• The disease
• Diagnosis
• Treatment options

Definition

Cerebral palsy describes a group of “permanent disorders of the development of movement and posture, causing activity limitation, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behavior, by epilepsy and by secondary musculoskeletal problems.”¹

Symptoms and impact on health

The symptoms of cerebral palsy are different in each patient and can be a combination of motor, sensory and intellectual impairment. Generally observed from six months of age, the symptoms are:

• spasticity (excessively stiff muscles caused by involuntary hypertonia). When spasticity affects the legs, it causes a crouched position, a scissors-like gait with the feet extended and toes pointed downward, and poor balance. Spasticity can often be painful;
• very awkward positioning of the legs (W-sitting position), and favoring one side of the body;
• hypotonia (floppy muscles with difficulty holding the head up and sitting);
• reduced manual dexterity (problems eating, dressing, writing and holding objects);
• problems swallowing and speaking (dyspraxia);
• convergent strabismus (squint);
• muscular atrophy, slow or asymmetric growth;
• hypersensitivity to noise, or the opposite, impaired hearing;
• excessive fatigue;
• emotional immaturity and exaggerated reactions to situations;
• a degree of intellectual disability in some patients.

If the brain injury is non-progressive, the child’s growth and degree of spasticity can cause other symptoms to develop over time. These can include:

• bone deformities;
• joint problems caused by muscle contractions;
• posture conditions (spasticity of the adductor muscles with a high risk of hip dislocation).

Etiology of cerebral palsy

The most common causes are ischemic anoxia (reduced or no supply of blood to some parts of the brain, depriving the brain of oxygen) or cerebral hemorrhage, but many other factors may be involved that occur before, during and after birth and in infancy – generally up to the age of two:

• Before birth, the brain cells of the fetus can be destroyed by fetal stroke, a central nervous system malformation, placenta or umbilical cord complications. A mother’s toxic reaction to some medicines or drugs and maternal infections such as German measles, toxoplasmosis or cytomegalovirus can also cause irreversible fetal brain damage. The damage in prenatal cerebral palsy usually happens during early pregnancy and the cause is often unknown. Other factors associated with increased risk of cerebral palsy include low birth weight and premature birth. The prevalence of preterm and low birth weight is close to 8% per year.
• Birth factors that increase risk for normal term babies include complicated delivery or umbilical cord problems that cut the supply of blood to the brain.
• After birth, convulsions, accident, cardiac arrest or infection (such as meningitis or encephalitis) are factors associated with cerebral palsy.

Incidence

Cerebral palsy affects an average of 2 to 2.5 live births per 1,000 in industrialized countries, and 1.5 to 5.6 live births per 1,000 in developing countries².