Hemiparetic cerebral palsy: Clinical pattern and imaging in prediction of outcome

Background: Hemiparetic cerebral palsy (HCP) is described as having two mai n forms: arm-dominant, associated with large cortical/subcortical lesions; leg-dominant, associated with lesions of central white matter. Epilepsy and cognitive deficits are common in the former pattern and rare in the latter . Some authors have recommended routine imaging studies in children with HC P as an assessment of etiology and a predictor of outcome. The present stud y compares the relative values of clinical analysis and imaging in predicti ng epilepsy and cognitive disabilities, Methods: Forty-one consecutive pati ents with HCP underwent careful clinical assessment and imagine studies (pr imarily computed tomography) and were followed prospectively for the develo pment of recurrent afebrile seizures and academic difficulties. Results: Tw enty of the 41 patients (48.8%) were arm-dominant, 14/41 (34.1%) leg-domina nt, and 7/41 (17.1%) proportional (arm = leg), The principal imaging findin gs were: arm-dominant patients - large arterial infarcts, porencephalic cys ts, brain malformations; leg-dominant - periventricular leukomalacia; propo rtional - porencephaly. Arm-dominant hemiparesis and radiologic evidence of cortical pathology were both predictive of cognitive deficits (odds ratios 14.2 [95% CI 2.6, 75.8] and 5.7 [95% CI 1.4, 22.3] respectively). For the development of epilepsy, both evaluation techniques were again predictive, with imaging findings of cortical pathology being particularly powerful (cl inical pattern OR 18.0 [95% CI 3.0, 107.7]; imaging OR 80.7 [95% CI 8.5, 76 7.3]), Conclusions: In this study, the clinical pattern of HCP and the radi ological findings were both predictive of outcome, with absence of cortical pathology on imaging bring particularly predictive for the absence of epil epsy. While the clinical pattern, in isolation, appears helpful in predicti ng outcome, our results suggest that both evaluation tools have important r oles to play in the evaluation of HCP patients.