Cerebral Palsy

What is Cerebral Palsy (CP)?

Cerebral Palsy (CP) refers to a group of motor development and coordination disorders that occur in early childhood and are permanent throughout life. This can result in abnormal muscle tone, reflexes, and improper posture.

Is Cerebral Palsy a Medical emergency?

Cerebral Palsy is not a medical emergency.

Types

It is classified into four types depending upon the type of movement disorder and the body parts that are affected:

• Spastic Cerebral Palsy: Spastic Cerebral Palsy is the most common type of CP. The part of the brain which controls voluntary movements is damaged. This causes stiffness in one side of the body, abnormal gait, and jerky movements.
• Athetoid Cerebral Palsy or Dyskinetic Cerebral Palsy: Athetoid CP affects voluntary motor function, eye movements, balance, and coordination. Basal ganglia and/or cerebellum is affected.
• Ataxic Cerebral Palsy: Ataxic CP damages the part of the brain that is essential for coordination and balance.
• Mixed Cerebral Palsy: Mixed CP has symptoms of athetoid, ataxic, and spastic CP.

Causes

It is caused by abnormal brain development during pregnancy. The part of the brain that controls movement, balance, and posture is affected.

The causes of abnormal brain development may be:

• Genetics: CP can be inherited
• Preterm birth and low birth weight
• Maternal infections
• Lack of blood supply to the developing brain of the infant
• Fetal infections while in the womb
• After birth complications like breathing meconium into the lungs, seizures after birth, stressful labor, respiratory distress syndrome, etc.
• Early childhood complications like physical brain injury, stroke, severe jaundice, etc.

Risk factors

Factors that influence the risk of Cerebral Palsy include:

• Preterm birth
• Being a twin
• Certain infections during pregnancy such as toxoplasmosis, rubella, herpes, syphilis, etc.
• Maternal problems like thyroid disorders, seizures, intellectual disabilities, or exposure to toxins such as methylmercury
• Strained labor or a difficult delivery
• Head trauma during the first few years of life

Signs & symptoms

Signs and symptoms of Cerebral Palsy start to appear at the age of 6 to 9 months when the child starts to walk. Children with Cerebral Palsy may exhibit the following:

• Deformities in motor development, which are observed through the gait
• Excessive drooling
• Difficulty sucking or swallowing
• Hip dislocations
• Muscle tone deformities like muscles being very floppy or very stiff
• Poor balance and coordination
• Developmental delays like delay in sitting up or crawling
• Gait deformities like walking on toes, a wide gait, a crouched gait, or dragging one leg
• Delay in speaking
• Delay in learning
• Difficulty in thinking
• Weakness in hands and inability to hold objects
• Seizures or tremors

Investigations

Investigations that are done to diagnose Cerebral Palsy include:

• Laboratory tests:
  • Blood, urine, and skin tests: These tests are performed to check for any genetic or metabolic abnormalities
• Imaging tests:
  • Brain scan: Cranial ultrasound and MRI imaging are done to detect areas of damage in the brain and determine any abnormal development
• Electroencephalogram (EEG): The electroencephalogram records the electrical activity of the brain. This is done in case of seizures

Diagnosis

A diagnosis of Cerebral Palsy is made based on medical history, clinical evaluation, monitoring of the growth and development of the child, and results of the investigations done.

Treatment options

Treatment of Cerebral Palsy requires long-term care and management. Treatment focuses on making individual suffering and leads to a better quality of life.

Medical treatment

Medications that are used to treat some of the symptoms caused by CP include:

• Anti-seizure medications to control seizures
• Analgesics to provide relief from pain
• Muscle relaxants - like diazepam, dantrolene, baclofen, and tizanidine help to relax muscles
• Muscle or nerve injections like botox and Dysport are used to treat muscle tightening

Interventional treatment including surgery and indications for surgery/ Surgical treatment

Several therapies are followed to treat the conditions caused by CP. Some of them include:

• Physical therapy
• Occupational therapy
• Speech and language therapy
• Recreational therapy
• Orthotic devices like braces, rolling walkers, splints, wheelchairs, etc are provided
• Assistive devices like computer-based communication machines, special shoes, and crutches are provided to improve the quality of life

Surgeries that are performed for this disorder are:

• Orthopedic surgeries are performed on bones and joints to improve posture and gait
• Surgeries to lengthen the muscles and tendons are performed to correct deformities
• Cutting nerve fibers in a few cases, nerve fibers are dissected to relax the muscles and reduce pain

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Though CP cannot be prevented, some measures can be taken to lessen the risk of developing CP. They include:

• Regular prenatal checkups
• Maintaining a healthy diet during pregnancy
• Avoiding smoking, alcohol, or recreational drugs during pregnancy
• Up-to-date vaccinations such as rubella
• Taking appropriate care of the child and avoiding any head injury.

Complications

It can lead to the following complications:

• Delayed development
• Seizures
• Intellectual disability
• Communication problems
• Vision and hearing problems
• Difficulty with eating and swallowing
• Problems with sensation
• Learning disabilities
• Gait difficulties
• Osteoporosis
• Malnutrition
• Sleep disorders
• Mental health disorders like depression and anxiety
• Gastrointestinal disorders like vomiting, constipation, etc.

Prognosis

The overall prognosis of CP is poor.

When to contact the doctor? / How to identify the complications?

A medical consultation is advisable if any movement disorders or developmental delays in children are observed.

Indications for hospitalization if required

Hospitalization will be required for CP when there are serious episodes of convulsions or when surgical procedures need to be done to correct deformities.

Suggested clinical specialists/ Departments to consult for this condition

• Pediatrics
• Neurology
• Psychiatry