Clinical and Functional Severity of Cerebral Palsy in a Tertiary Referral Cohort From Northeast Brazil: Insights From a Middle-Income Country.

BACKGROUND

Cerebral palsy (CP) is the leading cause of childhood motor disability and is characterized by marked clinical and functional heterogeneity. Although most epidemiologic and clinical evidence derives from high-income countries, important gaps remain in low- and middle-income settings, where socioeconomic and health care disparities may influence severity patterns and functional outcomes. Understanding how clinical severity manifests in these contexts is essential for prognosis and service planning.

METHODS

This retrospective hospital-based study reviewed medical records of 207 children and adolescents with CP followed at a tertiary referral center in Northeast Brazil between 2018 and 2022. Clinical characteristics included motor type and topographic classification. Functional severity was estimated based on age at acquisition of head control, trunk control, and independent walking. Sociodemographic and perinatal variables were collected, and exploratory subgroup analyses were conducted according to prenatal care adequacy, gestational age, birth weight, and history of seizures.

RESULTS

Spastic CP was the most prevalent motor type (61.3%), and quadriplegia was the most frequent topographic presentation (63.2%). Prematurity (39.3%) and low birth weight (38.6%) were common. Most participants (74.1%) did not achieve independent walking after 2 years of age, indicating substantial functional impairment. A history of seizures was significantly associated with quadriplegia (P = 0.027). No significant associations were observed between prenatal care adequacy, gestational age, or birth weight and functional severity indicators.

CONCLUSIONS

Children and adolescents with CP followed at a tertiary referral center in this middle-income setting showed a high prevalence of severe motor impairment and delayed postural and locomotor milestone acquisition. Rather than identifying novel severity markers, these findings illustrate how well-established indicators cluster within a socially and clinically complex referral population. This context-sensitive characterization may support functional stratification, prognostic assessment, and health service planning in settings with limited population-based data.