Main etiological factors and comorbid pathology in severe cerebral palsy

Introduction The largest number of factors contributing to the development of cerebral palsy (CP) relate to the pre- and intranatal periods. Premature birth and low birth weight are the most important predictors of cerebral palsy and are associated with persistent brain and motor disorders. Purpose To evaluate the main etiological factors of severe cerebral palsy and comorbid pathology in children with severe motor disorders. Material and methods A retrospective observational study included 170 patients with severe forms of cerebral palsy, divided into two groups (85 subjects each) depending on motor disorders: GMFCS IV, GMFCS V. Perinatal risk factors for severe cerebral palsy were assessed, correlations between perinatal risk factors for expressed movement disorders and height/weight indicators, comorbid pathology in children at the time of admission to the trauma and orthopaedic hospital. Results Prenatal risk factors were responsible for the development of cerebral palsy in children in 71 % of cases. In the GMFCS IV group, gestational age had an inverse correlation with preterm birth (R = –0.53; R2 = 28 %). In the GMFCS V group, disorders caused by a shorter gestational age were interrelated with the duration of the antenatal period (R = –0.79; R2 = 62 %), and also directly correlated with delivery by cesarean section (R = 0.58; R2 = 34 %). Among the comorbid pathologies, eye diseases and psychological development disorders were most often detected. Discussion Low height/weight parameters of patients were due to comorbid pathology, rather than phenotypic constitutional features. Inverse correlation between the disorders caused by the gestational age, low birth weight and duration of pregnancy, risk of developing respiratory disorders, and a direct correlation with cesarean section seem logical. Severe conmobid diseases were more frequently diagnosed in patients with GMFCS V, indicating more extensive perinatal catastrophes in the central nervous system and the relationship between the developed pathology and severe motor disorders. Conclusions The main risk factors for the development of cerebral palsy in patients with severe GMFCS IV–V motor impairments are associated with the pre- and intranatal periods. Comorbid pathology of patients with severe forms of cerebral palsy is caused by severe brain damage and movement disorders that have developed against this background.