Co esponding au ho : Isam Eldin A. Magid
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Causes, ypes and clinical ou comes in child en wi h ce eb al palsy: A e ospec i e
s udy
Isam Eldin A. Magid 1, * and Ome Saeed Magzoub 2
1 Depa men o Pedia ics, Facul y o Medicine, Na ional Uni e si y, Kha oum, Sudan.
2 Specialis Gene al Pedia ic, Ain Al-Khaleej Hospi al, UAE.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1474-1481
Publica ion his o y: Recei ed on 10 July 2025; e ised on 17 Augus 2025; accep ed on 19 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2965
Abs ac
Backg ound: Ce eb al palsy (CP) is he mos common mo o disabili y in childhood, p esen ing in di e se clinical
o ms, including spas ic, dyskine ic, a axic, and mixed ypes. Unde s anding i s epidemiological pa e ns, e iological
ac o s, and clinical ou comes is essen ial o imp o ing managemen s a egies.
Objec i es: This s udy examined he demog aphic p o iles, unde lying causes, clinical ea u es, and ou comes o CP
pa ien s ea ed a El-Shamal Specialized Hospi al be ween Decembe 2023 and Feb ua y 2024.
Me hods: A e ospec i e analysis was conduc ed on 45 pa ien s diagnosed wi h CP. Da a we e collec ed on sex, age,
esidence, e iology, mo o sub ype, associa ed impai men s (including in ellec ual disabili y, speech delay, and
epilepsy), se e i y, and clinical ou comes.
Resul s: Mos pa ien s we e male (64.4%) and aged 0–5 yea s (55.6%), wi h he majo i y esiding in he No he n S a e
(71.1%). Pe ina al ac o s we e he leading cause o CP (64.4%), ollowed by p ena al (20%) and pos na al (15.6%)
causes. Spas ic CP was he mos common sub ype (62.2%), ollowed by hypo onic (15.5%) and dyskine ic (13.3%)
ypes; among dyskine ic cases, dys onic ea u es we e mo e common han a he oid. A axic CP was a e (4.4%).
Como bidi ies we e common, including miles one delays (97.8%), speech delays (88.9%), and in ellec ual disabili y
(84.4%). Epilepsy was p esen in 26.7% o pa ien s, and no cases o hea ing impai men we e epo ed. Rega ding
se e i y, 48.9% we e classi ied as se e e. Clinical imp o emen was obse ed in 57.8% o pa ien s, and no mo ali y
was eco ded.
Conclusion: The indings e lec global CP pa e ns while highligh ing egional di e ences, pa icula ly he
p edominance o pe ina al causes and spas ic sub ypes. The high bu den o como bidi ies unde sco es he need o
ea ly, mul idisciplina y in e en ions. Fu he la ge-scale s udies a e ecommended o alida e hese indings and guide
local managemen s a egies.
Keywo ds: Ce eb al Palsy; Mo o Disabili y; Pe ina al Fac o s; Clinical Ou comes.
1. In oduc ion
Ce eb al palsy (CP) is he mos common physical disabili y in childhood, wi h a global p e alence anging om 1.5 o 4
pe 1,000 li e bi hs [1]. I is de ined as a g oup o pe manen diso de s o mo emen and pos u e caused by non-
p og essi e dis u bances in he de eloping e al o in an b ain [2]. The clinical spec um includes spas ic (70–80%),
dyskine ic (10–15%), a axic (5%), and mixed ypes [3], wi h conside able a ia ion in he se e i y o mo o impai men
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and associa ed como bidi ies such as in ellec ual disabili y (30–50%), speech delay (40–60%), and epilepsy (25–45%)
[4].
CP can esul om p ena al (e.g., congeni al in ec ions, gene ic diso de s), pe ina al (e.g., hypoxic-ischemic
encephalopa hy, p ema u i y), o pos na al (e.g., meningi is, auma ic b ain inju y) insul s [5]. In low- esou ce se ings,
pe ina al complica ions—pa icula ly bi h asphyxia and p ema u i y—accoun o 50–60% o cases [6], while p ena al
ac o s a e mo e p edominan in high-income coun ies [7].
