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A Systematic Review on Etiology, Epidemiology, and Treatment of Cerebral

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Article  in  International Journal of Nutrition, Pharmacology, Neurological Diseases · October 2017

DOI: 10.4103/ijnpnd.ijnpnd_26_17

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Vol 7 / Issue 4 / October-December 2017
 Review Article

A Systematic Review on Etiology, Epidemiology, and

Treatment of Cerebral Palsy
Mahendra Rana, Jyoti Upadhyay, Amita Rana, Sumit Durgapal, Arvind Jantwal
Department of Pharmaceutical Sciences, Kumaun University, Campus Bhimtal, Bhimtal, Uttarakhand, India

Abstract
The most common physical disability in childhood is cerebral palsy (CP). It is difficult to assess and clarify the risk factors associated with this
disorder. The aim of this article is to review the recent literature relating to etiology, epidemiology, and advances in the treatment of CP. A
systematic search for peer-reviewed articles with keywords “cerebral palsy” and “neurodisability” since 1980 was performed. An
investigational research on CP offers an excellent opportunity in understanding the risk factors associated with this disorder as well as
its incidences and prevalence. Various new techniques have evolved in the management of CP, such as traditional physiotherapy, occupational
therapy, selective dorsal rhizotomy, sensory integration, botulinum toxin injection, and intrathecal baclofen. The care and management of CP
in an individual is a very complex process. Although a number of therapeutic interventions have been used by healthcare professionals, but the
efficacy of only few has been established by scientific research. To prevent the chances of CP, we need to understand the causes as well as risk
factors associated with this disorder.

Keywords: Cerebral palsy, diplegia, hemiplegia, quadriplegia, spasticity

INTRODUCTION (1) body movement or posture disorder, (2) static abnormality

Cerebral palsy (CP) is a heterogenous permanent neurological
disorder caused by nonprogressive damage to the developing
brain. We all know that brain controls all the functions of our
body like muscle movement. In this disorder, injury or
malformation occurs in the growing central nervous system
that affects the development of motor function and body posture
before, during, or shortly after birth.[1] The term “Cerebral”
refers to the brain and “Palsy” means lack of control in muscles.
The problem associated with CP in children involves muscle
weakness, shakiness, balance problems, and slow response,
with symptoms ranging from mild to severe. In the case of
mild CP, the child may be heavy handed in one arm to some
extent, and this problem may be barely noticeable, whereas
in severe CP, the child may have difficulties in performing
daily activities and maintaining movement, posture, and
neuromuscular control, resulting in epilepsy, osteoporosis,
and dysphagia.[2] The prevalence of CP occurs in 2.5% per
1000 live births globally, and this abnormality varies with
its involvement distribution like hemiplegia and diplegia,
and changes with age and surgery.[3,4] The exact definition
of CP depends upon three common characteristics, which are
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in the brain, and (3) acquired brain disorder (early in life).
However, these characteristics do not specify (1) the severity of
the movement disorders, (2) the static nature of the cerebral
abnormality, (3) age at which the abnormality occurs, and (4)
age before which CP was not detected. Postneonatal and
nonpostneonatal are the two widest distinctions in age of
acquiring cerebral abnormality.[5]
CLASSIFICATION OF CEREBRAL PALSY
The topographic classification of CP involves (1) quadriplegia,
(2) hemiplegia, (3) diplegia, (4) monoplegia, and (5) triplegia.
Monoplegia and triplegia are uncommon as there is substantial
overlap of the affected areas. The most common form of
CP in most of the studies is diplegia, which is the most
prevalent form (30–40%), followed by hemiplegia (20–30%)
Address for correspondence: Research Scholar, Jyoti Upadhyay, Department
of Pharmaceutical Sciences, Kumaun University, Campus Bhimtal, Bhimtal,
Uttarakhand, India.
E-mail: jyotsna_pharma07@yahoo.co.in
This is an open access article distributed under the terms of the Creative Commons
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tweak, and build upon the work noncommercially, as long as the author is
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For reprints contact: reprints@medknow.com

How to cite this article: Rana M, Upadhyay J, Rana A, Durgapal S,

DOI: Jantwal A. A Systematic Review on Etiology, Epidemiology, and
10.4103/ijnpnd.ijnpnd_26_17 Treatment of Cerebral Palsy. Int J Nutr Pharmacol Neurol Dis
2017;7:76-83.

