Theme 3 | Rare diseases

Prognostic value of brain abnormalities for cognitive functioning in cerebral palsy: a prospective cohort study

Irene Moll

Irene Moll1, Jeanine Voorman2, Marjolijn Ketelaar3, Petra van Schie4, Jan Willem Gorter5, Maarten Lequin6, Linda S. de Vries7, R. Jeroen Vermeulen1
1.Department of Neurology, Maastricht UMC+; department of Nutrition and Movement Sciences, School of Mental Health and Neuroscience, Maastricht University, The Netherlands.
2.Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands and Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
3.Center of Excellence for Rehabilitation Medicine; UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
4.Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
5.CanChild, department of Pediatrics, School of Rehabilitation Science, McMaster University, Hamilton, Canada.
6.Department of Radiology, UMC Utrecht, The Netherlands.
7.Department of Neonatology, UMC Utrecht, The Netherlands.

Brain abnormalities in cerebral palsy (CP) are known to relate to motor outcome; however, its association with cognitive functioning is less clear. 

Aim of the study
1) To investigate prognostic value of brain abnormalities for cognitive functioning 2) To explore added value of prognostic variables across domains of the International Classification of Functioning, Disability and Health (ICF).(1) 

We retrospectively analyzed brain MRI scans of 75 children with CP (Gross Motor Function Classification System [GMFCS] level I-V)(2), as part of a longitudinal study. MRI classification: qualitative classification of brain abnormality pattern by Himmelmann et al.(3) and semi-quantitative grading of the extent of damage, according to a scale adapted from Cioni et al.(4) Cognitive functioning was dichotomized into ‘impaired cognition’ (intelligent quotient (IQ) ≤70) and ‘normal’ (IQ >70). Multivariable logistic regression produced odds ratios of risk factors for impaired cognition (with 95% confidence intervals).

Overall, 27% of the tested participants had an IQ below 70 and 36% of the participants was classified as ‘having impaired cognition’. At young age, more extensive white matter damage (OR 1.6, 95% C.I. 0.97-2.67) and more severe GMFCS level (OR 3.2, 95% C.I. 1.70-5.98) are risk factors for impaired cognition at school-age (4-7 years of age). This model predicts correctly in 89% of the cases. Brain damage alone predicts 71% of the presence of impaired cognition.

Brain MRI characteristics and GMFCS level can each help identify children with CP at risk for ID and together have a strong predictive value.

Cerebral palsy, Intellectual disability, MRI classification

1. World Health Organisation. International Classification of Functioning, Disability and Health. Geneva 2001.
2. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental medicine and child neurology. 1997;39(4):214-23.
3. Himmelmann K, Horber V, De La Cruz J, Horridge K, Mejaski‐Bosnjak V, Hollody K, et al. MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Developmental Medicine & Child Neurology. 2017;59(1):57-64.
4. Cioni G, Di Paoo MC, Bertuccelli B, Paolicelli PB, Canapicchi R. MRI findings and sensorimotor development in infants with bilateral spastic cerebral palsy. Brain and Development. 1997;19(4):245-53.

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