The Epidemiology Of Cerebral Palsy Incidence Impairments And Risk Factors Pdf

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Cerebral palsy CP is the most common motor disability in childhood. This syndrome is the manifestation of intrauterine pathologies, intrapartum complications, and the postnatal sequel, especially among preterm neonates.

Cerebral Palsy in the Middle East: Epidemiology, Management, and Quality of Life

Cerebral palsy CP is the most common motor disability in childhood. This syndrome is the manifestation of intrauterine pathologies, intrapartum complications, and the postnatal sequel, especially among preterm neonates.

A double hit model theory is proposed suggesting that an intrauterine condition along with intrapartum or postnatal insult lead to the development of CP.

Recent reports demonstrated that treatment during the process of preterm birth such as magnesium sulfate and postnatal modalities such as cooling may prevent or reduce the prevalence of this syndrome. Moreover, animal models demonstrated that postnatal treatment with anti-inflammatory drugs coupled with nanoparticles may affect the course of the disease in pups with neuroinflammation.

This review will describe the changes in the epidemiology of this disease, the underlying prenatal mechanisms, and possible treatments that may reduce the prevalence of CP and alter the course of the disease.

Cerebral palsy CP is the most common motor disability in childhood 1. CP is a heterogeneous group of clinical syndromes that describe permanent disorders of movement and posture. It is characterized by abnormal muscle tone, posture, and movement, thereby limiting the activity of the affected person. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication and behavior, epilepsy, and secondary musculoskeletal problems 2.

These disorders are attributed to non-progressive disturbances in the developing fetal brain 2 , alteration in fetal development 2 , pathologic intrauterine processes 3 — 8 , or considered as prematurity complication 9.

Although CP itself is not a progressive disease, its clinical expression may change over time as the brain matures. In this review, we describe the changes in the epidemiology of this disease and the underlying prenatal mechanisms as well as possible treatments that may reduce its prevalence and alter the course of the disease. Population-based studies from around the world report that the prevalence estimates of CP range from 1. The overall birth prevalence of CP is approximately 2 per 1, live births 15 — Of interest, there were racial disparities in the changes of the prevalence of CP along that time period: while in non-Hispanic White population, the overall prevalence declined from 1.

These surveys found a CP prevalence per 1, live births that ranged from 2. In a population-based study from Iceland 20 , the prevalence of CP per 1, live births did not change significantly from to , which stayed between 2. However, it decreased from 1. An observation that may explain some of these findings is the parallel increase in the rate of cesarean sections. The Australian Cerebral Palsy Register, including information from to reported an overall CP prevalence of 2.

Overall, the total rate of CP is relatively stable, yet the contribution of prematurity and its complication to the prevalence of this syndrome are steadily increasing due to improvements in obstetric and neonatal care.

Cerebral palsy can be derived from any event that will affect the fetal and neonatal developing brain. Indeed, congenital malformations, fetal growth restriction, multiple gestations, infection during the fetal and neonatal period, birth asphyxia, preterm delivery, untreated maternal hypothyroidism, perinatal stroke, and thrombophilia were all recognized as risk factors for CP 22 — The impact of fetal growth restriction on the prevalence of CP is well established.

This association is independent of gestational age at delivery and extenuated by the presence of congenital anomalies, especially of the central nervous system Growth restriction was prevalent in A population-based study in Denmark reported a CP prevalence of 1. Thus, the intrauterine processes associated with fetal growth restriction also lead to neuronal damage and subsequent CP.

The association between preeclampsia and subsequent development of CP was under constant debate. However, a recent population-based cohort study demonstrated that early-onset preeclampsia is an independent risk factor for CP OR 8.

This was not the case regarding preeclampsia at term 6. The association between congenital malformations and subsequent CP is well documented. Major birth defects were the most frequently occurring risk factor in children with CP, and when combined with fetal growth restriction, they were associated with the highest relative risk Congenital microcephaly is the most common birth defect in CP Twins have a higher frequency of malformations and CP than singletons 37 , Indeed, among twin gestations, an affected twin with CP increases the risk by a factor of 15 that the other one will have this syndrome as well Additionally, the in utero death of one twin, even if it occurs early in gestation, leaves the surviving twin at markedly increased risk for CP The prevalence of CP in an Australian study 40 was 1.

The explanation for this observation was that the dissolving twin releases thromboplastin and emboli that may lead to brain injury of the surviving twin and subsequent development of CP. Fetal and neonatal cerebral accidents are associated with increased risk for subsequent development of CP.

