Child's Nervous System

, Volume 35, Issue 1, pp 149–156 | Cite as

Prevalence and demographic characteristics of comorbid epilepsy in children and adolescents with cerebral palsy: a nationwide population-based study

  • Kuo-Liang Chiang
  • Fang-Chuan Kuo
  • Chen-Yang ChengEmail author
  • Kai-Ping Chang
Original Paper



The nationwide prevalence of cerebral palsy (CP) is unknown due to the lack of a population-based registration system for CP in Taiwan. This study was the largest nationwide, population-based, cross-sectional study to estimate the prevalence of CP, prevalence rates of comorbid epilepsy in patients with CP, and association with socioeconomic status (SES) in Taiwan. The crude prevalence rate and age- and gender-specific prevalence rates were estimated.


A total of 8419 patients with CP were enrolled, and the estimated prevalence of CP was 1.76‰ in the pediatric population and 1.51‰ and 1.98‰ in girls and boys, respectively. The prevalence rate of epilepsy in patients with CP was 29.8%.


The result revealed a higher prevalence of CP and epileptic CP in members of families with lower insurance premiums than those with higher insurance premiums and those from East Taiwan compared with those from other areas of Taiwan. Moreover, a higher prevalence of CP is shown in rural area than urban area.


SES and geographic variables were significantly associated with the risk of epilepsy in children with CP. Patients with epileptic CP had a higher odds ratio of several neuropsychiatric diseases, including mental retardation, ophthalmologic problems, hearing impairment, and hydrocephalus.