Despi e ad ances in neona al ca e, CP emains a leading cause o childhood disabili y, wi h a epo ed male
p edominance (male- o- emale a io o 1.2:1) [8]. Ea ly diagnosis and in e en ion a e c ucial, as mo o and cogni i e
impai men s o en pe sis in o adul hood, signi ican ly a ec ing quali y o li e [9]. Ou comes a y widely: while some
child en achie e unc ional independence, o he s—pa icula ly hose wi h se e e spas ic o dyskine ic sub ypes—
equi e li elong ca e [10].
This s udy in es iga es he demog aphic dis ibu ion, e iological pa e ns, clinical sub ypes, and ou comes o CP in a
clinical coho om El-Shamal Specialized Hospi al, No he n S a e, Sudan, along wi h associa ed como bidi ies. By
analyzing hese ac o s, we aim o con ibu e o a egion-speci ic CP p o ile ha can guide ea ly in e en ion s a egies
and in o m esou ce alloca ion.
2. Me hodology
2.1. S udy Design
This s udy was designed as a e ospec i e, hospi al-based cha e iew conduc ed a El-Shamal Specialized Hospi al,
loca ed in he No he n S a e, Sudan. The hospi al se es as a e e al cen e o pedia ic neu ological cases ac oss he
egion. The s udy co e ed he pe iod om Decembe 2023 o Feb ua y 2024, du ing which medical eco ds o child en
diagnosed wi h ce eb al palsy (CP) we e e iewed. A o al o 45 pa ien s who me he eligibili y c i e ia we e included
in he inal analysis.
2.2. Inclusion C i e ia
Pa ien s we e included in he s udy based on he ollowing c i e ia:
• A con i med diagnosis o ce eb al palsy, es ablished h ough comp ehensi e clinical and neu ological
e alua ions by a pedia ician o neu ologis .
• A ailabili y o comple e and de ailed medical eco ds, allowing o he ex ac ion o all ele an a iables.
• Age be ween 0 and 18 yea s a he ime o diagnosis o ea men .
2.3. Exclusion C i e ia
Pa ien s we e excluded om he s udy i hey me any o he ollowing condi ions:
• Incomple e o missing medical eco ds ha p e en ed accu a e da a analysis.
• A diagnosis o o he mo o diso de s o p og essi e neu ological condi ions no classi ied unde ce eb al
palsy.
2.4. Da a Collec ion
Rele an da a we e sys ema ically ex ac ed om pa ien s’ medical eco ds using a p e-designed da a collec ion o m.
The ollowing a iables we e eco ded:
• Demog aphic in o ma ion: age a p esen a ion, sex, and geog aphic esidence.
• E iological ac o s: ca ego ized based on he p esumed iming o he insul in o p ena al (e.g., congeni al
anomalies, in au e ine in ec ions), pe ina al (e.g., bi h asphyxia, p ema u i y), o pos na al (e.g., CNS in ec ions,
head auma).
• Clinical cha ac e is ics: including CP sub ypes (spas ic, dyskine ic, hypo onic, a axic, and mixed o ms) and
associa ed como bidi ies such as de elopmen al delays, epilepsy, speech impai men , and in ellec ual disabili y.
• Se e i y classi ica ion: ca ego ized as mild, mode a e, o se e e based on mo o unc ion, cogni i e abili y, and
he le el o assis ance equi ed o daily ac i i ies.
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• Ou come assessmen : based on ollow-up no es and clinical p og ession, ou comes we e classi ied as imp o ed,
imp o ing, s a ic, o wo sening.
2.5. S a is ical Analysis
The collec ed da a we e en e ed in o a s uc u ed da abase and analyzed using desc ip i e s a is ical me hods.
Ca ego ical a iables—such as sex, CP sub ype, e iological ca ego ies, se e i y, and ou come—we e p esen ed as
equencies and pe cen ages. No in e en ial s a is ics we e applied due o he obse a ional and desc ip i e na u e o
he s udy, as well as he ela i ely small sample size. Da a we e analyzed manually.
2.6. E hical Conside a ions
E hical app o al was ob ained om he adminis a ion o El-Shamal Specialized Hospi al. Pa ien con iden iali y,
anonymi y, and da a p o ec ion we e s ic ly main ained h oughou he s udy.
