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Cerebral palsy during the 20th century in Iceland


1. State Diagnostic and Counseling Center, Kopavogur, Iceland;
2. University of Iceland, School of education, Reykjavik, Iceland;
3. Department of Laboratory Medicine, Chidrens and Womens Health, Norwegian University of Science and Technology, Trondheim, Norway

Background/Objectives: To describe historical trends in prevalence and characteristics of Cerebral Palsy (CP) during the 20th century in Iceland.

Design: We compare results from a study by Dr. Gudmundsson (Acta Neurl Scand 1967, with permission from the publisher) on CP prevalence and characteristics during the first half of the 20th century with data originating at the central developmental centre in Iceland on children with congenital CP born 1990-2003.

Participants and Setting: Dr. Gudmundssons report included results on 133 individuals with CP born during the first half of the 20th century and 102 children with CP born 1953-1962 (period one). Our report includes data on 139 Icelandic children born 1990-2003 (period two).
Materials/Methods: Birth history and thorough clinical descriptions were available for all individuals while data on prevalence was confined to children born 1953-1962 and 1990-2003.

Results: Prevalence of CP per 1000 live births was 2.2 for children born 1953-1962 compared with 2.3 for children born 1990-2003 (n.s.) coinciding with a decrease in neonatal mortality rate (NMR) from 11.4 to 2.6 per 1000 live births.The proportion of children with birthweight ≥2500g and <1500g was 73.2%and 5.9% in period one compared with 53.2%and 24.5% respectively in period two (p<0.001). Among individuals born in period one 77% had bilateral spastic CP and 15.3% had unilateral spastic distribution compared with 54.7% and 27.3% in period two (p<0.001). The comparison also suggests a significant improvement in gross motor function over time. The rate of intellectual impairment decreased from 59% during period one to 45% during period two (p<0.001) while 24.2% of the group in period one had epilepsy compared with 26.6% in period two (p=0.6).

Conclusions/Significance: Prevalence of CP remained stable in Iceland during the 20th century while we observed significant changes in the clinical characteristics of the condition over time. Changes in the clinical picture of CP coincided with a dramatic decrease in NMR indicating marked improvements in obstetric and neonatal care at the turn of the century.

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