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 Rana, et al.: Review on cerebral palsy

and quadriplegia (10–15%). A study of CP of 1000 cases
from India shows the highest percentage of cases with
spastic quadriplegia (61%) followed by diplegia (22%).[6]
Quadriplegic cerebral palsy
It is the most severe form and includes all four limbs;
upper limbs are more severely affected than the lower limbs,
related with acute hypoxic intrapartum asphyxia. Excessive
cystic degeneration of the brain, which is polycystic
encephalomalacia, polyporencephalon, and developmental
abnormalities (such as polymicrogyria and schizencephaly),
is often revealed by neuroimaging. Very few voluntary
movements are observed. Pseudobulbar signs are detected in
most children with recurrent aspiration of food material and
difficulty in swallowing. Optic atrophy and seizures are
also observed in half of the patients. Severe intellectual
abnormality is reported in most of the cases.[7]
Hemiplegic cerebral palsy
It is spastic unilateral hemiparesis wherein upper limbs are
affected more severely than the lower limbs. It is commonly
observed in term infants (56%) and preterm infants (17%).
It has multifactorial pathogenesis. Impaired voluntary
movements are observed mostly affecting hand functions.
Other functions affected are pincer grasp of thumb, supination
of the forearm, and extension of the wrist. Dorsiflexion and
aversion of foot are severely impaired in the lower limb.
Flexor tone is increased with hemiparetic posture. Affected
limbs also have sensory abnormalities. Seizures occur in
most children (>50%). Most common facial nerve palsies
are visual field defects, cranial nerve abnormalities, and
homonymous hemianopia.[7]
Diplegic cerebral palsy
Prematurity and low birth weight are risk factors for spastic
diplegia. Neuroimaging study reveals cystic periventricular
leukomalacia (PVL). The most common ischemic brain
injury is PVL in premature infants. This ischemia occurs
in the white matter adjacent to the lateral ventricles.[7,8]
Monoplegic cerebral palsy
It is a form of paralysis affecting only one limb. Sometimes,
the paralysis is limited only to a single muscle affecting body
functions. Monoplegic people are able to take care of
themselves. They perform their daily activities.[8]
Triplegic cerebral palsy
It is a form of paralysis involving three limbs, that is, paralysis
on one side of the body and of an arm or leg on the opposite
side.[8,9]
Based on the types of neuromuscular defects, CP is
also classified as (1) spastic, (2) dyskinetic (including
choreoathetoid and dystonic), (3) ataxic, (4) hypotonic, and
(5) mixed. The most common CP is spastic CP (70–75%),
followed by dyskinetic (10–15%) and then ataxic (less than
5% of cases).[8]
The CP disorder was classified according to Gross Motor
Function Classification (GMFCS) and internationally used for
research and clinical purposes. Researchers and therapist classify
the severity of CP using terms such as “mild,” “moderate,” and
“severe.” These classifications help validate the use of Gross
Motor Function Measure and evaluate children’s motor function.
This classification system has been extensively used and
internationally adopted. The major challenges for researchers
and clinicians in the classification of CP include generating and
validating similar classification for conditions like autism and
mental retardation.[9]
Another classification of CP called differential
classification is based on etiology, pathology, and
clinical description. Classification of CP depends upon
distribution and severity of motor impairments and
related (nonmotor) impairments. As some of the
terminologies are interpreted differently by clinicians
from different disciplines, poor reliability of these
classification systems often ensues.[5]
ETIOLOGY
The etiology behind CP in infants remains unknown.
Complications like low birth weight, birth asphyxia,
premature separation of placenta, and abnormal fetal
position were associated with this disease. The associated
etiology for CP is given in Table 1. If a mother or infant
suffer from any of these associated conditions, it does not
mean this will result in CP, rather it means higher prevalence
of CP.[10]

