Epilepsy in children with cerebral palsy: perinatal, clinical and neuroimaging correlates - a cross-sectional study from a tertiary care centre in North India.

BACKGROUND: Cerebral palsy (CP) frequently coexists with epilepsy, amplifying disability through compounded neurological impairments. This cross-sectional study at a tertiary care centre in Northern India characterises seizure profiles, epilepsy severity, motor function, neuroimaging correlates and perinatal predictors in 95 children aged 1-13 years with CP and epilepsy. METHODS: Consecutive paediatric neurology patients underwent prospective evaluation with clinical, electroencephalographic and MRI assessments to characterise seizures in CP and examine their relation to Gross Motor Function Classification System (GMFCS) and MRI severity. Epilepsy severity was assessed using the Early Childhood Epilepsy Severity Scale (E-CHESS), CP severity using GMFCS and MRI severity using the scoring system by Trivedi et al. MRI findings and perinatal factors were analysed in relation to epilepsy severity in children with CP. RESULTS: Spastic quadriplegic CP was predominant (78.9%), and generalised tonic-clonic seizures were the most common seizure types. E-CHESS was weakly and non-significantly associated with GMFCS (r=0.079, p=0.12); MRI severity increased with E-CHESS scores (p=0.0427); grey matter injury was associated with severe seizures, while white matter lesions were more often associated with moderate severity. Low/moderate 5 min APGAR score was strongly associated with severe seizures (adjusted OR 47.4-52.1, p<0.013), and children with quadriplegic CP more often showed perinatal compromise, including low 5 min APGAR scores. CONCLUSION: Epilepsy severity in CP was associated with grey matter MRI injury and low 5 min APGAR but showed less association with motor impairment. Low 5 min APGAR scores may serve as early clinical markers of increased risk of severe seizure in CP and may help prioritise MRI assessment and closer seizure surveillance. This study emphasises the need for parallel management strategies-addressing seizures and motor deficits separately but comprehensively.