se��ures were see� am��g 161 pa��e��s �14.4%� fr�m �he ���al s�ud�ed c�h�r�. Respec��vely, �here were als� �bserved ����c se��ures �� 198 pa��e��s �17.8%�, a����c �r as�a��c se��ures �� 24 pa��e��s �2.2%�, my�cl���c se��u-res �� 55 pa��e��s �4.9%�, �yp�cal abse�ce se��use��u-res �� 71 pa��e��s �6.3%�, a�yp�cal abse�ce se��ures �� 42 pa��e��s �3.8%�, s�mple par��al se��ures �� 58 pa��e��s, �5.2%�, c�mplex par��al se��ures �� 232 pa��e��s �20.8%� a�d sec��dar�ly ge�eral��ed ����c-cl���c se��ures �� 347 pa��e��s �31.1%�.
I� was pr�ved �ha� sec��dar�ly ge�eral��ed ����c-cl���c se�-�ures were �bserved m�re freque�� am��g ch�ldre� w��h C� �� c�mpar�s�� �� c���r�l gr�up a�d �h�s d�ffere�ce was s�a��s��cally s�g��f�ca�� �110 pa��e��s; 62% �� �he gr�up 1 vs. 237 pa��e��s; 25% �� �he gr�up 2�. The �ype �f se��ure �ha� was �he m�s� rarely �bserved �� �he s�udy p�pula���� referred �� �he pr�mar�ly ge�era-l��ed ����c-cl���c se��ure �2 pa��e��s; 1%; p<0.05�.
Freque�cy �f par��cular se��ure �ypes �� b��h gr�ups �f pa��e��s �s prese��ed �� �he �able IV.
Table IV. Incidence of different seizures types in group 1 and group 2
Type of seizures Group 1 Group 2
Secondarily generalized tonic-clonic seizures
110 (62%)* 237 (25%)
Tonic seizures 39 (22%) 159 (17%)
Complex partial seizures 35 (20%) 197 (21%)
Myoclonic seizures 18 (10%) 37 (4%)
Atypical absence seizuresabsence seizures 14 (8%) 28 (3%) Typical absence seizures absence seizures 2 (1%) 69 (7%)
simple partial seizures 2 (1%) 56 (6%)
Atonic / astatic 6 (3%) 18 (2%)
Primarily generalized tonic-clonic seizures
2 (1%)* 159 (17%) * p<0.05
All �f �he pa��e��s were rece�v��g a���ep�lep��c drugs �AEDs� �hr�ugh �he wh�le per��d �f �he s�udy. 682 �f all ch�ldre� �61.3%� were �rea�ed by mea�s �f m����herapy bu� s��ll p�ly�herapy pr�ved �� be �ecessary �� 433 pa��e��s �38.9%�. I� has bee� ��ves��ga�ed �ha� appl�ca���� �f a���ep�lep��c m����herapy am��g ch�ldre� w��h C� was s�g��f�ca��ly smaller �ha� �� ch�ldre� w��h �s�la�ed ep�lepsy �36% vs. 66%�. O� �he ��her ha�d, p�ly�herapy c�mp�sed �f �w� AEDs was �he m�s� freque�� dec�s��� �� �he gr�up �f ch�ldre� w��h C� �40% �� gr�up 1 vs. 22% �� gr�up2, p<0.05�. 3 AEDs were appl�ed �� 28 pa��e��s �16%� fr�m gr�up 1 a�d 56 pa��e��s �6%� fr�m �he gr�up 2. M�re �ha� 3 AEDs were adm���s�ered �� 15 �6%� a�d 56 �6%� pa��e��s gr�up 1 a�d 2, respec��vely. These rela����s are prese��ed a� �he f�gure 1.
