Epilepsy in Children with Cerebral Palsy: Clinical, Neuroimaging, and Perinatal Correlates—A Cross-Sectional Study from Tertiary Care Center in North India

Introduction: Cerebral palsy (CP) frequently coexists with epilepsy, compounding motor, cognitive, and behavioral impairments and increasing care complexity. This cross-sectional study at a tertiary care center in Northern India evaluated seizure characteristics, epilepsy severity, motor function, neuroimaging patterns, and perinatal predictors in children with CP and epilepsy. Methods: A total of 95 children aged 1 to 13 years with clinically and radiologically confirmed CP and epilepsy were prospectively enrolled with clinical, electroencephalogram, and magnetic resonance imaging (MRI) assessments to characterize seizures in CP and examine their relation to CP and MRI severity. Seizures were classified according to the 2025 International League Against Epilepsy (ILAE) criteria. Seizure severity was assessed using the Early Childhood Epilepsy Severity Scale (E-CHESS), and CP severity using the Gross Motor Function Classification System (GMFCS). MRI brain was evaluated using the Trivedi et al scoring system to derive an MRI severity score. Associations between E-CHESS, GMFCS, MRI severity, and perinatal variables (including 5-minute APGAR) were analyzed using appropriate correlation and regression method. Results: Spastic quadriplegic CP was predominant (78.9%) and nearly half of the cohort had GMFCS levels III to V, indicating moderate to severe motor limitation. Generalized tonic–clonic seizures were the most common seizure type overall. E-CHESS remained independent of GMFCS ( r = 0.079, p = 0.12); MRI severity increased with E-CHESS scores ( p = 0.0427); gray matter injury predicted severe epilepsy, while white matter lesions indicated moderate severity. Low/moderate 5-minute APGAR independently predicted severe seizures (adjusted odds ratio 47.4–52.1, p < 0.013), with quadriplegic cases showing perinatal compromise (low APGAR scores at 5 minutes). Conclusion: Seizure severity in CP ties to gray matter MRI injury and low 5-minute APGAR but decouples from motor impairment. Low 5-minute APGAR scores serve as early biomarker for increased risk of severe epilepsy in CP, targeting MRI-guided antiseizure optimization in gray matter lesions. This study emphasizes the need for parallel management strategies—addressing seizures and motor deficits separately but comprehensively. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India