• Clinical science

Cerebral palsy

Abstract

Cerebral palsy (CP) is a heterogenous group of disorders affecting the muscle tone and the development of movement and posture. CP results from a non-progressive damage to the brain in utero or during infantile development up to the age of 3 years. Depending on the affected brain area, spastic, ataxic, or dyskinetic cerebral palsy develops. While, in many cases, there is no identifiable cause, risk factors for cerebral palsy are prematurity, perinatal complications such as chorioamnionitis, birth trauma with intracerebral hemorrhage, or postnatal infections such as meningitis. The diagnosis of CP is usually not made before later in infancy when children fail to meet certain milestones (e.g., inability to roll over or sit independently). Physical indicators of spastic cerebral palsy include spastic paresis of multiple limbs and joint contractures, scissors gait, and persistence of primitive reflexes. Patients with non-spastic cerebral palsy present with dysarthria and abnormal involuntary movements (choreoathetoid, dystonic, or ataxic) that worsen with stress. Seizure disorders and intellectual disability are associated with all types. Diagnosis is mainly based on the clinical picture but cranial ultrasound or MRI can help identify the causative lesion (e.g., hemorrhage, brain malformation). Since there is no cure, management follows a multidisciplinary approach with a focus on treating contractures (e.g., bracing, antispasmodics, physical therapy, surgery) and ensuring social participation (e.g., speech therapy, social support). Depending on the severity and type of cerebral palsy, patients may be slightly restricted or severely disabled and unable to walk.

Epidemiology

  • Most common motor disability in children
  • Approx. 2/1000 live births in developed countries

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[3][4][2]

Classification

  • Spastic cerebral palsy: spastic paresis of one or more limbs (75% of cases)
  • Non-spastic cerebral palsy :
    • Dyskinetic: abnormal involuntary movements (choreoathetoid, dystonic)
    • Ataxic: intention tremor, lack of balance and coordination

References:[3][4][2]

Clinical features

Patients may present with mixed types of cerebral palsy (e.g., combination of spastic and athetoid CP).

Definite hand preference before 1 year of age, suggests a one-sided muscle weakness and is a red flag for hemiplegia!

References:[3][4][2][5]

Diagnostics

Diagnosis is mainly based on the clinical picture.

  • Cranial ultrasonography: (early neonatal period): e.g., intracerebral hemorrhage and/or hypoxic-ischemic injury, structural abnormalities
  • MRI: (in older infants): to detect causative lesion (e.g., periventricular leukomalacia, congenital malformation, intracranial hemorrhage)

References:[3][2]

Differential diagnoses

References:[3][4][2]

The differential diagnoses listed here are not exhaustive.

Treatment

There is no curative therapy for cerebral palsy. A multidisciplinary approach is employed in management to improve function and quality of life.

  • Antispasmodics (e.g., botulinum toxin, baclofen, dantrolene, benzodiazepines)
  • Physical therapy
  • Surgery (e.g., to treat scoliosis or relieve joint contractures)
  • Bracing to prevent contractures
  • Speech therapy for dysarthria
  • Nutritional support for dysphagia
  • Special tuition for intellectual disability
  • Social and psychological support

References:[3][4][2]

last updated 11/19/2018
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