Homage toGudrun and Bengt

Hagberg

Pioneers in cerebral palsy research

Kate Himmelmann

Low profile research assistant at the Pediatric Department

• Smarter than the rest of us

• Never pointed that out

• Why not write her own thesis? ”I would never put

myself in that position”

PhD h.c. in 1989

“Her scientific papers have attracted international attention and she has made a decisive contribution to the knowledge in areas such as neuropediatric epidemiology, cerebral palsy and mental retardation.”

Pioneers in CP research (among many other things)

CP classification

Hagberg

Spastic hemiplegia

Spastic/atactic diplegia

Spastic tetraplegia

Dyskinetic CP

Ataxia

Clinical classification of cerebral palsy syndromes in children

d' AVIGNON, BILLE B, HAGBERG B, OLOW I. Lakartidn. 1960 Sep 9;57:2533-45.

The changing panorama of

cerebral palsy in Sweden

0

0,5

1

1,5

2

2,5

3

1954-

1958

1959-

1962

1963-

1966

1967-

1970

1971-

1974

1975-

1978

1979-

1982

1983-

1986

1987-

1990

1991-

1994

1995-

1998

1999-

2002

2003-

2006

Prevalence per

1000 live births

Cerebral palsy in western Sweden

1954-2006

24,5/1000 4,7/1000Perinatal mortality

0

0.5

1

1.5

2

2.5

3

Total CP

Term CP

Preterm CP

Preterm diplegia

The changing panorama of cerebral palsy in Sweden

All CP types covered

• Ataxia – Sanner 1974

• Dyskinetic CP – Kyllerman 1982

• Diplegia – Velkeen 1983

• Hemiplegia – Uvebrant 1988

• Tetraplegia – Edebol-Tysk 1989

Risk factors, not only for CP• Kyllerman M, Hagberg G. Reduced optimality in

pre- and perinatal conditions in a Swedish newborn

population.Neuropediatrics. 1983 Feb;14(1):37-42

• Uvebrant P, Hagberg G. Intrauterine growth in

children with cerebral palsy. Acta Paediatr. 1992

May;81(5):407-12.

• Jacobsson B, Hagberg G, Hagberg B, Ladfors L,

Niklasson A, Hagberg H. Cerebral palsy in preterm

infants: a population-based case-control study of

antenatal and intrapartal risk factors. Acta Paediatr.

2002;91(8):946-51

Where are we going?• In western Sweden the CP prevalence for children

born <26 weeks has increased from 78 to 107 per

1000 live births <26 weeks

0

2

4

6

8

10

12

14

16

18

1999-2002 2003-2006

27

26

25

24

23

1

10

100

Per

1,0

00 l

ive

bir

ths

Birth year

<28 w

28-31 w

32-36 w

>36 w

Gestational age

Himmelmann K, Uvebrant P..

Acta Paediatr. 2014;103:618-24.

Collaborations and network

• Extensive worldwide network ”Bengt was the social

one and I was happy to be in the background”

• Collaborations with e.g. Ingeborg Krägeloh-Mann

and Richard Michaelis regarding bilateral spastic

CP

• Member from the start in Surveillance of Cerebral

Palsy

Surveillance of cerebral palsy in Europe

Grenoble

Toulouse

Oxford

Newcastle

Liverpool

Belfast

DublinCork

Norway

Göteborg

Denmark

Tübingen

Roma

Madrid

KaunasC17

Galway

Portugal

Nicosia

C09

C08

C04

C05

C07

C10

C11

C18

C21

C15

C06

C12 C20

C22

C19

C01

C02

C13

C23

Slovenia Pecs

Riga

C24

IcelandC25

Edinburgh

C03

ArnhemC14

BolognaC16

C27

C26

C28

C31

Croatia

Leuven

Edinburgh

Newcastle

Innsbruck

Greece

Nicosia

Surveillance of cerebral palsy in Europe

Classification – type and

distribution

CP classification

Hagberg SCPE

Spastic hemiplegia Unilateral spastic CP

Spastic/atactic diplegia Bilateral spastic CP

Spastic tetraplegia

Dyskinetic CP Dyskinetic CP

Ataxia Ataxia

SCPE Surveillance of Cerebral Palsy in Europe

http://www.scpenetwork.eu/

Ongoing research based on the CP Register of western Sweden

(n≈2350 born 1954-2010)

Examples

• Report on prevalence and origin of CP in the birth-

years 2007-2010

• Neuropsychiatric disorders in CP

• Survival studies

• Health and quality of life in adults with CP living in

western Sweden (clinical and register study)

• Follow-up on gross and fine motor function,

communication and interventions

Thank you