Cerebral palsy

Spastic Cerebral Palsy, Dyskinetic Cerebral Palsy, Athetoid Cerebral Palsy

What is Cerebral palsy?

Cerebral palsy refers to a group of conditions caused by injury to the cerebral area of the brain before, during, or shortly after birth. Cerebral palsy is the most common crippling condition of childhood. It is a condition that does not progressively get worse (static). The cerebral injury can occur in several ways, including inadequate blood or oxygen supply to the fetus, premature birth, birth trauma, diseases in infancy, intracerebral hemorrhage in premature babies, or blood vessel damage.

Cerebral palsy is classified into three categories. Nearly half of all cerebral palsy individuals are diagnosed with spastic cerebral palsy, the most common and mildest form of the disease. Children in this group display varying degrees of paralysis in paired limbs (paraplegia). Dyskinetic or athetoid cerebral palsy occurs in twenty percent of cases. Children with this form of the disease typically display abnormal involuntary movements, such as twisting, twitching, writhing, or abrupt, jerky movements that may increase with tension and disappear during sleep. Children with ataxic cerebral palsy, who account for ten percent of cases, display tremors, unsteadiness, incoordination, and quick, jerky (choreic) movements.

How is it diagnosed?

Cerebral palsy signs and symptoms

Number and severity of the following symptoms vary widely among children with cerebral palsy:

  • Early sucking difficulty with the breast or bottle.
  • Lack of normal muscle tone (early).
  • Slow development (walking, talking).
  • Unusual body postures.
  • Stiffness and muscle spasms (later).
  • Purposeless body movements.
  • Poor coordination or balance.
  • Crossed eyes.
  • Deafness.
  • Convulsions.
  • Various degrees of mental retardation.

History: Cerebral palsy is only rarely diagnosable during early infancy. Children known to be at-risk are those with evidence of birth trauma, asphyxia, jaundice, meningitis, or with a neonatal history of seizures, hypotonia, or reflex suppression. Specific forms of cerebral palsy often cannot be characterized until the second year of life.

Physical exam: Before the specific motor syndrome develops, the child will show lagging motor development and, often, persistent infantile reflex patterns, hyperreflexia, and altered muscle tone. The affected limbs usually are underdeveloped and show increased deep tendon reflexes and muscular hypertonicity, weakness, and a tendency for the muscles and joints to be permanently tightened or shortened (contractures). A "scissors gait" and toe walking are characteristic. In mildly affected children, symptoms may be seen only during certain activities, such as running.

Tests: X-rays of the cranium, CT scans, MRI and electroencephalography (EEG) are often used in the diagnostic process. Laboratory testing of blood and other body fluids are also conducted to eliminate specific biochemical disorders capable of causing similar symptoms.

How is it treated?

The goal of treatment is to help these individuals attain maximal independence within the limits of their condition. With proper management and support, many individuals can lead near-normal lives. Physical and occupational therapy, bracing, orthopedic surgery and speech training may all be required. For some, anticonvulsant medication may be required to prevent seizures.

Medications

Information Brand Generic Label Rating
http://medtips.org/b/baclofen.html Lioresal Baclofen Off-Label
Seizure medications

Klonopin (Clonazepam), Valium (Diazepam), Depakote (Divalproex Sodium), Tegretol (Carbamazepine)

What might complicate it?

Individuals with cerebral palsy frequently experience neurological problems including epilepsy, mental retardation, learning disabilities, attention deficit hyperactivity disorder, visual impairment, swallowing difficulties, speech impairment (dysarthria), and hearing loss. Potential orthopedic problems include scoliosis, hip dislocation, muscle and joint stiffening, and discrepancy in leg length.

Predicted outcome

The severity of cerebral palsy varies widely. An individual may have high intelligence despite major muscular disability. Individuals with less severe impairment can lead productive, near-normal lives. For those with severe forms of cerebral palsy, special care may be required.

Alternatives

Differential diagnoses include spinal cord injury, spina bifida, congenital spinal cord malformation, phenylketonuria, amino-acidopathies, subdural hematoma, brain tumor, hemiparesis, Tay-Sachs disease, metachromatic leukodystrophy, and mucopolysaccharidosis.

Rehabilitation

Physical therapy, occupational therapy and speech therapy, three times a week, indefinitely.

Appropriate specialists

Neonatologist, neurologist, developmental pediatrician, child psychologist, neuropsychologist, speech therapist, occupational therapist, physical therapist, audiologist, orthopedic surgeon.

Last updated 15 December 2015

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