What is Cerebral Palsy?
Cerebral palsy is a medical term used to describe a group of neurological disorders that manifest in infancy or early childhood and permanently affect muscle coordination and body movement. “Cerebral” refers to something related to the brain, whereas “palsy” refers to problems or weakness with using the muscles.
Cerebral palsy hampers the body's ability to move in a purposeful and coordinated way. It can also seriously affect other bodily functions that involve the muscles and motor skills, such as eating, breathing, talking, as well as bowel and bladder control. In many cases, sensation, hearing, and vision are also affected. Cerebral palsy is the most common form of movement and motor disability in childhood.
Types of Cerebral Palsy
Cerebral palsy is categorized into different types based on the parts of the brain it affects. Each type causes particular movement disorders, as follows:
- Spastic cerebral palsy: This is the most common type of cerebral palsy and accounts for approximately 80 percent of all cases. This type causes exaggerated reflexes and stiff muscles, making walking difficult along with other walking abnormalities. Paralysis and muscle weakness may also be manifested.
- Dyskinetic cerebral palsy: This is the second-most common type of cerebral palsy in which people have difficulty controlling their body movements. It causes abnormal and involuntary movements in the hands, legs, and arms. Sometimes the tongue and face are also affected.
- Hypotonic cerebral palsy: This type causes symptoms of overly relaxed muscles and impaired muscle tone, in which the legs and arms move extremely freely and look floppy, similar to a rag doll.
- Mixed cerebral palsy: People with this type of cerebral palsy manifest a combination of symptoms from different types of cerebral palsy. In most cases, people exhibit a mix of spastic and dyskinetic cerebral palsy symptoms.
- Ataxic cerebral palsy: This is the least common type of cerebral palsy and is characterized by voluntary muscle movements that appear jerky, clumsy, or disorganized. People with this type usually have difficulty with balance and coordination.
Causes of Cerebral Palsy
Cerebral palsy is most often caused by abnormal brain development or damage to the brain during or before a child’s birth, or during the first three to five years of a child's life. In most cases, the precise cause of cerebral palsy is not known. Some potential causes include:
- Gene mutations, resulting in abnormal brain development
- Brain infections, such as meningitis and encephalitis
- Maternal infections, such as herpes simplex and German measles
- Severe jaundice as a baby
- Damage to the head due to a fall, motor vehicle accident, or trauma
- Intracranial hemorrhage or bleeding in the brain
- Lack of oxygen to the brain during labor and delivery
Risk Factors for Cerebral Palsy
Some risk factors that can put a baby at increased risk of developing cerebral palsy include:
- Low birth weight
- Premature birth
- Infantile seizures
- Maternal health
- Breech delivery
- Multiple births during one pregnancy
- Malnourishment at the time of pregnancy
- Sexually transmitted infections
- Exposure to illegal drugs, alcohol, or toxic substance during delivery
- Low Apgar score (a numbered rating that indicates a baby’s health)
- Complicated labor and delivery
Signs and Symptoms of Cerebral Palsy
Some common signs and symptoms of cerebral palsy include:
- Increased drooling or difficulty with swallowing
- Difficulty with eating or sucking
- Difficulty speaking or delays in speech development
- Learning difficulties
- Problem with fine motor skills, such as buttoning clothes
- Trouble with walking
- Tremors or involuntary movements
- Ataxia or impaired muscle coordination and balance
- Spasticity or stiff muscles and exaggerated reflexes
- Variations in muscle tone, such as being too stiff or too floppy
- Delays in attaining motor skill milestones, such as sitting up alone, crawling, or rolling over
Diagnosis of Cerebral Palsy
If your family physician or pediatrician thinks your child may have cerebral palsy, they will evaluate your child's signs and symptoms, review their medical history, assess their growth and development, and perform a physical examination that includes a detailed neurological exam. Additional testing may also be ordered to confirm the diagnosis and rule out other potential causes. These tests may include:
- A cranial ultrasound, an inexpensive and relatively quick method of diagnostic testing that uses high-frequency sound waves to produce basic images of the brain.
- A CT scan uses x-rays to produce clear and cross-sectional images of the brain that can help reveal any damage to the brain.
- An MRI scan uses a magnetic field and radio waves to produce anatomical images of the brain’s tissues and structures and offers finer levels of details than CT.
- An electroencephalogram (EEG) uses a series of electrodes to evaluate the electrical activity in the brain that may help indicate signs of epilepsy or seizures.
- Urine or blood tests are obtained to screen for metabolic or genetic problems associated with cerebral palsy.
Treatment for Cerebral Palsy
There is no cure for cerebral palsy, but the condition can be managed and treated effectively with early intervention. The main objective of the treatment is to prevent complications and improve limitations. The different treatment methods employed may include:
Muscle relaxants and oral anticonvulsants are most often used as first-line treatments to improve functional capabilities, ameliorate pain, and manage complications associated with spasticity or other symptoms of cerebral palsy. These medications include:
- Dantrolene (Dantrium)
- Tizanidine (Zanaflex)
- Diazepam (Valium)
Your physician may also recommend local injections of Botox or intrathecal baclofen therapy, in which the drug is administered via an implantable pump.
Assistive aids employed in the management of cerebral palsy include:
- Walking aids
- Body braces
- Hearing aids
Various therapies play a key role in the treatment of cerebral palsy, including:
- Occupational therapy: Occupational therapists work with your child to help gain independence in activities of daily living in the school, home, and community.
- Speech and language therapy: Speech-language pathologists work to improve your child's capacity to talk clearly or using sign language to communicate. They also assist your child with the use of communication devices, such as a voice synthesizer or computer, if there are communication barriers.
- Physical therapy: Physical therapists help your child with exercises and muscle training to improve their flexibility, balance, mobility, motor development, and strength.
- Recreational therapy: Competitive sports and adaptive recreational activities, such as therapeutic skiing and horseback riding can help improve your child's speech, emotional well-being, and motor skills.
Orthopedic surgery may be used to release muscle tightness or correct bony abnormalities caused by spasticity. It is also used to elongate muscles and tendons that have been shortened as a result of contractures. This surgery helps to improve mobility and relieve pain.
A selective dorsal rhizotomy (SDR) procedure may be advised as a last option to reduce spasticity or chronic pain. The procedure involves cutting nerves close to the base of the vertebral column, which serves the spastic muscles. This releases the muscles and alleviates pain.