3. Resul s
This s udy included 45 pa ien s diagnosed wi h ce eb al palsy (CP), p o iding insigh s in o hei demog aphic
cha ac e is ics, e iological ac o s, clinical sub ypes, associa ed como bidi ies, and ou comes, as obse ed a El-Shamal
Specialized Hospi al, No he n S a e, Sudan.
3.1. Demog aphic P o ile
A clea male p edominance was no ed, wi h 64.4% o pa ien s being male (n = 29), compa ed o 35.6% emale (n = 16),
e lec ing a male- o- emale a io o app oxima ely 1.8:1 (Figu e 1). The majo i y o cases (55.6%, n = 25) we e wi hin
he 0–5 yea s age g oup, indica ing ea ly onse and diagnosis o CP. Child en aged 6–10 yea s comp ised 31.1% (n =
14), while hose aged 11–15 yea s and o e 15 yea s accoun ed o 8.9% (n = 4) and 4.4% (n = 2), espec i ely (Figu e
2). A subs an ial p opo ion o he coho (71.1%, n = 32) esided in he No he n S a e, consis en wi h he hospi al’s
ca chmen a ea (Figu e 3).
3.2. E iological Pa e ns
Pe ina al e en s we e he mos common con ibu o s o CP, accoun ing o 64.4% (n = 29) o cases. These included
complica ions such as bi h asphyxia, p ema u i y, and neona al in ec ions. P ena al ac o s—such as congeni al
anomalies and in au e ine insul s—accoun ed o 20% (n = 9), while pos na al causes, including cen al ne ous
sys em in ec ions, auma, and o he acqui ed condi ions, we e iden i ied in 15.6% (n = 7) (Figu e 4).
3.3. Clinical Sub ypes
Spas ic CP was he mos equen ly encoun e ed sub ype, a ec ing 62.2% (n = 28) o he coho . Al hough sub-
classi ica ion in o diplegia, hemiplegia, and quad iplegia was no ed, i was no de ailed in he cu en da ase . Hypo onic
CP was obse ed in 15.5% (n = 7), ollowed by dyskine ic CP in 13.3% (n = 6). A axic and mixed ypes we e he leas
common, each accoun ing o 4.4% (n = 2) o cases (Figu e 5).
3.4. Associa ed Como bidi ies
De elopmen al como bidi ies we e highly p e alen in he s udy popula ion. Nea ly all pa ien s (97.8%, n = 44)
exhibi ed global de elopmen al delay, wi h speci ic speech and communica ion delays epo ed in 88.9% (n = 40).
In ellec ual disabili y was also common, a ec ing 84.4% (n = 38). Epilepsy was p esen in o e a qua e o pa ien s
(26.7%, n = 12), unde sco ing he neu ological complexi y o CP. In e es ingly, no cases o hea ing impai men we e
documen ed, which may e lec ei he a ue absence o possible unde assessmen (Figu e 6).
3.5. Se e i y and Clinical Ou comes
In e ms o unc ional se e i y, pa ien s we e ca ego ized in o h ee g oups: se e e (48.9%, n = 22), mode a e (33.3%,
n = 15), and mild (17.8%, n = 8), based on clinical judgmen and unc ional s a us (Figu e 7). Wi h ongoing ca e and
ehabili a ion, clinical imp o emen was obse ed in 57.8% (n = 26) o cases, p ima ily in g oss mo o and
communica ion skills. The emaining 42.2% (n = 19) showed s a ic clinical p og ess, wi h no documen ed eg ession.
Impo an ly, no mo ali y was epo ed du ing he s udy pe iod, indica ing a ela i ely s able clinical cou se o he
coho unde e iew.
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Figu e 1 Dis ibu ion o pa ien s acco ding o sex
Figu e 2 Dis ibu ion o pa ien s acco ding o age
Figu e 3 Dis ibu ion o pa ien s acco ding o hei esidence
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Figu e 4 Dis ibu ion o pa ien s acco ding o he e iology
Figu e 5 Dis ibu ion o pa ien s acco ding o CP ype
Figu e 6 Dis ibu ion o pa ien s acco ding o clinical p esen a ion
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Figu e 7 Dis ibu ion o pa ien s acco ding o se e i y o CP
4. Discussion
This e ospec i e s udy o 45 pa ien s wi h ce eb al palsy (CP) p o ides aluable insigh s in o he demog aphic,
e iological, and clinical cha ac e is ics o CP wi hin ou popula ion. The indings a e la gely consis en wi h exis ing
li e a u e and con ibu e o he g owing body o e idence while highligh ing a eas o u he in es iga ion.
