CEREBRAL PALSY.

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Presentation transcript:

CEREBRAL PALSY

CEREBRAL PALSY Chronic disability of central nervous system origin characterised by aberrant control of movement of posture, appearing early in life and not the result of progressive neurological disease.

Spastic: Upper motor neurone lesion. Hemiplegia: UMNL of one side of body. Diplegia: UMNL of all four limbs but legs more than arms. May be symmetric or asymmetric. Quadriplegia: Equal involvement of arms and legs.

Rigidity: ↑ tone throughout range of movement. Dyskinesia: Involuntary movements and changes in muscle tone. Damage to basal ganglia and extraphyomides pathways. Athetosis: Slow writhing movements of limbs. Extension and fanning of fingers and extension of wrist. Chorea: Quick jerky movements of trunk and prox, limb muscles.

Paraplegia: Legs involved only. Double Hemiplegia: Bilateral UMNL. Arms and legs. Also pseudobulbar palsy. Monoplegia: One Limb.

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

Types of Cerebral Palsy Spastic Hemiplegia Diplegia Quadriplegia Ataxic Dyskinetic Dystonic Hypokinesia Hypertonia Chored-Athetoid Hyperkinesia Hypotonia

CEREBRAL PALSY Hemiplegia. Double Hemiplegia. Diplegia (hypotonic, dystonic, spasticity, ataxic). Ataxia. Dysequilibrium Syndrome. Dyskinetic. Mixed.

Early Signs of Cerebral Palsy Birth History Prematurity. Seizures. Low apgars. Intracranial haemorrhage. Periventricular leucomalacia. Delayed Milestones Abnormal Motor Performance Handedness. Reptilian crawl. Toe waking.

Early Signs of Cerebral Palsy Altered Tone. Persistence of primitive reflexes. Abnormal posturing.

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

Maternal infection & cerebral palsy ANTENATAL Maternal infection & cerebral palsy Maternal fever> 38oc + Chorioamnionitis associated with ↑ risk of cerebral palsy. ↑ Inflammatory markers in children with cerebral palsy.

Cerebral Palsy Fall in incidence of Cerebral Palsy in low birth weight babies. ⇧ in incidence in babies 2.5-4kg (2/3 of cases). Excess boys (C58%). ⇩in incidence of dyskinetic cerebral palsy. ⇧in lowest socio-economic groups. Maternal age and parity. U shaped curve < 20 years - > 34 years. 4 children or >. Breach delivery.

Cerebral Palsy Associated Disabilities Mental retardation 1/3 N. 1/2 I.Q. < 55. Epilepsy 20-50% > 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. Chilblains and cold injury. Growth.

Treatment of Cerebral Palsy Parent guidance. Physiotherapy - Bobath method. Peto. Doman-Delacato. Orthopaedic. Speech and Occupational Therapy. Medical. Psychiatric.

Management of Spasticity in Cerebral Palsy Oral Medicines: Baclofen Diazepam Tizanidine Dantrolene Intrathecal Baclofen. Botulinum Toxin. Selective Posterior Rhizotomy.

Botulinum Toxin Produced by bacterium clostridium Botulinum. Blocks release of Acetylcholine from cholinergic nerve terminals. Duration of effects, 3-4 months. Adverse effects: muscle weakness. Allergic reaction – rare. Autonomic Dysfunction. Occasional flu like symptoms. Antibody development.

Prevention Antenatal and Neonatal care. Early detection and advice. Drugs. Immunization and screening. Genetic counselling. Health education.