G��d se��ure c���r�l was �b�a��ed �� 54% �f pa��e��s w��h C� a�d 87% �f pa��e��s fr�m c���r�l gr�up. �e��ure-free per��d�e��ure-free per��d �f 3 m���hs was �bserved �� 38% �f pa��e��s fr�m �he 1 gr�up a�d eve� 78% �f �he 2 gr�up
Figure 1. Number of applied AEDs in children with and without CP I� has bee� pr�ved �ha� am��g a var�e�y �f ava�lable AEDs, valpr��c ac�d a�d cl��a�epam were �he m�s� c�mm��ly
adm��-Neurologia Dziecięca 3
�s�ered �� ch�ldre� w��h C�. These resul�s �ccurred �� be s�a��s��-cally s�g��f�ca�� �p<0.05�. Valpr��c ac�d was als� appl�ed very �f�e� �� ch�ldre� w��h �s�la�ed ep�lepsy �59% �� gr�up 2 vs. 74% �� gr�up 1�, h�wever, �� was ��� s�a��s��cally releva��. There was �� c�rrela���� be�wee� �he usage �f ��her AEDs a�d C� ��able VI�.
Table VI. Treatment of epilepsy according to the presence of CP
AEDs Group 1 Group 2
Valproic acid 131 (74%)* 534 (59%) Carbamazepine 73 (41%) 365 (39%) Clonazepam 69 (39%)* 37 (4%) Topiramate 46 (26%) 196 (21%) Lamotrigine 26 (15%) 178 (19%) Oxcarbazepine 10 (6%) 84 (9%) Vigabatrin 8 (4%) 25 (3%) *p<0.05
DISCUSSION
I�c�de�ce �f ep�lepsy c���ec�ed w��h C� was es��ma�ed �� 16% am��g all ep�leps�es �� s�ud�ed p�pula����. Ab�ve ��ves��ga���� was perf�rmed �� large �umer�cally gr�up �f 1115 pa��e��s a�d �h�s aspec� ampl�fy �he rel�ab�l��y �f �ur f��d��gs. Espec�ally as �he �umber �f pa��e��s �� ��her s�ud�es rarely exceeds 100 [1, 10].
M�re�ver, we als� pr�ved as �he ��her au�h�rs �ha� spas��c quadr�pleg�a a�d spas��c d�pleg�a are �he m�s� freque�� �ypes �f C� ass�c�a�ed w��h ep�lepsy �ccurre�ce [1, 3, 4, 10] a�d �h�s fac� u�d�ub�edly depe�ds �� a� ex�e�s��� �f bra�� damage.
Ep�lepsy ��se� s�r��gly c�rrela�ed w��h �eur�l�g�cal def�c��s. The age �f f�rs� se��ures �� ch�ldre� w��h C� was s�g��f�ca��ly l�wer �ha� �� ch�ldre� w��h �s�la�ed ep�lepsy. I� �he gr�up 1 se�-�ure ��se� was es��ma�ed �� sl�gh�ly �ver �he f�rs� year �f l�fe. Early ep�lepsy ��se� up �� 12 m���hs �� C� �s w�dely c��f�rmed �� �he l��era�ure [10–14]. �e��ure ��se� be�wee� �he f�rs� a�d �he sec��d year �f l�fe were als� �bserved by �auc�c-K�r��c�c �� 2005 [9] a�d ���gh� �� 2003 [15].
��me �f �he s�ud�es c��s�der a rela����sh�p be�wee� �he �e��a�al c��vuls���s a�d fu�ure prese�ce �f ep�lepsy a�d ��her �eur�l�g�cal def�c��s [16, 17]. We als� �bserved �h�s ass�c�a����. There was a �w�ce h�gher perce��age �f �e��a�al c��vuls���s �� a�am�es�s �� �he s�ud�ed gr�up w��h C�.
I� �ur research, ch�ldre� w��h C� prese��ed d�ffere�� �ypes �f ep�lep��c se��ures. Ob�a��able sc�e���f�c da�a d� ��� descr�be a d�rec� c�rrela���� be�wee� class�f�ca���� �f C� a�d charac�e-r�s��c �ype �f ep�lep��c se��ures. Due �� ��� u��f�ed c��d�����s �f �he s�ud�es �d�ffere�� �umer�cal f�rce �f �he p�pula���� �r ��me
�f �bserva����, e�c.�, �he freque�cy �f par��cular ep�lep��c se��u-res vary fr�m 12.9% [19] �� 50% [9] f�r sec��dar�ly ge�eral��ed ����c-cl���c se��ures �r fr�m 44% [19] �� eve� 85% [20] f�r pr�-mar�ly ge�eral��ed ����c-cl���c se��ures. Our f��d��gs �� gr�up 1 ��d�ca�e �ha� sec��dar�ly ge�eral��ed ����c-cl���c se��ures were �bserved �he m�s� freque��ly. O� �he c���rary, pr�mar�ly ge�e-ral��ed ����c-cl���c se��ures �ccurred very rarely �� c�mpar�s�� w��h ch�ldre� fr�m gr�up 2. Def����ely, �he d�screpa�c�es refer-r��g �� �he ��c�de�ce �f d�ffere�� ep�lep��c se��ures �� C� pa��e��s �eed fur�her ��ves��ga����.
