What is cerebral palsy?
Cerebral palsy is a group of conditions that affect association and muscle tone or posture. It is caused by the destruction that occurs to the unripe brain as it develops, most often before birth.
People with cerebral palsy may have trouble swallowing and commonly have an imbalance of the eye muscles, in which the eyes do not focus on the same object. They may also have a reduced range of motion in various joints in their bodies due to muscle stiffness.
The effect of cerebral palsy on function varies greatly. Some affected people can walk; others need help. Some people show normal or near-normal intellect, but others have knowledgeable incapacities. There may also be epilepsy, blindness, or deafness.
Types of cerebral palsy
There are four types of cerebral palsy:
Spastic cerebral palsy: Spastic cerebral palsy accounts for 75 percent of all cases. It causes an increase in muscle tone, known as spasticity, and causes:
- Developmental milestones delayed to move
- Abnormal movements
- Inhibition of movement
- Stiff and spastic muscles
- Difficulties controlling muscle movement
- Difficulties moving from one position to another
Spastic quadriplegia affects the child’s upper and lower extremities and body, severely restricting mobility.
Spastic diplegia only affects the lower half of the body. Many of these children are still able to walk with some disabilities and may need assistive devices such as walkers.
Spastic hemiplegia affects only one side of the body, usually the arm more than the leg. Most children with hemiplegia can walk.
Dyskinetic cerebral palsy: Dyskinetic cerebral palsy is the other most common type of CP. Symptoms include:
- Dystonia, repetitive, and twisting movements
- Athetosis, twisting movements
- Unpredictable movements
- Poor posture
- Painful movements
- Difficulty swallowing or speaking
Ataxic cerebral palsy: Ataxic cerebral palsy is the least common. It causes poor balance, limited coordination, tremors, and unsteady movements that are difficult to control.
Mixed cerebral palsy: Mixed cerebral palsy causes symptoms that are characteristic of two or three of the other types. Spastic-dyskinetic cerebral palsy is the most common type of mixed cerebral palsy.
Causes of cerebral palsy
Brain damage is the cause of cerebral palsy, but many different things can trigger the damage. For this reason, the exact cause of cerebral palsy cannot always be determined. Possibilities include:
- Poor brain development in utero
- Maternal infections or medical conditions
- Interruption of blood flow to the developing brain
- Genetic conditions
- Ingestion of toxins or drugs during pregnancy
- A loss to the head or skull during delivery
- Complications related to preterm birth
Several factors are associated with an increased risk of cerebral palsy.
Certain infections or toxic exposures during pregnancy can significantly increase the risk of cerebral palsy for the baby. Infections of particular concern include:
- Cytomegalovirus: This common virus causes flu-like symptoms and can lead to birth defects if the mother has her first active infection during pregnancy.
- German measles (rubella): This viral disease can be prevented with a vaccine.
- Herpes: This can be passed from mother to child during pregnancy and affect the uterus and placenta. Inflammation caused by infection can damage the developing nervous system of the fetus.
- Syphilis: This is a sexually transmitted bacterial infection.
- Toxoplasmosis: This infection is caused by a parasite found in contaminated food, soil, and the feces of infected cats.
- Zika virus infection: Babies in whom maternal Zika infection makes their heads smaller than normal (microcephaly) can develop cerebral palsy.
- Other conditions: Other diseases that can raise the risk of cerebral palsy include thyroid problems, intellectual disabilities or seizures, and exposure to toxins, such as methylmercury.
Diseases of a newborn baby that can greatly increase the risk of cerebral palsy include:
- Bacterial meningitis: This bacterial infection causes inflammation in the membranes that surround the brain and spinal cord.
- Viral encephalitis: This viral infection also causes inflammation in the membranes that surround the brain and spinal cord.
- Severe or untreated jaundice: Jaundice appears as a yellowing of the skin. The condition occurs when certain by-products of “used” blood cells are not filtered from the bloodstream.
- Bleeding in the brain: This condition is commonly caused by a baby having a stroke in the womb.
