title: Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and cognitive impairment: a population-based study in children born at term.
abstract: BACKGROUND
  Antecedents of accompanying impairments in cerebral palsy and their relation to neuroimaging patterns need to be explored.
  
  
  METHODS
  A population-based study of 309 children with cerebral palsy born at term between 1983 and 1994. Prepartum, intrapartum, and postpartum variables previously studied as antecedents of cerebral palsy type and motor severity were analyzed in children with cerebral palsy and cognitive impairment and/or epilepsy, and in children with cerebral palsy without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analyzed. Data were retrieved from the cerebral palsy register of western Sweden, and from obstetric and neonatal records.
  
  
  RESULTS
  Children with cerebral palsy and accompanying impairments more often had low birthweight (kg) (odds ratio 0.5, 95% confidence interval 0.3-0.8), brain maldevelopment known at birth (p = 0.007, odds ratio ∞) and neonatal infection (odds ratio 5.4, 95% confidence interval 1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (odds ratio 7.2, 95% confidence interval 2.9-17.2), cortical/subcortical lesions (odds ratio 5.3, 95% confidence interval 2.3-12.2) and basal ganglia lesions (odds ratio 7.6, 95% confidence interval 1.4-41.3) were more common, wheras white matter injury was found significantly less often (odds ratio 0.2, 95% confidence interval 0.1-0.5). In most children with maldevelopment, the intrapartum and postpartum periods were uneventful (p < 0.05). Cerebral maldevelopment was associated with prepartum antecedents, whereas subcortical/cortical and basal ganglia lesions were associated with intrapartum and postpartum antecedents.
  
  
  CONCLUSIONS
  No additional factor other than those related to motor impairment was associated with epilepsy and cognitive impairment in cerebral palsy. Timing of antecedents deemed important for the development of cerebral palsy with accompanying impairments were supported by neuroimaging patterns.
authors.affiliation: Department of Perinatal Center, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
authors.forename: Kristina
authors.identifier: http://orcid.org/0000-0001-6591-3343
authors.initials: K
authors.lastname: Ahlin
authors.affiliation: Department of Perinatal Center, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.|Department of Genes and Environment, Division of Epidemiology, Institute of Public Health, Oslo, Norway.
authors.forename: Bo
authors.initials: B
authors.lastname: Jacobsson
authors.affiliation: Department of Mathematical Statistics, Institute for Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
authors.affiliation: Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Himmelmann
mesh_terms: D002547:Cerebral Palsy / Q000150:complications / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000150:complications / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D004827:Epilepsy / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D047929:Term Birth
keywords: Cerebral palsy; cognitive function; epilepsy; neuroimaging; risk factors