Epilepsy in children with cerebral palsy

The heightened risk of epilepsy in cerebral palsy (CP) was recognized by Freud more than 100 years ago.1 His descriptions of the characteristics of the seizures indicate his appreciation of their essentially symptomatic nature. Much more recently, the importance of epilepsy as an adverse factor for cognitive function in children with hemiplegic CP has been highlighted.2 The possibility that subclinical seizure discharges may add to cognitive problems requires particular attention in any child whose abilities may be already impaired secondary to structural brain abnormalities. Nevertheless, it is important to recognize that the motor difficulties, and any intellectual disabilities, as well as complicating seizures, are likely to stem from the same underlying pathology.
Cerebral palsy (CP) is the result of non-progressive damage to the developing brain and consists of a number of clinical neurological syndromes of heterogeneous aetiology. Epilepsy is known to have a higher association with cerebral palsy; 15–60% of children with cerebral palsy have been reported to have epilepsy. It has been observed that seizures in these children tend to have an earlier onset, necessitating the use of more than 1 antiepileptic drug (AED) with the risk of seizure relapse after AED discontinuation.
The objective of the study was to explore the relationship between cerebral palsy and epilepsy and to determine the occurrence, associated factors, nature and prognosis of epilepsy in children with cerebral palsy. We feel that this study differs from most other previous studies on CP and seizures since the comparison groups included children with CP but no seizures and children with seizures only.

Diagnosis of epilepsy
Epileptic seizures can take many forms. They may be difficult to distinguish from other involuntary movements, particularly in dystonic/dyskinetic or ataxic CP. In addition, children with CP may have breath-holding spells, reflex anoxic attacks, vaso-vagal syncope, and other types of non-epileptic paroxysmal disorders. Therefore it is important to consider all possible causes of sudden alterations of movement and/or Annotation *UK usage. US usage: mental retardation. consciousness before concluding that an attack is epileptic. Most difficulties arise in distinguishing tonic, atonic, and myoclonic seizures from dyskinesia, and stereotyped movement patterns sometimes seen in children with severe learning disabilities. Although an individual child may have several sorts of epileptic seizures, the pattern of each type of seizure tends to be the same each time it occurs. Video recordings of characteristic attacks can be helpful even if movement artefacts make the EEG difficult to interpret. There are also problems with taking the EEG findings in isolation: children with CP may have changes comparable with those seen in epilepsy even if no clinical seizures have occurred.