About cerebral palsy

What is cerebral palsy?

Cerebral palsy facts

  • Cerebral palsy (CP) is an abnormality of motor function, the ability to move and control movements.
  • Cerebral palsy is acquired at an early age, usually less than a year of age.
  • Cerebral palsy is due to a brain abnormality that does not progress in severity.
  • The causes of cerebral palsy include prematurity, genetic disorders, strokes, and infection of the brain.
  • Taking certain precautions during the pregnancy might decrease the risk of cerebral palsy.
  • Asphyxia, the lack of oxygen to the brain, at birth is not as common a cause of cerebral palsy as had been thought.
  • There are different types of cerebral palsy based on symptoms -- spastic, hypotonic, choreoathetoid, and mixed types.
  • The best approach for diagnosis, treatment, and management is through and interdisciplinary team.
  • Cerebral palsy may be associated with many other medical conditions, including mental retardation or seizures. Many of these conditions can be treated with improved quality of life.
  • Many children with cerebral palsy have a normal intellect and have no seizures.
  • Treatment of cerebral palsy is for the symptoms only; there are few treatments for the underlying causes.
  • There are many alternative medicines promoted for the treatment of cerebral palsy that have never been proven to be helpful. Families and advocates of persons with cerebral palsy should be aware of the lack of scientific basis for these treatments.

What is cerebral palsy?

Cerebral palsy (CP) is an abnormality of motor function (as opposed to mental function) and postural tone that is acquired at an early age, even before birth. Signs and symptoms of cerebral palsy usually show in the first year of life.

This abnormality in the motor system is the result of brain lesions that are nonprogressive. The motor system of the body provides the ability to move and control movements. A brain lesion is any abnormality of brain structure or function. "Nonprogressive" means that the lesion does not produce ongoing degeneration of the brain. It is also implies that the brain lesion is the result of a one-time brain injury, that will not occur again. Whatever the brain damage that occurred at the time of the injury is the extent of damage for the rest of the child's life.

Cerebral palsy affects approximately one to three out of every thousand children born. However, it is much higher in infants born with very low weight and in premature infants.

Interestingly, new treatment methods that resulted in an increased survival rate of low-birth weight and premature infants actually resulted in an overall increase in the number of children with cerebral palsy. The new technologies, however, did not change the rate of cerebral palsy in children born full term and with normal weight.



What are the symptoms for cerebral palsy?

Signs and symptoms can vary greatly. Movement and coordination problems associated with cerebral palsy may include:

  • Variations in muscle tone, such as being either too stiff or too floppy
  • Stiff muscles and exaggerated reflexes (spasticity)
  • Stiff muscles with normal reflexes (rigidity)
  • Lack of muscle coordination (ataxia)
  • Tremors or involuntary movements
  • Slow, writhing movements (athetosis)
  • Delays in reaching motor skills milestones, such as pushing up on arms, sitting up alone or crawling
  • Favoring one side of the body, such as reaching with only one hand or dragging a leg while crawling
  • Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
  • Excessive drooling or problems with swallowing
  • Difficulty with sucking or eating
  • Delays in speech development or difficulty speaking
  • Difficulty with precise motions, such as picking up a crayon or spoon
  • Seizures

The disability associated with cerebral palsy may be limited primarily to one limb or one side of the body, or it may affect the whole body. The brain disorder causing cerebral palsy doesn't change with time, so the symptoms usually don't worsen with age. However, muscle shortening and muscle Rigidity may worsen if not treated aggressively.

Brain abnormalities associated with cerebral palsy also may contribute to other neurological problems. People with cerebral palsy may also have:

  • Difficulty with vision and hearing
  • Intellectual disabilities
  • Seizures
  • Abnormal touch or Pain perceptions
  • Oral diseases
  • Mental health (psychiatric) conditions
  • Urinary incontinence

When to see a doctor

It's important to get a prompt diagnosis for any movement disorder or possible delays in your child's development. See your child's doctor if you have any questions or concerns about episodes of loss of awareness of surroundings or of abnormal bodily movements (also known as seizures), abnormal muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.



What are the causes for cerebral palsy?

Cerebral palsy is caused by an abnormality or disruption in brain development, usually before a child is born. In many cases, the exact trigger isn't known. Factors that may lead to problems with brain development include:

  • Mutations in genes that lead to abnormal brain development
  • Maternal infections that affect the developing fetus
  • Fetal stroke, a disruption of blood supply to the developing brain
  • Infant infections that cause inflammation in or around the brain
  • Traumatic head injury to an infant from a motor vehicle accident or fall
  • Lack of oxygen to the brain (asphyxia) related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought



What are the treatments for cerebral palsy?

Children and adults with cerebral palsy may require lifelong care with a medical care team. Besides a pediatrician or physical medicine and rehabilitation specialist (physiatrist) and possibly a pediatric neurologist to oversee your child's medical care, the team might include a variety of therapists and mental health specialists. These experts give special attention to needs and issues that are more common in people with cerebral palsy and can work together with your primary care provider. Together you can develop a treatment plan.

There is no cure for cerebral palsy. However, there are many treatments options that may help improve your child's daily functioning. Selecting care will depend on his or her specific symptoms and needs, and needs may change over time. Early intervention can improve outcomes.

