Relation of serum tumor necrosis factor-α level with disease severity in spastic cerebral palsy

Objective To detect the relation between serum tumor necrosis factor-α (sTNF-α) level and disease severity in children with lower limb spastic cerebral palsy (CP). Background Glial cells are activated following a primary insult to the immature brain, secreting chemical mediators such as tumor necrosis factor-α, leading to secondary white matter injury, causing CP. Patients and methods A randomized controlled clinical trial was conducted, including 80 ambulatory children with lower limb spastic CP and 80 healthy age-matched and sex-matched children as control group. At baseline, patients with CP were assessed using Modified Modified Ashworth Scale, bilateral adductor tone score, passive range of motion of lower limb joints, and outcome measures, such as Edinburgh Visual Gait Scale, Gross Motor Functional Measure-88, and Caregiver Priorities and Child Health Index of Life with Disabilities. Interventions were botulinum toxin-A injection, sTNF-α measurement, and rehabilitation. Follow-up after 2, 6, and 12 weeks had the same assessment as baseline, except for sTNF-α, and outcome measures were done at baseline and week 12. The control group had sTNF-α measured. Results Modified Modified Ashworth Scale, ankle dorsiflexion, popliteal angle, and outcome measures significantly improved after intervention (P > 0.001). Baseline sTNF-α was significantly higher in patients with CP (P > 0.001), positively correlated with CP severity (P = 0.01), and significantly improved after treatment (P > 0.001). Age and weight negatively correlated with baseline sTNF-α. Outcome measures significantly correlated with sTNF-α after intervention. Conclusion Baseline sTNF-α in spastic CP was higher than controls and positively correlated with disease severity. It significantly improved after rehabilitation and significantly correlated with improvement in all outcome measures.