The mechanisms leading to perinatal strokes are not clear; in some cases, preeclampsia was proposed as a risk factor; in addition, there are those who relate that to placental vascular disorder. The association between CP and thrombophilia is not that clear. In an Australian population-based case—control study 42 , among term neonates, there was no association between a single thrombophilic mutation and CP. On the other hand, an Israeli retrospective case—control study found no increased prevalence of thrombophilic mutations among children with non-stroke CP The association between perinatal stroke and subsequent CP may suggest that these conditions may represent that in some of the cases, the course of progression of a disease, starting in the uterus, has a neonatal presentation as acute ischemic stroke and subsequently develop into CP.

This hypothesis requires further investigation. Genetic investigations of CP are performed using population-genetic and pedigree inquiries. Population-based genetic studies have identified several candidate genes, whose variants were more frequent in CP patients in certain populations, some of which are associated with processes of inflammation, coagulation, and blood flow 45 — Pedigree studies are mostly aimed at specific forms of CP that are found to be frequent in some families.

One interesting case, involving a family with repeated congenital CP, has led to the identification of a candidate gene with an imprinting-like inheritance pattern, whereas the mutation is expressed only when it is inherited from the father This gene is crucial for normal fetal neurodevelopment, but its levels may also be decreased in the setting of hypoxia and low birth weight. It is suggested that this mechanism, as deduced from a pedigree data, may also play a role in sporadic CP cases Understanding the mechanisms leading to a disease is a crucial part in the development of treatment and prevention modalities.

In the next sections, we will discuss the effect of predisposing intrauterine factors, especially the role of infection and inflammation. Underlying mechanisms leading to cerebral palsy CP. The mechanisms leading to cerebral palsy can be attributed to the following exposures: 1 intrauterine exposure including infection elicit a fetal inflammatory response syndrome and white matter damage in the fetus, fetal growth restriction, placental vascular disorders that are associated with vascular injuries in the fetal brain and congenital anomalies.

These events can be isolated but also combined, and the two-hit theory proposed that a neonate who suffered from hostile intrauterine environment such as infection may be further affected by acute intrapartum event such as abruption or post-partum complication and develop CP.

The placental histologic lesions enable us to identify some of the intrauterine pathological processes that may lead or contribute to the development of CP. Moreover, the fetal inflammatory response in the placenta and villous edema are associated with subsequent abnormal cognitive testing in the child 53 , and umbilical cord inflammation funisitis is associated with an increased risk for CP Collectively, placental inflammatory and vascular lesions are associated with subsequent development of CP.

Although fetal growth restriction FGR is a greater risk factor for CP than both birth asphyxia and fetal inflammation combined 33 , intra-amniotic infection and inflammation are the only mechanisms in which there is an evidence of causality between the intrauterine process and PVL.

Indeed, intrauterine administration of lipopolysaccharides LPSs to pregnant rabbits was associated with a significant increase in the rate of PVL in the pups of the treated vs.

Evidence from amniotic fluid cultivation suggests that in general, the intrauterine cavity is a sterile environment during the mid-trimester and the prevalence of infection and or inflammation IAI in mid-trimester amniocentesis is 0. The rate of intrauterine inflammation is higher than that of intrauterine infection at any given gestational age.

Of note, there is a ninefold increase in CP for infants of mothers who had a fever during labor It means that the ascending intrauterine infection or the inflammatory processes like in FIRS type 2 affect the fetus. This syndrome is characterized by systemic activation of the fetal innate immune system similar to the adult systemic inflammatory response syndrome.

FIRS was originally defined in fetuses with preterm labor and preterm PROM by an elevation of the fetal plasma interleukin-6 concentration 7. Affected fetuses had evidence of multi-organ involvement, had a higher morbidity rate after adjustment for gestational age, and were more likely to have a subsequent spontaneous preterm delivery in cases of preterm PROM 7.

A live demonstration of the effect of fetal neuroinflammation on neonatal neurologic functions was recently reported. In a study on New Zealand white rabbits that had an intrauterine injection of E. Moreover, in comparison with a group that had an intrauterine injection of sterile saline, the LPS-injected newborn pups had a greater mortality rate, were hypertonic, and demonstrated significant impairment in posture, righting reflex, locomotion, and feeding.

