Cerebral Palsy: Causes, Signs, Diagnosis & Treatment!

Cerebral palsy – an unscrupulous diagnosis which leaves a burden on the fate of the whole family.

What Is Cerebral Palsy?

Cerebral palsy (CP) is a chronic movement disorder due to lesions of the central nervous system. Cerebral palsy manifests through muscles contractions (spasms) and involuntary reflex movements which may affect the entire body or just a part of it. There are other medical conditions associated with CP: auditory or visual dysfunctions, convulsions.

Causes

There are many causes that may determine cerebral palsy. The antenatal factors are responsible of 40% to 60% of the total cases of this disorder. Among them, we remind:

• Central nervous system malformations: they aren`t evident at birth, but they might be among the causative factors (porencephaly, encephalomalacia).
• Environmental factors.
• Intrauterine infections: they interfere with the development of the nervous system.
• Intrauterine malnutrition.
• Genetic syndromes.
• Chromosomal malformations.
• Placental insufficiency.
• Prematurity: the lower is the birth weight, the greater is the risk of CP; therefore, for an premature baby having the birth weight below 1.500 g, the risk of developing the illness is of 90.4%.

Perinatal factors are found in 10% of cases. They are represented by:

• Central nervous system infections.
• Hypoxia, asphyxia; it was found that the Apgar score at 5 minutes after birth will increase the risk of CP both in premature and some of the infants born at term.
• Obstetrical cranio-cerebral trauma.

Postnatal factors are found in only 5% to 8% of cerebral palsy.

• Infections: viral or bacterial meningitis.
• Intoxications.
• Nuclear jaundice.
• Cranio-cerebral trauma.
• Protein deficiency.
• Serious metabolic malformations.
• Neuroinfectives.
• Serious dehydration.

However, there are cases where an exact cause of CP syndrome hasn`t been identified.

Signs & Symptoms

Even if it`s present from birth, cerebral palsy may become obvious only between 1 and 3 years. This occurs because of the way children grow and develop. Experts or parents recognize the irregular movements of the child only when the child grows and they become obvious. These infants and young children may keep the reflexes of a newborn and may delay their normal development of their age. Parents or supervisors are generally the first ones to notice the delay in the development of their child, which can be premature signs of CP.

In the severe forms of CP, there are signs present even from birth or immediately after. Still, some premature symptoms of severe CP are different depending on the specific type of illness present.

Signs of severe cerebral palsy that can be noticed immediately after birth include:

• Difficulties in sucking and swallowing.
• Poor or acute crying.
• Abnormal positions; either the body is very relaxed and soft or too stiff; when they are taken in the arms, babies can extend their back, arms and legs; these abnormal positions are different and a lot more severe than the ones that occur in babies with colic. – Visit this page!

Some issues related to CP may occur or become obvious with the child`s growth. They include:

• Muscle atrophy in the affected limbs. Nervous system damage leads to limiting the movement of the affected limbs. Their limitation affects the normal development of the muscles.
• Dental affections. Because of the pains that may occur when brushing teeth, the risk of caries and gingivitis may increase. The side effects of drugs taken when treating crisis may also contribute to the occurrence of gingivitis.
• Perceptions and abnormal sensations, as pain to an easy touch. Even the daily activities, like teeth brushing, may cause pain. Abnormal sensations might worsen the identification of common objects simply by touch; for instance, seeing the difference between a hard baseball ball and a soft soap bubble.
• Skin irritations. Abundant salivation is frequent when they are the facial and neck muscles are affected. Abundant salivation irritates the skin, especially the one around the mouth, chin and anterior chest.
• Trauma. There`s a risk of falling and other types of accidents, depending on the muscle control, joint mobility and overall muscle tone. Cerebral palsy-related crisis might also lead to accidental contusions.
• Chronic infections and illnesses. Severe cerebral palsy determines feeding difficulties. The inhalation of the food bowl in the lungs may increase the risk of pneumonia. Adults will always have a high risk of lung or heart damage.

Some children with cerebral palsy present a series of behavioral disorders, such as excessive drowsiness, decreased interest in the surrounding world and irritability.

Diagnosis

Diagnosis is difficult to establish during the first months of life. There are cases when diagnosis is evoked near the age of 2 years. For a proper diagnosis, it`s necessary to be excluded all the neurological, neurovegetative and muscle illnesses as well as mental retardation from other causes.

The doctor will follow the physical development of the child to detect a possible delay in development. Anamnesis will allow the doctor to find out more about the child`s history, risk factors (if they exist), some signs that can be noticed by the family, or eventual affections that the child has suffered or is currently suffering. The physical examination is useful in recognizing the signs of CP. The muscle functionality will be evaluated, and it will be noticed the presence of possible visual, auditory or behavioral disorders.

Among the investigations that can be recommended, there are: nuclear magnetic resonance, cerebral tomography, cerebral ultrasound, basal radiography (because of the high number of hip dislocation cases), ophthalmic investigation, intellectual level testing, electroencephalogram.

Prophylaxis

In some situations, the etiology of cerebral palsy is unknown. Still, a number of links were found between cerebral palsy and specific circumstances during pregnancy, labor and right after birth. Some of these circumstances can be prevented, while others cannot. – Click this link!

Cerebral palsy before and during pregnancy can be prevented by adopting and maintaining healthy habits:

• Consuming healthy foods.
• Avoiding smoking.
• Avoiding exposure to harmful substances.
• Medical checkup on a regular basis.

It`s also quite possible to prevent cerebral palsy in children by avoiding situation which may lead to brain damage:

• Taking measures to prevent accidents.
• Knowing the symptoms of mechanical jaundice.
• Avoiding contact with patients with serious contagious illnesses, like meningitis.
• Vaccination of children at the proper time.

Treatment

The treatment when it comes to CP is represented by the neuromotor reeducation: multiple stimulations will be achieved at the the kinestezico-postural and sensitio-sensorial level. The choice of this method will be made only after the diagnosis was properly determined and will be individualized for every child.

Medication treatment is addressed to the treatment of spasticity, using the following medications: chlorzoxazone, diazepam and baclofen.

The obtained results are still modest. The use of botulinum has been proven to be efficient in certain cases of spastic CP, the effects of which are potentiated by the association of kinetotherapy.

Orthopedic treatment will follow the correction of the deformations which cause dynamic and static imbalances.

Dorsal selective rhyzotomy will involve cutting the roots of the limbs` nerves which are most affected by involuntary movements.

The treatment of complications is especially addressed to epileptic seizures and involves antiepileptic drugs.

It`s essential to children with CP to be correctly guided in what involves professional and school training, taking into consideration the existence or not of mental retardation, associated writing or speech disorders.