الفهرس 
CEREBRAL PALSYOnly 14 pages are availabe for public view
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Abstract
Cerebral palsy is a group of non progressive but often changing motor impairment syndromes secondary to lesions or anomalies of brain arising in early stages of its development. Cerebral palsy is the commonest physical disability in childhood, occurring in 2.0 to 2.5 per 1000 live births. These disorders become manifest early in life and are permanent and non-progressive conditions. It is the most common and costly form of chronic motor disability that begins in childhood. It is caused by damage to the motor control centers of the young developing brain.
Children with severe cerebral palsy (CP) may have an intellectual disability. These children frequently experience health problems such as epilepsy, recurrent pulmonary infections, gastro-oesophageal reflux, and constipation. In addition these children are prone to develop low bone mineral density (BMD).
This study was conducted on 58 children suffering from Cerebral palsy of mean age 6 years till 10 years. The children were recruited from both Neurology out patient clinic in Pediatrics hospital, Ain shams University and Institute of Postgraduate Childhood studies, Ain shams University during the period from March, 2013 to March, 2014.
The aim of our present study was to assess the BMD in different GMFCS levels according to severity of the motor impairment or resulting disability in children with cerebral palsy mainly spastic type. To assess level of Vit. D and IGF-1 in those children and correlation between them with the effect of anti-epileptic drugs.
Comparison between patients group and control group showing that there was a highly significant lower frequency of distribution of Length for age percentile and weight for length percentile in the patients when compared to the control.
In our present study Wt/age, Lt/age and Wt/lt is significantly lower as we proceed from mild to severe stages GMFCS. Z-score in moderate stage being significantly lowest. Vit.D is significantly lower in severe stage of GMFCS than milder stages. Weight and BMD Z-score is also significantly lower in severe stage than milder stages.
Calcium and Vit.D were significantly lower in cases compared to control, while IGF-1 level was comparable in cases and control. Mean alkaline phosphatase was higher though not significant in cases than control.
Mean BMD Z-score in patients was highly significantly lower than mean in control group.
There is statistically significant effect on BMD (Z-score) when patients were receiving polytherapy mainly showing highest significance (the BMD was lowest). Patients on Carbamazepine were affected next and minimal affection in BMD was seen in those receiving Valproic acid alone.There was also a high statistical significance in calcium and vit. D levels being lower on those receiving polytherapy mainly. There was no statistical significance as regards effect of antiepileptics on GMFCS.
There was a significant positive correlation between BMD Z-score with Vit. D and IGF 1. A Positive correlation between weight, BMD Z-score, Vit. D and IGF-1 and there was a positive correlation between BMI, BMD Z-score, Vit.D and IGF-1.There was also a positive correlation between vitamin D and IGF-1.
In mild GMFCS there was a significant positive correlation with BMI as well as with calcium, phosphorus, alkaline phosphatase and Vit. D. Additionally a positive correlation was found withIGF-1 as well as with BMD. In moderate GMFCS there was a significant positive correlation between Vit. D and IGF-1 and with BMI and BMD. In severe GMFCS a significant positive correlation with Vit D and IGF-1 as well as with BMD was found.
By regression analysis it was seen that that in descending order of significance as regard effect on BMD, GMFCS was most significant, then nutritional status followed by Vit. D and IGF -1, antiepileptic drugs and difficulty of feeding were of no significance.