Original articleGastrointestinal manifestations in children with cerebral palsy
Introduction
The survival of children with severe central nervous system damage has created a major challenge for medical care [1], [2]. Numerous clinical reports, in small series of patients, have indicated that brain damage may result in gastrointestinal (GI) dysfunction. Dysphagia, dysfunctional feeding patterns, vomiting and chronic constipation have all been reported in neurologically impaired children [3], [4], [5], [6]. Usually, all these symptoms are not specifically evaluated and/or related to any particular syndrome of perinatal brain damage. Cerebral palsy refers to a group of chronic, non progressive disorders of movement, posture, and tone due to a central nervous system damage during early development. The prevalence of cerebral palsy is approximately 2 per 1000 live births [1], [2]. The proportion of the different types of cerebral palsy varies from series to series, the spastic type being invariably the most frequent, while periventricular leukomalacia and/or cortical/cerebral atrophy stand out as the main neuropathological substrates [2], [7], [8], [9].
The aims of our study were to document gastrointestinal pathology in a series of patients with cerebral palsy and to possibly correlate GI symptoms with findings on neuroimaging studies.
Section snippets
Subjects and methods
From September 1995 to May 1997 gastrointestinal symptoms were evaluated in 58 consecutive children (M/F:25/33; Meanage+SD: 5.2+4.9 years) with cerebral palsy referred to a pediatric neurology outpatient clinic. The degree of functional brain impairment was defined on the basis of the IQ level, according to DSM-IV [10]. The type and distribution of the cerebral palsy were categorized according to the definitions proposed by Hagberg et al [11].
Clinical features in our patients with cerebral
Results
Fifty-three out of 58 (91%) children affected by cerebral palsy had gastrointestinal symptoms of at least 6 months’ duration. Clinical GI manifestations in our patients are reported in Table 3. Computed tomography and/or magnetic resonance imaging gave were normal findings in five of the 58 (9%) patients. Three of the five patients with normal neuroimaging did not show GI symptoms. Abnormal neuroimaging findings included: ventricular dilation in 14 (24%) patients, periventricular leukomalacia
Discussion
Our results indicate that, when appropriate diagnostic techniques are employed, children with cerebral palsy, particularly in its most severe form, show a multitude of gastrointestinal motility dysfunctions, which may be responsible for significant morbidity. The high prevalence of GI functional abnormalities among retarded children may not be generally recognized: however, early recognition could allow for specific therapy for the GI disorder.
GI motor dysfunctions are known to occur frequently
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