Clinical and electophysiological evaluation of autonomic dysfunction in children with spastic cerebral palsy

Objectives: to assess autonomic dysfunction in children with cerebral palsy and to relate the results to the level of motor impairment Methods The study was carried out on sixty children aged from 4 to 12 years. They were forty children with spastic CP were randomly selected from outpatient Neurology and Rehabilitation Clinics and twenty age and sex matched healthy siblings serving as a control group for sympathetic skin response and Heart rate variability. CP children were subjected to thorough history of any symptoms of autonomic dysfunction and full clinical examination. All studied children were subjected to electrophysiological sympathetic skin response (SSR) and electrocardiogram with head tilt test to assess heart rate variability. Results: The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards SSR, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy controls upon head tilt test. Conclusions: Autonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.