The in utero LPS-exposed pups also had neuroinflammation indicated by activated microglia and hypomyelination in the periventricular regions. Therefore, collectively, the data presented here suggest that IAI has a causal role in the pathway that subsequently leads to the development of CP. This process requires fetal involvement in the form of FIRS, which in turn leads to brain dysfunction and premature labor which are suggested to cause CP Finally, there are reports suggesting that CP may be the result of a two-hit model in which the mechanisms leading to the delivery of an affected neonate i.

Evidence in support of this view are the finding by Mor et al. Some examples of this hypothesis are that SGA newborns who also had systemic inflammation were at a greater risk of a low Bayley Mental Development score than their peers who had neither SGA nor systemic inflammation This shows that a first hit SGA contributed less to developmental delay then SGA combined with a second hit such as systemic inflammation White and gray matter lesions are the most prevalent type of injury observable in the magnetic resonance images MRIs of children with CP, and a quantitative measure of gray and white matter lesion burden correlates with motor and cognitive dysfunction in children with unilateral CP PVL is associated with reactive gliosis, excitotoxicity microglial activation, the release of free radicals, and subsequent hypomyelination.

This type of injury is divided into cystic and diffuse. Cystic WMI are necrotic lesions with a loss of cellular elements partially filled by glial scars that can be detected by ultrasound. Gray matter injury is related to neuronal and axonal degeneration including the somatosensory pathways.

Several studies suggest that abnormal somatosensory inputs may be a causal factor of motor impairments in CP Any intervention that will lead to modification of the risk factors for CP as well as for the prevention or treatment of the underlying mechanisms that leads to this syndrome eventually will affect its prevalence.

In the following paragraphs, we will discuss these strategies in relation to the most prominent risk factor for CP today, and that is preterm birth.

Strategies for the reduction of cerebral palsy CP. The strategies to reduce the rate of CP are as follows: 1 prevention of adverse events during pregnancy mainly of preterm birth spontaneous or indicated ; 2 the administrations of supportive medical treatment during an acute event such as magnesium sulfate of betamethasone during preterm labor; and 3 postexposure treatment to reduce the neurologic injury.

The basis of an effective preventive strategy of any disease is represented by setting the goals which we would like to achieve. A basic tool for a successful preventive program is the ability to identify patients at risk and to tailor the treatment according to the mechanisms of disease.

A good example for this is the progress made during the last decade in the prevention of spontaneous premature birth. This progress is relevant to the potential reduction of CP since about half of the cases of this disease are due to prematurity and its complications. Meis et al. The second step in that direction was the fact that women who have a short cervix with or without a history of premature birth can benefit from vaginal progesterone for the prevention of premature birth and improvement of neonatal outcome 78 — This finding led to the development of primary prevention of preterm birth in women with a short cervix.

A cervical cerclage is an additional tool for the prevention of recurrent preterm birth in women with a short cervix. Comparisons of the use of vaginal progesterone or cerclage were found to be equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid-trimester, singleton gestation, and previous preterm birth.

Cerebral palsy

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Cerebral Palsy CP. Section Navigation. Facebook Twitter LinkedIn Syndicate. Data and Statistics for Cerebral Palsy.

Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 23 December Published 12 June Volume Pages — Review by Single anonymous peer review. Editor who approved publication: Dr Roger Pinder.

Handbook of Healthcare in the Arab World pp Cite as. The type and severity of motor impairment caused by CP is different for each child and is frequently accompanied by comorbidities such as chronic pain, intellectual disability, and epilepsy. The understanding and responses to CP vary substantially in the Middle East, due largely to the diverse language, cultural, religious, geographic, and economic conditions in the region. A growing body of epidemiological research informs practice in some regions; however, other regions lack data to guide service planning, delivery, and policy. Notably, low- and middle-income economies account for more than half of Middle Eastern countries and typically report a higher prevalence and severity of CP. Data from Middle Eastern countries is limited, and public health infrastructure in these settings is often poorest. Improved understanding and multidisciplinary collaboration is required to extend knowledge and improve practice including in the areas of early diagnosis and intervention in order to improve the lives of children with CP in the Middle East.

Prevalence of Cerebral Palsy

Metrics details. The burden of disability is more severe among children in low income countries. Moreover, the number of children with disabilities CWDs in sub-Saharan Africa is predicted to increase with reduction in child mortality. Although the issue on CWDs is important in sub-Saharan Africa, there are few researches on risk factors of disabilities.

The epidemiology of cerebral palsy: Incidence, impairments and risk factors

Javascript is currently disabled in your browser. Several features of this site will not function whilst javascript is disabled. Received 23 December

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Я люблю тебя, Сьюзан, - подумал.  - Помни это…. Ему казалось, что с него сорваны все внешние покровы. Не было ни страха, ни ощущения своей значимости - исчезло. Он остался нагим - лишь плоть и кости перед лицом Господа.

