Cerebral Palsy (CP)

Last updated 13.02.13

 

Index

 

Definition

-  Group of motor syndromes caused by early brain development disorders

-  Divided by motor abnormalitiy & anatomy into syndromes

 

Features

-  Clinical Dx

-  Lifelong disorder

-  Incidence 1/400

-  Typically non-progressive (static encephalopathy)

-  Most common shronic motor disability beginning in childhood

-  Typically detected in 1st 12-18 months of life

-  Most born at term wo labour or delivery problems

-  80% have some antenatal cause

-  <10% intrapartum asphyxia

 

Associated S/S

-  Mental retardation 30-50%

-  Epilepsy 15-60%

-  Speech, vision, hearing or intellectual abnormalities

-  Contractures

-  Hypotonia is 1st 6/12 --> spasticity

-  Ankle clonus, +ve Babinski

-  Strabismus, nystagmus & optic atrophy common

-  Equinovarus deformity

-  Paraparetic gait

-  Secondary athetoid dystonia

-  Cramped synchronised general movements

-  Failure to reach early milestones

-  Gross motor

-   Head control 2/12

-   Roll 4/12

-   Sit 6/12

-   Walk 1yr

 

Types

-  Functionally defined as mild, mod or severe

-  Combinations of:

-  Spastic

-  70-80%, most common

-  Spastic Hemiplegia

-  Unilateral arm + leg

-  Seizures 1/3

-  Usually arm > leg

-  Early hand preference

-  Circumducting gait

-  Oromotor dysfunction

-  Visual field defects & strabismus

-  Spastic Diplegia

-  Bilateral

-  Leg > arm

-  Commando crawl

-  Scissor gait, toe walking

-  Seizures uncommon

-  Spastic Quadraplegia

-  Most severe

-  All extremeties +/- trunk & face

-  Mental retardation

-  Seizures

-  Oromotor dysfunction

-  Dyskinetic

-  10-20%

-  Athetosis

-  Intellect usually preserved

-  Seizures uncommon

-  Less common than spastic types

-  Hypotonia

-  Most likely to be ass w birth asphyxia

-  Oromotor dysfunction

-  Truncal instability

-  Dystonia

-  Ataxic

-  Least common

-   Atonic

-  Truncal & extremity hypotonia & hyperreflexia

-  Rare

 

Causes

-  Genetic, metabolic, infective, cerebral malaria, ischaemic, developmental

-  Intra-uterine infection

-  Sepsis, chorioamnionitis, UTI

-  Increased incidence in LBW (<1000g) due to intracerebral haemorrhage & periventricular leukomalacia

 

Ix

-  MRI: brain + spinal cord

-  Hearing & vision testing

-  Genetic studies

 

Mx

-  Anticonvulsants

-  MDT (Multidisciplanary)

-  Physio: strength, gait, stretch

-  OT

-  Speech therapy

-  Nutritional therapy

-  Parent education

-  Exercises to prevent contractures

-  Dressing, bathing, feeding, caring..

-  Support groups

-  Muscle contractures

-  Botox

-  Baclofen pumps 

-  Orthopaedic Sx