Treatment options can include medications, therapies, surgical procedures and other treatments as needed.

Medications

Medications that can lessen muscle tightness might be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

  • Muscle or nerve injections. To treat tightening of a specific muscle, your doctor might recommend injections of onabotulinumtoxinA (Botox), or another agent. The injections will need to be repeated about every three months.

    Side effects can include pain at the injection site and mild flu-like symptoms. Other more-serious side effects include difficulty breathing and swallowing.

  • Oral muscle relaxants. Drugs such as baclofen, tizanidine (Zanaflex), diazepam (Valium) or dantrolene (Dantrium) are often used to relax muscles.

    In some cases, baclofen is pumped into the spinal cord with a tube (intrathecal baclofen). The pump is surgically implanted under the skin of the abdomen.

  • Medications to reduce drooling. One option is Botox injections into the salivary glands.

Talk to your doctor about benefits and risks and possible side effects of recommended medication options.

Therapies

A variety of therapies play an important role in treating cerebral palsy:

  • Physical therapy. Muscle training and exercises can help your child's strength, flexibility, balance, motor development and mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child. Your therapist can provide guidance on how you can continue muscle training and exercise at home between therapy visits.

    For the first 1 to 2 years after birth, both physical and occupational therapists work on issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

    Braces, splints or other supportive devices might be recommended for your child to help with function, such as improved walking, and stretching stiff muscles.

  • Occupational therapy. Occupational therapists work to help your child gain independence in daily activities and routines at home and school and in the community. Adaptive equipment recommended for your child can include walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
  • Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language. They can also teach the use of communication devices, such as a computer and voice 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, such as therapeutic horseback riding or skiing. This type of therapy can help improve your child's motor skills, speech and emotional well-being. Both adults and children benefit from regular physical activity and exercise for general health and fitness.

Surgical procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

  • Orthopedic surgery. Children with severe contractures or deformities might need surgery on bones or joints to place their arms, spine, hips or legs in their correct positions. Surgical procedures can also lengthen muscles and lengthen or reposition tendons that are shortened by contractures. These corrections can lessen pain and improve mobility. The procedures can also make it easier to use a walker, braces or crutches.
  • Cutting nerve fibers (selective dorsal rhizotomy). In some severe cases, when other treatments haven't helped, surgeons might cut the nerves serving specific spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle in the legs and reduces pain, but can cause numbness.

Other treatments

As needed, medications and other treatments may be recommended for seizures, pain, osteoporosis, mental health conditions, and problems with sleep, oral health, feeding and nutrition, bladder incontinence, vision, or hearing.

Adults with cerebral palsy

As your child with cerebral palsy becomes an adult, his or her health care needs can change. In addition to general health screenings recommended for all adults, ongoing health care includes evaluation and treatment for conditions that are more common in adults with cerebral palsy. These can include:

  • Vision and hearing problems
  • Maintenance of muscle tone
  • Seizure management
  • Problems with pain and fatigue
  • Dental issues
  • Orthopedic problems, such as contractures, arthritis and osteoporosis
  • Heart and lung disease
  • Mental health issues, such as depression



What are the risk factors for cerebral palsy?

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or health problems during pregnancy can significantly increase cerebral palsy risk to the baby. Infections of particular concern include:

  • German measles (rubella). Rubella is a viral infection that can cause serious birth defects. It can be prevented with a vaccine.
  • Chickenpox (varicella). Chickenpox is a contagious viral infection that causes itching and rashes, and it can cause pregnancy complications. It too can be prevented with a vaccine.
  • Cytomegalovirus. Cytomegalovirus is a common virus that causes flu-like symptoms and may lead to birth defects if a mother experiences her first active infection during pregnancy.
  • Herpes. Herpes infection can be passed from mother to child during pregnancy, affecting the womb and placenta. Inflammation triggered by infection may then damage the unborn baby's developing nervous system.
  • Toxoplasmosis. Toxoplasmosis is an infection caused by a parasite found in contaminated food, soil and the feces of infected cats.
  • Syphilis. Syphilis is a sexually transmitted bacterial infection.
  • Exposure to toxins. Exposure to toxins, such as methyl mercury, can increase the risk of birth defects.
  • Zika virus infection. Infants for whom maternal Zika infection causes microcephaly can develop cerebral palsy.
  • Other conditions. Other conditions may increase the risk of cerebral palsy, such as thyroid problems, intellectual disabilities or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

  • Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
  • Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
  • Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.

Other factors of pregnancy and birth

While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:

  • Breech births. Babies with cerebral palsy are more likely to be in a feet-first position (breech presentation) at the beginning of labor rather than headfirst.
  • Complicated labor and delivery. Babies who exhibit vascular or respiratory problems during labor and delivery may have existing brain damage or abnormalities.
  • Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
  • Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. If one or more of the babies die, the chance that the survivors may have cerebral palsy increases.
  • Premature birth. A normal pregnancy lasts 40 weeks. Babies born fewer than 37 weeks into the pregnancy are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
  • Rh blood type incompatibility between mother and child. If a mother's Rh blood type doesn't match her baby's, her immune system may not tolerate the developing baby's blood type and her body may begin to produce antibodies to attack and kill her baby's blood cells, which can cause brain damage.



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