Cerebral Palsy: definition causes symptoms and treatment

Definition of Cerebral Palsy

Cerebral palsy (CP) is the name of a group of disorders of the central nervous system that affect a person's capability to control body movement and coordination. These disorders usually appear in infancy or early childhood. They're not contagious and aren't progressive; that is, they do not get worse over time even though the disabilities are permanent.

Description

CP refers to various injuries to the brain that can happen during pregnancy or at any point during a child's first three years of life. The severity of symptoms varies considerably; some kids are only mildly affected while others are almost completely disabled.

Although problems with movement and coordination are the defining characteristics of cerebral palsy, 30-50 percent of patients diagnosed with CP are also mentally retarded, and 15-60 percent have epilepsy. Other patients have problems with vision and hearing. Doctors distinguish four fundamental kinds of cerebral palsy according to the nature of the movement disorder involved.

Spastic: The most typical type of CP, spastic cerebral palsy is characterized by stiffness of the muscles. These kids may also have scoliosis (an abnormal curvature of the spine) and possibly seizures. About 81 percent of kids diagnosed with CP have the spastic form. It might affect only one side of the body, affect both legs, or affect all four limbs.
Athetoid (also called dyskinetic): The child's movements have a twisting, jerky, or writhing high quality. Kids with athetoid CP may drool or make strange faces if the facial muscles are affected by the disorder. About 20 percent of kids with CP have the athetoid type.
Ataxic: The child with ataxic CP has difficulty walking because of poor balance, poor depth perception, and loss of coordination. This is the least common type of CP.
Mixed: The child has a mixture of symptoms that do not correspond neatly to any of the 3 previous kinds.

Demographics

According to the Centers for Illness Control and Prevention (CDC), about twenty-three kids in every 10,000 in the United States have cerebral palsy. Each year about 10,000 kids are born in the United States with symptoms of CP. The United Cerebral Palsy Foundation estimates that nearly 800,000 kids and adults in the United States are living with one or more of the symptoms of the disorder. Cerebral palsy affects children of all races and ethnic groups; nevertheless, boys appear to be at slightly higher risk than girls. You will find about 135 boys with cerebral palsy for every 100 girls with the disorder. Since the 1960s, doctors have identified a number of risk factors for cerebral palsy:

Premature birth
Extremely low birth weight
Complicated and lengthy childbirth
Infection in the mother during pregnancy, most frequently genital herpes, rubella, or toxoplasmosis
Head injury
Several births (twins or triplets)
High blood pressure, seizures, mental retardation, or thyroid disorders in the mother
Exposure to certain toxic chemicals
Jaundice in the baby

Cerebral Palsy: Causes and Symptoms

At one time it was thought that cerebral palsy was caused by difficulties in childbirth that cut off the flow of oxygen to the baby's brain lengthy sufficient to cause brain damage. However, birth complications are now thought to account for only 5-10 percent of instances of CP. It now appears that most instances of CP begin before the baby's birth and are the end result of a number of various factors ranging from genetic mutations to infections and trauma. Doctors have identified four various kinds of brain injury that may give rise to CP:

Damage to the white matter of the brain. This is the part of the brain that transmits nerve signals to other parts of the brain and to the rest of the body. It can be damaged before birth by infections in the mother.
Abnormal development of the various structures in the brain. This type of brain damage is sometimes caused by genetic mutations that affect the development of the central nervous system. It can also happen before birth as a result of fever, infection, or trauma to the mother.
Bleeding in the brain. A baby can develop bleeding inside the brain or even a stroke before birth if the mother has high blood pressure.
Damage caused by loss of oxygen to brain tissue. The parts of the baby's brain that control movement and coordination can be damaged by a long period of oxygen deprivation. This can happen if the mother has low blood pressure or if problems with blood flow to the baby occur. Cerebral palsy isn't usually obvious at the time of a child's birth. In many cases, the parents first notice developmental delays; that is, the child does not sit, stand, or walk at the regular times for these milestones. In other instances, the child's muscle tone isn't regular; his or her limbs might seem either loose and floppy or stiff and rigid. A common pattern is an early period of low muscle tone and floppy limbs followed by a phase of muscular rigidity and tightness.

