CEREBRAL PALSY

CEREBRAL PALSY None progressive, static disorder of the tone, posture or movement, due to lesion in developing brain. But symptoms may change

Cerebral Palsy Rates Multiple births 7.5 / 1000 live births Singletons 2.1 / 1000 live births 1500gr or less 80 / 1000

RISK FACTORS ASSOCIATED WITH CEREBRAL PALSY GENERAL Gestational age < 32 weeks Birth weight <2500 g MATERNAL HISTORY Mental retardation Seizure disorder Hyperthyroidism Two or more prior fetal deaths Sibling with motor deficits DURING GESTATION Twin gestation Chorionitis Fetal growth retardation Third-trimester bleeding Low placental weight Premature placental separation FETAL FACTORS Abnormal fetal presentation Fetal malformations Fetal bradycardia Neonatal seizures

CP: ETIOLOGY Majority is idiopathic (thought to present prenatally) PRENATAL PERIOD- wherein most causes of CP occur. TORCH infections Intrauterine stroke Genetic malformations The most common currently understood causes are related to brain injury occurring in children born prematurely.

Prenatal Associations with Cerebral Palsy Placental insufficiency. Brain malformation. Congenital infection. Chromosomal defects. Exposure to toxins.

Types of Cerebral Palsy Spastic Hemiplegic Diplegic Quadriplegic Ataxic Dyskinetic Dystonic Hypokinesia Hypertonia Chored-Athetoid Hyperkinesia Hypotonia Mixed

Spastic: Hemiplegia: UMNL one side of body. Diplegia: UMNL of legs more than arms. Quadriplegia: Equal involvement of arms and legs.

Diplegic CP : The most common type 30% Speech / cognitive function : normal . no Epilepsy. UL : gross motor (Normal) LL : spastic Infant ( commando crawl by hand), Delay sitting. O/E Scissoring position, hyper-reflexia knee & ankle, Bilateral Babinski sign. Child, Delay walking, walk on tiptoe O/E disuse atrophy hip: flexion, adduction, int. rotation knee: flexor / extensor spasticity /or equal ankle: equinovarous. foot: pes valgus Most walk independently by 4 years

Fragile brain musculature Physical stresses of prematurity Immature Fragile brain musculature Physical stresses of prematurity Compromised cerebral blood flow ( blood vessels in the water shed zone next to lateral ventricles in the capillaries of the germinal matrix)

Hemiplegic CP : 25 % of all CP One side affection, upper > lower extremity 25 % mentally retarded 33 % seizures Infant: Hand preference Child: Circumductive gait, hyper-reflexia Cause :Thromboembolism

All four limbs involved – and trunk- UMNL Often with MR & seizures Spastic Quadriplegia (Most severe)20% All four limbs involved – and trunk- UMNL Often with MR & seizures Most ( 80 % ) non walkers Swallowing difficulty & Aspiration pneumonia due to Pseudo-bulbar palsy .Speech &visual abn. Flexion contracture of knee & elbow, scissoring posture. Hypertonia, hyper-reflexia.

Dyskinetic CP Less common than spastic CP.15%. Infant is hypotonic, head lag then rigidity& dystonia(mov. Disorder that persons muscle contract uncontrollably, repetitive mov.). Feeding and speech are typically affected. Cause : birth asphyxia., kernicterus, metabolic disease that effect basal ganglia.

Diagnosis of CP Birth History Delayed Milestones Prematurity. Seizures. Low apgars. Intracranial haemorrhage. Periventricular leucomalacia. Delayed Milestones Abnormal Motor Performance Handedness. Reptilian crawl. (abdomen) like snake Toe waking.

Early Signs of Cerebral Palsy Altered Tone. Persistence of primitive reflexes. Abnormal posturing. Inv.: MRI of brain, Test for vision & hearing Genetic evaluation

Cerebral Palsy Associated Disabilities Mental retardation 1/3 N. 1/2 I.Q. < 55. Epilepsy 25% > generalised. Speech disorders 50% delay/dysarthria. Vision and hearing 25%. Behaviour abnormalities. Learning difficulties.

Common Management Problems in Cerebral Palsy Feeding Problems: Failure to suck. Tongue trusting, gagging and choking. Vomiting and regurgitation. Dribbling. Constipation. Crying, screaming and sleep disturbances. Growth.

Treatment of Cerebral Palsy Parent guidance. Physiotherapy Orthopaedic: scoliosis, contractures, deformities. Speech and Occupational Therapy. Medical. Psychiatric.

Management of Spasticity in Cerebral Palsy Oral Medicines: Baclofen, Diazepam, Dantrolene Intrathecal Baclofen. Botulinum Toxin.(to affected muscle) Selective dorsal Rhizotomy on spinal n. for severe spasticity. Tenotomy of Achilles tendon Hemiplegic : constrained the affected side Rigidity, dystonia Levodopa-carbidopa (Sinemet) Dystonia : carbamazepine.