Table 1: Known etiology of cerebral palsy

S. No. Etiology References
1. Antenatal Causes Congenital brain malformations, and malformations of cortical developmentVascular events [11–14]
like middle cerebral artery occlusion Maternal infections during the first and second trimester of pregnancy
like rubella, cytomegalovirus, and toxoplasmosis. Metabolic disorders, maternal ingestion of toxins, and genetic syndromes
2. Perinatal care (during labor and delivery) Obstructed labor, cord prolapsed, antepartum hemorrhage causing [15]
hypoxia. Metabolic acidosis in fetal scalp (pH<7). Neonatal encephalopathy in infants (>34 weeks gestation)
results in cerebral palsy of Quadriplegic or dyskinetic type
3. Neonatal problems Severe hypoglycemia, jaundice, and neonatal infection [16]
4. Postneonatally acquired conditions Surgery for congenital malformations, Meningitis, septicemia, and other [16]
conditions like malaria

International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 7 ¦ Issue 4 ¦ October-December 2017 77
 Rana, et al.: Review on cerebral palsy

Several risk factors play a major role in the pathogenesis of
CP and may be present before or after pregnancy, during
labor, and shortly after birth of the baby.[16] It is essential for
us to distinguish between risk factors, associations, and
known etiology of CP. It was found in some cases that not
a single event, but a series of events, is responsible for the
damage of motor nerves which finally results in this
condition.[17] The risk factors associated with CP are given
in Table 2.
Epidemiological studies on the possible risk factors
associated with cerebral palsy
A study at University of California, San Francisco, and Kaiser
Permanente Division of Research, Oakland, California, shows
the association between chorioamniontis and high risk of CP
that was determined in term and near-term infants, and 109
children with CP were observed as compared to 218 controls.
Forty percent of the cases were hemiparetic, and 38% were
quadriparetic. Most common findings related to CP were white
matter abnormalities, atrophy, and hypoxic–ischemic injury.
Diagnosis of chorioamnionitis or endometritis was done
clinically and 14% of cases were observed as compared to
4% of controls. Other risk factors associated with CP are
maternal fever, maternal age more than 25 years, intrauterine
growth restriction, prolonged rupture of membranes, and
nulliparity.[38]
In some studies, investigation on the relationship between
birth asphyxia and spastic CP was done, and data on children
born with spastic CP (N = 183) were compared with matched
group of control children (N = 549) in Western Australia
between 1975 and 1980. Epidemiological methods were used
for collecting information on perinatal events for both CP
children and control group. It was found that there is a relation
between clinically observed signs of birth asphyxia and
spastic CP, and in only about 8% cases (15/183) of all the
children with spastic CP, the possible cause of brain injury
was intrapartum asphyxia.[39]
Another study compared a 3-day course of dexamethasone
(N = 132) treatment with a control group given saline placebo
(N = 116), administered shortly after birth, that is, from

Table 2: Cerebral palsy associated risk factors

S. No. Risk factors References
1. Before pregnancy i.e. maternal factors
Delay in menstrual cycle, irregular menstruation or long intermenstrual intervals [18]
Unusual long or short intervals between pregnancies [18,19]
Low social class [20,21]
Maternal medical conditions like intellectual disability, epilepsy, and thyroid disorders [22,23]
2. During pregnancy
Preeclampsia (results in preterm births) [24]
Maternal trauma in pregnancy [25]
Mother taking thyroid hormone or other estrogen during pregnancy [26]
Antepartum hemorrhage [27]
Multiple pregnancies [27]
3. During labor
A cause of perinatal asphyxia includes prolapsed cord, massive intrapartum hemorrhage, traumatic, [27]
or prolonged delivery due to cephalopelvic disproportion
Prolonged second stage of labor and ceserian section in emergency [28]
Premature separation of the placenta, abnormal fetal position [18]
Intrauterine exposure to infection like chorioamnionitis, in the latter stages of pregnancy and during labor [29–32]
Prolonged rupture of the membranes in infants of all gestation [26]
Presence of meconium-stained fluid [32]
Tight nuchal cord [33]