Other factors of pregnancy and childbirth
While the potential contribution of each is limited, additional pregnancy or birth factors associated with an increased risk of cerebral palsy include:
- The breech presentation: Babies with cerebral palsy are more likely to be in this position on their feet first at the beginning of labor rather than on their heads.
- Low birth weight: Babies who weigh less than 5.5 pounds (2.5 kilograms) have a higher risk of developing cerebral palsy. This risk increases as birth weight decreases.
- Several babies: The risk of cerebral palsy increases with the number of babies who share a uterus. If one or more of the babies die, it increases the risk of cerebral palsy for survivors.
- Premature birth: Babies born less than 28 weeks pregnant are at higher risk for cerebral palsy. The earlier a baby is born, the greater the risk of cerebral palsy.
Symptoms of cerebral palsy
The signs and symptoms can vary greatly. Movement and coordination problems associated with cerebral palsy include:
- Variations in muscle tone, such as being too stiff or too flabby
- Stiff muscles and exaggerated reflexes (spasticity)
- Stiff muscles with normal reflexes (stiffness)
- Lack of balance and muscle coordination (ataxia)
- Tremors or involuntary movements
- Slow and twisting movements
- Delays in reaching milestones in motor skills, such as pushing arms up, sitting, or crawling
- Favoring one side of the body, such as reaching with one hand or dragging one leg while crawling
- Difficulty walking, such as toe walking, crouching, scissoring with crossed knees, wide gait, or asymmetric gait
- Excessive drooling or swallowing problems
- Difficulty sucking or eating
- Delays in speech development or difficulty speaking
- Learning difficulties
- Struggle with fine motor skills, such as buttoning clothes or picking up utensils
Cerebral palsy can affect the whole body or it can be confined mainly to one limb or one side of the body. The brain disorder that causes cerebral palsy does not change over time, so symptoms generally do not get worse with age.
However, as the child grows older, some symptoms may become more or less obvious. And muscle shortening and stiffness can get worse if not treated aggressively.
Diagnosis of cerebral palsy
The signs and symptoms of cerebral palsy can become more apparent over time, so a diagnosis may not be made until a few months after birth.
If your GP or pediatrician suspects that your child has cerebral palsy, he or she will assess your child’s signs and symptoms, monitor growth and development, review your child’s medical history, and perform a physical exam. Your doctor can refer you to a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist, pediatric physical medicine and rehabilitation specialist, or child development specialist).
Your doctor may also order a series of tests to make a diagnosis and rule out other possible causes.
Brain imaging skills can reveal areas of damage or abnormal development in the brain. These tests may include the following:
MRI: An MRI uses radio waves and a magnetic field to produce full 3D or cross-sectional images of your child’s brain. An MRI scan can often identify injuries or abnormalities in your child’s brain.
This test is painless, but it is noisy and can take up to an hour to complete. Your child will likely receive a sedative or light general anesthesia previously.
Cranial ultrasound: This can be done during childhood. Cranial ultrasound uses high-frequency sound waves to produce images of the brain. An ultrasound does not produce a detailed image, but it can be used because it is quick and inexpensive, and can provide a valuable preliminary evaluation of the brain.
Electroencephalogram (EEG): If your child is suspected of having seizures, an EEG can further evaluate the condition. Seizures can develop in a child with epilepsy. In an EEG test, a series of electrodes are placed on your child’s scalp.
The EEG records the electrical activity of your child’s brain. Ups and downs in normal brain wave patterns are joint in epilepsy.
Lab tests: Blood, urine, or skin tests can be used to detect genetic or metabolic problems.
Treatment for cerebral palsy
Children and adults with cerebral palsy require long-term care with a health care team. In addition to a pediatrician or physiatrist and possibly a pediatric neurologist to oversee your child’s medical care, the team may include a variety of mental health therapists and specialists.
Medications that can decrease muscle tension can be used to improve functional abilities, treat pain, and manage complications related to spasticity or other symptoms of cerebral palsy.
Side effects can contain pain at the injection site and mild flu-like symptoms. Other more serious side effects include trouble breathing and swallowing
Diazepam carries some risk of dependence, so its long-term use is not recommended. Side effects of these drugs include drowsiness, changes in blood pressure, and the risk of liver damage that requires monitoring.
