CEREBRAL PALSY

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CEREBRAL PALSY
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CEREBRAL PALSY

• Chronic disability of central nervous system
  origin characterised by aberrant control of
  movement of posture, appearing early in life and
  not the result of progressive neurological
  disease.

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Spastic Upper motor neurone lesion. Hemiplegia
UMNL of one side of body. Diplegia UMNL of
all four limbs but legs more than arms. May
be symmetric or asymmetric. Quadriplegia E
qual involvement of arms and legs.
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Rigidity ? tone throughout range of
movement. Dyskinesia Involuntary movements and
changes in muscle tone. Damage to basal
ganglia and extraphyomides pathways. Athetosi
s Slow writhing movements of limbs. Extension
and fanning of fingers and extension of
wrist. Chorea Quick jerky movements of trunk
and prox, limb muscles.
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Paraplegia Legs involved only. Double
Hemiplegia Bilateral UMNL. Arms and legs.
Also pseudobulbar palsy. Monoplegia One
Limb.
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Cerebral Palsy Rates
Multiple births 7.5 / 1000 live
births Singletons 2.1 / 1000 live
births 1500gr or less 80 / 1000
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Types of Cerebral Palsy

• Spastic Hemiplegia
• Diplegia
• Quadriplegia
• Ataxic
• Dyskinetic Dystonic Hypokinesia
• Hypertonia
• Chored-Athetoid Hyperkinesia
• Hypotonia

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Dysequilibrium Syndrome

1. Difficulty in maintaining an upright position and
   in experiencing the position of the body in
   space.
2. Autosomal recessive.

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CEREBRAL PALSY

1. Hemiplegia.
2. Double Hemiplegia.
3. Diplegia (hypotonic, dystonic, spasticity,
   ataxic).
4. Ataxia.
5. Dysequilibrium Syndrome.
6. Dyskinetic.
7. Mixed.

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Of 229 children ? cerebral palsy at 1 year of
age, more than ½ were free of motor handicap at 7
years. COLLAB, Perinatal Project
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Early Signs of Cerebral Palsy

• Birth History
• Prematurity.
• Seizures.
• Low apgars.
• Intracranial haemorrhage.
• Periventricular leucomalacia.
• Delayed Milestones
• Abnormal Motor Performance
• Handedness.
• Reptilian crawl.
• Toe waking.

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Early Signs of Cerebral Palsy

1. Altered Tone.
2. Persistence of primitive reflexes.
3. Abnormal posturing.

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Prenatal Associations with Cerebral Palsy

• Placental insufficiency.
• Brain malformation.
• Congenital infection.
• Chromosomal defects.
• Exposure to toxins.
• Abnormality of neuronal migration.

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PLACENTA

1. Correlation of placenta infarction or thrombosis
   with ischaemic lesions in the brains of babies
   who have suffered intrauterine or early neonatal
   deaths.
2. 11 / 15 placental slices from 15 patients with
   Cerebral Palsy contained thrombosis.

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THROMBOPHILIA CEREBRAL PALSY

1. Thrombosis in placental circulation.
2. Coagulation abnormalities in mother and foetus
   Factor V Leiden Mutation which is responsible for
   activated protein C resist (APCR).
3. Foetal and neonatal stroke have been reported in
   presence of maternal anticardiolipin antibodies.
4. 20 / 31 children with cerebral palsy had one or
   more disorders of coagulation in neonatal blood
   spot analysis.

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ANTENATAL

• Maternal infection cerebral palsy
• Maternal fevergt 38oc Chorioamnionitis
  associated with ? risk of cerebral palsy.
• ? Inflammatory markers in children with cerebral
  palsy.

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Cerebral Palsy

• Fall in incidence of Cerebral Palsy in low birth
  weight babies.
• ? in incidence in babies 2.5-4kg (2/3 of cases).
• Excess boys (C58).
• ?in incidence of dyskinetic cerebral palsy.
• ?in lowest socio-economic groups.
• Maternal age and parity.
• U shaped curve lt 20 years - gt 34 years.
• 4 children or gt.
• Breach delivery.

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Cerebral Palsy Associated Disabilities

• Mental retardation 1/3 N. 1/2 I.Q. lt 55.
• Epilepsy 20-50 gt generalised.
• Speech disorders 50 delay/dysarthria.
• Vision and hearing 25.
• Behaviour abnormalities.
• Learning difficulties.

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Common Management Problems in Cerebral Palsy

• Feeding Problems
• Failure to suck.
• Tongue trusting, gagging and choking.
• Vomiting and regurgitation.
• Dribbling.
• Constipation.
• Crying, screaming and sleep disturbances.
• Chilblains and cold injury.
• Growth.

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Treatment of Cerebral Palsy

• Parent guidance.
• Physiotherapy - Bobath method.
• Peto.
• Doman-Delacato.
• Orthopaedic.
• Speech and Occupational Therapy.
• Medical.
• Psychiatric.

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Management of Spasticity in Cerebral Palsy

• Oral Medicines Baclofen
• Diazepam
• Tizanidine
• Dantrolene
• Intrathecal Baclofen.
• Botulinum Toxin.
• Selective Posterior Rhizotomy.

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Botulinum Toxin

• Produced by bacterium clostridium Botulinum.
• Blocks release of Acetylcholine from cholinergic
  nerve terminals.
• Duration of effects, 3-4 months.
• Adverse effects muscle weakness.
• Allergic reaction rare.
• Autonomic Dysfunction.
• Occasional flu like symptoms.
• Antibody development.

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Preventio

1. Antenatal and Neonatal care.
2. Early detection and advice.
3. Drugs.
4. Immunization and screening.
5. Genetic counselling.
6. Health education.

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