Epilepsi Mioklonik pada Cerebral Palsy Berat dengan Global Development Delay dan Riwayat Kejang Neonatal: Laporan Kasus Berbasis Penilaian Fungsional

Abstrak

Background: Epilepsy is a frequent comorbidity in children with cerebral palsy (CP), particularly in those with severe motor impairment and a history of neonatal seizures. However, myoclonic epilepsy is less commonly reported in this population. Early brain injury and neonatal seizures are recognized risk factors for subsequent epilepsy and adverse neurodevelopmental outcomes. Comprehensive functional assessment is essential to characterize the severity of impairment and guide individualized management.

Case Presentation: We report a 3-year-old girl with severe spastic cerebral palsy and global developmental delay who presented with myoclonic seizures. She had a significant perinatal history, including maternal preeclampsia and placenta previa, followed by neonatal seizures requiring intensive care management. Brain magnetic resonance imaging revealed findings consistent with hypoxic-ischemic encephalopathy. Developmental evaluation confirmed global delay across multiple domains. Functional assessment demonstrated severe limitations, classified as level V in the Communication Function Classification System (CFCS), level IV in the Manual Ability Classification System (MACS), and level IV in the Eating and Drinking Ability Classification System (EDACS). The patient was managed with multidisciplinary rehabilitation and antiepileptic therapy.

Discussion: Neonatal seizures may reflect early cortical instability and increase the risk of subsequent epilepsy in children with CP. While focal and generalized tonic–clonic seizures are more commonly described, myoclonic manifestations are less emphasized in this population. This case illustrates a potential continuum from neonatal brain injury to later suspected myoclonic epilepsy. A structured functional assessment provides a comprehensive understanding of neurological burden and supports tailored management.

Conclusion: This case highlights the potential progression from neonatal seizures to suspected myoclonic epilepsy in a child with severe cerebral palsy and global developmental delay. A functional assessment–based approach provides valuable insight into the overall severity of impairment and supports comprehensive, individualized care planning in children with complex neurodevelopmental disorders.