CEREBRAL PALSY Dr. Meg-angela Christi Amores

Cerebral Palsy (CP)  diagnostic term used to describe a group of motor syndromes  resulting from disorders of early brain development  often associated with epilepsy and abnormalities of speech, vision, and intellect  selective vulnerability of the brain's motor systems

Epidemiology and Etiology  the most common and costly form of chronic motor disability that begins in childhood  prevalence of 2/1000  80% of cases – antenatal factors causing abnormal brain development  <10% - had evidence of intrapartum asphyxia  High prevalence in low birth weight infants due to intracerebral hemorrhage

Etiology  congenital anomalies external to the central nervous system  Intrauterine exposure to maternal infection (e.g., chorioamnionitis, inflammation of placental membranes, umbilical cord inflammation, foul- smelling amniotic fluid, maternal sepsis, temperature greater than 38°C during labor, and urinary tract infection)

Periventricular leukomalacia

Clinical manifestations - syndromes  Spastic hemiplegia  arm is often more involved than the leg  difficulty in hand manipulation is obvious by 1 yr old  Walking delayed until mo  growth arrest, particularly in the hand and thumbnail  1/3 have seizure disorder  25% have cognitive abnormalities including mental retardation  MRI : Focal cerebral infarction

Clinical manifestations - syndromes  Spastic diplegia  bilateral spasticity of the legs greater than in the arms  often noted when an affected infant begins to crawl  tends to drag the legs behind as a rudder (commando crawl)  scissoring posture of the lower extremities  Walking is significantly delayed  Excellent prognosis for normal cognition  Minimal seizures  MRI: periventricular leukomalacia

Clinical manifestations – syndromes  Spastic quadriplegia  Most severe form  marked motor impairment of all extremities  high association with mental retardation and seizures  speech and visual abnormalities  MRI: severe PVL and multicystic cortical encephalomalacia

Clinical manifestations – syndromes  Athetoid CP  also called choreoathetoid or extrapyramidal CP  characteristically hypotonic with poor head control and marked head lag  Feeding may be difficult, and tongue thrust and drooling  Speech is typically affected

Diagnosis  thorough history and physical examination should preclude a progressive disorder of the CNS  MRI scan of the brain is generally indicated to determine the location and extent of structural lesions  tests of hearing and visual function

Treatment  team of physicians from various specialties, as well as occupational and physical therapists, speech pathologists, social workers, educators, and developmental psychologists  no proof that physical or occupational therapy prevents development of CP  evidence shows that therapy optimizes the development of an abnormal child

Treatment  spastic diplegia  assistance of adaptive equipment, such as walkers, poles, and standing frames  Quadriplegia  motorized wheelchairs, special feeding devices, modified typewriters, and customized seating arrangements

Treatment  Communication skills  Bliss symbols, talking typewriters, and specially adapted computers including artificial intelligence computers  Drugs for spasticity:  dantrolene sodium, the benzodiazepines, and baclofen