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Cerebral Palsy

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  3. Cerebral Palsy

Overview of Cerebral Palsy

Cerebral palsy is a brain disorder present at the time of birth or after some external injury to the head. It mainly affects movements, posture or muscle tone.

Cerebral palsy (Dimaghi Falaj / فالج دماغی) defines as a brain disorder that affects the movement, muscle tone or posture. Its name denotes the meaning of disease which is cerebral refers to the brain's cerebrum and palsy refers to paralysis or a muscle disability.
Majorly, it starts on the area that is responsible for controlling the movement of muscles. But cerebral palsy can be caused by the immature development of the brain at the time of birth or damage to the brain in early life.

Prevalence of Cerebral Palsy

According to the current statistics, the prevalence rate of cerebral palsy is getting high in Pakistan. Every 4 out of 1000 children suffer from cerebral palsy in Pakistan. This is due to the lack of care of pregnant women against harmful diseases.

The symptoms of cerebral palsy depend on the severity of disease that ranges from mild to severe and specifically affects part of the brain. The symptoms vary from one person to another.

Signs and Symptoms of Cerebral Palsy

Following are the common signs of cerebral palsy:

  • Abnormal motor skill movements such as rolling over, sitting up alone, or crawling
  • Muscle tone variations such as being too floppy or too stiff
  • Have difficulty in speech and speaking
  • Spasticity, (stiff muscles and impaired reflexes)
  • Ataxia, (lack of muscle coordination)
  • Tremors or involuntary movements
  • Excessive problems with swallowing
  • Difficulty walking
  • Impaired movements on one side of the body, such as a problem with one hand.
  • Neurological problems, such as seizures, intellectual disabilities, and blindness

 

In children, cerebral palsy usually shows its signs and symptoms before they turn 3 or 4 ages.  Mostly this disorder is congenital but symptoms have been observed later.

Types of Cerebral Palsy

Doctors are classified the cerebral palsy according to the involvement of the specific area of the brain that can cause following movement disorders:

  • Muscle stiffness (spasticity)
  • Abnormal movements (dyskinesia)
  • Poor balance and coordination (ataxia)

On the basis of these disorders, it can be categorized into four main types, including:

  • Spastic Cerebral Palsy

Among all types, it is the most common type of cerebral palsy which affects about 80% of people.
People are suffering from spastic cerebral palsy have increased muscle tone. This leads to muscle stiffness, as a result of it, impairment of their body movements. Spastic cerebral palsy is further divided into three forms, depending on the affected parts of the body.

  • Spastic Diplegic Cerebral Palsy―This type results from muscle stiffness mainly in the legs, arms with less affected or not affected at all. Difficulty in walking because of stretching of hip and leg muscles.This molds the legs turn inward or cross at the knees known as scissoring.
  • Spastic Hemiplegic Cerebral Palsy ― In this type, cerebral palsy damages only one side of a person’s body. Typically, arms affect more than legs.
  • Spastic Quadriplegic Cerebral Palsy ―This type is the last and most severe form of spastic cerebral palsy. It affects all four limbs, the trunk, and the face. People with such disabilities cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

  • Dyskinetic Cerebral Palsy

It is associated with athetoid, choreoathetoid, and dystonic cerebral palsies. People with dyskinetic CP have difficulties controlling the movement of their hands, arms, feet and legs. This makes it difficult to sit and walk. Also have slow, rapid or jerky movements.

  • Ataxic Cerebral Palsy

Such types of cerebral palsy have balance and coordination problems.  People with ataxic cerebral palsy have quick, jerky or unsteady uncontrollable movements.  This makes it difficult for controlling hands or arms whenever they are trying to use it for multiple purposes.

  • Mixed Cerebral Palsy

Some people have more than one type of symptoms of cerebral palsy. It means they are showing multiple symptoms in which the most common is spastic-dyskinetic cerebral palsy.

Causes of Cerebral Palsy

Cerebral palsy is due to the disruption or abnormality in brain development. Most often it is more likely to be present during pregnancy.

Factors that increase the problem of brain development such as,

  • Gene mutations lead to the impaired brain development of children
  • Maternal infections affect the growth of the fetus
  • Fetal stroke, a damaging of blood supply to the developing brain
  • Bleeding into the brain in the womb or as a newborn
  • Infant infections that cause inflammation in or around the brain
  • A traumatic head injury to an infant from a motor vehicle accident or fall
  • Insufficient supply of oxygen to the brain may have difficulty in labour or delivery, although birth-related asphyxia is much less common.
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Risk Factors of Cerebral Palsy

Cerebral palsy is accompanied with the following factors that may increase the risk, includes:

  • Cerebral palsy during Women’s Maternal Period

If women have exposure to toxic agents or a variety of infections may increase the risk of babies include:

  • Cytomegalovirus develops flu-like symptoms and may cause potential birth defects during pregnancy.
  • German measles (rubella) is also a viral infection but can be reduced by a vaccine.
  • Herpes transfer from mother to child during pregnancy. This infection can also damage the brain of children.
  • Syphilis is a sexually transmitted bacterial infection that may increase cerebral palsy.
  • Toxoplasmosis is an infection caused by a parasite found in contaminated food, soil and the faeces of infected cats.
  • Zika virus infection during the maternal period becomes the head of a foetus larger than normal. This ultimately develops cerebral palsy.
  • Pregnant women are also prone to other conditions that include thyroid problems, intellectual disabilities or seizures, and exposure to toxins, such as methyl mercury.

