Monday, November 30, 2020

Cerebral palsy: Symptoms, diagnosis, treatment

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What is cerebral palsy?

Cerebral palsy, or CP, is a group of neurological conditions affecting movement and co-ordination because of problems with the brain and the body’s nervous system.

Symptoms of cerebral palsy include muscle stiffness, floppiness, weakness, uncontrolled body movements and problems with balance and co-ordination.

Cerebral palsy is one of the most common causes of chronic childhood disability, affecting around one in every 400 people in the UK.

Cerebral palsy usually appears in children before they are three years old.

Although the brain damage doesn’t worsen over a person’s lifetime, symptoms can vary in their severity.

Children with cerebral palsy may have an accompanying seizure disorder and may have some level of learning disability, vision, speech, hearing or language problems.

What causes cerebral palsy?

Causes of cerebral palsy include:

  • Infections during pregnancy that may damage the nervous system of a developing foetus. These include rubella (German measles), cytomegalovirus (aherpes-type virus) and toxoplasmosis (an infection caused by a parasite that can be carried in cat faeces or undercooked meat). Other infections in pregnant women that may go undetected are now being recognised as important causes of developmental brain damage in the foetus.
  • Severe jaundice in the baby. Jaundice is caused by excessive bilirubin in theblood. Normally, bilirubin is filtered out by the liver. But often a, newborn baby’s livers needs a few days to start doing this effectively, so it’s not uncommon for babies to have jaundice for a few days after birth. In most cases, phototherapy (light therapy) clears up jaundice and there are no lasting health effects. However, in rare cases, severe untreated jaundice can damage brain cells.
  • Rh (rhesus) incompatibility between mother and baby. With this blood condition, the mother’s body produces antibodies that destroy the foetus’s blood cells. This, in turn, leads to a form of jaundice in the baby and may cause brain damage.
  • The physical and metabolic trauma of being born. This can precipitate brain damage in a foetus whose health has been threatened during development.
  • Severe oxygen deprivation to the brain or significant trauma to the head duringlabour and delivery.

Some children with cerebral palsy acquire the disorder after birth. It results from brain damage in the first few months or years of life. Cerebral palsy often follows infections of the brain, such as bacterial meningitis or viral encephalitis, or it may be the result of a head injury.

Risk factors that increase the possibility of a child later being diagnosed with cerebral palsy include the following:

  • Breech births (when the feet, knees or buttocks of a baby come out first).
  • Vascular or respiratory problems in the baby during birth.
  • Physical birth defects such as faulty spinal bone formation, groin hernias or an abnormally small jaw bone.
  • Receiving a low Apgar score 10 to 20 minutes after delivery. An Apgar test provides a basic, immediate assessment of a newborn baby’s physical health. The test evaluates the baby’s heart rate, breathing, muscle tone, reflexes and colour, and gives each a score from 0 (low) to 2 (normal).
  • A low birth weight (less than 2,500 grams or 5 lbs 7.5 oz) and premature birth(born earlier than 37 weeks of pregnancy).
  • Being a twin or one of a multiple birth.
  • A congenital nervous system malformation such as an abnormally small head (microcephaly).
  • Seizures shortly after birth.

Mothers who had bleeding or severe proteinuria (excess protein in the urine) late in their pregnancy, have a higher chance of having a baby with cerebral palsy. The same applies to mothers who have hyperthyroidism or hypothyroidism or seizures.

Not all children who are exposed to these risk factors develop cerebral palsy. However, parents and doctors should be aware of these risks and watch such a child’s development carefully.

What are the symptoms of cerebral palsy?

The symptoms of cerebral palsy (CP) can vary from slight clumsiness to extensivespasticity (uncontrolled contraction of muscles attached to the skeleton). Early signs usually appear before the age of three. Parents are often the first to suspect that their child’s motor skills are not developing normally or that their child is slow in developing. Often babies with CP are slow to reach developmental milestones such as learning to roll over, sit, crawl, smile or walk. Some affected children seem rigid or stiff. They also may exhibit an unusual posture or favour one side of their body.