Maj�r��y �f pa��e��s fr�m �he s�udy gr�up were �rea�ed w��h 2 AEDs s�mul�a�e�usly a�d �he �mpr�veme�� was prese��. Over a half �f �he pa��e��s exper�e�ced a 75% reduc���� �� a �umber �f se��ures a�d 38% �f pa��e��s were se��ure-free f�r a� leas� 3 m���hs. H�wever, �hese pr�p�r����s were ��c�mparably h�gher am��g ch�ldre� w��h �s�la�ed ep�lepsy. There were �ver a half m�re ch�ldre� w��h 75% reduc���� �� se��ures a�d alm�s� �w� ��mes m�re �f se��ure-free ch�ldre� f�r a� leas� 3 m���hs. The �umber �f pa��e��s �� m����herapy was als� s�g��f�ca��ly h�gher �� ch�ldre� w��h �s�la�ed ep�lepsy. Al�h�ugh �he �herapy �f ep�-lepsy �� C� pa��e��s ��cluded c�mm��ly 2 AEDs, �he se��ure c���r�l �� �h�s gr�up was ��suff�c�e��. I� �s s��ll a ma��er �f d�scus-s��� �f �here �s a real dema�d �� sw��ch��g fr�m m����herapy �� 2 AEDs �� ch�ldre� w��h C� �r �he dec�s��� �� p�ly�herapy �s useless due �� �he ex�e�� bra�� damage a�d p��r �u�c�me. Assu-m��g all ab�ve fac�s, we ca� say �ha� �ecess��y �f p�ly�herapy �� ch�ldre� w��h c��curre�� C� a�d ep�lepsy has s��ll bee� u�c��f�r-med. Valpr��c ac�d was �he m�s� freque��ly appl�ed a���ep�lep��c spec�me� �� b��h gr�ups. The perce��age �f valpr��c ac�d adm�-��s�ra���� am��g ch�ldre� w��h C� was 15% h�gher a�d �h�s pr�-p�r���� �ccurred �� be s�a��s��cally s�g��f�ca��. �ubseque�� AEDs c�mm��ly prescr�bed �� �he s�udy gr�up was cl��a�epam. These dec�s���s were �he m�s� l�kely made due �� �he ex�e�s�ve ra�ge �f ac���� �f b��h AEDs.
We als� pr�ved �ha� �ha� me��al re�arda���� acc�mpa��es C� a�d ep�lepsy par��cularly �f�e�. I� �ccurred �� be �hree ��mes h�gher �ha� �� �he c���r�l gr�up.
Th�s s�udy clearly ��d�ca�es �ha� ep�lepsy �� pa��e��s w��h C� �s ass�c�a�ed w��h prese�ce �f �e��a�al c��vuls���s. M�re�ver, �hese pa��e��s prese�� w�rse se��ure c���r�l, eve� �h�ugh p�ly�he-rapy was appl�ed. Me��al re�arda���� as well as c�ex�s�e�ce �f phys�cal ha�d�cap a�d ep�lep��c se��ures w��h p��e���al adverse eve��s �f appl�ed AEDs are add�����al fac��rs, �ha� s�g��f�ca��ly l�wer qual��y �f l�fe �� pa��e��s w��h C�. E���re�y �f var��us c��-d�����s a�d aspec�s �f C� c�mpl�ca�ed by �he ep�lepsy leads �� �he ge�eral c��clus��� �ha� �� �s esse���al �� �mpr�ve me�h�ds �f �rea�-me�� as well as accura�e a�d cer�a�� d�ag��s�s, ��clud��g ge�e��c a�d pre�a�al fac��rs de�erm����g �ccurre�ce �f C� �� ch�ldre�.
