Aim: To compare the clinical and radiological profile of term and preterm children with spastic diplegia.
Methods: Children aged 1 -14 years with spastic diplegia being followed up at our rehabilitation center from 2009 -2013 were evaluated. Antecedent antenatal and neonatal risk factors, clinical features and radiological findings were compared between term (> 37 weeks) and preterm born (< 37 weeks) children. Neuroimaging findings were categorized (9 categories) and periventricular white matter injury (PVWMI), when present was further scored. Univariate and binomial logistical regression analyses were done to identify factors that correlate with PVWMI in term and preterm children.
Results: Of 110 children evaluated, 96 met the inclusion criteria, 3 were excluded and 93 analyzed. Eighty nine children had magnetic resonance imaging (MRI) of brain done. There were 45/93 (48%) term born children. Periventricular white matter injury (PVWMI) was seen in 64 % of term and 89.4% of preterm children; Perirolandic injury in 16.6% of term and 4.2% of preterm children and malformations in 7.1% of term and none in preterm children. MRI brain was normal in 9.5% of term children but none in preterm group. An eventful antenatal or neonatal period and NICU admission > 5 days predicted PVWMI in term children with spastic diplegia. In contrast to preterm children with PVWMI, term PVWMI was significantly associated with perinatal asphyxia, moderate to severe intellectual disability and epilepsy.
Conclusion: Spastic diplegia and PVWMI is not restricted to preterm birth. Infact, term and preterm children with spastic diplegia represent two distinct clinicopathogenic entities.