There are four types of CP:

  • Spastic CP, the most common type, is a disorder where certain muscles are stiff and weak. The stiffness can occur mainly in the legs (diplegia), only in the arm and leg of the same side (hemiplegia) or in both arms and legs (quadriplegia). A wide-based, staggering or “scissors” gait is characteristic of this type.
  • Dyskinetic (or athetoid) CP generally involves impairment of voluntary muscle control. People with this form of CP have incomplete or fragmented motor movements often involving bizarre twisting motions, tremors and exaggerated posturing (athetosis).
  • Mixed CP is a combination of the previous two types of CP.
  • Ataxic CP can be the combination of uncoordinated movements, loss of power, hypotonia and tremor.

Seek medical advice about cerebral palsy if:

  • Your baby is feeding (sucking) poorly or is very floppy.
  • Your child does not seem to be developing motor skills, such as rolling over, sitting up or crawling, at a normal pace.
  • Your child’s muscles seem unusually stiff.
  • Your child has an unusual posture or seems to favour one side of his or her body.

How is cerebral palsy diagnosed?

There is no definitive test for cerebral palsy (CP) at the moment. The diagnosis is made by reviewing a child’s medical history and performing a physical examination. A CP diagnosis can be difficult because babies may have more than one type of the disease and their symptoms may change in the early years making an exact diagnosis impossible. CP is easier to diagnose in more severely affected children. With these children, a diagnosis can often be made within the first months of life, but with more mildly affected children, doctors may not be able to confirm their diagnosis until the children are three or four years old.

Doctors diagnose CP by testing the baby’s motor skills, looking for characteristic symptoms and considering the child’s medical history. They also may use computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to look for abnormalities in the baby’s brain. Certain laboratory tests may help rule out various progressive biochemical disorders that involve the motor system such as Tay-Sachs disease.

What treatment is there for cerebral palsy?

Cerebral palsy is a lifelong condition that cannot be cured. However, treatment can improve an affected person’s capabilities, increasing motor function and independence. Many people who have CP enjoy near-normal lives. Depending on his or her symptoms, a person with CP may need the following:

  • Surgery is used to correct muscle contractures, bending at a joint due to muscles that are too short or are spastic. With this surgery, muscle is lengthened. In another type of surgery, certain spinal nerves may be severed to help reduce spasticity in the legs.
  • Medicines which treat muscle problems and other symptoms. Medicines such as diazepam, baclofen and dantrolene are sometimes used to control muscle spasticity. Anticholinergic medicines may be used to help control abnormal movements. Alcohol or Botox injections into muscle may be used to reduce spasticity for a short time so doctors can work to lengthen a muscle. Baclofen infused into the spinal canal under control of an electronic pump may be used to control spasticity for long periods of time. Other medicines may also be given to control seizures.
  • Physiotherapy which consists of special exercises designed to increase and improve the child’s movement and strength. In healthy children, normal daily activity stretches muscles, which helps the muscles to grow faster to keep up with the child’s growing bones. However, the muscles of children with CP do not stretch and grow normally. As the child ages, the difference between bone growth and muscle growth can interfere with motor abilities. Physiotherapy helps combat this.
  • Mechanical aids which may help with a wide variety of functions. These aids can range from orthotic braces that help stretch muscles by holding bones in certain positions, to a computer equipped with special input devices and a speech synthesiser to help the person communicate.
  • Occupational therapy designed to help the child develop the fine motor skills needed to function day to day at home and school.
  • Speech therapy to help the child overcome communication problems.
  • Counselling to help the child and his or her family cope with the child’s condition and access useful services.
  • Specially designed educational programmes for those who have learning disabilities.
  • Reviews by an audiologist regarding hearing and an ophthalmologist regarding visual conditions may also be required.

Because of the range of treatments for cerebral palsy, a child typically receives care from a number of medical specialists. These include a paediatrician, who co-ordinates all aspects of the child’s treatment; an orthopaedic surgeon, who specialises in surgery to treat muscular and skeletal problems; and a variety of other therapists and aides. The treatment that’s right for someone with cerebral palsy depends not only on their symptoms but also on his or her life stage. The treatment should be geared to help the person develop skills appropriate for his or her age and prepare them for future educational and occupational activities.
Many adults with cerebral palsy are able to live and care for themselves independently. Others may need assistance in caring for themselves, help with transportation and special employment arrangements geared to their abilities.

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