Cerebral Palsy Disease

BASICS

DESCRIPTION

A term used to describe a group of patients with a non-progressive disorder of movement or posture that is a result of a central nervous system abnormality that occurred prenatally, perinatally, or during the first three years of life

System(s) affected: Nervous
Genetics: Although familial cases have been described, this is not considered a genetic disease
Incidence/Prevalence in USA: 2.1 per 1,000 live births
Predominant age: Because of the definition, this problem is restricted to life. The disease is lifelong, although changes occur as the patient matures.
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

By subtypes

Spastic
- Associated and significant spasticity
- Contractures
- Mental retardation
- Aphonia
- Seizures
Athetotic
- Usually normal intelligence
- Choreiform movements
- Muscular hypertrophy
Ataxic
- Clumsy disposition
- Normal intelligence
- Some are highly talkative (cocktail party syndrome)
Spastic diplegia
- Spares upper extremities
- Spastic (scissor gait)
- Normal intelligence

CAUSES

70% of the time, neither causes nor risk factors can be identified
In utero infections, malformations, chromosomal abnormalities and strokes are causes

RISK FACTORS

Prematurity
Hypoxic ischemia
Encephalopathy in the perinatal period
Seizures in the perinatal period
Interventricular hemorrhage in the perinatal period
In utero infections
Meningitis/encephalitis postnatally
Child abuse

DIAGNOSIS

LABORATORY

Laboratory data is not required to make the diagnosis.
Other tests may help exclude Tay-Sachs metachromatic leukodystrophy, mucopolysaccharidosis

Drugs that may alter lab results: None
Disorders that may alter lab results: None

PATHOLOGICAL FINDINGS

Central nervous system abnormalities: CT and MRI might show abnormalities of the brain including cysts, cerebral atrophy, calcification, tumors, malformation, strokes, etc.

SPECIAL TESTS

Urine amino acid screening

IMAGING

N/A

DIAGNOSTIC PROCEDURES

History and careful physical exam
EEG

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Physical therapy, occupational therapy, orthosis, adaptive equipment
Medications by mouth usually not very successful; side effects occur before beneficial effects are present
Alter muscle tone, assuming that the abnormal tone is adversely affecting function, by:
- Injection of botulinum toxin into the abnormal muscles
- Rhizotomy
- Continuous infusion of intrathecal baclofen

SURGICAL MEASURES

Tendon transfers, release of contractures, rhizotomy to decrease spasticity

ACTIVITY

Full activity depending upon the patient's dysfunction

DIET

Normal diet, although constipation is frequent and stool softeners might be considered

PATIENT EDUCATION

It is very important to educate the patient and parents about the child's disabilities as well as prognosis; mental retardation seen in 20-25% of patients with cerebral palsy.
United Cerebral Palsy Associations, 7 Penn Plaza, Suite 804, New York, NY 10001, (800)USA-1UCP

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Chronicity with permanent disability

EXPECTED COURSE AND PROGNOSIS

The patient should improve in function with time
Muscle tone may change for the worse during adolescence (does not mean that the disease is progressive)

MISCELLANEOUS

ASSOCIATED CONDITIONS

Epilepsy
Learning disabilities
Mental retardation
Behavioral problems
Strabismus
Hearing loss

AGE-RELATED FACTORS

Pediatric: Contractures will increase as a result of growth associated with asymmetrical muscle tone and strength. Scoliosis may develop as a result.
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.