Neuropediatrics 2020; 51(02): 113-119
DOI: 10.1055/s-0039-3402007
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Origin of the Cerebral Palsies: Contribution of Population-Based Neuroimaging Data

Veronka Horber
1   Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
Elodie Sellier
2   CNRS, Grenoble INP, CHU Grenoble Alpes, Univ. Grenoble Alpes, TIMC-IMAG, Grenoble, France
Karen Horridge
3   Department of Paediatrics, Sunderland Royal Hospital, Sunderland, United Kingdom
Gija Rackauskaite
4   Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Guro L. Andersen
5   Vestfold Hospital Trust, Cerebral Palsy Registry of Norway, Tønsberg, Norway
Daniel Virella
6   Neonatology Intensive Care Unit/Research Centre, Lisbon, Central Lisbon Hospital, Portugal
Els Ortibus
7   Department of Development and Regeneration, KULeuven and University Hospitals Leuven, Belgium
Ivana Dakovic
8   Department of Neuropediatrics, Children's Hospital Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
Owen Hensey
9   Central Remedial Clinic, Clontarf, Dublin, Ireland
Anja Radsel
10   Community Health Centre Medvode, Paediatric Medical Office, Slovenia
Antigone Papavasiliou
11   Department of Paediatric Neurology, IASO Children's Hospital, Athens, Greece
Javier Cruz De la
12   Research Institute (i + 12), SAMID, University Hospital “12 Octubre,” Madrid, Spain
Catherine Arnaud
13   UMR Inserm U1027, team SPHERE University Toulouse III Paul Sabatier, Toulouse, France
14   Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
Ingeborg Krägeloh-Mann
1   Department of Paediatric Neurology, University Children's Hospital, Tübingen, Germany
15   Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden
› Author Affiliations
Further Information

Publication History

20 August 2019

11 November 2019

Publication Date:
02 March 2020 (online)


Background Surveillance of cerebral palsy in Europe (SCPE) presents the first population-based results on neuroimaging findings in children with cerebral palsy (CP) using a magnetic resonance imaging classification system (MRICS).

Method MRIs of children with CP born between 1999 and 2009 from 18 European countries were analyzed. MRICS identifies patterns of brain pathology according to timing during brain development which was analyzed with respect to CP subtypes and gestational age.

Results MRIs or written reports from 3,818 children were available. The main clinical characteristics were similar to the 5,415 without such data. Most frequent was predominant white matter injury (49%), followed by predominant gray matter injury (21%). Maldevelopments were found in 11% of cases. Miscellaneous findings were present in 8.5% and normal findings in 10.6%. MRI patterns of children with unilateral spastic, bilateral spastic, and dyskinetic CP were mainly lesional (77, 71, and 59%, respectively), whereas children with ataxic CP had more maldevelopments, miscellaneous, and normal findings (25, 21, and 32%, respectively). In children born preterm, predominant white matter injury was most prevalent (80% in children born <32 weeks of gestation).

Conclusion Analysis of MRI in the European CP database identified CP as a mainly lesional condition on a large population basis, maldevelopments were relatively uncommon. An exception was ataxic CP. Children born preterm mostly presented with a lesion typical for their gestational age (GA) at birth. The decreasing prevalence of CP in this group suggests that progress in perinatal and neonatal medicine may lead to a reduction of these lesions.

  • References

  • 1 Surveillance of Cerebral Palsy in Europe (SCPE). A collaboration of cerebral palsy registers. Dev Med Child Neurol 2000; 42: 816-824
  • 2 Surveillance of Cerebral Palsy in Europe (SCPE). Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002; 44 (09) 633-640
  • 3 Platt MJ, Cans C, Johnson A. , et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet 2007; 369 (9555): 43-50
  • 4 Sellier E, Platt MJ, Andersen GL, Krägeloh-Mann I, De La Cruz J, Cans C. ; Surveillance of Cerebral Palsy Network. Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol 2016; 58 (01) 85-92
  • 5 Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS. Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol 2014; 56 (03) 222-232
  • 6 Korzeniewski SJ, Birbeck G, DeLano MC, Potchen MJ, Paneth N. A systematic review of neuroimaging for cerebral palsy. J Child Neurol 2008; 23 (02) 216-227
  • 7 Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol 2007; 49 (02) 144-151
  • 8 Himmelmann K, Horber V, De La Cruz J. , et al; SCPE Working Group. MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Dev Med Child Neurol 2017; 59 (01) 57-64
  • 9 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (04) 214-223
  • 10 Ashwal S, Russman BS, Blasco PA. , et al; Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 62 (06) 851-863
  • 11 Krägeloh-Mann I, Helber A, Mader I. , et al. Bilateral lesions of thalamus and basal ganglia: origin and outcome. Dev Med Child Neurol 2002; 44 (07) 477-484
  • 12 Himmelmann K, Hagberg G, Wiklund LM, Eek MN, Uvebrant P. Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol 2007; 49 (04) 246-251
  • 13 Steggerda SJ, Leijser LM, Wiggers-de Bruïne FT, van der Grond J, Walther FJ, van Wezel-Meijler G. Cerebellar injury in preterm infants: incidence and findings on US and MR images. Radiology 2009; 252 (01) 190-199
  • 14 Krägeloh-Mann I, Toft P, Lunding J, Andresen J, Pryds O, Lou HC. Brain lesions in preterms: origin, consequences and compensation. Acta Paediatr 1999; 88 (08) 897-908
  • 15 Limperopoulos C, Chilingaryan G, Sullivan N, Guizard N, Robertson RL, du Plessis AJ. Injury to the premature cerebellum: outcome is related to remote cortical development. Cereb Cortex 2014; 24 (03) 728-736
  • 16 Sellier E, McIntyre S, Smithers-Sheedy H, Platt MJ. , on behalf of SCPE and the ACPR Group. European and Australian cerebral palsy surveillance networks working together for collaborative research. Neuropediatrics 2020; 51 (02) 105-112
  • 17 Galea C, Mcintyre S, Smithers-Sheedy H. , et al; Australian Cerebral Palsy Register Group. Cerebral palsy trends in Australia (1995-2009): a population-based observational study. Dev Med Child Neurol 2019; 61 (02) 186-193
  • 18 Schiariti V, Fowler E, Brandenburg JE. , et al. A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations. Dev Med Child Neurol 2018; 60 (10) 976-986
  • 19 Fiori S, Guzzetta A, Pannek K. , et al. Validity of semi-quantitative scale for brain MRI in unilateral cerebral palsy due to periventricular white matter lesions: Relationship with hand sensorimotor function and structural connectivity. Neuroimage Clin 2015; 8: 104-109