Cerebral palsy

Cerebral palsy: Discription

A generic term for various types of non-progressive motor dysfunction present at birth or beginning in early childhood. Causes are both hereditary and acquired; depending upon cause, classified as intrauterine, natal, and early postnatal; motor disturbances include diplegia, hemiplegia, quadriplegia, choreoathetosis, and ataxia.Alternative Names: Spastic hemiplegia, spastic paralysis, spastic diplegia, and spastic quadriplegia.Abbreviation: CP.Cerebral palsyCerebral palsy is a condition that affects motor skills development between the brain and certain nerves and muscles in the body. The disease is most apt to occur during the time of fetal development or at infancy. While cerebral palsy can affect both the upper and lower extremities, when the disease is associated with the legs, it is known as cerebral palsy spastic diplegia.Types:Spastic Cerebral Palsy: About 70 to 80 percent of affected individuals have spastic cerebral palsy, in which muscles are stiff, making movement difficult. When both legs are affected (spastic diplegia), a child may have difficulty walking because tight muscles in the hips and legs cause legs to turn inward and cross at the knees (called scissoring). In other cases, only one side of the body is affected (spastic hemiplegia), often with the arm more severely affected than the leg. Most severe is spastic quadriplegia, in which all four limbs and the trunk are affected, often along with the muscles controlling the mouth and tongue. Children with spastic quadriplegia have mental retardation and other problems.Dyskinetic Cerebral Palsy: About 10 to 20 percent have the dyskinetic form, which affects the entire body. It is characterized by fluctuations in muscle tone (varying from too tight to too loose) and sometimes is associated with uncontrolled movements (which can be slow and writhing or rapid and jerky). Children often have trouble learning to control their bodies well enough to sit and walk. Because muscles of the face and tongue can be affected, there also can be difficulties with sucking, swallowing and speech.Ataxic Cerebral Palsy: About 5 to 10 percent have the ataxic form, which affects balance and coordination. They may walk with an unsteady gait and have difficulty with motions that require precise coordination, such as writing.The prevalence of cerebral palsy is approximately 1.5-2.5 cases per 1000 live births. The incidence of cerebral palsy has not changed in more than 4 decades, despite significant advances in the medical care of neonates.Cerebral palsy is a lifelong disorder. Long-term care may be required. The disorder does not affect expected length of life. The amount of disability varies.Many adults are able to live in the community, either independently or with different levels of help. In severe cases, the person may need to be placed in an institution.With treatment, most children can significantly improve their abilities. Although symptoms may change over time, cerebral palsy by definition is not progressive, so if increased impairment occurs, the problem may be something other than cerebral palsy. Many children with cerebral palsy have other problems that require treatment. These include mental retardation; learning disabilities; seizures; and vision, hearing and speech problems.Symptoms:Cerebral palsy signs aren't the same for every child. This is because there are various types of the disorder. The signs and symptoms also therefore tend to differ.Cerebral palsy may cause a number of symptoms, including seizures, spasms, visual and hearing problems, hyperactivity, and learning disorders.Other symptoms of cerebral palsy include.Speech problem.
  • Visual and hearing problem.
  • Motormental and mental retardation.
  • Peg teeth.
  • Delayed in the development of motor skills.
  • Unbalanced breathing.
  • Difficulty sucking or feeding.
  • Seizures.
  • Spasticity.
Causes and Risk factors:The exact cause of CP is unknown, although many different types of injury can cause it. In the majority of cases, CP occurs during pregnancy. It may be due to ongoing oxygen deprivation of the fetus, metabolic or blood abnormalities, or even the mother having rubella (German measles) during pregnancy. Poor oxygen supply to the brain or injuries during birth can also result in CP. In other cases, the brain damage may be caused by illness, such as meningitis, or it might be due to accidental injury in early childhood.In early childhood, cerebral palsy can occur if a young child's brain is damaged by:Infections such as meningitis.
  • Brain haemorrhages.
  • Head injury following falls, accidents, and abuse.
  • Drowning accidents.
  • Poisoning
In woman, alcohol and cigarette smoking both have powerfully adverse effect on a fetus's development and are frequently underestimated as a cause of cerebral palsy.Cigarette smoking lowers birth weight. Low birth weight and premature birth are primary risk factors for cerebral palsy.Severe jaundice caused by erythroblastosis fetalis, the result of incompatibility between the Rh blood types of a mother and child, has resulted in brain damage and cerebral palsy, particularly athetoid CP. What occurs is the mother's immune system attacks the child's blood cells destroying their ability to process bilirubin resulting in liver overload and brain damage. The yellow pallor of the skins and eyes is caused when the ambient bilirubin dissolves in the layer of fat beneath the skin instead of being processed in the liver the excreted through the bile.A new study undermines the long-held belief among obstetricians that oxygen deprivation, or hypoxia, is the main cause of cerebral palsy in premature infants. If was found that the brain injury that leads to cerebral palsy was much more commonly associated with infection than with hypoxia.Research suggests that cerebral palsy results from incorrect cell development early inpregnancy. For example, a group of researchers has recently observed that more thanone-third of children with cerebral palsy also have missing enamel on certain teeth.Scientists are also examining other