In some cases, the baclofen is pumped into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.
In some cases, baclofen is pumped into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.
Your child may also be prescribed medications to reduce drooling, possibly Botox injections into the salivary glands. Therapies
Several therapies play an important role in the treatment of cerebral palsy:
Physical therapy: Muscle training and movements can help your child’s strength, flexibility, balance, motor growth, and mobility. You will also learn how to safely take care of your child’s daily needs at home, such as bathing and feeding.
For the first one to two years after birth, both physical and occupational therapists provide support on topics such as head and trunk control, rolling, and grasping. Later, both types of therapists participate in wheelchair evaluations.
Braces or splints may be recommended to help your child with function, such as walking better and stretching stiff muscles.
Occupational therapy: Occupational therapists work to help your child gain independence in daily activities and routines at home, school, and the community. The adaptive equipment recommended for your child may include walkers, quadruped canes, seating systems, or power wheelchairs.
Speech and language therapy: Speech-language pathologists can help improve your child’s ability to speak clearly or communicate using sign language. They can also teach the use of communication devices, such as a computer and speech synthesizer if communication is difficult.
Speech therapists can also address difficulties with eating and swallowing.
Recreational therapy: Some children benefit from regular or adaptive recreational or competitive sports activities, such as therapeutic horse riding or skiing. This kind of therapy can help improve your child’s motor skills, speech, and expressive well-being.
Surgery may be necessary to reduce muscle tension or correct bone abnormalities caused by spasticity. These treatments include:
Orthopedic surgery: Children with severe contractures or deformities may need bone or joint surgery to get their arms, hips, or legs in their correct positions.
Surgical procedures can also lengthen muscles and tendons that are shortened by contractures. These corrections can decrease pain and improve mobility. The procedures can also make it easier to use a walker, braces, or crutches.
Cutting of nerve fibers (selective dorsal rhizotomy): In some severe cases, when other treatments have not helped, surgeons may cut the nerves that serve the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can cause numbness.
Most cases of cerebral palsy cannot be prevented, but you can reduce the risks. If you are pregnant or planning to become pregnant, you can take these steps to stay healthy and minimize pregnancy complications:
- Make sure you are vaccinated. Getting vaccinated against diseases like rubella, preferably before you get pregnant, could prevent an infection that could cause fetal brain damage.
- Beware. The healthier you are entering a pregnancy, the less likely you are to develop an infection that results in cerebral palsy.
- Seek early and ongoing prenatal care. Regular visits to your doctor during your pregnancy a good way to reduce the risks to your health and that of your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight, and infections.
- Practice good child safety. Avoid head injuries by providing your child with a car seat, bicycle helmet, safety rails on beds, and proper supervision.
- Avoid alcohol, tobacco, and illegal drugs. These have been linked to the risk of cerebral palsy.
Muscle weakness, muscle spasticity, and coordination problems can contribute to several complications during childhood or adulthood, including:
- Contracture: The contracture is the shortening of muscle tissue due to severe muscle tension (spasticity). Contracture can inhibit bone growth, cause bones to bend, and lead to joint deformities, dislocation, or partial dislocation.
- Premature aging: Some form of premature aging will affect most people with cerebral palsy in their 40s due to the strain the condition places on their bodies.
- Malnutrition: Swallowing or feeding problems can make it difficult for a person with cerebral palsy, particularly a baby, to get enough nutrition. This can affect growth and weaken bones. Some children need a serving tube to get enough nutrition.
- Mental health conditions: People with cerebral palsy can have mental health problems, such as depression. Common isolation and the challenges of surviving with disabilities can contribute to depression.
- Heart and lung disease: People with cerebral palsy can develop heart and lung disease and respiratory disorders.
- Osteoarthritis: Pressure on the joints or abnormal joint alignment due to muscle spasticity can lead to the early onset of this painful degenerative bone disease.
- Osteopenia: Fractures due to low bone density (osteopenia) can be caused by several common factors, including lack of mobility, nutritional deficiencies, and the use of antiepileptic drugs.
Departments to consult for this condition
- Department of Neurology