Cerebral Palsy Definition , Types and Treatment

Mohammad Damseh

Definition

A group of permanent disorders of movement and posture causing activity limitation

Resulting from non-progressive lesions to the developing fetal or infant brain

Affecting mainly the motor centers; cerebral cortex , cerebellum , and basal ganglia

With frequent neurologic associations including:

• Mental retardation

• Epilepsy

• Impaired hearing ;deafness

• Impaired vision

• Emotional disturbances

• Behavioral disturbances

Risk factors

Pre-natal (80%)

• Antenatal Infections

• Congenital malformations

• Fetal asphyxia

Natal (10%)

• Birth asphyxia

• Birth trauma

Post-natal (10%)

• VLBW with intracranial hemorrhage

• Meningitis, encephalitis

• Metabolic e.g. phenyleketonuria

• Hypoglycemia

• Hyper bilirubinemia

• Hydrocephalus.

Types

Topographic classification

Clinical Types

Spastic cerebral palsy

Ataxic cerebral palsy

Extrapyramidal (dyskinetic,

asthetoid) cerebral palsy

Atonic cerebral palsy

Mixed cerebral palsy

Diagnosis

1. Clinical: A thorough history and physical examination should rule out a progressive disorder of the CNS,

including degenerative diseases, metabolic disorders, spinal cord tumor, or muscular dystrophy

2. Investigations: Value: Exclude progressive brain insults and may detect a cause or association

a. CT & MRI

May detect the cause e.g. brain malformations and spinal cord lesions

Rule out brain tumors & degenerative brain disease.

CT scan may be useful for detecting calcifications associated with congenital infections

b. TORCH screen.

c. Genetic evaluation

d. Metabolic screen.

e. For associations: Test for Hearing, Visual function , EEG for seizures

Treatment

Multidisciplinary approach is most helpful in the assessment and treatment of such children;

Assist: Feeding & defecation

Vision and hearing

Walking: Walkers, standing frames, motorized wheel chair

Communication by talking typewriters and special computers

Rehabilitation according to the degree of motor disability

Medications

1. Anti spastic drugs

Drug Action Side effect

Diazepam GABA agonist

Useful in short term relief of painful spasms

• Sedation

• Dependency

with long term

use

Baclofen GABA agonist and inhibit spinal neuronal

transmission

When used intrathecally, via a surgically

implanted continuous-delivery pump greater

efficacy with fewer adverse effects

• Sedation

Tizanidine Alpha-2 adrenergic receptor agonist and inhibit

spinal neuronal transmission

Useful in severely disabled by cerebral palsy and

in those with night-time spasms

• Sedation

Dantrolene Block calcium intake by skeletal muscles

decrease free intracellular calcium

• Hepatic

dysfunction

• Blood dyscrasia

2. Botox A: injection in spastic muscles and salivary glands to reduce drooling. It stops the release of acetylcholine at the synapse and blocks neurotransmission. The effects gradually wear

off (over about 3–6 months)

3. Levodopa: Small doses may be helpful for dystonia and rigidity

Surgery: For marked spasticity of the lower extremities surgical soft tissue procedures that reduce muscle spasm

e.g. adductor tenotomy or psoas transfer and rhizotomy

(roots of the spinal nerves are divided)

Thank you