Neurophysiological features of spastic syndrome in children with cerebral palsy depending on the severity of motor disorders

I.A. Zorii, V.M. Pashkovskyy, N.V. Vasilieva, O.M. Nika


Background. Infantile cerebral palsy is a collective term that combines numerous severe diseases of the nervous system. Eighty percent of children with cerebral palsy suffer from spastic forms, the main symptom of which is an increase in muscle tone — spasticity. Objectification of the state of muscle tone and control over the dynamics of spasticity can be carried out using methods of biomechanics and electroneuromyographic (ENMG) research, which makes it possible to qualitatively and quantitatively study the state of the neuromuscular system. The purpose is to establish the clinical and neurophysiological features of spastic syndrome in children with infantile cerebral palsy, depending on the severity of motor disorders. Materials and methods. We examined 122 children with cerebral palsy (average age 8.8 ± 3.7 years), who were divided into groups according to the values of the Gross Motor Function Classification (GMFCS E&R). All patients underwent a thorough neurological examination and ENMG studies. To assess the suprasegmental (upper motor neuron) and segmental (α-motor neurons of the spinal cord and peripheral nerves) levels of damage, the parameters of the H-reflex and F-wave were analyzed. Results. The majority of the examined children were diagnosed with spastic forms of cerebral palsy: 40 (32.8 %) children — spastic diplegia, 25 (20.5 %) — hemiparetic form, 6 (4.9 %) — spastic triparesis, 34 (27.9 %) — spastic tetraparesis. Children with cerebral palsy with severe motor disorders were significantly more likely to have orthopedic pathology, namely equino-valgus installations and flat-valgus deformities of the feet. Based on ENMG parameters in patients with cerebral palsy, there were recorded suprasegmental violations, manifested in the increase of the amplitude of M-response, especially when testing the tibial nerve, the increased ratio of Hmax/Mmax, increased amplitude of H-reflex and F-wave. Conclusions. With an increase in the severity of motor disorders on the Gross Motor Function Classification Scale (GMFCS E&R) in children with cerebral palsy, neurophysiological changes significantly worsened.


cerebral palsy; electroneuromyography; spasticity; Gross Motor Function Classification Scale


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