4.1. Demog aphic Pa e ns
The male p edominance (64.4%) obse ed in ou coho aligns wi h global ends, whe e CP is epo ed o be 1.2–1.5
imes mo e common in males [11]. This dispa i y may be a ibu ed o biological ac o s, including inc eased male
ulne abili y o pe ina al b ain inju y and complica ions ela ed o p e e m bi h [12]. The high p opo ion o pa ien s
in he 0–5-yea age g oup (55.6%) e lec s ypical diagnos ic imelines, as mo o impai men s o en become e iden in
ea ly childhood [13].
4.2. E iological Fac o s
Pe ina al causes accoun ed o he majo i y o cases (64.4%), ein o cing exis ing e idence ha his pe iod is he mos
c i ical window o CP de elopmen [14]. This inding unde sco es he need o con inued imp o emen s in obs e ic
and neona al ca e o educe CP isk [15]. The p ena al causa ion a e (20%) is consis en wi h epo s om high-income
coun ies [16], while he ela i ely low pos na al a e (15.6%) may e lec ad ancemen s in pos -neona al ca e,
pa icula ly in p e en ing in ec ion- ela ed b ain inju ies [17].
4.3. Clinical Cha ac e is ics
Spas ic CP (62.2%) was he mos p e alen sub ype, consis en wi h global da a indica ing ha spas ic o ms cons i u e
70–80% o all CP cases [18]. The high p e alence o de elopmen al como bidi ies—pa icula ly mo o miles one delay
(97.8%) and speech delay (88.9%)—highligh s he mul isys em na u e o CP and ein o ces he impo ance o ea ly,
mul idisciplina y in e en ion [19]. The absence o hea ing impai men in ou coho con as s wi h Wes e n s udies
epo ing a 10–20% p e alence [20], possibly due o di e ences in e iological p o iles, small sample size, o limi a ions
in diagnos ic assessmen s.
4.4. Se e i y and Ou comes
Nea ly hal o he pa ien s (48.9%) had se e e CP, which likely e lec s he e ia y ca e se ing, whe e mo e complex
cases a e ypically managed [21]. The obse ed imp o emen a e (57.8%) should be in e p e ed cau iously due o he
subjec i e na u e o e ospec i e assessmen s. The absence o mo ali y aligns wi h global ends indica ing imp o ed
su i al a es in CP o e ecen decades [22], al hough i is impo an o no e ha unc ional ou comes o en pla eau
du ing adolescence [23].
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4.5. Limi a ions
This s udy has se e al limi a ions. I s e ospec i e design may in oduce selec ion and epo ing biases. The ela i ely
small sample size and single-cen e scope may limi he gene alizabili y o indings o b oade popula ions. Addi ionally,
ou come assessmen s we e based on clinical documen a ion a he han s anda dized unc ional scales, which may
a ec he eliabili y and objec i i y o epo ed imp o emen s.
5. Conclusion
Ou indings ein o ce global CP pa e ns while e ealing egional a ia ions, pa icula ly in pe ina al causes and spas ic
sub ypes. The high como bidi y bu den unde sco es he need o ea ly, mul idisciplina y ca e. Fu u e la ge s udies
should alida e hese indings o op imize local managemen s a egies.
Recommenda ions
To imp o e ou comes o indi iduals wi h ce eb al palsy, we ecommend enhancing pe ina al ca e, implemen ing ea ly
sc eening p og ams, and adop ing mul idisciplina y ehabili a ion app oaches. Es ablishing egional egis ies would
suppo moni o ing ends and op imizing esou ce alloca ion. Fu u e esea ch should ocus on de eloping cos -
e ec i e, ailo ed in e en ions adap able o di e se heal hca e se ings.
Compliance wi h e hical s anda ds
Acknowledgmen s
We since ely hank Elshamal Specialized Hospi al in No he n Sudan o i s suppo , pa icula ly he pedia ic and
neu ology eams o hei e o s in da a collec ion and e alua ion, and he hospi al adminis a ion o i s
encou agemen . We hope ou indings help ad ance pedia ic neu ology se ices locally and beyond.
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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