4. At birth
Premature children, decrease in length of gestation [27]
Low placental weight [18]
Low Apgar scores children with scores 0 to 3 at 5 min had an 81-fold increased risk of cerebral palsy [34,35]
5. Newborn period
Neonatal seizures [18,28]
Sepsis [36]
Respiratory disease [28]
Patient ductus arteriosus, hypotension, blood transfusion, prolonged ventilation, pneumothorax, sepsis, [37]
hyponatremia, total parenteral nutrition, seizures, and parenchymal damage with appreciable ventricular
dilatation detected by cerebral ultrasound
Neonatal seizures [18,37]

78 International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 7 ¦ Issue 4 ¦ October-December 2017
 Rana, et al.: Review on cerebral palsy
before 12 h of age in preterm infants ventilated for respiratory
distress syndrome. It was found that administration of
dexamethasone in the early stages of postnatal period
associated with high risk of CP and developmental delay.[40]
PREVALENCE OF CEREBRAL PALSY
Epidemiological studies on the prevalence of cerebral
palsy
According to a study on the prevalence of CP and CP
subtypes among children in three areas of the United
States, a multisite collaboration shows that the average
prevalence of CP was 3.6 cases per 1000. The CP cases in
Wisconsin were 3.3 cases per 1000, Alabama 3.7 cases per
1000, and Georgia 3.8 cases per 1000. The prevalent cases of
CP were highest in boys and black non-Hispanic children as
compared to girls and Hispanic children. It was also found
that prevalence among children living in low and middle-
income neighborhoods was higher in comparison with high-
income neighborhoods. The most common subtype of CP
among 77% of all cases was spastic CP; bilateral spastic CP
was the most common type (70%) in the spastic group. These
findings added new knowledge in the epidemiological study
of CP.[41]
A study determined the birth-weight-specific trends in the
prevalence of CP. This study shows a modest increase in the
prevalence pattern of congenital CP from 1.7 to 2.0 per 1000
during the period from 1975 to 1991. The proportion of
children having CP increased in normal birth weight
infants from 17% in 1975 to 1977 to 39% in 1986 to
1991. Children weighing <1500 g, cases of spastic
diplegic CP in these children were also increased overtime,
that is, in the year 1975 to 1977 it was 7%, whereas 36% cases
in the year 1985 to 1988 and 32% in the year 1986 to 1991.
Low and very low birth weight infants show similar trends,
whereas increase was seen in normal birth weight infant
survivors.[38] A prospective descriptive study determining
the impact of health-related quality of life of CP patients
in their lives and families shows 11.1% patient’s quality of
life was affected severely, 25.9% moderately, and 37%
mildly. Future studies can be done for measuring the
dynamics of this condition and also its influence on the
relationship between CP subtypes and quality of life.[42]
A report provides information regarding the prevalence of CP
and its severity of the disability or comorbidity in England
and Scotland. The result of this report shows a total of
798,411 live births in between 1984 and 1989, with
neonatal deaths 3651 (i.e., neonatal mortality 4.6 per 1000
live births), and cases of CP were 1649, showing prevalence
of 2.1 per 1000 neonatal survivors, specified birth-weight-
related CP prevalence from 1.1 per 1000 neonatal survivors.
No significant time trends in CP prevalence were observed in
any of the birth weight groups. As every one in five children
with CP suffers from severe multiple disabilities, the social
and clinical impacts must be addressed to provide continuous
care for these children.[43]
International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 7 ¦ Issue 4 ¦ October-December 2017
An epidemiological study of patients with CP determines the
demographical as well as clinical features of patients with CP
attending various outpatient and inpatient clinics. This study
included total 130 children. The known etiological risk
factors for CP were bleeding and threatened miscarriages
in prenatal period, birth asphyxia, premature baby and low
birth weight in the perinatal period, convulsions, and
hyperbilirubinemia in the postnatal period. Types of CP
included spastic quadriplegic, spastic diplegic, dyskinetic,
spastic hemiplegic, mixed type, and hypotonic or ataxic.
Spastic quadriplegic was the most prevalent subtype of CP
among children.[44]
A study in Norway showed prevalence, subtypes, and severity
of CP. A total of 374 children born with CP were registered in
