Risk factors of cerebral palsy (CP), seizures, CP severity, EEG, and MRI findings were compared in 38 children with spastic diplegic (DCP) and 48 with spastic tetraplegic (TCP), in a report from Medical University of Bialystok, Poland. The Apgar score was lower in TCP cases than DCP, the gross motor function was more limited, mental retardation more frequent, cerebral atrophy on MRI more frequent (31% cf 5%), epilepsy more common (50% cf 16%) and more often intractable. Periventricular leukomalacia on MRI was more frequent in DCP (76%) than in TCP (44%). Gestational history was not related to increased risk of DCP or TCP; the frequencies of cesarean section, low birth weight, and perinatal pathology were the same in both groups. [1]

COMMENT. Spastic diplegia involves the legs more than the arms, and is frequently associated with premature birth. Spastic quadriplegia, the most severe form of CP, affects all 4 limbs, but impairment of motor function is usually more severe in the upper limbs. In the classification of CP by Crothers and Paine (1959), 65% of cases were spastic (19% quadriplegic, 2.8% diplegic, 40.5% hemiplegic), 22% extrapyramidal, and 13% mixed types. Changes in the classification of CP in the years 1954-90 were related to increased survival rates of preterm infants [2]. Bilateral spastic forms (diplegias, quadriplegias, and extrapyramidal) were most prevalent, and 75% were in preterm and 45% in term infants. In the above Polish study (Kulak et al), 55% of both DCP and TCP cases were born prematurely. In the above Australian study (Badawi et al), the classification of CP in term infants (% of total cases; and with/without encephalopathy) was as follows: spastic quadriplegic (17%;31/12%), spastic diplegic (23%; 19/24%), hemiplegic (34%;22/38%), athetotic dystonic (17%;25/14%), and ataxic hypotonic (10%;3/11%).