scholarly journals Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy

2021 ◽  
Vol 11 (8) ◽  
pp. 765
Author(s):  
Stephanie Lee ◽  
Karyn Robinson ◽  
Madison Lodge ◽  
Mary Theroux ◽  
Freeman Miller ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Neuromuscular Blockade ◽  
Gestational Age ◽  
Low Birthweight ◽  
Neuromuscular Blocking ◽  
Anticonvulsant Therapy ◽  
Surgical Patients ◽  
Spastic Cerebral Palsy ◽  
Post Intubation ◽  
Gmfcs Level

: Individuals with spastic cerebral palsy (CP) often exhibit altered sensitivities to neuromuscular blocking agents (NMBAs) used for surgical intubation. We assessed usage of the NMBA rocuronium in patients with spastic CP and evaluated potential modifiers of dosing including gross motor function classification system (GMFCS) level, birthweight, gestational age, and the use of anticonvulsant therapy. In a case-control study, surgical patients with spastic CP (n = 64) or with idiopathic or non-neuromuscular conditions (n = 73) were enrolled after informed consent/assent. Patient data, GMFCS level, anticonvulsant use, and rocuronium dosing for intubation and post-intubation neuromuscular blockade were obtained from medical records. Findings reveal participants with CP required more rocuronium per body weight for intubation than controls (1.00 ± 0.08 versus 0.64 ± 0.03 mg/kg; p < 0.0001). Dosing increased with GMFCS level (Spearman’s rho = 0.323; p = 0.005), and participants with moderate to severe disability (GMFCS III-V) had elevated rocuronium with (1.21 ± 0.13 mg/kg) or without (0.86 ± 0.09 mg/kg) concurrent anticonvulsant therapy. Children born full-term or with birthweight >2.5 kg in the CP cohort required more rocuronium than preterm and low birthweight counterparts. Individuals with CP exhibited highly varied and significant resistance to neuromuscular blockade with rocuronium that was related to GMFCS and gestational age and weight at birth.

scholarly journals Risk factors for hip dislocation in dyskinetic cerebral palsy

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110011
Author(s):  
Kyoko Okuno ◽  
Yukihiro Kitai ◽  
Toru Shibata ◽  
Hiroshi Arai
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Gestational Age ◽  
Brain Mri ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Lesion Location ◽  
Hip Displacement ◽  
Gmfcs Level

Purpose: To investigate the risk factors for hip displacement in patients with dyskinetic cerebral palsy (DCP). Methods: We evaluated 81 patients with DCP, 45 males and 36 females, aged 10–22 years, risk factors for hip displacement were evaluated using multivariate logistic regression analysis with primary brain lesions, Gross Motor Function Classification System (GMFCS) level, gestational age, birth weight, Cobb’s angle, and complication of epilepsy as independent factors. Hip displacement was defined as migration percentage >30%. Primary brain lesions were classified into globus pallidus (GP), thalamus and putamen (TP), and others using brain magnetic resonance imaging (MRI). Perinatal and clinical features were compared between patients with GP lesions and those with TP lesions. Results: Hip displacement was observed in 53 patients (67%). Higher GMFCS levels (p = 0.013, odds ratio [OR] 2.6) and the presence of GP lesions (p = 0.04, OR 16.5) were independent risk factors for hip displacement. Patients with GP lesions showed significantly higher GMFCS levels, more frequent hip displacement, and lower gestational age and birth weight than those with TP lesions. Conclusion: Primary brain lesion location may be an important factor in predicting hip displacement among patients with DCP. Appropriate risk assessment using brain MRI may contribute to the early detection and intervention of hip displacement because brain lesion location can be assessed during infancy before GMFCS level is decided.

The Influence of Gestational Age on Severity of Impairment in Spastic Cerebral Palsy

2008 ◽  
Vol 153 (2) ◽  
pp. 203-208.e4 ◽  
Author(s):  
Karla Hemming ◽  
Allan Colver ◽  
Jane L. Hutton ◽  
Jennifer J. Kurinczuk ◽  
Peter O.D. Pharoah
Keyword(s):  
Cerebral Palsy ◽  
Gestational Age ◽  
Spastic Cerebral Palsy

scholarly journals MRI findings in patients with spastic cerebral palsy. I: correlation with gestational age at birth

2008 ◽  
Vol 39 (6) ◽  
pp. 363-368 ◽  
Author(s):  
Akihisa Kumura ◽  
Fumio Hayakawa ◽  
Toru Kato ◽  
Kuniyoshi Kuno ◽  
Kazuyoshi Watanabe
Keyword(s):  
Cerebral Palsy ◽  
Gestational Age ◽  
Spastic Cerebral Palsy ◽  
Mri Findings ◽  
Gestational Age At Birth ◽  
Age At Birth

scholarly journals Association between Gait Deviation Index and Physical Function in Children with Bilateral Spastic Cerebral Palsy: A Cross-Sectional Study

2019 ◽  
Vol 9 (1) ◽  
pp. 28 ◽  
Author(s):  
Tadashi Ito ◽  
Koji Noritake ◽  
Hiroshi Sugiura ◽  
Yasunari Kamiya ◽  
Hidehito Tomita ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gait Speed ◽  
Spastic Cerebral Palsy ◽  
Cross Sectional ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Gait Deviation Index ◽  
Level I ◽  
Gmfcs Level

