Definition and Overview

Cerebral palsy (CP) is a neurological disorder caused by damage or abnormal development of the part of the brain that controls movement, posture, and balance. Often, it develops during pregnancy, but it can also occur during birth or shortly after. Although it is neither progressive nor life-threatening, it is incurable, permanent, and potentially debilitating.

CP is the most common motor disability in childhood, affecting about 4 in every 1,000 live births. It can be mild, moderate, or severe. In mild cases, patients experience slight movement tremors but are able to live long and quality lives, requiring minimal assistance from people around them. Those suffering from moderate cerebral palsy, on the other hand, require medications, braces, and adaptive technology in order to accomplish their daily activities. In severe cases, patients are often completely paralysed, requiring the use of a wheelchair for the rest of their lives. They can also develop some complications, including seizures and intellectual, vision, or hearing impairment.

There are four main types of CP, namely:

1.) Spastic CP - The most common form of cerebral palsy that accounts for up to 75% of all cases. This type is characterised by exaggerated reflexes, joint stiffness, jerky movements, and muscle tightness or increased muscle tone. The condition makes everyday tasks, such as picking up small objects or walking, extremely challenging. Spastic CP is further classified into:

  • Spastic diplegia - The muscle stiffness is mainly in the legs

  • Spastic hemiplegia - Affects only one side of the body

  • Spastic quadriplegia - Affects all four limbs

2.) Dyskinetic cerebral palsy - Accounts for approximately 15% of all cases of cerebral palsy. This type is associated with fluctuating muscle tone, varying from too loose to too tight.

3.) Ataxic cerebral palsy - The rarest type of CP marked by abnormal movements of the legs, arms, hands, and trunk. Patients are often unable to balance and have difficulty with precise motions, which make simple tasks like using scissors and writing extremely challenging.

4.) Mixed cerebral palsy - In rare cases, patients present symptoms of at least two types of CP.

Causes of Condition

Cerebral palsy occurs either as a result of abnormal brain development or when the brain is injured or damaged before birth, during delivery or within the first few years of life. The damage can be caused by:

  • Birth trauma during labour and delivery

  • Certain infections during pregnancy, such as chickenpox and rubella.

  • Exposure to radiation

  • Foetal growth restriction due to placental insufficiency

  • Injury or infection to the baby’s brain, such as meningitis

  • Neonatal stroke - Contrary to popular beliefs, infants are also at risk of stroke. A neonatal stroke occurs when the baby’s brain becomes deprived of oxygen due to blockages in the blood vessels. The condition affects approximately 1 in every 4,000 babies.

  • Periventricular leukomalacia (PVL) - A type of brain injury characterised by damage to the periventricular white matter of the brain. It is believed that the condition occurs due to intrauterine infection or when the foetus has had an insufficient supply of blood or oxygen during pregnancy. Approximately 60-100% of infants with PVL are diagnosed with cerebral palsy.

  • Gene mutations that affect normal brain development

The risk of cerebral palsy can be increased by the following factors:

  • Lack of antenatal care

  • Low birth infants

  • Multiple births

  • Severe pre-eclampsia and eclampsia

  • Very young or elderly mothers

Key Symptoms

The symptoms of the disorder can vary depending on the type of CP the patient has. These symptoms include:

  • Delayed development, such as not walking by 12-18 months or not speaking in sentences by 24 months

  • Difficulty falling or staying asleep

  • Difficulty with precise motions

  • Excessive drooling

  • Eye problems, such as uncontrollable eye movements

  • Feeding or swallowing difficulties

  • Fluctuating muscle tone

  • Hearing loss

  • Inability to hold head while lying on the stomach (in babies)

  • Involuntary movements (tremors)

  • Lack of muscle coordination

  • Poor posture

  • Scoliosis

  • Seizures

  • Stiff muscles with either normal or exaggerated reflexes

  • Urinary incontinence

  • Walking on tip-toes

Who to See and Types of Treatments Available

Infants and children who have cerebral palsy are treated by paediatric neurologists, or doctors who specialise in the diagnosis, treatment, and management of disorders and conditions affecting the brain and the nervous system.

Cerebral palsy is diagnosed using the following tests and procedures:

  • Physical examination, review of medical history and symptoms, and assessment of patient’s movement and learning disabilities

  • Imaging tests, such as cranial ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scans - Used to obtain detailed images of the brain.

  • Electroencephalogram (EEG) - A test that measures and records the brain’s electrical activity.

  • Blood tests - Used to check chemistry, plasma, and chromosome levels.

There is no cure for cerebral palsy, but various therapies are widely available to help patients improve their functional abilities, manage complications, and treat symptoms, such as pain. Cerebral palsy patients are usually placed under the care of a multidisciplinary team of medical professionals headed by a paediatrician who oversees the patient’s treatment plan and long-term medical care. The team may consist of the following:

  • Occupational, physical, language, and developmental therapists - Physical, occupational, speech, and language therapies are popular forms of treatment for children with cerebral palsy. These therapies help children effectively manage their physical impairment and optimise mobility to foster self-care, functionality, and independence.

  • Orthopaedic surgeon - In some cases, patients require orthopaedic surgery for the treatment of musculoskeletal conditions associated with CP, such as dislocated hips and scoliosis.

  • Paediatric neurologist - A doctor that specialises in the treatment and management of children with conditions or disorders that affect the brain, spinal cord, nerves, and muscles.

  • Psychologist or psychiatrist - Mental health specialists can help patients, as well as their family members, better understand their disability.

  • Recreation therapists

  • Special education teachers

  • Diet experts - CP patients can benefit from eating a diet that is high in calcium, phosphorus, and vitamin D. Diet experts, such as nutritionists and dietitians, can work together to create a meal plan that will help keep the patient’s bones strong.

References:

  • Cerebral palsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm.

  • Van Eerden, Peter. “Summary of the Publication, ”Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology,“ by the ACOG Task Force on Neonatal Encephalopathy and Cerebral Palsy”.

  • Pakula AT, Van Naarden Braun K, Yeargin-Allsopp M. “Cerebral palsy: classification and epidemiology,” in Cerebral Palsy, Volume 20, Number 3. Edited by Linda J. Michaud, MD, PT. 2009, W.B. Saunders Company, Philadelphia, PA. p437.

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