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abstract: Cerebral palsy is a static non progressive motor disability that occurs at birth or early childhood. It results of injury to the neuromotor components of the central nervous system. Evoked potentials (EPs) are neurophysiological investigations used to demonstrate the existence of central nervous system lesions and were used as a screening method for neuropediatric diseases. Motor and somatosensory evoked potential (SEP) are the most sensitive methods of evoked potentials. They can provide a non- invasive objective method of evaluating the central and peripheral nervous system. The present study included 20 Egyptian children, 11 males and 9 females ranging in age from 3 to 6 years with a mean age of 3.9 years, presenting with spastic diplegia. All patients had mild to moderate motor disability and I.Q. above 50. Control group included 20 children, age and sex-matched with patients group. We studied motor and somatosensory evoked potentials in those patients and their correlation with motor functions. Transcranial magnetic stimulation (TMS) to the right upper limb (abductor pollicis brevis muscle) and somatosensory evoked potentials testing from the right median nerve and the left posterior tibial nerve were used to assess function of the corresponding systems.
Motor evoked potentials from the right upper limb showed significant delay in cortical latencies and significant prolongation of central motor conduction time in CP patients compared to control group. However, the amplitude of cortical response showed no significant changes. Somato-sensory evoked potentials of right median nerve showed significantly prolonged cortical N19 / P22 absolute latency, N13 – N20, Erb’s – N20 , N13 – N20 inter peak latencies respectively, however, Erb’s, N13, Erb’s – N13 absolute latencies and inter peak latency showed non significant changes but N20 amplitude was significantly decreased. Somatosensory evoked potentials of the left posterior tibial nerve showed significant prolonged cortical and lumber absolute latencies and inter peak latency. Also, significant decrease of amplitude of cortical wave. A statistically highly significant positive correlation was observed between the hand function and N20 amplitude (P < 0.01) of SEPs of the right median nerve while all other variables showed no statistically significant correlation with each other. Also, a statistically significant positive correlation was observed between the foot function and cortical amplitude (P < 0.05) of SEPs of the left posterior tibial nerve while all other variables showed no statistically significant correlation with each other. A tendency towards positive correlation was observed between hand functions and cortical latency (P < 0.09) of motor evoked potentials to the right abductor pollicis brevis muscle.
We concluded that somatosensory evoked potentials are sensitive, non-invasive techniques for detection of the severity of motor impairment. We recommend MEPs and SSEPs as a relatively fast and effective means of assessing the functional integrity of the central nervous system in cerebral palsy patients.
author: Amina S. Hendawy,1 Hanan H. Abd-El-Alim,3 Magdy M.Kamel,2 Abdel-Raouf Omar,4 Amal T. Khafagy,4 and Dina F. Mansour4
address: Departments of Pediatrics, Cairo1 and El-Minia2 Universities, Neurophysiology , Bani-Suef University,3 and Neurology, El-Minia University,4 Egypt
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