A Tale of Two Cerebral Palsies.

There is limited understanding of cerebral palsy (CP) in low-middle-income countries (LMICs). This retrospective cross-sectional study aims to describe and compare the phenotype, severity and etiologic profile of children with CP born either in a LMIC or high-income country (HIC) assessed in a single setting. Data from consecutive children with CP initially assessed by a single neurologist over a 5-year interval (2020-2024 inclusive) were extracted from hospital records. Children were classified into one of two groups based on location at birth (HIC or LMIC). Pearson chi-square analyses compared the two CP populations along the following characteristics: CP subtype, etiology, magnetic resonance imaging finding, functional impairments, and comorbidities. Eighty-nine Canadian (HIC) born and 48 LMIC born children met inclusion criteria. LMIC children were significantly (P < 0.01) more likely to have spastic quadriparetic or dyskinetic CP, magnetic resonance imaging signs of deep gray matter injury, Gross Motor Function Classification System/Manual Ability Classification System level IV-V functional severity or cognitive disability and be nonverbal, deaf or cortically blind than a child born in a HIC. Intrapartum asphyxia or kernicterus was significantly (P < 0.01) more likely as an etiology in LMIC born children. Children from LMICs have a substantially different CP phenotype. This phenotype is markedly more severe with respect to functional impairments and comorbidities. This likely reflects a significantly greater degree of deep gray matter injury that is the consequence of an altered etiologic profile. These results provide greater insight into the profile of CP in LMICs offering specific targets for preventative strategies. Greater service needs for children with CP derived from migrant populations in HICs can be expected.