cerebral palsy ( cp ) is a chronic disorder of movement and posture caused by a non - progressive brain lesion . cp can manifest itself in many ways , causing spastic , dyskinetic , dystonic , ataxic and mixed palsies . the prevalence of cp is 2  2.5 of every 1000 live - born children in the western world , making it one of the most common causes of motor disability in children . cp has important comorbidities , such as visual impairments , learning difficulties and epilepsy ( 5 ) . epilepsy is one of the most common neuroimpairments in childhood , with a prevalence of 5  7% in the general population ( 5 ) . although there is some conflict in the literature , it appears that the prevalence of epilepsy in children and adults with cp is between 15  55% ( 5 ) . in addition , if learning difficulties and cp coexist , the risk of epilepsy in children with cp rises to 71% ( 5 ) . furthermore , robinson found that 21% of children with language impairment had seizures ( 6 ) . these are children who can not understand or express themselves ( either verbally or non - verbally ) in the normal way expected of age - matched peers within the general population ( 6 ) . utilizing an audit of clinical notes for children at two schools in one city , this study investigated whether a higher incidence of epilepsy existed in children with cp , learning difficulties ( ld ) or language and communication difficulties ( lacd ) compared to children without these conditions . in addition , data was studied to ascertain whether an earlier age of onset , low birth weight or gestational age is associated with increased incidence of cp , ld or lacd . conclusions made from local data could then allow for the possibility of adequate planning of services for these children . school a and school b are special primary schools in the city of newcastle upon tyne , uk . school a enrolls children with a variety of developmental difficulties , whereas pupils at b , a more specialist school , either have cp or lacd . medical records for current pupils in 2004 were obtained and carefully studied over seven weeks ( january to february ) to collate epidemiological information . details of the child s birth history , diagnosis ( as cp , lacd and/or ld ) , past history of syndromes , past history of epilepsy , age of onset , presence of neonatal encephalopathy , infantile spasms and febrile convulsions , type of epilepsy , frequency of fits were recorded . epilepsy was recorded as active if the child was currently on anti - epileptic medication . medical records for all 59 of the pupils at school b were obtained and studied . medical records for 83 ( 77% of pupils ) at school a were collected . the mean age of children at school b was 8.20 years ( s.d . 2.48 ) . children at school b were older ( t = 2.17 , p = 0.03 ) table 1 shows the number of children with each diagnosis by gender . many children had a combination of diagnoses , therefore totals in each gender row exceed 100% . epilepsy , both active and inactive , was more common in females than males ( x = 9.07 , p < 0.01 ) . although there were more females with cp and more males with lacd and ld , the differences between groups were not statistically significant . at each school there were three children that had a combination of cp , ld and lacd . there were 62 cases of epilepsy ( seizures at any time ) in the combined school population , representing 43% of the total . separate school data shows that more children at school b had cp than school a ( x = 9.56 , p < 0.01 ) or language and communication problems ( x 4.25 , p = 0.04 ) . more children at school a had learning difficulties ( x = 32.41 , p < 0.01 ) or active epilepsy ( x = 3.03 , p = 0.08 ) compared to school b. table 3 reports the association between active epilepsy or cp , lacd , or ld . the results show that active epilepsy was significantly more common in those children with cp when compared to children without cp ( x = 7.58 , p = 0.01 ) . there was no association between active epilepsy and the presence of ld however , all children with cp and ld had epilepsy ( n = 6 ) . interestingly , epilepsy was more likely to occur in children without lacd ( x = 8.45 , p < 0.01 ) . using combined data from both schools , females had an earlier age of onset of epilepsy than males ( t = 2.27 , p = 0.03 , data not shown ) . the average age of onset in children with cp was earlier at 21.50 months compared to 37.15 in children without cp , although this was not statistically significant ( t = 1.40 , p = 0.17 ) . there was no difference in age of onset of epilepsy in those with or without lacd ( t = 0.51 , p = 0.62 ) or ld ( t = 0.10 , p = 0.92 ) . although not statistically significant , the data also showed a trend that those children who developed epilepsy within the first 24 hours of life were more likely to have cp than