Cerebral palsy

Cerebral palsy is a term used to describe various movement disorders caused by damage to the brain during pregnancy, birth or in infancy. Sufferers may also have cognitive impairment, delayed mental development and problems with movement and co-ordination that can have serious negative consequences for their quality of life and independence. Learn more about the condition, its diagnosis and the different treatment options available.

 

Definition

Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to non-progressive disturbances that might have occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behavior, by epilepsy and by secondary musculoskeletal problems.”1

The term cerebral palsy is used around the world to describe the symptoms secondary to non-progressive brain injury.

 

Symptoms and impact on health

The symptoms of cerebral palsy are different in each patient and can be a combination of motor, sensory and intellectual impairment. Generally observed from during the first three years of a childs life, the symptoms are:

  • spasticity (excessively stiff muscles caused by involuntary hypertonia). When spasticity affects the legs, it causes a crouched position, a scissors-like gait with the feet extended and toes pointed downward, and poor balance. Spasticity can often be painful;
  • very awkward positioning of the legs (W-sitting position), and favoring one side of the body;
  • hypotonia (floppy muscles with difficulty holding the head up and sitting);
  • reduced manual dexterity (problems eating, dressing, writing and holding objects);
  • problems swallowing and speaking (dyspraxia);
  • impaired hearing;
  • a degree of intellectual disability in some patients.
  • Repeated seizures or fits.
  • Skeletal abnormalities, particularly hip dislocation or an abnormally curved spine.

Equinus or spastic equinovarus is a foot deformity that most commonly occurs secondary to cerebral palsy, but may also be a congenital deformity. The pathology causes gait abnormality in patients and is a very real handicap when it comes to mobility. Equinus (from the Latin “equus” for horse) is a downward flexion deformity of the foot. With this condition, toe walking replaces the normal walking pattern.

There are several possible causes:

  • uncontrolled contraction (spasticity) of the calf muscles following brain injury, which can cause insufficient dorsiflexion (the upward bending motion of the foot towards the tibia) of the foot and toes;
  • a deformity of one foot, or often both feet, in the uterus. It is the cause of a congenital dysplasia (a development anomaly leading to a malformation or deformation) of all the tissue under the knee (bone, ligaments, nerves and blood vessels).

The severity of equinus deformation varies. It is termed ‘dynamic’ when it is still possible to stretch the calf muscles. When fibrosis (the formation of excess fiber after significant amount of tissue is destroyed) prevents stretching the calf muscle, the condition is known as static equinus deformity.
The abnormal gait (on the front of the foot) caused by equinus affects the patient’s mobility and balance and puts excess pressure on the ankle. The resulting claudication – or limp – also has a negative effect on patients’ mental well-being and social life.

 

Etiology of cerebral palsy

The most common causes are ischemic anoxia (reduced or no supply of blood to some parts of the brain, depriving the brain of oxygen) or cerebral hemorrhage, but many other factors may be involved that occur before, during and after birth and in infancy – generally up to the age of two:

  • Before birth, the brain cells of the fetus can be destroyed by fetal stroke, a central nervous system malformation, placenta or umbilical cord complications. A mother’s toxic reaction to some medicines or drugs and maternal infections such as German measles, toxoplasmosis or cytomegalovirus can also cause irreversible fetal brain damage. The damage in prenatal cerebral palsy usually happens during early pregnancy and the cause is often unknown. Other factors associated with increased risk of cerebral palsy include low birth weight and premature birth.
  • Birth factors that increase risk for normal term babies include complicated delivery or umbilical cord problems that cut the supply of blood to the brain.
  • After birth, convulsions, accident, cardiac arrest or infection (such as meningitis or encephalitis) are factors associated with cerebral palsy.

 

Incidence

Cerebral palsy affects an average of 2 to 2.5 live births per 1,000 in industrialized countries, and 1.5 to 5.6 live births per 1,000 in developing countries2. Up to 80% of children with cerebral palsy present with spasticity.

2 to 2.5

cases per 1,000 live births in industrialized countries

Motor, sensory and intellectual impairment

3 to 18 months

the average age of diagnosis

Sources :

http://www.nhs.uk/conditions/Cerebral-palsy/Pages/Introduction.aspx Last accessed 18/07/2017
http://emedicine.medscape.com/article/1179555-overview
http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Diagnosis.aspx Last accessed 18/07/2017
http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx Last accessed 18/07/2017
 
1 Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. The Definition and Classification of Cerebral Palsy. Dev Med Child Neurol 2007; 49 : 1-44, doi: 10.1111/j.1469-8749.2007.00001.x
2 http://emedicine.medscape.com/article/1179555-clinical
http://emedicine.medscape.com/article/1179555-overview

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Date of preparation January 2018 / ALL-UK-000455