Cerebral palsy

Summary

• Cerebral palsy is a group of disorders involving brain and nervous system functions such as movement, learning, hearing, seeing and thinking.
• These disorders appear in the first two years of life and generally do not worsen over time.
• There are several types of cerebral palsy including spastic, ataxic, hypotonic and mixed.
• Cerebral palsy is caused by an injury to or abnormality of the brain, usually while the baby grows in the womb.

Description

Cerebral palsy is a broad term used to describe a group of chronic disorders of the nervous system. These disorders all involve impaired control of movement and appear during the first 2 years of life and usually do not worsen over time.

Cerebral palsy cannot be cured, but many patients can enjoy near-normal lives if their neurological problems are properly managed. The goal of treatment is to enable the child with cerebral palsy to be as independent as possible.

Cause

Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb, but can happen at any time during the first 2 years of life while the baby’s brain is still developing. In some children parts of the brain are injured due to low levels of oxygen (hypoxia) during birth. In many cases the cause for the hypoxia is not found. Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy due to bleeding in the brain, meningitis, head injury, severe jaundice or infections in the mother during pregnancy, such as German measles. Damage to the motor areas of the brain disrupts the brain’s ability to control movement and posture.

Symptoms

Symptoms of cerebral palsy include difficulty with fine motor tasks (such as writing or using scissors), difficulty maintaining balance or walking and involuntary movements. The symptoms differ from person to person and may change over time.

Some children with cerebral palsy are also affected by other medical disorders, including seizures or mental impairment, but cerebral palsy does not always cause severe handicap.

Early signs of cerebral palsy usually appear before two years of age. Infants with cerebral palsy are often slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk.

Diagnosis

Doctors diagnose cerebral palsy by testing motor skills and reflexes, looking into the medical history and employing a variety of specialized tests.

Although the symptoms may change over time, cerebral palsy by definition is not progressive. Thus, if a patient shows increasing impairment, the problem may be something other than cerebral palsy.

Treatment

There is no cure for cerebral palsy. The goal of treatment is to enable the child to be as independent as possible. Treatment requires a team approach involving occupational therapists, physiotherapists, speech therapists, paediatric neurologists and nurses. Medication can be used to control seizures and muscle spasms while special braces can compensate for muscle imbalance. Surgery and mechanical aids to help overcome impairments may be necessary .At home the child needs good food and nutrition, a safe home environment, regular exercises as recommended by the health team, careful attention to the child’s bowel needs and protection of the child’s joints from injury. Children with cerebral palsy often require special glasses or hearing aids and may need special walking aids and a wheel chair.

Professional counseling for emotional and psychological needs is often needed.

Previously reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven

Reviewed by Prof  Eugene Weinberg, FCPaeds [SA}, FAAAAI, Paediatrics and Paediatric Allergology, Allergy Diagnostic Unit,UCT Lung Institute, September 2011