The Imageological Research Of Brain MRI In Children With Cerebral Palsy And Epilepsy

OBJECTIVE: To analyze the Brain MRI changes in children with cerebral palsy(CP)and epilepsy(EP).To find out the connection between the MRI changes and the clinical features of the children with CP and EP.To help the doctors make the early diagnosis and predict the outcomes of these patients.METHODS: A total of 73 cases of brain MRI reports collected from Children's Hospital of Soochow University and Lianyungang Maternal and Child Health-Care hospital were analyzed retrospectively.Classify these cases by the CP types and GMFCS(Gross Motor Function Classification System).The clinical manifestations of epilepsy are also considered.Each patient is evaluated by 0-6 years-old Children's Neuropsychological Development Scale and Wechsler Children's Intelligence Scale(Chinese revised version).Comprehensive analyze these patients' s clinical characteristics,brain MRI imaging changes and clinical significance.RESULTS:(1)Among the 73 children with cerebral palsy and epilepsy,62 cases showed abnormal MRI imaging(84.93%,62/73).These 62 cases of brain MRI abnormalities were: 22 cases of cerebral dysplasia(30.14%,22/73),13(17.81%,13/73)of periventricular leukomalacia,10 of encephalatrophy(13.70%,10/73),6 of Pachygyria(8.22%,6/73),5 of schizencephaly(6.85%,5/73),2 of gray matter heterotopia(2.74%,2/73),2 of congenital hydrocephalus(2.74%,2/73)and 2 of perencephaly(2.74%,2/73).Different types of cerebral palsy and epilepsy in children may have different MRI changes.For example,cerebral dysplasia and encephalatrophy was more common in Spastic quadriplegia.Cerebral dysplasia and encephalatrophy are much more offen to be seen In Spastic diplegia.In general,cerebral dysplasia of the brain MRI changes were the most common and periventricular leukomalacia and encephalatrophy were also common.(2)Among the 73 children with cerebral palsy and epilepsy,14 cases showed spastic quadriplegia(19.18%,14/73),18 of spasticity diplegia(24.66%,18/73),24 of spastic hemiplegia(32.88%,24/73),2 of dyskinetic CP(2.74%,2/73),6 of ataxia CP(8.22%,6/73),9 of mixed-type CP(12.33%,9/73).Of all 9 cases of mixed-type cerebral palsy children,including 5 cases of spastic mixed dyskinetic,4 cases of Spastic diplegia mixed spastic hemiplegia.Among children with cerebral palsy and epilepsy,spasticity(14 cases of spastic quadriplegia,18 cases of spastic diplegia,24 cases of spastic hemiplegia)were significantly more than other types,accounting for 76.71%(56/73).Spasmodic hemiplegia was the most common in spastic CP children.Asymmetric changes in brain MRI of cerebral palsy and epilepsy was also common.(3)There were 29(39.72%)cases is considered as GMFCS I andII in,23(31.51%)of this case is consider as GMFCS III,21 of(28.77%)the 73 children with cerebral palsy and epilepsy is consideredas as GMFCSIV andV.Abnormalities showed in images of brain MRI were more severe than the degree of limb movement disorders(P = 0.010 <0.05).(4)All of the 73 cases of cerebral palsy and epilepsy showed different degrees of cognitive impairment: 8(10.96%)of mild abnormalities,37(50.68%)of moderate abnormalities,28 of(38.36%)severe abnormalities.The degree of cognitive impairment was small(P = 0.020 <0.05)in children with negative cerebral palsy and epilepsy examined by brain MRI.CONCLUSION:(1)The abnormal rate of brain cerebral MRI was 84.93% in children with cerebral palsy and epilepsy.The MRI abnormality of brain dysplasia was the most common.White matter softening and local brain atrophy were common as well.(2)spastic cerebral palsy was significantly more than other types in children with cerebral palsy and epilepsy.Spastic hemiplegia was the most common in children with spastic cerebral(including spastic quadriplegia,spastic type of paralysis and spastic hemiplegia).In addition,the presence of asymmetric lesions in the brain MRI(including spastic hemiplegia),epilepsy was more likely happen in children with cerebral palsy.(3)There were no significant differences in head MRI of epilepsy patients with different levels of GMFCS.Patients with normal head MRI had less degree of paralysis compared to imaging abnormalities.Cerebral palsy patients with epilepsy head MRI abnormalities were more seriousn in the degree of physical movement(4)All children with cerebral palsy and epilepsy showed different degrees of cognitive impairment.However the patients with normal brain MRI had less degree of cognitive impairment.