Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin

Deepta A Ghate, Vettaikorumakankav Vedanarayanan, Abdulbaset Kamour, James J. Corbett, Sachin Kedar

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background It is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2–5 years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. Methods 54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio ≥ 0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. Results Mean age at examination was 10.98 ± 6.49 years; mean gestational period was 33.26 ± 4.78 weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70%) patients. Of patients with pallor (n = 17), 88% were quadriplegic and 82% non-ambulatory. Mean cup/disc ratio was 0.45 ± 0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p = 0.003) and quadriplegia (OR: 12.8; p = 0.03). Large cup was associated with age at examination (OR 1.15; p = 0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r = 0.39; p = 0.003). There was no significant association of ONH parameters with gestational age. Conclusion Clinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalJournal of the neurological sciences
Volume368
DOIs
StatePublished - Sep 15 2016

Fingerprint

Pallor
Cerebral Palsy
Optic Nerve
Optic Disk
Nervous System
Logistic Models
Retinopathy of Prematurity
Quadriplegia
Hydrocephalus
Gestational Age
Referral and Consultation
Rehabilitation

Keywords

  • Cerebral palsy
  • Ophthalmoscopy
  • Optic cup
  • Optic nerve hypoplasia
  • Optic nerve pallor
  • Periventricular leukomalacia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin. / Ghate, Deepta A; Vedanarayanan, Vettaikorumakankav; Kamour, Abdulbaset; Corbett, James J.; Kedar, Sachin.

In: Journal of the neurological sciences, Vol. 368, 15.09.2016, p. 25-31.

Research output: Contribution to journalArticle

Ghate, Deepta A ; Vedanarayanan, Vettaikorumakankav ; Kamour, Abdulbaset ; Corbett, James J. ; Kedar, Sachin. / Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin. In: Journal of the neurological sciences. 2016 ; Vol. 368. pp. 25-31.
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abstract = "Background It is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2–5 years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. Methods 54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio ≥ 0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. Results Mean age at examination was 10.98 ± 6.49 years; mean gestational period was 33.26 ± 4.78 weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70{\%}) patients. Of patients with pallor (n = 17), 88{\%} were quadriplegic and 82{\%} non-ambulatory. Mean cup/disc ratio was 0.45 ± 0.22; 50{\%} patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p = 0.003) and quadriplegia (OR: 12.8; p = 0.03). Large cup was associated with age at examination (OR 1.15; p = 0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r = 0.39; p = 0.003). There was no significant association of ONH parameters with gestational age. Conclusion Clinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.",
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T1 - Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin

AU - Ghate, Deepta A

AU - Vedanarayanan, Vettaikorumakankav

AU - Kamour, Abdulbaset

AU - Corbett, James J.

AU - Kedar, Sachin

PY - 2016/9/15

Y1 - 2016/9/15

N2 - Background It is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2–5 years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. Methods 54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio ≥ 0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. Results Mean age at examination was 10.98 ± 6.49 years; mean gestational period was 33.26 ± 4.78 weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70%) patients. Of patients with pallor (n = 17), 88% were quadriplegic and 82% non-ambulatory. Mean cup/disc ratio was 0.45 ± 0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p = 0.003) and quadriplegia (OR: 12.8; p = 0.03). Large cup was associated with age at examination (OR 1.15; p = 0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r = 0.39; p = 0.003). There was no significant association of ONH parameters with gestational age. Conclusion Clinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.

AB - Background It is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2–5 years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. Methods 54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio ≥ 0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. Results Mean age at examination was 10.98 ± 6.49 years; mean gestational period was 33.26 ± 4.78 weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70%) patients. Of patients with pallor (n = 17), 88% were quadriplegic and 82% non-ambulatory. Mean cup/disc ratio was 0.45 ± 0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p = 0.003) and quadriplegia (OR: 12.8; p = 0.03). Large cup was associated with age at examination (OR 1.15; p = 0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r = 0.39; p = 0.003). There was no significant association of ONH parameters with gestational age. Conclusion Clinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.

KW - Cerebral palsy

KW - Ophthalmoscopy

KW - Optic cup

KW - Optic nerve hypoplasia

KW - Optic nerve pallor

KW - Periventricular leukomalacia

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