The main objective of the talk is to review the factors that influence the long-term prognosis of epilepsy in patients with cerebral palsy. As a secondary objective, the neurocognitive repercussion of interictal epileptiform discharges -IEDs- in the electroencephalogram -EEG- will be discussed.
1. According to the literature, epilepsy is present in 10-80% of patients with cerebral palsy and this has a remission - with medication - of between 5,2-75% and a resolution - without medication - of between 5,2-86,6%.
Looking at this data, we can see that there is a great deal of variability. This is due to the great heterogeneity of causes that cause cerebral palsy. Together with this variability, the lack of consensus on the concept of remission - 6 months or 3 years -, the great methodological variability of the studies and, finally, the absence of prospective studies, mean that knowledge in this matter is scarce.
It seems that, in general terms, patients with cerebral palsy of perinatal etiology, those who present absence of lesions in gray matter in nuclear magnetic resonance - MRI - of the brain, as well as those who present normalization of epileptiform activity in the EEG and/or less motor deficit, have a better chance of achieving epilepsy remission/resolution. With regard to the factors of poor prognosis we find: Apgar 0-4 at 5 minutes, neonatal crises, severe tetraplegia/hemiplegia, focal alterations or malformations in MRI and EEG with discharges or focal/multifocal slowing
2. Interictal epileptiform discharges - IEDs - are characterized by electrical activity in the form of spikes, spike-waves and/or sharp waves, which translates into neuronal depolarization. Some prospective studies with a small sample size indicate that treating these electrical disturbances - in the absence of a crisis - could improve/slow down cognitive impairment, as well as behavioral disorders in patients with ADHD, autism or epileptic encephalopathies. However, today, due to the lack of studies that provide robust evidence, there is no consensus on how to act if IEDs are found.
Conclusion:
- There are a number of factors that make it possible to identify those patients with cerebral palsy who are more likely to have epilepsy remission/resolution.
- We should not rush to get off antiepileptic medication as scientific evidence shows that the vast majority of drugs do not cause cognitive deterioration.
