FAMILIAL CEREBRAL PALSY: RECURRENCE OF CEREBRAL PALSY IN THE PRESENCE OF MULTIPLE RISK FACTORS

Objectives: To identify risk factors involved in the familial recurrence of cerebral palsy (CP) within individual families.

Methods: The records of two families with two or more affected siblings with cerebral palsy (CP) were reviewed. A detailed medical record abstraction was performed to identify possible factors contributing to the recurrence of cerebral palsy within these families.

Results: Family 1: A married, Metis mother delivered three sequential children with spastic quadriplegic CP between the maternal age of 26 and 29. Prior to these pregnancies she delivered three healthy children at term. No specific genetic factor or clinical syndrome was identified following extensive investigation of the children and the mother. Multiple hematological abnormalities (AT III, protein S, elevated Factor VIII, 'low to medium positive' anticardiolipin) were identified in the mother whom also later suffered a cerebrovascular accident. Placental pathology was abnormal in the only child on which it was performed. Pre-eclampsia and intra-uterine growth restriction (IUGR) were additional indicators of feto-placental dysfunction. Family 2: The second family includes two children with right hemiparetic CP. The pregnancies for both children were complicated by pre-eclampsia and insulin-dependent diabetes mellitus. A left middle cerebral artery territory infarct and right hemiplegic cerebral palsy was diagnosed in both children. The older boy was later diagnosed with insulin-dependent diabetes mellitus and celiac disease, while his sister was diagnosed with a presumably immune related dilated cardiomyopathy.

Conclusion: Our case series highlights the risk of recurrent CP in families in whom multiple risk factors exist. The overall risk of recurrent CP is low, but we hypothesize that the degree of risk is modified by the number of risk factors present. Our ability to council parents and families appropriately will depend on the depth of our search for known risk factors.