Pediatric epilepsy Socioeconomic status National Health Insurance 


Compliance with ethical standards

This study was approved by and conducted in accordance with the Institutional Review Board of Kuang-Tien General Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Fan HC, Ho LI, Chi CS, Cheng SN, Juan CJ, Chiang KL, Lin SZ, Harn HJ (2015) Current proceedings of cerebral palsy. Cell Transplant 24:471–485CrossRefGoogle Scholar
  2. 2.
    Wallace SJ (2001) Epilepsy in cerebral palsy. Dev Med Child Neurol 43:713–717CrossRefGoogle Scholar
  3. 3.
    Bruck I, Antoniuk SA, Spessatto A, Bem RS, Hausberger R, Pacheco CG (2001) Epilepsy in children with cerebral palsy. Arq Neuropsiquiatr 59:35–39CrossRefGoogle Scholar
  4. 4.
    Zelnik N, Konopnicki M, Bennett-Back O, Castel-Deutsch T, Tirosh E (2010) Risk factors for epilepsy in children with cerebral palsy. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 14:67–72CrossRefGoogle Scholar
  5. 5.
    Hadjipanayis A, Hadjichristodoulou C, Youroukos S (1997) Epilepsy in patients with cerebral palsy. Dev Med Child Neurol 39:659–663CrossRefGoogle Scholar
  6. 6.
    Singhi P, Jagirdar S, Khandelwal N, Malhi P (2003) Epilepsy in children with cerebral palsy. J Child Neurol 18:174–179CrossRefGoogle Scholar
  7. 7.
    Kulak W, Sobaniec W (2003) Risk factors and prognosis of epilepsy in children with cerebral palsy in north-eastern Poland. Brain Dev 25:499–506CrossRefGoogle Scholar
  8. 8.
    Gururaj AK, Sztriha L, Bener A, Dawodu A, Eapen V (2003) Epilepsy in children with cerebral palsy. Seizure J British Epilepsy Assoc 12:110–114CrossRefGoogle Scholar
  9. 9.
    Carlsson M, Hagberg G, Olsson I (2003) Clinical and aetiological aspects of epilepsy in children with cerebral palsy. Dev Med Child Neurol 45:371–376CrossRefGoogle Scholar
  10. 10.
    Sellier E, Uldall P, Calado E, Sigurdardottir S, Torrioli MG, Platt MJ, Cans C (2012) Epilepsy and cerebral palsy: characteristics and trends in children born in 1976-1998. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 16:48–55CrossRefGoogle Scholar
  11. 11.
    Chiang KL, Cheng CY (2014) Prevalence and neuro-psychiatric comorbidities of pediatric epilepsy in Taiwan: a national population-based study. Epilepsy Res 108:1451–1460CrossRefGoogle Scholar
  12. 12.
    Okumura A, Hayakawa F, Kato T, Kuno K, Watanabe K (1999) Epilepsy in patients with spastic cerebral palsy: correlation with MRI findings at 5 years of age. Brain Dev 21:540–543CrossRefGoogle Scholar
  13. 13.
    El-Tallawy HN, Farghaly WM, Shehata GA, Badry R, Rageh TA (2014) Epileptic and cognitive changes in children with cerebral palsy: an Egyptian study. Neuropsychiatr Dis Treat 10:971–975Google Scholar
  14. 14.
    Kwong KL, Wong SN, So KT (1998) Epilepsy in children with cerebral palsy. Pediatr Neurol 19:31–36CrossRefGoogle Scholar
  15. 15.
    Chien IC, Lin CH, Chou YJ, Chou P (2012) Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996–2005: a national population-based study. Psychiatry Psychiatr Epidemiol 47:1885–1990CrossRefGoogle Scholar
  16. 16.
    Kuo RN, Lai MS (2013) The influence of socio-economic status and multimorbidity patterns on healthcare costs: a six-year follow-up under a universal healthcare system. Int J Equity Health 12:69CrossRefGoogle Scholar
  17. 17.
    Chien LC, Wu JC, Chen YC, Liu L, Huang WC, Chen TJ, Thien PF, Lo SS, Cheng H (2012) Age, sex, and socio-economic status affect the incidence of pediatric spinal cord injury: an eleven-year national cohort study. PLoS One 7:e39264CrossRefGoogle Scholar
  18. 18.
    Chen CC, Chen LS, Yen MF, Chen HH, Liou HH (2012) Geographic variation in the age- and gender-specific prevalence and incidence of epilepsy: analysis of Taiwanese National Health Insurance-based data. Epilepsia 53:283–290CrossRefGoogle Scholar
  19. 19.
    Liu C-Y, Hung Y, Chuang Y, Chen Y, Weng W, Liu J, Liang K (2006) Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 4:1–22Google Scholar
  20. 20.
    Lin Y-H, Tseng Y-H, Chen Y-C, Lin M-H, Chou L-F, Chen T-J, Hwang S-J (2013) The rural-urban divide in ambulatory care of gastrointestinal diseases in Taiwan. BMC Int Health Hum Rights 13:15CrossRefGoogle Scholar
  21. 21.
    Winter S, Autry A, Boyle C, Yeargin-Allsopp M (2002) Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics 110:1220–1225CrossRefGoogle Scholar
  22. 22.
    Arneson CL, Durkin MS, Benedict RE, Kirby RS, Yeargin-Allsopp M, Van Naarden BK, Doernberg NS (2009) Prevalence of cerebral palsy: Autism and Developmental Disabilities Monitoring Network, three sites, United States, 2004. Disability Health J 2:45–48CrossRefGoogle Scholar
  23. 23.
    Paneth N, Hong T, Korzeniewski S (2006) The descriptive epidemiology of cerebral palsy. Clin Perinatol 33:251–267CrossRefGoogle Scholar
  24. 24.
    Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, Stevenson R (2004) Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 62:851–863CrossRefGoogle Scholar
  25. 25.
    (2000) Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Developmental Medicine Child Neurology 42: 816–824Google Scholar
  26. 26.
    Reid SM, Carlin JB, Reddihough DS (2011) Rates of cerebral palsy in Victoria, Australia, 1970 to 2004: has there been a change? Dev Med Child Neurol 53:907–912CrossRefGoogle Scholar
  27. 27.
    Toyokawa S, Maeda E, Kobayashi Y (2017) Estimation of the number of children with cerebral palsy using nationwide health insurance claims data in Japan. Dev Med Child Neurol 59:317–321CrossRefGoogle Scholar
  28. 28.