the Cerebral Palsy Registry of Norway from January 1996 to
December 1998. This study shows the prevalence of CP 2.1
per 1000 live births. The percentage of subtypes of CP was
spastic unilateral CP 33%, spastic bilateral 49%, dyskinetic
6%, ataxic 5%, and others 7% (not classified). A total of 5%
of impaired vision and 4% of hearing impairment cases were
present and also 31% of mental retardation, 28% of active
epilepsy, and 28% of no speech cases were found in children.
Children with low Apgar scores show severe impairment in
gross motor function, and children who had born in term, with
normal birth weight and low Apgar scores, show severe
impairment in fine motor function.[45]
Another study shows the risk factors for CP were very low
birth weight (VLBW), that is, babies born, weighing
<1500 g, from multiple pregnancies than in infants having
normal birth weight. A total of 1575 infants having VLBW
are born with CP; out of which, 414 (26%) infants have birth
low weight (less than 1000 g) and 317 (20%) were from
multiple pregnancies. CP subtypes included spastic CP 1426
(94%) which was unilateral, that is, hemiplegic in 336 (24%).
Decline in the prevalence of birth of VLBW infants was
reduced from 60.6 per 1000 live born in the year 1980 to 39.5
per 1000 in 1996. This decline was due to reduction in the
frequency of bilateral spastic CP among infants weighing
1000 to 1499 g at the time of birth. In the group of birth weight
between 1000 and 1499 g, the frequency of CP was found
higher in male babies as compared to female babies. This
population-based study provides evidence that the prevalence
of CP in infants of birth weight less 1500 g has fallen,
especially of bilateral spastic CP, and has implications for
parents and healthcare services.[46]
A pilot study in 53 Indian children with CP shows their oral
health status and investigated various dental problems like
dental caries, plaque index, malocclusion, and drooling. A
comparative study was done with the control group of same
age and sex of matched normal children. The result of this
study shows a significant difference between cases and
controls for caries. It was found that maximum cases were
in the age group of 6 to 8 years and quadriplegic and diaplegic
cases were highest among these children. Also one of the
significant findings of this study shows that those children
79
 Rana, et al.: Review on cerebral palsy
who were affected with drooling were not affected with dental
carries.[47] A study in India shows trends of CP. This study
was conducted in Rajasthan, India. Diagnosed cases of spastic
CP were observed from year 2010 to 2014. A total of 240
children were included in this study; the male-to-female ratio
was found to be 2.3:1. Among these children, the cases of
diplegic CP were found maximum, that is, 52.92% followed
by quadriplegic CP which is 27.50 and 12.50% cases have
hemiplegic pattern. The most commonly associated dental
problem was drooling. Prenatal asphyxia was found to be
major cause of CP.[48]
Subtypes of CP were studied using 2-deoxy-2(18F)fluoro-d-
glucose (FDG) and positron emission tomography (PET) in
23 children. The subtypes of CP included spastic quadriparesis
(N = 6), spastic diplegia (N = 4), infantile hemiplegia (N = 8),
and choreoathetosis (N = 5). Computed tomography or
magnetic resonance imaging was used for correlating the
FDG–PET images. In spastic diplegic patients, PET shows
focal areas of cortical hypometabolism, in which apparent
structural abnormality was absent, whereas in choreoathetoid
CP, normal pattern of cortical metabolism was observed instead
of hypometabolism in thalamus and nucleus of lenticular cells.
Symmetric cerebellar glucose metabolism with absence of
crossed cellular hypometabolism (diaschisis), FDT–PET
revealed symmetric cerebellar glucose metabolism in
patients with infantile hemiplegia. FDG–PET may be useful
in identifying CP patients.[49]
TREATMENT OF CEREBRAL PALSY
Diagnosis of cerebral palsy
CP diagnosed on the basis of clinical assessment. CP is a
permanent disorder of movement and posture development
that causes limitations in the activity, characterized by
nonprogressive disturbances occurring on the developing
brain of infant. This impairment in the movement and posture
due to brain disorder is the invariant clinical manifestations.[50]
The GMFCS used by some researchers to include or exclude the
cases of CP without functional impairment, in the Western
Australian Cerebral Palsy Register. This register grades the
