Cerebral Palsy and Other Encephalopathies
Cerebral palsy and related encephalopathies of the central nervous system (CNS) are conditions that often affect lower urinary tract function in obvious as well as subtle ways. It is important for clinicians to recognize that CNS conditions can lead to ab
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Stuart Bauer
15.1 Background Cerebral palsy is a nonprogressive neurologic disturbance due to a presumed anoxic injury to the fetal or infant brain during this critical time in development that results in disorders of movement and posture causing limitations in activities of affected individuals. It is the most common physical disability in childhood, affecting approximately 3.3 per 1000 8-year-old children in the United States with variable degrees of disability. Its prevalence varies by region and is more common in black and white children than in those of Hispanic descent and 1.2 times more common in boys than girls [1]. It is seen in premature, low birth weight infants who were subjected to perinatal infection, seizures, or intracranial hemorrhage. Sensation, perception, cognition, communication, and behavior may also be affected [2]. In addition, physical impairments ranging from gross or fine motor development to altered muscle tone and gait abnormalities are often apparent [3]. The Gross Motor Function Classification System (2007; GMFCS–E & R; http:// motorgrowth.canchild.ca/en/GMFCS/resources/GMFCS-ER.pdf) is based on self-initiated movement, with emphasis on sitting, transferring, and mobility. This five-level scale ranges from 1 (walks without limitations) to 5 (transported in a manual wheelchair) has specific descriptions with relevant age band categories for each level of disability.
S. Bauer Department of Urology, Boston Children’s Hospital, Boston, MA, USA e-mail: [email protected] © Springer International Publishing AG, part of Springer Nature 2018 G. Mosiello et al. (eds.), Clinical Urodynamics in Childhood and Adolescence, Urodynamics, Neurourology and Pelvic Floor Dysfunctions, https://doi.org/10.1007/978-3-319-42193-3_15
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15.2 Causative Factors for Incontinence Affected children will often achieve urinary continence, albeit at an age later than their age-adjusted normal peers [4, 5]. Not infrequently, daytime continence is achieved first, followed by nighttime continence within the next year, but this is clearly dependent on either the ability to get to a bathroom facility quickly enough or signal that there is a need to empty the bladder. Overall, 14% [6] to 34% [7] of children are continent of urine before 5 years of age. The median age for achieving continence in those with high intellectual capacity and diplegia or hemiplegia varies from 3.6 to 4.1 years. For those with low intellectual capacity and tetraplegia, this milestone is achieved much later (10.1– 13.2 years) [4]. Most studies do not correlate mobility (or GMFCS level) with achievement of continence [6, 8, 9]. In 97 children evaluated with a standardized dysfunction voiding symptom survey, investigators found 25% of those who were able to walk had lower urinary tract (LUT) dysfunction compared with 75% in those who were unable to do so (P
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