What are the other Names for this Condition? (Also known as/Synonyms)

• Little's Disease
• Spastic Cerebral Palsy
• Spastic Diplegia

What is Cerebral Palsy? (Definition/Background Information)

• Cerebral Palsy is a disorder that is caused by injury to the fetus brain in the womb, during or immediately after delivery. It usually affects movement, tone, and posture of the baby
• It is seen in early childhood with floppy or stiff limbs, unsteady gait, mental disability, and seizures. There may be impairment of hearing, speech, or vision
• Treatment of this condition involves support from multiple disciplines of medicine, to provide an enhanced quality life. This leads to a better prognosis

Who gets Cerebral Palsy? (Age and Sex Distribution)

• Clinical features of Cerebral Palsy are usually identified in infancy or during pre-school years; usually by age 3 years
• Cerebral palsy is more common in male infants than female infants

What are the Risk Factors for Cerebral Palsy? (Predisposing Factors)

The exact cause of Cerebral Palsy is unclear, but there are certain risk factors that may predispose an individual to this condition.

• Medical conditions in pregnant mother, like thyroid abnormalities or seizures, may increase the risk
• Infections during pregnancy, like chickenpox, toxoplasmosis, syphilis, cytomegalovirus, and German measles, increases the risk to the baby in the womb
• Exposure to toxins, such as methyl mercury in mother
• Infection of the brain in infants, especially when acquired from mother
• Jaundice in infants is also a risk factor. Jaundice is caused by elevated bilirubin levels, which can build-up in the brain and cause damage
• Premature babies and low birth weight babies
• Multiple babies in the uterus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cerebral Palsy? (Etiology)

• The exact cause of Cerebral Palsy is unclear, but reduction in blood supply and oxygen to the fetal brain is the frequent underlying cause
• Genetic mutations involving brain development is also cited as one of the causes
• Infections during pregnancy, endocrine disorders like thyroid abnormalities, diabetes may affect the fetal brain
• When multiple fetuses are present in the womb, blood supply received by each fetus can be compromised and the brain may suffer damage

There are 3 types of Cerebral Palsy:

• Spastic Cerebral Palsy
• Ataxic Cerebral Palsy
• Athetoid Cerebral Palsy

What are the Signs and Symptoms of Cerebral Palsy?

The signs and symptoms of Cerebral Palsy depend on the type of Cerebral Palsy. These include:

• In the spastic type, there is increase in the tone of the muscles. The muscles get stiff and tense; reflexes may be exaggerated
• The ataxic type is characterized by gait abnormalities, difficulty in coordination of movements, and activities, such as writing may be affected; the child may also suffer from speech difficulties
• In athetoid variety, there is both stiff and floppy muscle tone; the child may exhibit involuntary movements of the body. In this form of Cerebral Palsy, the child may appear as though he/she is dancing with slow writhing movements
• Developmental delay is one of the common clinical features - picking up a crayon or coloring, may be difficult for the affected child
• Some children may favor using only one side of their body
• Gait abnormalities, like walking on toes, or scissor-like gait, where knees are crossed, while walking, may be seen
• Feeding difficulties may be present along with vision and hearing impairment
• Mental retardation and seizure disorder are also commonly seen

Although, the disease is non-progressive as the damage to the brain has already occurred, a worsening of the symptoms may still take place.

How is Cerebral Palsy Diagnosed?

A diagnosis of Cerebral Palsy would involve a physical examination with complete medical history evaluation. The diagnosis is also aided by the following imaging and lab studies:

• Magnetic resonance imaging (MRI) of the brain is preferred over computerized tomography (CT). A cranial ultrasound also may be done
• Electroencephalogram (EEG) to record electrical activity of brain, when the presenting symptom is seizure
• Lab tests to screen for blood disorders or endocrine and metabolic derangements may be carried out to assess the cause
• Tests to assess vision, hearing, and speech, may also be performed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cerebral Palsy?

Complications of Cerebral Palsy may include the following:

• The muscle stiffening can lead to contractures, whereby the muscles get tightened and shorten in length. This can hamper the growth of bones, causing them to be deformed or dislocated at the joints. There may be erosions of the bones at the joints as well
• Seizures, vision, and hearing problems may lead to accidents and make individuals dependent on others (family members) for care and support
• Feeding problems can cause choking and aspiration of food into the lungs, leading to breathing difficulties. The affected child may also be malnourished, due to poor feeding
• Individuals affected with Cerebral Palsy may have premature aging. They may develop diseases early in their lives
• Death may occur on account of respiratory difficulties

How is Cerebral Palsy Treated?

Healthcare providers from multiple disciplines may be needed to prepare a treatment regimen for a child with Cerebral Palsy. The affected child is initially treated by a pediatrician, who may refer him/her to several other specialists.

• For any neurological disorders, like seizures, a pediatric neurologist may be consulted
• Regular visit to a developmental therapist is important to get assessment of the age-appropriate development for a child and necessary interventions, when development lags
• A child psychiatrist or psychologist is often required to help in the child’s treatment
• Drugs like Diazepam, Dantrolene, and Baclofen, can be used for generalized muscle spasticity. These medicines help relax the muscles
• Isolated muscle spasticity may be treated by Botox injections. If muscle spasticity persists then surgical procedures, like releasing the contracted muscle or cutting the nerves supplying the muscle, may need to be performed
• Corrective surgical procedures to heal the bones and joints affected by the spastic muscles include, un-twisting of bones and the use of orthotic devices, to help the bones and joints align properly
• An orthopedic doctor can help manage bone and joint problems and recommend corrective devices or surgery, if necessary

Other healthcare professionals involved in the treatment plan and care of the affected child may include:

• A social worker, who helps the family in accessing the appropriate care and health facilities, informing the options available, while guiding their choices
• A physical therapist and occupational therapist may work to make the child more independent in his/her activities; they may work on factors, such as co-ordination, muscle flexibility, and balance
• To improve the child’s speech ability, a speech therapist is often involved
• A special education teacher or interventionist works in conjunction with a developmental therapist and provides education as appropriate, working to maximize the child’s potential, even though he/she is with compromised abilities

How can Cerebral Palsy be Prevented?

A few preventive measures for Cerebral Palsy include:

• Vaccination for pregnant mothers against rubella and chicken pox may reduce the risk of these infections
• Raw and uncooked food should be avoided by pregnant mothers
• Getting adequate healthcare during pregnancy, visiting obstetrician regularly, and being cautious at the time of delivery is very important, to prevent any adverse health situation for the child
• Safe sexual practices can help prevent sexually-transmitted diseases, like syphilis
• Habits, such as smoking and alcohol drinking, should be avoided during pregnancy
• All medicines use by the mother-to-be, must be first assessed for their safety, by the primary caregiver
• When the child is born, all methods to ensure the safety and health of the child should be undertaken
• Immunization schedules must be meticulously followed for the newborn child
• A proper nutrition is essential to ensure good health of the child
• Safety rails around the baby’s cradle and car safety measures, like car seats are valuable preventive measures

What is the Prognosis of Cerebral Palsy? (Outcomes/Resolutions)

• There is no reduced life expectancy observed with Cerebral Palsy. It is a non-progressive disorder
• With the help of a multi-disciplinary team effort and appropriate care, the child may be able to lead a life of quality, with minimal assistance
• Mental retardation and seizures may require some more assistance with suitable medication
• There is no increased risk of the disorder occurring in an offspring, born to an individual with Cerebral Palsy

Additional and Relevant Useful Information for Cerebral Palsy:

It is important to provide a strong support for the child and encourage self-sufficiency and independence, as much as can be safely possible.