severity of the cases. The diagnosis of CP, in clinical practice,
is generally based on observations of symptoms like sitting,
walking, pulling to stand evaluation of postures, deep tendon
reflexes, and muscle tone. In premature infants, neurological
abnormalities observed in early months may resolve during the
first 1 or 2 years of life. Such abnormality may or may not be
associated with motor impairment; one of these abnormalities
is transient dystonia, an abnormal neurological syndrome
(e.g., hyperextension of the trunk) resolves after 1 year of age.
Severe CP can be seen in infants within first 12 months of birth.
The baby shows slow motor movement, floppy muscle tone, and
abnormal body posture. The diagnosis of CP is also based upon
its classification according to the nature of the movement
disorder, that is, spasticity, ataxia, dystonia, and athetosis and
also according to the topographic distribution of the motor
abnormalities. Spasticity is the most predominant abnormality
present among premature infants and analyzed clinically.
80 International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 7 ¦ Issue 4 ¦ October-December 2017
In this condition, increased muscle tone is encountered at
the joint angle. Dystonia is also referred to as hypertonia
and decrease in the activity, whereas choreoathetosis is an
involuntary irregular spasmodic movement of the limbs or
facial muscles. Loss of order of muscle coordination occurs in
ataxic CP.[51]
Role of brain imaging
Magnetic resonance imaging provides information about
the adverse events timing, like cortical dysplasia’s date
during early pregnancy, that is, from 12th to 20th week
gestation, per ventricular leukomalacia between 28th and
34th week.[52]
Treatment
CP cannot be cured. As a result, various therapeutic
interventions with interdisciplinary approaches have been
used to manage CP. The main objective is to use a
combination of physical, developmental, medical, chemical,
surgical, and technical procedures to treat patients. These
procedures assist in preventing secondary impairments and
improving child’s developmental capabilities.[53] Traditional
physiotherapy and occupational therapy are broadly used
measures and have shown benefit in the treatment of CP.
These therapeutic measures are found highly effective in
improving the functional capabilities of the children with
CP.[54] For the treatment of inadequate muscle growth, the
following methods are used, that is, passive stretch, physical
therapy, botulinum toxin injections, phenol injections,
orthopedic surgeries, and spasticity reduction. For the
treatment of spasticity, selective dorsal rhizotomy (SDR)
may be employed, whereas for mixed patterns and
spasticity, selection criteria of SDR respond to intrathecal
baclofen (ITB).[53]
Traditional physiotherapy
It improves muscle strength, joint movement, and tolerance
to muscular movements. Traditional physiotherapy is a
routinely used interdisciplinary treatment approach for
school going children as it fulfills the requirement of
cooperation and active participation of these children with
CP. Progressive resistance training program can help in
progressively improving muscular strength. For improving
joint mobility, a range of motion exercises are carried out by
physical therapists. Static and gentle stretches are performed
on the patient joint for preventing joint contractions. Such
stretches performed within a pain-free joint range of
movement. A group of healthcare providers, including
physical therapist, orthopedic surgeons, and orthotist, helps
in designing and implementing exercises, which improves
posture, balance control, gait, and mobility.[54]
Physical/occupational therapy
The goal of this therapy is to improve infant–caregiver
interaction, providing family support, parental education,
and supplying resources. This therapy also promotes
 Rana, et al.: Review on cerebral palsy
developmental skills which are essential in performing
daily activities. These include self-care activities like
grooming, dressing, feeding, and fine motor tasks (like
painting and writing). Occupational therapy also directed
cognitive and noncognitive disabilities, particularly in the
visual motor area and adjustment of apparatus and seating to
improve upper extremity use and to develop functional
independence. Some therapists use specialized techniques
like neurodevelopmental treatment and sensory integration
for achieving these goals, which are given below.
Neurodevelopmental treatment
In 1940, Berta and Karl Bobath developed this method of
