Cerebral palsy: Interictal epileptiform discharges and cognitive impairment

Prevalence of cerebral palsy (CP) has been found to rise in the last 40 years with its management becoming an issue of considerable socio-economic concern worldwide. Further, there is mounting evidence regarding the association of CP with a high incidence of cognitive impairment, and a causal–effect relationship between interictal epileptiform discharges (IEDs) and cognitive impairment is being established through recent scientific studies. A few clinical trials aimed at treatment/suppression of IEDs in such patients have resulted in significant improvement in cognitive behavior and performance. The author in an earlier article has proposed inclusion of suppression of IEDs as an important parameter in the multidimensional management protocol of CP patients to improve their prognostic outcome. This brief paper is intended to strengthen the earlier postulation made by the author emphasizing the role of IEDs in cognitive impairment and their subsequent timely treatment to obtain improvement in cognitive functioning. At cellular level, since epileptiform discharge generating neurons exhibit increased proneness to premature death, an early detection of IEDs and appropriate intervention can also check further neuronal damage in CP patients.