EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY I4(20I0)67-72 Table 1- The clinical subgroups of CP in the epileptic and the non-epileptic children and their respective type of epilepsy. CP subgroup CP Onl CP Epilepsy(epilepsy subtypes) Total 18(27.7%)infantile spasms 2, partial seizures 9 70(355%) 5, atonic/tonic sz 1, not classified 1] 2. Diplegia 35(265% 7(10.8%)partial seizures 2, GTCS 3, myoclonic sz 1, 42(213% 1 32(49.2%)[infantile spasms 3, partial seizures 6, GTCS 13, onic/tonic sz 5, myoclonic sz 2, not classified 3 13(9.9% 5(7.7%)partial seizures 2, GTCS 1, myoclonic sz 1, 1 5. Dyskinetic/mixed (6.8%) 3(4.6%)infantile spasms 2, atonic/tonic sz 1] 12(6.1%) Total 132(100%) 65(100%)infantile spasms 7, partial seizures 19, GTCS 97(100%) tonic/tonic sz 8, myoclonic sz 4, not classified 51 Abbreviations: CP-cerebral palsy, GTCS- generalized tonic-clonic seizures, and sz- seizures years of life; an additional 16 children had their first seizure 3.3. Birth history between the second and sixth year of age and only 4 children (6.2%)developed their epilepsy beyond 6 years(Fig. 1). The gestational age of the patients at birth was recorded in 190 The clinical subtypes of CP among the epileptic and the (96.4%)of the children with CP In the group of children with non-epileptic patients and the clinical epilepsy subgroups are epilepsy 41(65.1%)were term infants and 20(31.7%)were shown in Table 1, demonstrating that epilepsy was particu- preterm infants(6 of which were extreme preterm). In the larly common in patients with quadriplegia(58.2% VS. 23.2%), group of children without epilepsy 56(44.1%)were term OR=459,95%CI(2.37-891),p<0.001. The mean age infants while 69(54.4% were bom pretermly (34 of which were seizures onset was 1.8+2.0 years. The prevalence of epilepsy extreme preterm). Four children(2 in each group)were post was consistent across ethnic groups(p=0.13)and genders term infants. An increased prevalence of epilepsy was noted (p=0.62). Twenty-seven children with CP had documented in the term infants(p<0.01) neonatal seizures. Twenty two of them( 81.5%)subsequently The mode of delivery was recorded in 178(90.4%)children. had epilepsy, OR=12.99, 95%CI (4.64-36. 43), p<0.001. Out of Normal vaginal delivery was conducted in 29(49.1%)children ninety seven term infants, thirteen children had a history of with epilepsy and 54(45.4%)children without epilepsy neonatal seizures (12 of them subsequently developed Instrumental delivery was conducted in only 6 children with epilepsy), and of the 89 preterm infants, 14 children had epilepsy and 5 children without epilepsy. Caesarian sections neonatal seizures (10 of them subsequently developed were relatively common and performed in 24(40.7%)of chil epilepsy). Most of the children with neonatal seizures who dren with epilepsy(15 of which were urgent) 504%)of later developed epilepsy had quadriplegia(54.5%)and hemi- children without epilepsy (24 of which were urgent). None of plegia(27. 2%). The types of epilepsies that were preceded by these modes of delivery was found as a significant risk factor neonatal seizures were predominantly GTCS (59.0%), partial for developing epilepsy(p=0.2). Urgent caesarian sections seizures(18.2%)and infantile spasms(18.2%). One additional infant had unclassified seizures Table 2- The imaging findings in the epileptic and the non-epileptic children 3. 2. Imaging data Imaging CP Only CP Epilepsy Total The imaging findings were available for 148 children which Normal imaging 25(287%10(164%)35(236% encompass 75.1% of all the subjects(Table 2). For 72 patients CT Abnormal Imaging (713%)51(836%)113(764% scans were available, for 48 patients MRI scans were available Non-specific atrophy (4.6%)11(180%)16(10.8% d for 28 patients both CT and MRI scans were available In 49 Grey matter insult 14(161%)17(27.9%)31(210% patients we had no data or they had documented head ultra- (including infarctions) only during early infancy. Abnormal White matter insult 16(18 4(115%)23(155% imaging was more common in CP children with epilepsy as (including PVL) compared to children without epilepsy(p<0.003). Within the Cerebral malformations 10(11. 5%) 7(11.5%) (115% patients with abnormal imaging findings only cerebral atrophy Hydrocephalus 5(5.7%) 5(82% 8(54% was more common in children with epilepsy, than in children Brain Hemorrhage 13(14.9%) 7(11.5%) 20(13. 