events -- such as bleeding in the brain, seizures, andbreathing and circulation problems -- that threaten the brain of a newborn baby. Someinvestigators are conducting studies to learn whether certain drugs can help preventneonatal stroke, and other investigators are examining the causes of low birth-weight.Other scientists are exploring how brain insults (like brain damage from a shortage ofoxygen or blood flow, bleeding in the brain, and seizures) can cause the abnormal releaseof brain chemicals and trigger brain disease.Risk Factors:There are a number of other variables or risk factors associated with the development of cerebral palsy. They include infant thyroid hormone levels, coagulation disorders or clotting defects in the mother or infant, vaginal bleeding, hypocalcaemia, polycythaemia, hypoglycaemia in infants, the mother being exposed to radiation or methylmercury and delivery room depression.Over 400 premature babies were discovered to have lower than normal levels of thyroxine and a correlated higher risk of cerebral palsy. Thyroxine is thyroid hormone. This hormone in low levels this is called hypothyroxinemia. It has not been concluded whether this is a sign of the condition or a cause.Infection During Pregnancy - Rubella, cytomegalovirus, and toxoplasmosis can cause severe damage to the nervous system of the fetus and result in cerebral palsy.
  • Jaundice - severe jaundice can result in brain damage.
  • Rh Incompatibility - can cause jaundice, this is a condition where the mother's immune system attacks the fetus.
  • Oxygen Shortage - a shortage of oxygen during birth can cause brain damage to the child.
  • Stroke - a stroke in the fetus can occur if the mother suffers from coagulation disorders.
  • Toxicity - Drug or alcohol use can result in brain damage.
  • Bleeding - bleeding in the brain of the infant after birth can cause brain damage.
Diagnosis:There is no medical test that confirms the diagnosis of cerebral palsy. The diagnosis is made on the basis of various types of information gathered by the child's health care provider and, in some cases, other consultants.Lab studies: Various blood and urine tests may be ordered if your child's health care provider suspects that the child's difficulties are due to chemical, hormonal, or metabolic problems. Analysis of the child's chromosomes, including karyotype analysis and specific DNA testing, may be needed to rule out a genetic syndrome.Tests:Ultrasound of the Brain: Ultrasound uses harmless sound waves to detect certain types of structural and anatomic abnormalities. For instance, it can show hemorrhage (bleeding) in the brain or damage caused by lack of oxygen to the brain. Ultrasound is often used on newborns who cannot tolerate more rigorous tests such as CT scans or MRI.CT scan of the brain: This scan is similar to an x-ray but shows greater detail and gives a more 3-dimensional image. It identifies malformations, hemorrhage, and certain other abnormalities in infants more clearly than ultrasound.MRI of the brain: This is the preferred test, since it defines brain structures and abnormalities more clearly than any other method. Children who are unable to remain still for at least 45 minutes may require a sedative to undergo this test.MRI of the spinal cord: This may be necessary in children with spasticity of the legs and worsening of bowel and bladder function, which suggest an abnormality of the spinal cord. Such abnormalities may or may not be related to cerebral palsy.Electroencephalography (EEG): EEG is important in the diagnosis of seizure disorders. A high index of suspicion is needed in order to detect non-convulsive or minimally convulsive seizures. This is a potentially treatable cause of a CP-look-alike, which is easier to treat when treated early.Electromyography (EMG) and nerve conduction studies (NCS) may be helpful in distinguishing CP from other muscle or nerve disorders.Treatment:The perfect treatment of cerebral palsy have not found yet because repair of brain damage is not so easy but there are some treatment which have been very helpful in the treatment of cerebral palsy. The treatment of cerebral palsy is depends upon the symptoms of this disease according to the symptoms it is treated and treatment includes Physiotherapy, occupational therapy and speech therapy. These therapies are used to improve communication skills and other things which cause symptoms like spasticity, paralyses etc.Your doctor or paediatrician may be able to prescribe medicines that can control seizures and muscle spasms. Medicines are also used to control spasticity. Botulinum toxin A (brand names include Botox and Dysport), a neurotoxin derived from the bacterium Clostridium botulinum, is sometimes injected into the calf muscles to relax tight muscles and make walking easier by improving the position of the ankle and allowing the foot to make heel-to-floor contact, so helping to amend tip-toe walking.Special braces or splints may be recommended to aid balance and movement, or surgery may be recommended to aid mobility.A physiotherapist can provide exercises to be conducted at home that will help with mobility. They can also advise parents on how to position their child properly and lift them safely. They can also advise on the best walking aids and seating aids to make life more comfortable.A speech therapist can help with eating and communication difficulties and can help with communication aids, sign language, or symbol language to replace speech or assist with speech.An occupational therapist can help provide equipment or adaptations to the home or workplace to help a person with CP function as well as possible in everyday life.Hyperbaric oxygen therapy (breathing pure oxygen while in a sealed, pressurized container) has been promoted by some for people with CP. However, research has not so far shown that hyperbaric oxygen benefits CP.Medicine and medications:Botulinum Toxin Type A (Botox), Baclofen, Dantrolene, Valium, Diazepam, and Zanaflex.Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 


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