    Park MS, Kim SJ, Chung CY, Kwon DG, Choi IH, Lee KM (2011) Prevalence and lifetime healthcare cost of cerebral palsy in South Korea. Health Policy 100:234–238CrossRefGoogle Scholar
  29. 29.
    He P, Chen G, Wang Z, Guo C, Zheng X (2017) Children with motor impairment related to cerebral palsy: prevalence, severity and concurrent impairments in China. J Paediatr Child Health 53:480–484CrossRefGoogle Scholar
  30. 30.
    Nissen S, Purssell E, Shaw K, Bailey C, Efstathiou N, Dunford C (2017) Impaired mobility associated with an increased likelihood of death in children: a systematic review. Journal of child health care : for professionals working with children in the hospital and community: 1367493517732839Google Scholar
  31. 31.
    Strauss D, Brooks J, Rosenbloom L, Shavelle R (2008) Life expectancy in cerebral palsy: an update. Dev Med Child Neurol 50:487–493CrossRefGoogle Scholar
  32. 32.
    Solaski M, Majnemer A, Oskoui M (2014) Contribution of socio-economic status on the prevalence of cerebral palsy: a systematic search and review. Dev Med Child Neurol 56:1043–1051CrossRefGoogle Scholar
  33. 33.
    Oskoui M, Coutinho F, Dykeman J, Jette N, Pringsheim T (2013) An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 55:509–519CrossRefGoogle Scholar
  34. 34.
    Dolk H, Pattenden S, Johnson A (2001) Cerebral palsy, low birthweight and socio-economic deprivation: inequalities in a major cause of childhood disability. Paediatr Perinat Epidemiol 15:359–363CrossRefGoogle Scholar
  35. 35.
    Hemming K, Hutton JL, Colver A, Platt MJ (2005) Regional variation in survival of people with cerebral palsy in the United Kingdom. Pediatrics 116:1383–1390CrossRefGoogle Scholar
  36. 36.
    King G, Imms C, Palisano R, Majnemer A, Chiarello L, Orlin M, Law M, Avery L (2013) Geographical patterns in the recreation and leisure participation of children and youth with cerebral palsy: a CAPE international collaborative network study. Developmental neurorehabilitation 16:196–206CrossRefGoogle Scholar
  37. 37.
    Wang CM, Chen CY, Leong CP, Wong MK (1992) Cerebral palsy investigation in South Taiwan. J Rehabilitation Med Republic China 20:113–117Google Scholar
  38. 38.
    Aisen ML, Kerkovich D, Mast J, Mulroy S, Wren TA, Kay RM, Rethlefsen SA (2011) Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol 10:844–852CrossRefGoogle Scholar
  39. 39.
    Bottcher L (2010) Children with spastic cerebral palsy, their cognitive functioning, and social participation: a review. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence 16:209–228CrossRefGoogle Scholar
  40. 40.
    Song CS (2013) Relationships between physical and cognitive functioning and activities of daily living in children with cerebral palsy. J Phys Ther Sci 25:619–622CrossRefGoogle Scholar
  41. 41.
    Odding E, Roebroeck ME, Stam HJ (2006) The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 28:183–191CrossRefGoogle Scholar
  42. 42.
    Van Hus JW, Potharst ES, Jeukens-Visser M, Kok JH, Van Wassenaer-Leemhuis AG (2014) Motor impairment in very preterm-born children: links with other developmental deficits at 5 years of age. Dev Med Child Neurol 56:587–594CrossRefGoogle Scholar
  43. 43.
    Yim SY, Yang CY, Park JH, Kim MY, Shin YB, Kang EY, Lee ZI, Kwon BS, Chang JC, Kim SW, Kim MO, Kwon JY, Jung HY, Sung IY (2017) Korean database of cerebral palsy: a report on characteristics of cerebral palsy in South Korea. Annals of rehabilitation medicine 41:638–649CrossRefGoogle Scholar
  44. 44.
    Minocha P, Sitaraman S, Sachdeva P (2017) Clinical spectrum, comorbidities, and risk factor profile of cerebral palsy children: a prospective study. J Pediatr Neurosci 12:15–18CrossRefGoogle Scholar
  45. 45.
    Shang Q, Ma CY, Lv N, Lv ZL, Yan YB, Wu ZR, Li JJ, Duan JL, Zhu CL (2015) Clinical study of cerebral palsy in 408 children with periventricular leukomalacia. Experimental and therapeutic medicine 9:1336–1344CrossRefGoogle Scholar
  46. 46.
    Staudt M, Pavlova M, Bohm S, Grodd W, Krageloh-Mann I (2003) Pyramidal tract damage correlates with motor dysfunction in bilateral periventricular leukomalacia (PVL). Neuropediatrics 34:182–188CrossRefGoogle Scholar
  47. 47.
    Cooper MS, Mackay MT, Fahey M, Reddihough D, Reid SM, Williams K, Harvey AS (2017) Seizures in children with cerebral palsy and white matter injury. Pediatrics 139:e20162975CrossRefGoogle Scholar
  48. 48.
    Hirschberger RG, Kuban KCK, O'Shea TM, Joseph RM, Heeren T, Douglass LM, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Rollins JV, Paneth N (2018) Co-occurrence and severity of neurodevelopmental burden (cognitive impairment, cerebral palsy, autism spectrum disorder, and epilepsy) at age ten years in children born extremely preterm. Pediatr Neurol 79:45–52CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kuo-Liang Chiang
    • 1
    • 2
    • 3
  • Fang-Chuan Kuo
    • 4
  • Chen-Yang Cheng
    • 2
    • 5
    Email author
  • Kai-Ping Chang
    • 6
  1. 1.Department of Pediatric NeurologyKuang-Tien General HospitalTaichungTaiwan, Republic of China
  2. 2.Program of Health AdministrationTunghai UniversityTaichungTaiwan
  3. 3.Department of NutritionHungkuang UniversityTaichungTaiwan
  4. 4.Department of Physical TherapyHungkuang UniversityTaichungTaiwan
  5. 5.Department of Industrial Engineering and ManagementNational Taipei University of TechnologyTaipeiTaiwan, Republic of China
  6. 6.Department of PediatricsTaipei Veterans General HospitalTaipeiTaiwan

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