الفهرس 
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Abstract
Cerebral palsy is the most prevalent severe motor disability among children, it represents a burden on affected children, their families and societies.
Autonomic dysfunction is common and severely affecting the quality of life of many children. Disturbances in homeostatic functions which could be attributed to autonomic dysfunction have been observed in individuals with cerebral palsy.
The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electro-physiologically and to relate the results to the level of motor impairment as classified by the Gross Motor Function Classification System.
The study was conducted on forty children with cerebral palsy among those attending Alexandria University Children’s Hospital (AUCH) and its outpatient-clinics (neurology and physical medicine) and twenty healthy children with matched age and sex as control group.
CP children were subjected to full history taking, full physical examination, and questionnaire for autonomic dysfunction symptoms. They were assessed for SSR and HRV through orthostatic test.
Control group was assessed for SSR and HRV.
The age of CP children ranged from 4-12 years with a mean of 7.76 ± 2.82 years. The majority of them were males constituting 60% of children. Anthropometric measures of CP children were significantly lower than healthy children. 82% of children were from rural areas. The origin of cerebral palsy was perinatal in the majority of children (80%). Perinatal history in CP children revealed 72.5% had history of normal vaginal delivery: 52.5 % of them had prolonged or instrumental delivery and 20% had spontaneous delivery. 27.5 % of CP children had history of cesarean section delivery: 20% of them had emergency CS delivery and 7.5% had elective CS delivery.
Most of children had quadriplegic spastic cerebral palsy (82.5%). Based on GMFCS classification the majority of children were in levels 4 and 5. Clinical assessment of autonomic dysfunction among CP children demonstrated that persistent cold extremities was reported in 80% of the children, chronic constipation in 65%, sleep disturbance in 52.5%, loss of appetite in 47.5%, sweating abnormalities in 40% of them; hyperhidrosis (25%) and hypohidrosis (15%), recurrent nausea and/or vomiting in 25%, increased sensitivity to light in 22.5% and bloating in 15%.
Sympathetic skin response in CP children showed considerable percentage of unelicited responses, as 47.5% of children had unelicited response in upper limbs and 60% had unelicited response in lower limbs, all of them were in level 4 and 5 of GMFCS.
Regarding cardiovascular abnormalities 20% of CP children had postural hypotension.
Regarding HRV: CP children showed higher resting mean HR than healthy children but with no significant difference, both CP children group and control group showed significantly increased mean HR in 90° hea