Neuropediatrics 2013; 44 - PS11_1027
DOI: 10.1055/s-0033-1337756

Visual disorders in children with cerebral palsy

M Honold 1, I Baldissera 2, A Gedik 1, U Albrecht 1, B Tschiderer 2, C Arnold 1, K Rostásy 1
  • 1Departement of Pediatrics I, Division of Pediatric Neurology, Medical University Innsbruck, Austria
  • 2Universitätsklinik Innsbruck, Department für Augenheilkunde und Optometrie, Innsbruck, Austria

Aims: Cerebral Palsy (CP) is the most common motor impairment in childhood and is often accompanied by a broad spectrum of comorbidities.

To analyze incidence and prevalence of visual disorders among children with CP and to investigate whether type and severity of visual impairment (VI) correlates with CP-subtypes, GMFCS/BFMF, etiology, or other comorbidities such as intellectual impairment and epilepsy.

Methods: In this hospital-based, retrospective study, patients records of 200 children with CP (males = 55%, females = 45%), between the ages of 2 and 17 years (mean = 11.07 years), were reviewed. Detailed ophthalmologic patients records were available in 129 cases. Statistical analysis was performed using contingency tables and Pearson χ2 test, and Pearson correlation coefficient was used to determine statistical significance and correlation for categorical variables. A confidence interval of 95% (p < 0.05) was used.

Results: Bilateral spastic CP was the most common subtype (50%), followed by unilateral spastic CP (37%). VIs were diagnosed in 61% (45% mild to moderate, 16% severe) and were much more frequent in children with CP than with neurologically healthy children (OR = 12.6, p < 0.001). Most children with a VI had bilateral spastic CP (78.8%). The main visual disorders found were strabismus (53.5%), especially esotropia (62%), and refractive errors (48.8%) with hyperopia (81%) and astigmatism (62%) being most prevalent. Overall prevalence of visual disorders was higher than in children not having CP: visual acuities (< 0.7; 18.6%), ROP (13%), cerebral VI (CVI) (12%), optic atrophy (11.6%), and congenital nystagmus (10%). Children with severe CP were at higher risk for severe VI, especially CVI accompanied by epilepsy and mental retardation. Two major etiological factors were identified in children with SVI: brain malformations or extreme prematurity with hypoxia and/or neonatal encephalopathy.

Conclusion: All children with CP should undergo detailed ophthalmologic and orthoptic assessment at time of diagnosis to enable early intervention and therapy in order to improve their overall function.