Cerebal Palsy

Definition

Cerebral palsy is a disorder of movement, muscle tone or posture that is caused by an insult to the immature, developing brain, most often before birth.

Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteadiness of walking, or some combination of these.

People with cerebral palsy may have difficulty with swallowing and commonly have eye muscle imbalance. People with cerebral palsy may have reduced range of motion at various joints of their bodies due to muscle stiffness.

The effect of cerebral palsy on functional abilities varies greatly. Some people are able to walk while others aren't able to walk. Some people show normal to near normal intellectual function, but others may have intellectual disabilities. Epilepsy, blindness or deafness also may be present.

People with cerebral palsy often have underlying developmental brain abnormalities.

Symptoms

Signs and symptoms can vary greatly. Movement and coordination problems associated with cerebral palsy may include:

• Variations in muscle tone, such as being either too stiff or too floppy
• Stiff muscles and exaggerated reflexes (spasticity)
• Stiff muscles with normal reflexes (rigidity)
• Lack of muscle coordination (ataxia)
• Tremors or involuntary movements
• Slow, writhing movements (athetosis)
• Delays in reaching motor skills milestones, such as pushing up on arms, sitting up alone or crawling
• Favoring one side of the body, such as reaching with only one hand or dragging a leg while crawling
• Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing or a wide gait
• Excessive drooling or problems with swallowing
• Difficulty with sucking or eating
• Delays in speech development or difficulty speaking
• Difficulty with precise motions, such as picking up a crayon or spoon

The disability associated with cerebral palsy may be limited primarily to one limb or one side of the body, or it may affect the whole body. The brain disorder causing cerebral palsy doesn't change with time, so the symptoms usually don't worsen with age, although the shortening of muscles and muscle rigidity may worsen if not treated aggressively.

Other neurological problems

Brain abnormalities associated with cerebral palsy also may contribute to other neurological problems. People with cerebral palsy may also have:

• Difficulty with vision and hearing
• Intellectual disabilities
• Seizures
• Abnormal touch or pain perceptions
• Oral diseases
• Mental health (psychiatric) conditions
• Urinary incontinence

When to see a doctor

It's important to get a prompt diagnosis for any movement disorder or possible delays in your child's development. See your child's doctor if you have any questions or concerns about muscle tone, muscle movement, coordination or other developmental issues.

Causes

Cerebral palsy is caused by an abnormality or disruption in brain development, usually before a child is born. In many cases, the exact trigger of this abnormality isn't known. Factors that may lead to problems with brain development include:

• Random mutations in genes that control brain development.
• Maternal infections that affect the developing fetus.
• Fetal stroke, a disruption of blood supply to the developing brain.
• Lack of oxygen to the brain (asphyxia) related to difficult labor or delivery. This is rarely a cause.
• Infant infections that cause inflammation in or around the brain.
• Traumatic head injury to an infant from a motor vehicle accident or fall.

Risk Factors

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or health problems during pregnancy can significantly increase the risk of giving birth to a baby with cerebral palsy. Infections of particular concern include:

• German measles (rubella). Rubella is a viral infection that can cause serious birth defects. It can be prevented with a vaccine.
• Chickenpox (varicella). Chickenpox is a contagious viral infection that causes itching and rashes, and it can cause pregnancy complications. It can be prevented with a vaccine.
• Cytomegalovirus. Cytomegalovirus is a common virus that causes flu-like symptoms and may lead to birth defects if a mother experiences her first active infection during pregnancy.
• Toxoplasmosis. Toxoplasmosis is a parasitic infection caused by a parasite found in contaminated food, soil and the feces of infected cats.
• Syphilis. Syphilis is a sexually transmitted bacterial infection.
• Exposure to toxins. Exposure to toxins, such as methyl mercury, can increase the risk of birth defects.
• Other conditions. Other conditions may increase the risk of cerebral palsy, such as thyroid problems, intellectual disabilities or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

• Bacterial meningitis. This is a bacterial infection that causes inflammation in the membranes that surround the brain and spinal cord.
• Viral encephalitis. This viral infection causes inflammation in the membranes that surround the brain and spinal cord.
• Severe or untreated jaundice. Jaundice is a condition that appears as a yellowing of the skin. Jaundice occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.

