Cerebral palsy is a neurological disorder that is characterized by damage or abnormal development that occurs in the brain early on in life. This condition affects body movements, posture, muscular tone and motor capabilities and can lead to loss of balance, lack of coordination, involuntary movement and even difficulty with speaking or walking. In some cases, it is associated with epilepsy, vision problems, hearing problems or intellectual disability.
Cerebral palsy can be caused by decreased oxygen to the brain during delivery, but it can also emerge due to a cerebral hemorrhage, genetic factors that lead to abnormal fetal brain development during pregnancy, or even maternal infections that affect the fetus.
How cerebral palsy presents in a patient depends on the region of the brain that is affected. This condition should be monitored on an ongoing basis by a doctor, pediatrician or neurologist, so that the most appropriate treatment is always delivered. Treatment typically consists of medication, physiotherapy and/or occupational therapy.
Main symptoms
The main symptoms of cerebral palsy are generally not observed following birth. They start to present in the first 2 or 3 years of the child’s life. Symptoms can be mild or severe, and can worsen or improve, all depending on the part of the brain that is affected.
The most common symptoms of cerebral palsy include:
- Developmental delays during infancy, like sitting, crawling or walking
- Muscular rigidity that it makes it hard to move the arms or legs
- Difficulty walking
- Lack of balance and motor coordination
- Tremors or involuntary movements
- Leg or arm weakness
- Difficulty chewing or eating
- Problems with swallowing and excess drooling
- Language delays or difficulty speaking
- Vision problems, blindness or abnormal eye movements
- Hard of hearing or deafness
- Intellectual or learning difficulties
- Growth delays
- Epilepsy
- Convulsions
- Difficulty breathing
- Excessive sensitivity when touched
- Bladder or intestinal problems, like incontinence or constipation
- Behaviors disturbances
It is important to consult your doctor if any of the above symptoms emerge, so that the child can be diagnosed and treatment can be initiated promptly.
Possible causes
Cerebral palsy is caused by the abnormal development of the brain during pregnancy, or by brain damage that can occur before, during or after birth.
The most common causes of cerebral palsy are:
- Genetic mutations that lead to brain malformations
- Maternal infections during pregnancy, like rubella, herpes, syphilis, toxoplasmosis or Zika
- Bleeding or intracranial hemorrhage while in-utero or after birth
- Fetal stroke
- Premature birth
- Lack of oxygen to the baby’s brain during birth
- Neonatal hypoglycemia
- Untreated newborn jaundice
- Neonatal infections like meningitis, sepsis, vasculitis or encephalitis
- Cranial trauma during infancy
In addition, there are other factors that can increase the risk for cerebral palsy, like multiple gestation, reduced intrauterine growth, drug abuse during pregnancy, pre-eclampsia, chorioamnionitis, placenta abnormalities or meconium aspiration.
How it’s diagnosed
Cerebral palsy is diagnosed by a pediatrician or neurologist through a physical exam and a thorough neurological exam. The doctor will review the presenting symptoms and order diagnostic imaging like MRI, brain ultrasound and an EEG to help located the part of the brain that is affected.
Other tests the doctor may order are bloodwork, urine tests and skin swabs to investigate for other genetic or metabolic abnormalities.
In addition, the doctor may refer the child to other specialists, like an ophthalmologist or otolaryngologist to rule out other conditions that may present similarly to cerebral palsy.
Types of cerebral palsy
There are different types of cerebral palsy that are classified by the part of the brain affected. They can cause abnormality or rigidity to specific muscle groups. The types of cerebral palsy include:
- Spastic cerebral palsy: This is the most common type of CP, as about 80% of cases are diagnosed as spastic. It is characterized by muscular rigidity and exaggerated reflexes that make the coordination of movements very difficult. Patients, for example, will experience difficulty with walking, crossing their legs or picking up objects.
- Hypotonic cerebral palsy: This type is characterized by decreased muscle tone or excessively relaxed and weakened muscles. Babies will often have difficulty lifting their head up and controlling head movements, leading to difficulty breathing, speaking and walking.
- Dyskinetic (athetoid) cerebral palsy: This type of CP affects the coordination of motor movements and can cause involuntary, slow, or quick spasm-like movements in the arms, legs and hands. It leads to difficulty walking or sitting, and in some cases, it additionally affects the face, tongue movements and swallowing.
- Ataxic cerebral palsy: This is the least common type of CP and is characterized by tremors and uncoordinated movements. Children often experience lack of balance, motor coordination, difficulty walking and difficulty with fine motor skills, like grabbing objects or writing.
Some children can present with a combination of different symptoms, and therefore are diagnosed with mixed cerebral palsy. The most common types of mixed cases involve both spastic and dyskinetic cerebral palsy.
How it is treated
Treatment of cerebral palsy if lifelong and chronically monitored by a doctor. Starting early can help the child to gain or develop skills and decrease the risk for complications, like deformed joints, respiratory problems or seizures.
The main treatments used for cerebral palsy are:
1. Medications
Medications prescribed by the doctor are aimed at reducing rigidity and muscular spasms, like oral muscle relaxants or botox injections in the muscles or nerves.
Botox can also be injected in the salivary glands to help with excessive saliva production and drooling.
2. Physiotherapy
Physiotherapy is done with exercises indicated by a registered physiotherapist. Treatment goals are to strengthen muscles and improve flexibility, balance and motor coordination. Some of these exercises can be done at home, as recommended by the physiotherapist.
In some cases, a physiotherapist can also help with speaking, eating and breathing.
3. Occupational therapy
Occupational therapy is a great option to increase quality of life and to help the child gain independence in their activities of daily living. Occupational therapists can help with activities like walking or eating in the home or school setting, for example.
During sessions, the therapist will help the child to use special equipment, like adapted cutlery, a walker or a power wheelchair.
4. Speech therapy
Speech therapy is indicated to improve the ability to speak to communicate through sign language. These therapists can also help with eating or swallowing difficulties.
5. Orthopedic surgery
Orthopedic surgery can be recommended to help with bone or joint deformities caused by muscular rigidity.
In addition, the orthopedic surgeon can help to relieve pain and improve muscular movements in affected regions.
