CEREBRAL PALSY

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.

Spastic:
Hemiplegia:
Diplegia:
or
Quadriplegia:
and legs.

Upper motor neurone lesion.

UMNL of one side of body.
UMNL of all four limbs but legs more
than arms. May be symmetric
asymmetric.
Equal involvement of arms

Rigidity:

tone throughout range of movement.

Dyskinesia: Involuntary movements and changes in

muscle
tone. Damage to basal ganglia and
extraphyomides pathways.
Athetosis: Slow writhing movements of limbs.
Extension
and fanning of fingers and
extension of wrist.
Chorea:
limb

Quick jerky movements of trunk and prox,

muscles.

Paraplegia:

Legs involved only.

Double Hemiplegia:
Arms and
pseudobulbar

Bilateral UMNL.
legs. Also
palsy.

Monoplegia:

One Limb.

Cerebral Palsy Rates

Multiple births

7.5 / 1000 live births

Singletons

2.1 / 1000 live births

1500gr or less

80 / 1000

Types of Cerebral Palsy

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

Hypokinesia
Hyperkinesia

Dysequilibrium Syndrome
1.

Difficulty in maintaining an upright

position and in experiencing the
position of the body in space.

2.

Autosomal recessive.

CEREBRAL PALSY
1.
2.
3.
4.
5.
6.
7.

Hemiplegia.
Double Hemiplegia.
Diplegia (hypotonic, dystonic,
spasticity, ataxic).
Ataxia.
Dysequilibrium Syndrome.
Dyskinetic.
Mixed.

Of 229 children cerebral palsy at

1 year of age, more than were
free of motor handicap at 7 years.

COLLAB, Perinatal Project

Early Signs of Cerebral Palsy

1.

Birth History
a)
b)
c)
d)
e)

2.
3.

Prematurity.
Seizures.
Low apgars.
Intracranial haemorrhage.
Periventricular leucomalacia.

Delayed Milestones
Abnormal Motor Performance
a) Handedness.
b) Reptilian crawl.
c) Toe waking.

Early Signs of Cerebral Palsy

4.

Altered Tone.

5.

Persistence of primitive reflexes.

6.

Abnormal posturing.

Prenatal Associations with

Cerebral Palsy
Placental

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

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.

THROMBOPHILIA &
CEREBRAL PALSY
a)
b)

c)

d)

Thrombosis in placental circulation.

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

ANTENATAL
Maternal infection & cerebral palsy
a)

Maternal fever> 38oc +

Chorioamnionitis associated with
risk of cerebral palsy.

b)

Inflammatory markers in children

with cerebral palsy.

Cerebral Palsy
1.
2.
3.
4.
5.
6.

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 < 20 years - > 34 years.
4 children or >.

7.

Breach delivery.

Cerebral Palsy Associated

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

Common Management
Problems in Cerebral Palsy
1.

Feeding Problems:
Failure to suck.
Tongue trusting, gagging and choking.
Vomiting and regurgitation.

2.
3.
4.
5.
6.

Dribbling.
Constipation.
Crying, screaming and sleep disturbances.
Chilblains and cold injury.
Growth.

Treatment of Cerebral Palsy

1.
2.

3.
4.
5.
6.

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

Management of Spasticity in
Cerebral Palsy
1.

Oral Medicines:

Baclofen
Diazepam
Tizanidine
Dantrolene

Intrathecal Baclofen.
3. Botulinum Toxin.
4. Selective Posterior Rhizotomy.
2.

Botulinum Toxin
1.
2.
3.
4.

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.

Preventio
1.
2.
3.
4.
5.
6.

Antenatal and Neonatal care.

Early detection and advice.
Drugs.
Immunization and screening.
Genetic counselling.
Health education.