Clinical and MRI correlates of cerebral palsy - The European Cerebral Palsy Study
Clinical and MRI correlates of cerebral palsy - The European Cerebral Palsy Study
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DOI：
10.1001/jama.296.13.1602
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发表时间：
2006-10-04
影响因子：
120.7
通讯作者：
Flodmark, Olof
中科院分区：
文献类型：
--
作者：
Bax, Martin;Tydeman, Clare;Flodmark, Olof
背景磁共振成像（MRI）的结果已被报告为特定的临床脑性瘫痪（CP）亚组或病变类型，但不是在一个大的人群中的所有CP亚型的儿童。目的研究人群中CP的相关性，并将临床结果与MRI脑研究的信息进行比较。设计和设置在8个欧洲研究中心进行的横断面、基于人群的调查研究（英格兰西北伦敦和东伦敦;苏格兰爱丁堡;葡萄牙里斯本;爱尔兰都柏林;瑞典斯德哥尔摩;德国图宾根;和赫尔辛基，芬兰）。参与者585名患有CP的儿童被确定为在1996年和1999年之间出生; 431名儿童进行了临床评估，351名进行了脑MRI扫描。主要结果测量标准化的临床检查结果，父母问卷调查，MRI结果，以及产科，遗传，结果重要的发现包括高感染率的母亲在怀孕期间报告（n= 158 [39.5%]）。此外，235名儿童（54%）足月出生，47名儿童（10.9%）非常早产（< 28周）。双胞胎的比例很高，已知有51名儿童（12%）来自多胎妊娠。临床表现为偏瘫占26.2%，双瘫占34.4%，四肢瘫占18.6%，运动障碍占14.4%，共济失调占3.9%，其他类型占2.6%。脑MRI扫描显示，未成熟的白质损伤，包括脑室周围白质软化（PVL），是最常见的发现（42.5%），其次是基底节病变（12.8%），皮质/皮质下病变（9.4%），畸形（9.1%），局灶性梗死（7.4%）和其他病变（7.1%）。只有11.7%的儿童MRI表现正常。结论CP患儿的MRI表现与临床表现有较好的相关性，提示CP患儿中有一小部分可能发生产科意外。需要制定一种系统的办法来查明和治疗产妇感染。多胎妊娠应密切监测，婴儿中风的原因需要进一步调查，以便制定预防策略。所有患有CP的儿童都应该进行MRI扫描，以提供有关病变时间和范围的信息。
Context Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Further information about the causes of CP could help identify preventive strategies.Objective To investigate the correlates of CP in a population sample and compare clinical findings with information available from MRI brain studies.Design and Setting Cross-sectional, population-based investigative study conducted in 8 European study centers ( North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tubingen, Germany; and Helsinki, Finland).Participants Five hundred eighty-five children with CP were identified who had been born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan.Main Outcome Measures Standardized clinical examination results, parental questionnaire responses, MRI results, and obstetric, genetic, and metabolic data from medical records.Results Important findings include the high rate of infections reported by mothers during pregnancy (n= 158 [39.5%]). In addition, 235 children (54%) were born at term while 47 children (10.9%) were very preterm (< 28 weeks). A high rate of twins was found, with 51 children (12%) known to be from a multiple pregnancy. Clinically, 26.2% of children had hemiplegia, 34.4% had diplegia, 18.6% had quadriplegia, 14.4% had dyskinesia, 3.9% had ataxia, and 2.6% had other types of CP. Brain MRI scans showed that white-matter damage of immaturity, including periventricular leukomalacia (PVL), was the most common finding (42.5%), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Only 11.7% of these children had normal MRI findings. There were good correlations between the MRI and clinical findings.Conclusions These MRI findings suggest that obstetric mishaps might have occurred in a small proportion of children with CP. A systematic approach to identifying and treating maternal infections needs to be developed. Multiple pregnancies should be monitored closely, and the causes of infant stroke need to be investigated further so preventive strategies can be formulated. All children with CP should have an MRI scan to provide information on the timing and extent of the lesion.