Malnutrition and Epilepsy are Common Among Children With Cerebral Palsy, Study Says

Malnutrition and epilepsy are common among children with cerebral palsy, and should be carefully evaluated and managed by their families and physicians, a study says.

The study, “High rates of malnutrition and epilepsy: two common comorbidities in children with cerebral palsy,” was published in the Turkish Journal of Medical Sciences.

Usually caused by brain lesions that occur during fetal development or infancy, cerebral palsy is characterized by abnormal muscle tone, postural control, and motor function. Patients show different degrees of impairment in cognition, perception, and behavior, and can have seizures and poor nutritional status.

Malnutrition is highly prevalent among children with cerebral palsy, not only due to poor nutrient intake caused by “gastrointestinal disorders, including oral motor dysfunction, constipation, and gastroesophageal reflux,” but also because of other factors such as disease severity, cognitive and motor deficits, and use of anti-epileptic medications, the researchers wrote.

Their study involved a total of 197 children with cerebral palsy — 82 (41.6%) girls and 115 (58.4%) boys — with a median age of 6 years. Researchers evaluated the children’s nutritional status using the Gomez classification of weight-for-age and their motor function based on the Gross Motor Function Classification System (GMFCS).

Most children (163 or 82.7%) had spastic cerebral palsy, including 82 (41.6%) with quadriplegia (both arms and legs affected), 58 (29.4%) with diplegia (leg muscle stiffness), 17 (8.6%) with hemiplegia (one side of the body affected), and six (3%) with monoplegia (one limb affected).

According to GMFCS scores, 21.2% of children had severe impairments in motor function (level 5), 24% had moderate impairments (level 4), 6% had mild impairments (level 3), 12% had borderline impairments (level 2), and 36.6% had minimal physical disabilities (level 1).

Results showed that overall malnutrition was the most prevalent commorbidity observed in the children (76.6%), followed by epilepsy (51.7%). More than half of the children with epilepsy (54%) had spastic quadriplegia.

“The most common type of malnutrition was severe malnutrition, which was seen in 70 patients (35.5%); only one in five patients had a normal weight. More than half of the patients (58.4%) had difficulties consuming solid food, and they preferred puree (33%) or liquids only (7.1%),” the study said.

Of the children studied, 51.7% had epilepsy, and “in the majority of them (63.7%), the seizures had begun before they were 1,” the researcher wrote. The most common type of seizures observed, in 49.8% of the children, were general seizures (seizures that involve both sides of the brain), followed by partial seizures (affecting one side of the brain) in 47.4% of the children, and infantile spasms (rare type of seizures that usually occur in children under one year) in 2.8% of the patients.

“The complete control of seizures was achieved in 74 patients (72.6%), with partial control in 14 patients (13.7%), while 14 patients (13.7%) exhibited poor or no response to either older or newer generations of anti-epileptic drugs,” the researchers added.

“In conclusion, our study reported a higher rate of malnutrition and epilepsy in children with (cerebral palsy). Certainly, many factors can cause malnutrition, such as inadequate food intake and neurological and gastrointestinal problems, and these must be eliminated in these children,” they said. Therefore, “the awareness of families and physicians about the nutritional status of children with CP should be increased.”