  • Cerebral Palsy in Babies

Following conditions that can greatly stimulate the cerebral palsy includes:

  • Bacterial meningitis, inflammation of membranes around the brain and spinal cord.
  • Viral encephalitis, swelling of the brain.
  • Jaundice, severe or untreated jaundice may cause cerebral palsy.
  • Bleeding into the brain due to external injury or may have a chance of a stroke in the womb.

  • Other Risk factors of Pregnancy and Birth

Some other factors are also associated with increased risk of cerebral palsy include:

  • Low birth weight
  • Multiple babies
  • Premature birth

Health Complications of Cerebral Palsy

A variety of complications can be addressed with cerebral palsy during childhood or in adulthood including:

  • Contracture (loss of muscle tissue due to spasms)
  • Premature aging
  • Malnutrition
  • Mental health conditions
  • Heart and lung disease
  • Osteoarthritis
  • Osteopenia

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Prevention

Cerebral palsy can be reduced if people care about the following precautionary measures:

 

  • People should ensure that they are vaccinated against infectious disease.
  • During pregnancy, women should take care of themselves in order to minimize the risk of cerebral palsy.
  • Frequent prenatal care helps to prevent cerebral palsy.
  • Practice good children’s safety that prevents them from head injuries such as car seat belts, bicycle helmets, safety rails on beds and appropriate supervision.
  • Avoid alcohol, tobacco and illegal drugs.

 

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Diagnosis

A neurologist will diagnose cerebral palsy on the basis of medical history, physical examination and symptoms. Additional tests of the brain can also be conducted which are below:

  • An electroencephalogram (EEG) is used to check the functions of the brain whether the electrical activity of the brain works properly or not. It may be suggested when the patients may show the signs of epilepsy such as seizures.
  • An MRI scan is used to check the abnormality of the brain by creating a detailed image of it.
  • A CT scan also reveals a detailed, precise, or cross-sectional image of the brain for reviewing any damage.
  • A cranial ultrasound is conducted for young infants. It is a quick and easy method to check the basic images of the brain.
  • Blood tests are also performed to rule out other possible conditions, such as bleeding disorders.

Treatment of Cerebral Palsy | When to Consult a Doctor

The main aim of treatment is to improve the activity of the brain and prevent complications. Treatment may involve home remedies, assistive aids, medications, and surgery.

Home Remedies

There are a number of home remedies that prevent people from cerebral palsy which are as follows:

  • Ginger increases the circulation of blood to extremist regions and limbs, regrowth of tissues, and reduces inflammation, pain, and numbness.
  • Acupuncture is a therapy that focuses on key nerves and pressure points. It also improves flexibility and muscle control.
  • Echinacea controls the muscle and improves the blood circulation to the extremists.
  • Peppermint Essential Oil relieves the pain and inflammation along with cerebral palsy.
  • Apple Cider vinegar reduces muscle spasticity.
  • Fish oil contains omega-3-fatty acids that improve brain development and act as an anti-inflammatory agent. 
  • Epsom salt reduces pain and inflammation due to movement disorder.

Assistive Aids

A certain usage of medical tools that provides the assisting aids for the cerebral palsy treatment.

  • Eyeglasses
  • Hearing aids
  • Walking aids
  • Body braces
  • Wheelchairs

Medications

A neurologist commonly prescribes the oral anticonvulsants and muscle relaxants as first-line treatments for cerebral palsy. This includes:

  • Diazepam (Valium)
  • Dantrolene (Dantrium)
  • Baclofen
  • Tizanidine (Zanaflex)

Also, suggest the local injections that are administered by an implantable pump such as botulinum toxin type A (Botox) or intrathecal baclofen therapy.

Surgery

Orthopaedic surgery can be used for relieving the pain and improving mobility. It may also release muscle tightening or to treat the abnormalities caused by spasticity.

Selective dorsal rhizotomy (SDR) is another type of surgery that deals to reduce chronic pain or spasticity. It involves cutting nerves near the base of the spinal column.

Other Treatment

Other treatments that a neurologist may recommend along with medications and before or after surgery:

 

  • Speech therapy
  • Physical therapy
  • Occupational therapy
  • Recreational therapy
  • Counseling or psychotherapy
  • Social services consultations

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