5% without epilepsy (p<0.012). Children with infarcts and gray (including IVH) matter disease were somewhat more prone to develop epilepsy, Total 87(100%)61(100%)148(100%) the small number of patients in each group these differences did intraventricular Hemorrhage not reach statistical significance 第65页years of life; an additional 16 children had their first seizure between the second and sixth year of age and only 4 children (6.2%) developed their epilepsy beyond 6 years (Fig. 1). The clinical subtypes of CP among the epileptic and the non-epileptic patients and the clinical epilepsy subgroups are shown in Table 1, demonstrating that epilepsy was particu￾larly common in patients with quadriplegia (58.2% vs. 23.2%), OR ¼ 4.59, 95% CI (2.37–8.91), p < 0.001. The mean age for seizures onset was 1.8 2.0 years. The prevalence of epilepsy was consistent across ethnic groups ( p ¼ 0.13) and genders ( p ¼ 0.62). Twenty-seven children with CP had documented neonatal seizures. Twenty two of them (81.5%) subsequently had epilepsy, OR ¼ 12.99, 95% CI (4.64–36.43), p < 0.001. Out of ninety seven term infants, thirteen children had a history of neonatal seizures (12 of them subsequently developed epilepsy), and of the 89 preterm infants, 14 children had neonatal seizures (10 of them subsequently developed epilepsy). Most of the children with neonatal seizures who later developed epilepsy had quadriplegia (54.5%) and hemi￾plegia (27.2%). The types of epilepsies that were preceded by neonatal seizures were predominantly GTCS (59.0%), partial seizures (18.2%) and infantile spasms (18.2%). One additional infant had unclassified seizures. 3.2. Imaging data The imaging findings were available for 148 children which encompass 75.1% of all the subjects (Table 2). For 72 patients CT scans were available, for 48 patients MRI scans were available and for 28 patients both CT and MRI scans were available. In 49 patients we had no data or they had documented head ultra￾sounds that were done only during early infancy. Abnormal imaging was more common in CP children with epilepsy as compared to children without epilepsy ( p < 0.003). Within the patients with abnormal imaging findings only cerebral atrophy was more common in children with epilepsy, than in children without epilepsy ( p < 0.012). Children with infarcts and gray matter disease were somewhat more prone to develop epilepsy, while children with white matter disease were relatively more frequent in the group of CP without epilepsy. However, due to the small number of patients in each group these differences did not reach statistical significance. 3.3. Birth history The gestational age of the patients at birth was recorded in 190 (96.4%) of the children with CP. In the group of children with epilepsy 41 (65.1%) were term infants and 20 (31.7%) were preterm infants (6 of which were extreme preterm). In the group of children without epilepsy 56 (44.1%) were term infants while 69 (54.4%) were born pretermly (34 of which were extreme preterm). Four children (2 in each group) were post￾term infants. An increased prevalence of epilepsy was noted in the term infants ( p < 0.01). The mode of delivery was recorded in 178 (90.4%) children. Normal vaginal delivery was conducted in 29 (49.1%) children with epilepsy and 54 (45.4%) children without epilepsy. Instrumental delivery was conducted in only 6 children with epilepsy and 5 children without epilepsy. Caesarian sections were relatively common and performed in 24 (40.7%) of chil￾dren with epilepsy (15 of which were urgent) and 60 (50.4%) of children without epilepsy (24 of which were urgent). None of these modes of delivery was found as a significant risk factor for developing epilepsy ( p ¼ 0.2). Urgent caesarian sections Table 1 – The clinical subgroups of CP in the epileptic and the non-epileptic children and their respective type of epilepsy. CP subgroup CP Only CP & Epilepsy (epilepsy subtypes) Total 1. Hemiplegia 52 (39.4%) 18 (27.7%) [infantile spasms 2, partial seizures 9, GTCS 5, atonic/tonic sz 1, not classified 1] 70 (35.5%) 2. Diplegia 35 (26.5%) 7 (10.8%) [partial seizures 2, GTCS 3, myoclonic sz 1, atonic/tonic sz 1] 42 (21.3%) 3. Quadriplegia 23 (17.4%) 32 (49.2%) [infantile spasms 3, partial seizures 6, GTCS 13, atonic/tonic sz 5, myoclonic sz 2, not classified 3] 55 (27.9%) 4. Ataxic-Hypotonic 13 (9.9%) 5 (7.7%) [partial seizures 2, GTCS 1, myoclonic sz 1, not classified 1] 18 (9.2%) 5. Dyskinetic/mixed 9 (6.8%) 3 (4.6%) [infantile spasms 2, atonic/tonic sz 1] 12 (6.1%) Total 132 (100%) 65 (100%) [infantile spasms 7, partial seizures 19, GTCS 22, atonic/tonic sz 8, myoclonic sz 4, not classified 5] 197 (100%) Abbreviations: CP – cerebral palsy, GTCS – generalized tonic-clonic seizures, and sz – seizures. Table 2 – The imaging findings in the epileptic and the non-epileptic children. Imaging findings CP Only CP & Epilepsy Total Normal imaging 25 (28.7%) 10 (16.4%) 35 (23.6%) Abnormal Imaging (all findings) 62 (71.3%) 51 (83.6%) 113 (76.4%) Non-specific atrophy 4 (4.6 %) 11 (18.0%) 16 (10.8%) Grey matter insult (including infarctions) 14 (16.1%) 17 (27.9%) 31 (21.0%) White matter insult (including PVL) 16 (18.4%) 4 (11.5%) 23 (15.5%) Cerebral malformations Dysgenesis 10 (11.5%) 7 (11.5%) 17 (11.5%) Hydrocephalus 5 (5.7%) 5 (8.2%) 8 (5.4%) Brain Hemorrhage (including IVH) 13 (14.9%) 7 (11.5%) 20 (13.5%) Total 87 (100%) 61 (100%) 148 (100%) Abbreviations: PVL – Periventricular Leukomalacia, and IVH – Intraventricular Hemorrhage. p < 0.003. european journal of paediatric neurology 14 (2010) 67–72 69 第 65 页