treatment. The treatment approach is based on their personal
observations from working with CP children. The main
objective of this treatment is to facilitate the normal motor
development and prevention of development of secondary
impairments caused by muscle contractions and limb
deformities.[55,56]
Sensory integration
The theory of this treatment was developed by A. Jean
Ayres in 1970. This occupational therapy develops
treatment pathway for children with CP having sensory
processing difficulties. This model was designed to treat
learning disabilities. The main hypothesis of this therapy
is to develop and execute normal adaptive behavioral
response and to improve functional capabilities like ability
of the child to perform and integrate sensory network,
including visual, auditory, perceptual, and others. Sensory
integration disorders include sensory modulation, sensory
discrimination, and motor disorders (sensory based).[54,57]
Oral muscle relaxants
Diazepam, Baclofen, and dantrolene are muscle relaxants
used in the cases of CP, but their use is limited because of
the side effects caused by them like lethargy, impaired
cognitive skills, and others when given orally. They also
have poor bioavailability because of their low lipid
solubility.[53]
Selective dorsal rhizotomy
This neurosurgical operation includes laminoplasty of from
L1 to S1 of the dorsal nerve roots. The inclusion criteria of
patients for this operation includes spasticity, selective
motor control, children aged 4 to 7 years, and spastic
diplegia CP. Children who undergo this operation also
need orthopedic surgery after this. The ideal age for
lower limb surgery is between 4 and 6 years, and 6 to 8
years for upper limb surgery.[53]
Intrathecal baclofen
A microprocessor-controlled pump containing small
quantities of Baclofen administered into the subarachnoid
space. It is used in severe spastic quadriplegia. This drug is
International Journal of Nutrition, Pharmacology, Neurological Diseases ¦ Volume 7 ¦ Issue 4 ¦ October-December 2017
very expensive and causes life-threatening complications, for
example, neurological injuries due to dislodgement of
catheter tip. Both SDR and ITB act on lower limbs.[53]
Phenol injection
Neurolytic injection of phenol is used for motor nerves like
obturator nerve and musculocutaneous nerve. This phenol
injection is rarely used because of the availability of
botulinum toxin.[58]
Botulinum toxin injection
This injection causes a reversible chemodenervation of
muscle, which is dose dependent. It is ineffective in the
case of lever arm disease. This treatment is useful in
patients who are hypertonic either spastic or dystonic.[59]
Antenatal magnesium sulfate
Administration of antenatal magnesium sulfate alone can
prevent all cases of this illness in preterm infants. This
drug could be used for the prevention of CP in preterm
infants less than 34 weeks of gestational age.[60]
Orthosis
Newer light weight, made up of thermoplastic materials used
below the knees. Articulated ankle foot orthosis and ground
reaction articulated ankle foot orthosis are preferred over
solid articulated ankle foot orthosis in case of ambulatory
children.[61]
Hippotherapy
Also called as horseback riding therapy, it improves gross
motor function like tone, strength, balance, coordination, and
others in CP children. This therapy reduces the degree of
motor disability.[62]
CONCLUSION
CP is a group of nonprogressive disorders affecting body
movement and posture. This condition is permanent and
occurs during fetal development or infancy. Different
treatment options are available for patients with CP. In this
review paper, we summarize the risk factors associated
CP, epidemiology as well as recent advances in its
treatment. The major risk factor for CP is preterm birth,
and this risk increases with decreasing gestational age.
Better prenatal care and nutrition might reduce the chances
of CP in children. A multidisciplinary, comprehensive, and
coordinated approach is needed in the care of children with
CP. Recent advances in the management of CP have
increased. Implementation of new techniques like SDR,
ITB, and sensory integration helps in the treatment of CP.
Traditional physiotherapy and occupational therapy helps
reduce spasticity. To minimize the cases of CP in children,
additional research is required in understanding the etiology
of CP.
81
 Rana, et al.: Review on cerebral palsy
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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