CEREBRAL PALSY
Last Updated : 1/3/2011
Ira Shah
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What is cerebral palsy?
Cerebral palsy (CP) is a general term used to describe a group of disorders that impair muscle control due to damage to the developing brain.

What are the symptoms of CP?
CP may present from extreme clumsiness to extensive spasticity. Parents may first notice that their child is not developing motor milestones normally i.e. the baby may have delayed rolling over or the baby may be late to sit, crawl or walk. The child may also show an unusual posture or favor one side of their body.

Though spastic children are universally identified as children with CP, there are actually 4 types of CP:

Spastic CP: It is the most common type in which the muscles are stiff & weak (due to uncontrolled contraction of the muscles). The stiffness may occur in both legs (diplegia), in the leg & arm on the same side (hemiplegia), or in all four limbs (quadriplegia). These children usually show toe walking & typical crossed (scissoring) gait.

Dyskinetic CP (Athetotic CP): Patients with this type of CP have bizarre twisting motions or unusual posturing.

Mixed CP: It is a combination of the above two types.

Hypotonic CP: These children usually present with low muscle tone & increased floppiness. These children eventually develop spasticity or athetosis.

What are the causes of CP?
CP is caused by damage to the developing brain. It usually develops by 2-3 years of age. Though most of the causes remain unknown; infections during pregnancy in the mother, severe jaundice in the infant, birth injuries & stress to the fetus in the womb are some of the known factors. Babies born prematurely are at a particular risk. Any severe illness damaging the brain in the 1st year of life can result in CP.

Is CP progressive?
Though CP is due to damage to the developing brain, it is non-progressive. However, the symptoms due to brain damage often change with time, sometimes getting better & something worse.

My child has cerebral palsy. But he also has epilepsy. Why is it so?
Many children with cerebral palsy may have accompanying seizure disorders & some level of mental handicap. They may also have vision, speech, hearing & language problems.

What are the risk factors for having a CP child?
The risk factors for having a CP child are:
- Breech deliveries (babies delivered with feet coming out first).
- Birth defects such as spinal bone defects or abnormally small jaw bone
- Low birth weight and premature babies
- Twin deliveries
- Abnormally small head (microcephaly)
- Convulsions shortly after birth

How do I know whether my child has CP?
There is no definite test to detect CP. The diagnosis is made by reviewing the child's history and on examination. It may be difficult to diagnose due to changing symptoms over a period of time. In fact, some children with mild CP may be diagnosed at 3 to 4 years of the age. Certain blood tests and brain scans may be done to exclude other conditions.

What is the treatment for CP?
CP is a lifelong condition and cannot be cured. However, treatment may improve the quality of life by increasing independent mobility. A child with CP requires a multi-team approach - from a pediatrician, an orthopedic and physical and speech therapists. The treatment not only depends on the patient's symptoms but also his age.

Patients with severe muscle contractures may require surgery to lengthen the muscle or some spinal surgery to reduce spasticity in the legs. Medication may also be given to decrease the muscle spasticity. Now, botulinum toxin injections are available which when used with physical therapy, help in lengthening a muscle. Baclofen pumps are also available to control spastically for a longer period of time.

Physical therapy, which consists of special exercises may increase the movement & strength of the muscles. Occupational therapy may be required to develop skills to carry out day to day activities at home.

A variety of mechanical aids like braces, speech synthesizer may be required. For children with speech problems, speech therapy is required. In addition, medications may be required to control the seizures. Some children with learning disabilities & mental retardation may require special learning programs.

How can CP be prevented?
The pregnant mother should get regular antenatal care. Blood tests of mothers should be checked to detect Rh factor. Parents should seek treatment for a baby who is jaundiced at birth or has prolonged jaundice within a few days after birth.



Contributor Information and Disclosures

Ira Shah
Consultant Pediatrician, B J Wadia Hospital for Children, Mumbai, India


First Created : 1/3/2001

References

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