Cerebral Palsy

What is Cerebral Palsy ?

Cerebral palsy-the most common crippling disease in children - comprises several neuromuscular disorders resulting from prenatal, perinatal, or postnatal central nervous system damage. Although non progressive, these disorders may become more obvious as an affected infant grows older.

The three major types of cerebral palsy-spastic (affecting about 70% of children with cerebral palsy), athetoid (affecting about 20%), and ataxic (affecting about 10%) sometimes occur in mixed forms. Motor impairment may be minimal (sometimes apparent only during physical activities such as running) or severely disabling. Associated defects, such as seizures, speech disorders, and mental retardation, are common. The prognosis varies. In mild impairment, proper treatment may make a near-normal life possible.

Causes of Cerebral Palsy

Cerebral palsy usually stems from conditions that result in cerebral anoxia, hemorrhage, or other damage. Conditions that cause these problems can occur before, during, or after birth.

Prenatal causes include Rhesus (Rh) factor or ABO blood type incompatibility, maternal infection (especially rubella in the first trimester), maternal diabetes, irradiation, anoxia, toxemia, malnutrition, abnormal placental attachment, and isoimmunization.

During parturition, conditions that can cause cerebral palsy include trauma during delivery, depressed maternal vital signs from general or spinal anesthesia, asphyxia from the cord wrapping around the neck, prematurity, prolonged or unusually rapid labor, and multiple births (infants born last in a multiple birth have an especially high rate of cerebral palsy).

Signs & Symptoms of Cerebral Palsy

Cerebral palsy affects the central nervous system and changes the tone of muscles. It takes mild, moderate and severe forms and generally does not get progressively worse. Cerebral palsy may affect one limb (monoplegia), one side of the body (hemiplegia), both arms or legs (diplegia), three limbs (triplegia), or all four limbs (quadriplegia).

The affected limbs might be floppy, rigid, or spastic. They might have a tremor, move on their own, or be uncoordinated. The affected limbs might function so well that most people would not notice, they might be virtually unusable, or anywhere in between. Toe walking might be the only symptom of CP.

Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may resemble other conditions. Always consult your child's physician for a diagnosis.

Diagnostic Tests

Appropriate tests are performed to diagnose conditions associated with cerebral palsy and to determine the degree of visual, auditory, and mental impairment. For example, an EEG may be performed to identify the source of seizure activity.

Treatment

Cerebral palsy can't be cured, but proper treatment can help affected children reach their full potential within the limits set by this disorder. Such treatment requires a comprehensive and cooperative effort involving doctors, nurses, teachers, psychologists, the child's family, and occupational, physical, and speech therapists. Home care is often possible. Children with milder forms of cerebral palsy should attend a regular school; severely afflicted children may need special education classes.

Treatment usually includes:

• braces or splints and special appliances, such as adapted eating utensils and a low toilet seat with arms to help these children perform activities independently
• range-of-motion exercises to minimize contracture
• phenytoin, phenobarbital, or another anticonvulsant to control seizures
• sometimes muscle relaxants or neurosurgery to decrease spasticity
• orthopedic surgery to correct contractures (most often part of the treatment in spastic cerebral palsy). Children with this form are especially prone to developing equinous deformity because the heel cord shortens. Achilles tendon lengthening is commonly performed to improve foot function. Muscle transfer procedures are performed to improve function of the wrist or other joints.

Prevention Tips

The best prescription for having a healthy baby is to have regular prenatal care and good nutrition, and to avoid smoking, alcohol consumption, and drug abuse. Preventing and rapidly treating maternal infections is probably more effective.