Other early symptoms of CP might include scissors movements of the legs or other abnormal movements, or reflexes that persist long after they disappear in normally developing children. Other symptoms of CP may include:

Difficulty nursing or feeding.
Seizures.
Irregular breathing patterns.
Mental retardation.
Problems with speech, sight, or hearing.
Peg-shaped instead of normally shaped teeth, and a high rate of dental cavities.
Limited range of motion in the joints.
Difficulties with bowel and bladder control.
Deformities of the arms or legs. Kids who are affected by CP on only one side of the body frequently have smaller or shorter limbs on the affected side.

Diagnosis of Cerebral Palsy

There is no single laboratory or imaging test that could be used to diagnose cerebral palsy. The diagnosis is based on a thorough physical examination of the child and a detailed history of the mother's pregnancy and childbirth. The baby's parents will probably be asked for a complete medical history of both the mother's and father's families; the mother's medical problems or infections (if any) before and during pregnancy; and a detailed account of the pregnancy, labor, and delivery.

The parents will also be asked to describe the baby's early mental and physical development. Even though CP is frequently present at birth, it is difficult to evaluate during the first six to nine months of the child's life. Most children with cerebral palsy are diagnosed between one and two years of age. The doctor might order numerous tests and imaging studies in order to rule out other possible causes of the baby's symptoms.

Blood and urine tests. These may be done to rule out disorders caused by hormone imbalances or metabolic disturbances.
Genetic testing. This type of testing may be done to rule out genetic disorders that are associated with delayed development.
Imaging studies. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are the techniques most commonly used to evaluate a child with CP.
Electroencephalogram (EEG). An EEG is a record of the child's brain waves made by a machine attached to electrodes placed at numerous locations on the child's skull. It may be used to evaluate seizures in kids with CP.

Cerebral Palsy Treatment

There's no cure for cerebral palsy. Treatments for kids with CP are individualized because the symptoms vary so much from one child to an additional; they also frequently change over time as a child grows older. The various types of treatments and therapies that a child with cerebral palsy may need include:

Rehabilitation and physical therapy. Kids with the spastic form of CP might be treated with splints, braces, casts, walkers, and other devices as well as exercise therapy in order to enhance the range of motion in their joints.
Occupational therapy. This form of treatment helps the child to learn abilities that he or she will need for self-care, such as feeding, dressing, and grooming.
Speech and language therapy. This type of therapy is needed for children with hearing problems related to CP as well as those whose throat and facial muscles are affected by the disorder.
Medications. These are frequently prescribed to treat seizures, digestive disorders, and muscle cramps or spasms.
Nutritional therapy. Kids with CP frequently have difficulties with swallowing food or eating balanced diets. A dietitian may be consulted for guidance about special diets or tube feeding.
Vision and hearing aids.
Surgery. Some children with cerebral palsy develop severe deformities of the spine or contractures of the muscles that require surgical correction.
Unique education programs. Kids with CP range from those with regular intelligence who can frequently participate in mainstream school programs to those with severe mental retardation. In many instances personal computers could be utilized by kids with CP to enhance their communication abilities as well as complete homework assignments and maintain up with schoolwork.

Prognosis

The prognosis for individuals with cerebral palsy depends in component on the severity of their symptoms and also the parts of the body that are affected by the brain damage. Those with mild symptoms have a normal life expectancy; nevertheless, those with severe problems have a shortened life span. It's estimated that about 25 percent of children with CP have very couple of limitations on their activities; they can complete school and eventually live independently. An additional 50 percent can discover to walk, feed, and clothe themselves, and take care of their body functions but cannot live without some form of part-time help from other people. Only 25 percent are so severely disabled that they require extensive care and can't discover to walk.

Prevention

Many cases of cerebral palsy can't be prevented. A pregnant woman can, however, lower her risk of having a child with the disorder by quitting smoking, drinking alcohol, and using drugs during pregnancy all of these increase the risk of giving birth prematurely. She ought to also be tested for immunity to rubella before becoming pregnant and get immunized against the disease if she isn't already immune.

The Future

The number of people in the United States affected by cerebral palsy has increased since the 1960s. This increase might be due to the reality that larger numbers of premature infants are surviving. Many of these infants will have nervous system defects or suffer brain damage that causes the characteristic symptoms of cerebral palsy. Research is concentrated on ways to detect damage to a baby's brain before birth. Researchers hope that information supplied by new approaches to early diagnosis may eventually lead to new treatments for the disorder.

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