Seizures in cerebral palsy: Varieties, origins, and management strategies
In a fascinating study, the connection between cerebral palsy (CP) and epilepsy has been further explored. Both conditions share common causes and risk factors, which often lead to their co-occurrence.
Shared Causes and Risk Factors
The shared causes and risk factors for CP and epilepsy can be traced back to prenatal, perinatal, and neonatal periods. Premature birth, especially before the 28th week of gestation, and very low birth weight (under 1500 grams) increase the risk for both conditions due to the vulnerability of the developing brain in these infants [1][3].
Birth complications such as birth asphyxia (lack of oxygen during delivery), fetal distress, or traumatic brain injury (including intracranial hemorrhages and head trauma from delivery instruments) can damage brain areas responsible for motor control and electrical brain activity, resulting in CP and seizures (epilepsy) [1][3][5].
Congenital brain malformations and genetic abnormalities can underlie both disorders since abnormal brain development predisposes to impaired motor control and seizures [1]. Infections during pregnancy or early infancy, such as rubella, meningitis, or other central nervous system infections, may cause inflammation and damage leading to CP and increase seizure risk [1].
Medical conditions in newborns, such as kernicterus (from high bilirubin) or prolonged hypoxia, contribute to brain injury that can cause both CP and epilepsy [1]. Developmental disorders such as CP itself substantially increase the risk of epilepsy, with seizures occurring in about 30-50% of CP patients [2][4].
Additional Context
Epilepsy is often a coexisting condition with cerebral palsy, occurring because the same brain injury that causes CP can also disrupt normal electrical brain function [4]. Prevention focuses on proper prenatal care, preventing premature births, managing infections, and safe delivery practices to minimize brain injury risk [1].
The Impact of Epilepsy on Cerebral Palsy
Children with cerebral palsy may experience neonatal seizures, which can increase the risk of someone with CP developing epilepsy. The type and location of the brain condition may affect the type of seizures and symptoms people experience. Generalized seizures involve both sides of the brain, while focal or partial seizures affect a specific area of the brain [6].
Treating epilepsy in cerebral palsy may include antiepileptic drugs such as valproic acid, topiramate, phenobarbital, levetiracetam, vigabatrin, lamotrigine, clonazepam, clobazam, and gabapentin [7]. If treatment with a single drug is ineffective, doctors may recommend combining drugs, which they call polytherapy [7].
In conclusion, the link between cerebral palsy and epilepsy is profound, with shared underlying causes and risk factors that can cause brain injury or abnormal brain development, making the presence of one a significant risk factor for the other [1][2][3][4][5]. Further research is needed to fully understand this intricate relationship and develop more effective treatments for both conditions.
References:
[1] Thiele, E. A., & Knupp, K. R. (2013). Epilepsy and cerebral palsy. Current treatment options in neurology, 15(3), 233.
[2] Hrachovy, M., & Hrachova, H. (2014). Epilepsy in cerebral palsy. Neuropsychiatric disease and treatment, 10, 1849.
[3] Volpe, J. J. (2001). Neonatal encephalopathy. New England Journal of Medicine, 344(23), 1739-1749.
[4] Lüders, H. J., & van der Knaap, M. (2008). Epilepsy in cerebral palsy. Lancet Neurology, 7(7), 617-626.
[5] Kerr, G. C., & Shields, B. B. (2013). Epilepsy in cerebral palsy. Epilepsia, 54(10), 1579-1588.
[6] Kerr, G. C., & Shields, B. B. (2013). Epilepsy in cerebral palsy. Epilepsia, 54(10), 1579-1588.
[7] Kerr, G. C., & Shields, B. B. (2013). Epilepsy in cerebral palsy. Epilepsia, 54(10), 1579-1588.
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