Phenotypic manifestation, Etiology and Associated disorders of Cerebral Palsy: A Cohort study in Pakistan

Abstract

Cerebral palsy (CP) is a set of neurological disorder that affects neonates’ ability to move, and it is caused by abnormal brain development or injury to the areas of the brain that control movement, balance, and posture. Population-based studies from all around the world found that the prevalence of CP ranged from 1.5 to >4 per 1,000 live births. The overall prevalence recorded in Pakistan was 1.22 per 1000 live births. The majority of research carried out in Pakistan is related to the treatment and management of CP. There is a paucity of comprehensive data in the areas of epidemiology, etiology, maternal factors, and molecular genetic diagnosis which are essential toward the important goal of developing strategies for management and prevention of CP. The aim of this study was to elucidate the phenotypic manifestation, etiology, and associated disorders of CP in a multiethnic population. A cohort study on CP and its biodemographic correlates was conducted and 989 CP patients were recruited from National Institute of Rehabilitation Medicine (NIRM), Islamabad between 2020-2021. Data were collected from parents/guardians of affected children through a structured questionnaire. The questionnaire comprised of 5 sections including demographic detail, phenotypes, clinical variants, family attributes and maternal and risk factors. The data were recorded and maintained in MS-Excel (Office 365), and statistical analyses were done through SPSS (version 20) and GraphPad (Prism; version 5); descriptive statistics was applied and Chi-square test and t-test were employed. From the total of 989 patients recruited, 61% of the patients were male and 39% were female (male to-female ratio 1.6:1). Majority of the patients (51%) came from Punjab, had rural origin (68%), spoke Punjabi (48%), fall in the age range of 0.1-5 years (42%), belonged to low or low-mid socio-economic status (64%), and extended families (63%). Parental consanguinity was witnessed in 63% cases. The spastic CP had the highest representation (53%), followed by athetoid (29%), ataxic (14%) and mixed types (3.6%). Postnatal, natal and prenatal causes also found higher in spastic CP. Neonatal, maternal, obstetric and gynecological variables were also observed. Various anomalies associated with the CP were observed in which speech impairment was found very high (20%). Treatment given to CP patients and improvement after treatment was also analyzed. This study adds useful and detailed information on various important aspects of CP which could be primer for developing policies regarding the management and prevention of CP.