Other factors of pregnancy and birth

Other factors of pregnancy or birth that are associated with an increased risk of cerebral palsy include:

• Premature birth. A normal pregnancy lasts 40 weeks. Babies who are born fewer than 37 weeks into the pregnancy are at higher risk of cerebral palsy. The earlier the baby is born, the greater the risk of cerebral palsy.
• Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
• Breech births. Babies with cerebral palsy are more likely to be in a feet-first position (breech presentation) at the beginning of labor rather than in a headfirst position.
• Multiple babies. The risk of cerebral palsy increases with the number of babies sharing the uterus. If one or more of the babies die, the chance that the survivors may have cerebral palsy increases.

Complications

Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or later during adulthood, including:

• Contracture. Contracture is the shortening of muscle tissue due to severe tightening of the muscle (spasticity). Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation.
• Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This may cause impaired growth and weaker bones. Your child may need a feeding tube for adequate nutrition.
• Mental health conditions. People with cerebral palsy may have mental health (psychiatric) conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression.
• Lung disease. People with cerebral palsy may develop lung disease and breathing disorders.
• Neurological conditions. People with cerebral palsy may be more likely to develop movement disorders or worsened neurological symptoms over time.
• Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may result in the early development of painful degenerative bone disease (osteoarthritis).

Test and diagnosis

If your family doctor or pediatrician suspects that your child has cerebral palsy, he or she will evaluate your child's signs and symptoms, review your child's medical history, and conduct a physical evaluation. Your doctor may refer you to a doctor trained in treating children with brain and nervous system conditions (pediatric neurologist).

Your doctor will also order a series of tests to make a diagnosis and rule out other possible causes.

Brain scans

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests may include the following:

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of your child's brain. An MRI can often identify any lesions or abnormalities in your child's brain.
  This test is painless, but it's noisy and can take up to an hour to complete. Your child will likely receive a mild sedative before the test. An MRI is usually the preferred imaging test.
• Cranial ultrasound. This can be obtained during infancy. A cranial ultrasound uses high-frequency sound waves to obtain images of the brain. An ultrasound doesn't produce a detailed image, but it may be used because it's quick and inexpensive, and it can provide a valuable preliminary assessment of the brain.
• Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your child's brain. A CT scan may be used to identify abnormalities in your child's brain.
  Scanning is painless and takes about 20 minutes. Because your child will need to be very still during the test, he or she will likely receive a mild sedative.

Electroencephalogram (EEG)

If your child has had seizures, your doctor may order an electroencephalogram (EEG) to determine if he or she has epilepsy, which often occurs in people with cerebral palsy. In an EEG test, a series of electrodes are affixed to your child's scalp.

The EEG records the electrical activity of your child's brain. If he or she has epilepsy, it's common for there to be changes in normal patterns of brain waves.

Laboratory tests

Your child's blood may need to be checked to rule out other conditions, such as blood-clotting disorders that can cause strokes, which may mimic cerebral palsy signs and symptoms. Laboratory tests may also screen for genetic or metabolic problems.

Additional tests

If your child is diagnosed with cerebral palsy, you'll likely be referred to specialists for assessments of other conditions that are often associated with the disorder. These tests may identify:

• Vision impairment
• Hearing impairment
• Speech delays or impairments
• Intellectual disabilities
• Other developmental delays
• Movement disorders

Prevention

Most cases of cerebral palsy can't be prevented, but you can lessen risks. If you're pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:

• Make sure you're vaccinated. Vaccination against diseases such as rubella may prevent an infection that could cause fetal brain damage.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that may result in cerebral palsy.
• Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
• Practice good child safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on beds and appropriate supervision.