Characteristics of Epilepsy in Children with Cerebral Palsy: A Single Tertiary Center Study

Abstract

Purpose: The aim of this study was to describe the characteristics of epilepsy in cerebral palsy (CP) patients and identify risk factors for epilepsy and drug-resistant epilepsy. Methods: CP patients aged 18 years old or younger who visited the pediatric neurology department and/or rehabilitation department of a tertiary care hospital between January 2016 and December 2022 with a minimum follow-up period of 2 years were included. Demographic and clinical data, seizure characteristics, brain imaging, electroencephalography, and genetic evaluation results were reviewed retrospectively. Results: Among 268 patients included in this study, 36.9% had epilepsy and 10.8% had drug-resistant epilepsy. Asphyxia (29.3%), hemorrhage, infarction, and brain infection (25.3%) were associated with epilepsy. Epileptic CP patients were more likely to experience neonatal seizures (18.2% vs. 4.1%, P<0.001) and febrile seizures (12.1% vs. 7.1%, P=0.02) than non-epilepsy CP patients. The most common cerebral subtype in patients with epilepsy was spastic quadriplegia (59.6%). Epilepsy patients were more severely impaired in gross motor function, with worse intellectual disability. Patients with macrocephaly or cerebral malformation were more likely to have drug resistance. Valproate (51.7% and 25.7%) and levetiracetam (41.4% and 25.7%) were the two most commonly used antiseizure medications, both in monotherapy and polytherapy. Conclusion: A history of asphyxia, febrile seizure, neonatal seizure, spastic quadriplegia, more severely impaired gross motor function, and intellectual disability were found to be risk factors for epilepsy. Further research with prospective data collection to develop a model for predicting seizures or epilepsy in CP patients is needed.