Table of Contents
What is cerebral palsy?
Cerebral palsy (CP) is a group of conditions which involve permanent and nonprogressive motor dysfunction. Motor dysfunction is the inability of the brain to process movements in a normal manner, which can lead to difficulties with movement and balance. Motor dysfunction can affect muscle tone, posture, and/or general movement. Although the disease itself is not progressive, as the central nervous system (CNS) matures, the clinical manifestations may change over time. As we age, and our movements become more complex, it might appear that CP is becoming worse – for example, if the child is confined to a wheelchair, the child will likely not be able to drive as an adult. General motor dysfunction can result in limitations in functional abilities, such as getting dressed, putting shoes on, making a meal, or driving a car, and can range in severity. Some with CP might be able to perform basic activities of daily living, like getting dressed, going to the bathroom, and brushing their teeth. Others might be wheelchair bound and highly dependent on assistance for all activities. Because motor dysfunction affects the way our brain processes signals from the body, CP patients might experience other motor abnormalities, including altered sensation or perception, communication and behavioral difficulties, intellectual disability, and musculoskeletal complications. Those with CP might also experience growth failure, lung and bone problems, urinary disorders, generalized pain, and sleep disturbances.
Risk factors for Cerebral Palsy
Approximately two per one thousand live births result in CP1. This is a drastic reduction from even the 1990s, where we saw 155 per 1000 live births diagnosed with CP2. This improvement is likely related to the advancements in overall perinatal care that pregnant women receive. We most commonly see CP in preterm (prior to 37 weeks) and very low birth weight (< 3.3lbs) infants. In addition to gestational age and birth weight, there are numerous other prenatal and perinatal factors that must be accounted for. Some of these risk factors are modifiable on the mother’s part. If the mother is a heavy alcohol drinker, smoker, experiences obesity, or untreated vaginal infections during pregnancy, the fetus’ risk of CP can be increased. Though there are some things the pregnant woman can do to prevent CP, there are also factors that we have no control over. These factors include preeclampsia (high blood pressure in pregnancy), placental abruption (where the placenta detaches from the uterine wall), congenital abnormalities, neonatal infection, respiratory distress syndrome, and more.
How and when is Cerebral Palsy diagnosed?
CP is generally diagnosed between 12 and 24 months as a baby starts missing important milestones in development. This disease can be difficult to diagnose, as there is not one single test that can be done. Thus, many examinations, brain imaging, and thorough history of the pregnancy and events of delivery are crucial. Babies who exhibit early signs of CP may experience excessive irritability, trouble sleeping, poor feedings, frequent vomiting, and poor visual attention. Additionally, tone in the baby’s arms and legs might be increased or decreased, and the baby might exhibit poor head and body control from an early age. If you think your baby might have CP, frequent and routine visits to the pediatrician are of utmost importance. The pediatrician will be able to assess milestones (i.e. sitting, walking, hand function, and disappearance of infant reflexes) and determine if further evaluation is needed. There are three different types of CP which are usually diagnosed between 18 and 24 months of age. We will discuss those subtypes at length in a following article.
Prevention of Cerebral Palsy
So, what can be done to prevent cerebral palsy? First, and most importantly, routine prenatal care by a licensed obstetrician is a priority. Having routine care can help pick up on early warning signs of preterm labor, high blood pressure, and other complications that may arise throughout pregnancy. Prenatal care should be established between five and ten weeks gestation and should continue on a regular basis until delivery. Second, if a woman is at risk for a preterm birth, magnesium sulfate should be administered through an IV to help protect the developing brain of the fetus. Risk factors for preterm birth would be a history of preterm birth, shortened cervix after 20 weeks gestation, and intrauterine growth restriction. If magnesium does not prevent a preterm delivery, it can decrease the incidence and/or severity of CP in the baby. Lastly, measures should be taken quickly after delivery if there is suspicion for neurologic injury in the infant. For example, if the baby was born very prematurely with a very low birth weight, or if the baby went a prolonged amount of time without oxygen during labor and/or delivery. Since we cannot reverse a preterm delivery, or a birth injury, the goal of supportive measures is to simply reduce the likelihood of long term affects on brain development. These measures can include adequate ventilation for the baby, replacing fluids, electrolytes, and monitoring blood glucose levels, and controlling seizures quickly and efficiently, if present. Another very effective supportive measure, if performed in a timely manner, is therapeutic hypothermia. When started within six hours of delivery, keeping the baby at a cold temperature (91.4-95 degrees Fahrenheit) for 3 days can protect the brain and increase the baby’s likelihood of having a normally developed brain later in life3.
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Treatment of Cerebral Palsy
If your child has been diagnosed with CP, there are treatments which can help improve the child’s quality of life. First, medications can be given to help with stiff muscles, unusual body movement, or seizures. Second, doctors can provide equipment for the child depending on the severity of CP. Equipment can be leg braces, a walker, or a wheelchair to help with mobility and independence. Doctors can also prescribe special diets or perform procedures that will help the baby gain weight. A tube can be placed directly into the child’s stomach to properly deliver the nutrition the patient needs to thrive. Lastly, surgery can be done for severe symptoms. This can include orthopedic surgery to help put legs or arms in the proper position, eye surgery to help the muscles relax, or heart surgery if needed. Children with mild forms of CP can live a long and healthy life, however, children with more severe forms may not live as long and can have a difficult path. With the advancement of medicine and healthcare, doctors can ensure that the child has the best quality of life possible.
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