Vol. 16/007, nr 3 3
REfERENCES
1. Gururaj A.K., Sztriha L., Bener A. et al.: Epilepsy in children with cerebral palsy. Seizure, 2003:12, 110.
2. Kułak W., Sobaniec W.: Risk factors and prognosis of epilepsy in children with cerebral palsy in north-eastern Poland. Brain Dev., 2003:27, 499. 3. Hagberg B., Hagberg G., Olow I.: The changing panorama of cerebral palsy
in Sweden 1954-70. Acta Paediatr. Scand., 1975:64, 193.
4. Kułak W., Sobaniec W.: A comparison of spastic diplegic and tetraplegic cerebral palsy Pediatr Neurol. 2005:32, 311–317.2005:32, 311–317.
5. Steffenburg U., Hagberg G., Kyllerman M.: Characteristics of seizures in a population-based series of mentally retarded children with active epilepsy. Epilepsia, 1996:37, 850.
6. Nelson K.B., Swaiman K.F., Russman B.S. Cerebral palsy. In : Swamain K.F., ed. Pediatric neurology: Principles and practice, 2nd ed. St. Louis:
Mosby, 1994:471–482.
7. Rahman M.M., Akhter M.S., Karim B.A.: Epilepsy in children with cerebral palsy. Mymensigh Med. J., 2004:13, 67.
8. Kwong G.P.S., Hutton J.L.: Epilepsy in different types of cerebral palsy. J. R. Stat. Soc., 2003:52, 153.
9. Paucic-Kirincic E., Modrusan-Mozetic Z., Sindicic-Simundic N. et al.: Epi-lepsy among children with cerebral palsy born in Rijeka between 1982 and 1992. Medicina, 2005:41, 31.
10. Kwong K.L., Wong S.N., So K.T.: Epilepsy in children with cerebral palsy. Pediatr. Neurol., 1998:19, 31.
11. Lagunju I.A., Adedokun B.O., Fatunde O.J.: Risk factors form epilepsy in children with cerebral palsy. Afr. J. Neurol. Sci., 2006:25, 29.
12. Peet D.S.: Retrospective review of the epidemiology of epilepsy in special schools for children with cerebral palsy, learning difficulties, and language and communication difficulties. McGill J. Med., 2006:9, 19.
13. Bruck I., Antoniuk S.A., Spessatto A. et al: Epilepsy in children with cere-bral palsy. Arq. Neuropsiquiatr., 2001:59, 35.
14. Hdjipanayis A., Hadjichristodoulou C., Youroukos S.: Epilepsy in children with cerebral palsy. Dev. Med. Child Neurol., 1997:39, 659.
15. Singhi P., Jagirdar S., Khandelwal N. et al.: Epilepsy in children with cere-bral palsy. J. Child. Neurol., 2003:18, 174.
16. Mellitis E.D., Holden K.R., Freeman J.M. et al.: A multivariate analysis of factors associated with outcome. Pediatrics, 1982:70, 177.
17. Arpino C., Curatolo P., Stazi M.A., et al: Differing risk factors for cere-bral palsy in the presence of mental retardation and epilepsy. J. Child Neurol.,1999:14, 151.
18. Nelson K.B., Ellenberg J.H.: Predisposing and causative factors in child-hood epilepsy. Epilepsia, 1987:28 (Suppl. 1), 16.
19. Zafeiriou D.I., Kontopoulos E.E., Tsikoulas I.: Characteristics and prognosis of epilepsy in children with cerebral palsy. J. Child Neurol., 1999:14, 289. 20. Al-Sulaiman A.A.: Epilepsy in Saudi children with cerebral palsy. Saudi
Med. J., 2001:22, 19.
21. Wallace S.J.: Epilepsy in cerebral palsy. Dev. Med. Child Neurol., 2001:43, 713.
Adres do korespondencji:
Department of Developmental Neurology, Chair of Neurology Medical University of Grańsk, Dębinki 7 St. 80-952 Gdańsk, Poland e-mail: mmazur@amg.gda.pl