those who developed epilepsy later in life ( x = 3.10 , p = 0.08 ) . finally , children with neonatal encephalopathy are more likely to have cp than those without neonatal encephalopathy ( x = 8.74 , p < 0.01 , data not shown ) . table 4 shows the mean gestational age and birth weight in children with cp , lacd , and ld . the results showed that those with cp tended to have a lower birth weight ( t = 3.15 , p < 0.01 ) and a shorter gestation ( t = 3.17 , p < 0.01 ) than children without cp . although not statistically significant , children with lacd tended to be heavier at birth than children without lacd ( t = 1.79 , p = 0.08 ) . those with learning difficulties have a longer gestation compared to those without ( t = 2.00 , p = 0.047 ) there were three anomalous results for birth weight and gestation age . these results , although collected from the notes , seemed unlikely to be correct therefore were excluded from the analysis ( see discussion for details ) . medical records for all 59 of the pupils at school b were obtained and studied . medical records for 83 ( 77% of pupils ) at school a were collected . the mean age of children at school b was 8.20 years ( s.d . 2.48 ) . children at school b were older ( t = 2.17 , p = 0.03 ) table 1 shows the number of children with each diagnosis by gender . many children had a combination of diagnoses , therefore totals in each gender row exceed 100% . epilepsy , both active and inactive , was more common in females than males ( x = 9.07 , p < 0.01 ) . although there were more females with cp and more males with lacd and ld , the differences between groups were not statistically significant . at each school there were three children that had a combination of cp , ld and lacd . there were 62 cases of epilepsy ( seizures at any time ) in the combined school population , representing 43% of the total . separate school data shows that more children at school b had cp than school a ( x = 9.56 , p < 0.01 ) or language and communication problems ( x 4.25 , p = 0.04 ) . more children at school a had learning difficulties ( x = 32.41 , p < 0.01 ) or active epilepsy ( x = 3.03 , p = 0.08 ) compared to school b. table 3 reports the association between active epilepsy or cp , lacd , or ld . the results show that active epilepsy was significantly more common in those children with cp when compared to children without cp ( x = 7.58 , p = 0.01 ) . there was no association between active epilepsy and the presence of ld however , all children with cp and ld had epilepsy ( n = 6 ) . interestingly , epilepsy was more likely to occur in children without lacd ( x = 8.45 , p < 0.01 ) . using combined data from both schools , females had an earlier age of onset of epilepsy than males ( t = 2.27 , p = 0.03 , data not shown ) . the average age of onset in children with cp was earlier at 21.50 months compared to 37.15 in children without cp , although this was not statistically significant ( t = 1.40 , p = 0.17 ) . there was no difference in age of onset of epilepsy in those with or without lacd ( t = 0.51 , p = 0.62 ) or ld ( t = 0.10 , p = 0.92 ) . although not statistically significant , the data also showed a trend that those children who developed epilepsy within the first 24 hours of life were more likely to have cp than those who developed epilepsy later in life ( x = 3.10 , p = 0.08 ) . finally , children with neonatal encephalopathy are more likely to have cp than those without neonatal encephalopathy ( x = 8.74 , p < 0.01 , data not shown ) . table 4 shows the mean gestational age and birth weight in children with cp , lacd , and ld . the results showed that those with cp tended to have a lower birth weight ( t = 3.15 , p < 0.01 ) and a shorter gestation ( t = 3.17 , p < 0.01 ) than children without cp . although not statistically significant , children with lacd tended to be heavier at birth than children without lacd ( t = 1.79 , p = 0.08 ) . those with learning difficulties have a longer gestation compared to those without ( t = 2.00 , p = 0.047 ) there were three anomalous results for birth weight and gestation age . these results , although collected from the notes , seemed unlikely to be correct therefore were excluded from the analysis ( see discussion for details ) . the data from the schools shows that the percentage of children with epilepsy was high compared with the general population ( 43% compared to 7% ) . school a takes children with multiple and more complex disabilities , illustrated by the tendency of more children to have active epilepsy and learning difficulties at this school . school b takes children with cp or lacd , also shown by the data , and is therefore considered more specialised . the data demonstrates that 40% of children with cp alone and 100% of children with a combined diagnosis of cp and ld also had epilepsy ( x = 4.44 , p = 0.035 ) . this is comparable with the literature , in which epilepsy occurs in 15  55% of children and adults with cp alone , rising to 71% in children also suffering from ld ( 5,710 ) . the proportion of children with epilepsy and lacd ( 14% ) was comparable to that of the literature ( 21% ) , and is greater than that of the general population ( 6 ) . we found that epilepsy occured more in children without lacd , but this may be due to the fact that these children suffered from other , predisposing conditions . the average age of onset of 21.5 months in children with cp was higher when compared to children without cp . furthermore , this age of onset was greater than data in the literature [ 18.9 months ( 10 ) ] . we also found that children who developed epilepsy within the first 24 hours of life were more likely to develop cp than those with a later onset ( p = 0.08 ) , a fact supported by existing literature ( 7 ) . finally , we found that neonatal encephalopathy , characterised by disturbed neurological function including seizure activity occurring in the first days of life ( 7,11 ) , was associated with cp ( p < 0.01 ) . the bw and ga of children with cp from both schools was lower when compared to children without cp ( p < 0.01 ) , supporting theories that the etiology of cp is due to prenatal events ( 2,7 ) . this data also supports conclusions made by an epidemiological study of cp performed in the north east of england from 1964 to 1993 ( 3 ) . this study concluded that there was a substantial increase in the overall rate of cp over time , caused by increased rate of cp in those children born weighing less than 2.5 kg . it is conceivable that many children with cp who would have died in the past could now survive because of improvements in the perinatal care of premature and low birth weight babies . the small study cohort ( only 37 children had active epilepsy ) is a considerable limitation and it can not be determined whether the schools studied were representative of special schools as a whole . many of the medical records for pupils in school a were inaccessible due to the amalgamation of hospital files across three different sites . this issue limited data collection , and as a result , also limits potential conclusions that could be drawn . three pupils were left out of the analysis of bw and ga due to improbable data - two were noted to be above 4 kg at birth , likely reflecting an older weight , and one recording was illegible . in addition , the lack of documentation of certain details such as association with family history , type of epilepsy and frequency of seizure activity meant that this information could not be included in formal analyses . in addition , definite negatives , such as the absence of seizure activity and family history , are rarely recorded in medical records . the results are at risk of type two error , which indicates that statistical significance could have been found by chance . this is possible due to the fact that there was no hypothesis stated prior to the beginning of the study , and also to the fact that the the data was collected by data dredge and analysed looking for statistically significant results ( 12 ) . this study could be improved by carrying out a prospective study using questionnaires and consultations thereby directly asking patients and their families about their medical history . in addition , investigations such as eeg , video recording and ct could give useful information about the type of epilepsy and its underlying pathology . standardised scores for ld versus the relatively crude manner in which data was documented would refine the methodology in a future study . . the comparison group could be children with epilepsy and no cp at a mainstream school , or a random sample taken from the general population . it would be interesting to broaden the study questions to include a detailed look at the type and the severity of cp , as some studies have found that epilepsy occurs in a higher rate in certain types of cp ( 7 ) . in addition , it would be of benefit to look at behaviour and educational attainment in children with epilepsy and cp as opposed to no epilepsy and cp . the data in this study builds on conclusions made by existing studies , reinforcing the fact that epilepsy commonly accompanies cp . the association between low bw and ga , and early age of onset of seizures in children with cp , illustrates the importance of past medical history from birth to determine any risk factors for epilepsy in later life . diagnosis and treatment of these children require skills in addition to those needed for non - complicated cp . therefore , members of the multidisciplinary team managing children in special schools like a and b need to be aware of this association and be educated to adequately manage these children .