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- Torch Group Infections: a possible cause of cerebral palsyPublication . Cadete, Ana; Virella, Daniel; Folha, Teresa; Calado, Eulália; Gaia, Teresa; Gouveia, Rosa; Alvarelhão, José; Andrada, Maria da Graça; National Surveillance of Cerebral Palsy in PortugalIntroduction - TORCH infections are a cause of severe disorders in the foetus and newborn and may be associated to cerebral palsy (CP). Their importance was evaluated concerning aetiology, clinical presentation, evolution and intervention in children in CP Patients and methods: The National Portuguese Surveilllance of Cerebral Palsy at five years of age (PSCP5YA) systematically registers children with PC born since 2001. The definition and classification of Surveillance of Cerebral Palsy in Europe (SCPE) are used. Clinical and functional characterization as well as risk factors for CP was carried out in children born 2001-2010 comparing cases with TORCH infection (definition TORCHnet) with the remainder. Results: 70 cases out off 1193 (6%) were identified: CMV 44, HIV 13, syphilis 6 and CMV+VIH 2. Bilateral spastic CP predominated (71% vs 53%). Functional impairment is significantly more severe (GMFCS, BMFM, cognition and Viking Speech Scale), comorbidities more frequent (epilepsy, severe neurossensorial handicap). The MRI shows a greater percentage of brain malformations (40% vs 12%) and more miscellaneous cases (33% vs 10%) with rare cases of normal MRI (2,5% vs 5,7%). PC associated with TORCH infection is significantly associated with term/near term delivery, mother’s age < 20, small for gestational age (SGA), Apgar score < 6, less seizures in first 72 hours and less admissions in Neonatal Units. Conclusions: TORCH infections are relatively frequent in children with CP. Although neonatal presentation appears to be less severe is increased at 5 years of age. It is recommended to look for TORCH infection in children with CP or high suspicion of CP without known risk factors , born at term or near term, SGA, in young mothers and with encephalous malformations.
- Portuguese National Surveillance of Cerebral Palsy Registry 2005-2015 decade: clinical condition complexity of 5-year-old children not included in regular schoolPublication . Folha, Teresa; Virella, Daniel; Santos, Ana João; Cadete, Ana; Gouveia, Rosa; Alvarelhão, José; Calado, Eulália; Gaia, Teresa; Andrada, Maria da Graça; National Surveillance of Cerebral Palsy in PortugalIntroduction: For children with cerebral palsy (CP) attending kindergarten school promotes social and cognitive skills, which affects community participation. This study describes the association between complexity and (RS) for children with CP at 5 years old using the Portuguese National Surveillance of Cerebral Palsy Registry (PNSCPR). Patients and methods: Children residents in Portugal between 2005 and 2015 were selected from PNSCPR database. The Surveillance of Cerebral Palsy in Europe definitions, classifications and instruments were used. Children not attending RS were considered. Clinical complexity included four indicators: GMFCS (III-V); cognitive function (<50); active epilepsy and severe visual deficit. Univariate Chi-square test and logistic regression models were used to investigate association between complexity indicators and school inclusion. Results: Of 1102 children 18.5% (n=204) were not in RS. The number of indicators was significantly associated with the increase of the proportion of children not attending school: 2.2% presenting zero indicators, 11.4% one; 19.8% three; 35% four and 45.2% of children presenting all four indicators. The highest risk of not attending RS at 5 years old was observed for children indicating worse global motor function (GMFCS III-V; OR=3.9; 95% CI=2.1, 7.2; P<.0001), followed by children with cognitive deficit (<50; OR=3.3; 95% CI=1.8, 6.1; P<.0001) and active epilepsy (OR=1.9; 95% CI=1.1, 3.3; P<.05). Conclusion: Clinical complexity indicators are significantly associated with attending RS at the pre-school level. This knowledge may potentiate better inclusion experiences, the development of children is potential, committing resources and supporting families in these processes.