В отношении шифровалки в АНБ сложилась своеобразная философия. Нет смысла вбухивать миллиарды долларов в дешифровальный компьютер и одновременно экономить на тех, кто работает на этой превосходной технике. Сьюзан скинула туфли на низких каблуках от Сальваторе Феррагамо и блаженно погрузила обтянутые чулками ноги в густой шерстяной ковер. Высокооплачиваемые государственные служащие старались избегать демонстрации личного благосостояния. Для Сьюзан это не составляло проблемы: она была безмерно счастлива в своей скромной двухкомнатной квартире, водила вольво и довольствовалась весьма консервативным гардеробом. Но вот туфли - совсем другое. Даже во время учебы в колледже она старалась покупать самую лучшую обувь.

Покраснев, Сьюзан сказала, что созрела довольно поздно. Чуть ли не до двадцати лет она была худой и нескладной и носила скобки на зубах, так что тетя Клара однажды сказала, что Господь Бог наградил ее умом в утешение за невзрачные внешние данные. Господь явно поторопился с утешением, подумал Беккер. Сьюзан также сообщила, что интерес к криптографии появился у нее еще в школе, в старших классах. Президент компьютерного клуба, верзила из восьмого класса Фрэнк Гут-манн, написал ей любовные стихи и зашифровал их, подставив вместо букв цифры. Сьюзан упрашивала его сказать, о чем в них говорилось, но он, кокетничая, отказывался. Тогда она взяла послание домой и всю ночь просидела под одеялом с карманным фонариком, пытаясь раскрыть секрет.

Скорее всего Хейл держит там копию ключа. Она мне нужна. Сьюзан даже вздрогнула от неожиданности.

Я уже говорил это и могу повторить тысячу раз - Пьер Клушар описывает мир таким, каким его видит. Некоторые ваши туристические путеводители старательно скрывают правду, обещая бесплатный ночлег в городе, но Монреаль тайме не продается. Ни за какие деньги. - Простите, сэр, вы, кажется, меня не… - Merde alors. Я отлично все понял! - Он уставил на Беккера костлявый указательный палец, и его голос загремел на всю палату.

 - Уран распадается на барий и криптон; плутоний ведет себя несколько. В уране девяносто два протона и сто сорок шесть нейтронов, но… - Нам нужна самоочевидная разница, - подсказала Мидж.  - У Танкадо сказано: главная разница между элементами.

А теперь, если не возражаешь… - Стратмор не договорил, но Чатрукьян понял его без слов. Ему предложили исчезнуть.

 Там проблема с электричеством. - Я не электрик. Позвони в технический отдел. - В куполе нет света.

Джабба удивленно заморгал.  - Соши. Соши Кута, тонкая как проволока, весила не больше сорока килограммов.

 - Если он не знал, что мы его убиваем… Ничего не понятно. Слишком поздно.

 Да, да, конечно… очень приятно. - Так вы гражданин Канады. - Разумеется.

И уже мгновение спустя ее осенило. Ее глаза расширились. Стратмор кивнул: - Танкадо хотел от него избавиться.

Выслушай меня внимательно, - попросил Стратмор.

 Плохой совет, мистер Беккер, - огрызнулся Джабба.  - Нужно сразу быть точным. У шифров-убийц обычно есть функция злопамятства - чтобы не допустить использования метода проб и ошибок. Некорректный ввод только ускорит процесс разрушения. Два некорректных ввода - и шифр навсегда захлопнется от нас на замок.

Беккер отлично говорил по-французски, тем не менее обратился к этому человеку на языке, который тот, как он надеялся, должен был знать хуже. Убедить абсолютно незнакомого человека отдать вам золотое кольцо скорее всего будет весьма непросто, поэтому Беккер хотел заручиться хотя бы одним преимуществом. Пока старик собирался с мыслями, Беккер не произнес ни слова. Тот огляделся вокруг, указательным пальцем разгладил усы и наконец заговорил: - Что вам нужно? - Он произносил английские слова немного в нос. - Сэр, - начал Беккер чуть громче, словно обращаясь к глуховатому человеку, - я хотел бы задать вам несколько вопросов.


  1. Emmeline B. 12.05.2021 at 20:11

    Cerebral palsy CP is a group of permanent movement disorders that appear in early childhood.