Definition

     Cerebral palsy refers to a group of non-progressive disorders that affect the control of movements and posture.  These disorders are caused by brain damage before or during birth.  The lesion does not produce an ongoing degeneration of the brain, so the condition does not worsen.  The children can improve their functioning abilities with rehabilitation management

Causes

• Cerebral palsy is caused by injuries to the cerebrum (the largest part of the brain), which occur as the baby grows in the womb or near the time of birth.

• Initially cerebral palsy was thought to be related to trauma and strangulation during birth (birth asphyxia), which leads to lack of oxygen to the brain), but in a study of 45,000 births it was shown that birth asphyxia is an uncommon cause of cerebral palsy.

• In patients with cerebral palsy, parts of the brain areas receive lower levels of oxygen (hypoxia) at some point, but it is not known why this occurs.

• Premature infants have a slightly higher rate of cerebral palsy. Cerebral palsy may also occur during early infancy as a result of illnesses (encephalitis, meningitis, herpes simplex infections, and so on), head injury that results in subdural hematoma, blood vessel injuries, and many others conditions.

Symptoms

• Seizures

• Muscle contractions

• Difficulty sucking or feeding

• Irregular breathing

• Delayed development of motor skills, such as reaching, sitting, rolling, crawling, walking, and so on

• Motormental retardation

• Mental retardation

• Speech problems (dysarthria)

• Visual problems

• Hearing problems

• Spasticity

• Joint contractures that slowly get worse

• Limited range of motion

• Peg teeth

Treatment

• There is no specific cure for cerebral palsy, but proper management helps to prevent complications and maximize functional independence.

1. Physical therapy and occupational therapy enhances motor skills (such as sitting and walking) and functional skills required for daily living.  Physical therapy also improves muscle strength and prevents contractures (shortening of muscles that limits joint movement).

2. Braces, splints, casts or orthopedic surgery may prevent or release contractures, improving the function of the hands or legs.

3. Mechanical AIDS include walkers and wheelchairs

4. Management of spasticity -- oral drugs, botulinum injection directly into spastic muscles, or a surgery called selective dorsal rhizotomy.

5. Drugs for seizure control

6. Feeding tube placement for serious swallowing impairment

Screening and Diagnosis

• Early diagnosis is important for effective treatment and prevention of complications.  An examination indicates the delayed development of motor skills, abnormal muscle tone and persistent primitive reflexes that generally disappear by 6 to 12 months of age.  Some specialized tests help to diagnose cerebral palsy.

1. Brain imaging test (MRI, CT scan or Ultrasound)

2. Auditory evoked potential (AEP) -- screening test for hearing impairment

3. Visual evoked potential (VEP) -- screening test for visual impairment

Prognosis

     Cerebral palsy is not a curable disease.  The extent of the disability depends on the severity of brain damage.  It is extremely difficult to predict your child's prognosis.  Children who can sit without assistance within 2 years of their birth can usually walk independently.