This study examined the association between Gait Deviation Index (GDI) and the five-times-sit-to-stand test (FTSST) or gait speed results, which represent mobility and muscle strength of the lower extremities in ambulatory children with Gross Motor Function Classification System (GMFCS) level I and II spastic cerebral palsy. In this cross-sectional, observational study, three-dimensional gait analysis data were obtained during gait trials to evaluate the GDI in 35 children (age 5–16 years) with spastic palsy. Motor function was evaluated using FTSST and gait speed. Gross motor function was evaluated using GMFCS. Children with GMFCS level II spastic cerebral palsy demonstrated lower GDI (p < 0.001) and poorer FTSST (p = 0.031) than those with GMFCS level I spastic cerebral palsy. Correlation analysis showed that FTSST results were significantly correlated with GDI (r = −0.624; p < 0.001). Motor function may be important for the maintenance of gait quality in patients with GMFCS level I and II spastic cerebral palsy and should not be ignored. In conclusion, reduction in gait impairment may affect the values of FTSST and GDI in patients with spastic cerebral palsy who can ambulate without an assistive device.

scholarly journals Hip dysplasia among children with spastic cerebral palsy in rural Bangladesh

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Tasneem Karim ◽  
Mahmudul Hassan Al Imam ◽  
Prue Golland ◽  
Aynul Islam Khan ◽  
Iqbal Hossain ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Hip Dysplasia ◽  
Clinical History ◽  
Population Based ◽  
Spastic Cerebral Palsy ◽  
Study Cohort ◽  
X Rays ◽  
Gmfcs Level

Abstract Background Hip dysplasia is common among children with cerebral palsy (CP), particularly in spastic CP. It can result in pain, reduced function and quality of life. However, the burden of hip dysplasia among children with CP in llow-and middle-income countries (LMICs) like Bangladesh is unknown. We aimed to define the burden of hip dysplasia among children with spastic CP in Bangladesh. Methods This study includes a subset of the Bangladesh CP Register (BCPR) study cohort who were registered between January and March 2015. The BCPR is a population-based surveillance of children with CP (aged < 18 years) operating in a northern sub-district (Shahjadpur; child population ~ 226,114) of Bangladesh. Community-based key informant’s method (KIM) survey conducted to identify children with CP in the surveillance area. A diagnosis of CP was made based on clinical history and examination by the study physicians and physiotherapist. Study participants had an antero-posterior (AP) X-ray of their pelvis. The degree of subluxation was assessed by calculating the migration percentage (MP). Results During the study period, 196 children with CP were registered, 144 had spastic CP. 40 children with spastic CP (80 hips) had pelvic X-Rays (mean age 9.4 years, range 4.0–18.0 years) and 32.5% were female. Gross Motor Function Classification System (GMFCS) showed 37.5% (n = 15) with GMFCS level I-II and 62.5% (n = 25) with GMFCS level III-V. Twenty percent (n = 8) of the children had hip subluxation (MP: 33–80%). Osteopenic changes were found in 42.5% (n = 17) children. Conclusions To the best of our knowledge this is one of the first studies exploring hip dysplasia among children with spastic CP in Bangladesh. Our findings reflect that hip dysplasia is common among children with spastic CP. Introduction of hip surveillance programmes is imperative for prevention of secondary complications, reduced function and poor quality of life among these children.

scholarly journals Risk factors for intellectual disability in children with spastic cerebral palsy

2021 ◽  
pp. archdischild-2020-320441
Author(s):  
David Cummins ◽  
Claire Kerr ◽  
Karen McConnell ◽  
Oliver Perra
Keyword(s):  
Cerebral Palsy ◽  
Intellectual Disability ◽  
Gestational Age ◽  
Outcome Measure ◽  
Spastic Cerebral Palsy ◽  
Early Screening ◽  
Cross Sectional ◽  
Very Preterm Infants ◽  
Severe Intellectual Disability ◽  
Increased Risk

BackgroundCerebral palsy (CP) is a non-progressive disorder of posture and movement caused by prenatal or perinatal lesions of the brain. Children with CP are also at increased risk of other disabilities, for example, intellectual disability. Previous studies suggest the risk of intellectual disability varies in complex ways according to the type of motor impairment and perinatal factors such as gestational age.ObjectiveTo determine the patterns of risk of intellectual disability in children with spastic CP.DesignCross-sectional, population-based study using the Northern Ireland Cerebral Palsy Register.ParticipantsPersons born in 1981–2008 with congenital bilateral or unilateral spastic CP (N=1452).Outcome measureThe outcome measure was severe intellectual disability (IQ <50), as reported by clinicians known to the child. Data pertaining to CP subtype, sex, gestational age, birth weight and functional level were included in analyses.ResultsSevere intellectual disability was significantly more prevalent in children with bilateral spastic CP (BSCP) compared with children with unilateral spastic CP (χ² (2)=162.60, p<0.001). Compared with very preterm infants with BSCP, the risk of intellectual disability increased in moderately preterm (OR=3.97, 95% CI 1.04 to 15.23) and at-term (OR=2.51, 95% CI 1.16 to 5.44) children with BSCP.ConclusionsChildren with BSCP are at increased risk of intellectual disability, with those born at term at the highest risk. The findings highlight the importance of early screening, particularly for children with BSCP born at term.

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