CEREBRAL PALSY

CEREBRAL PALSYChronic 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:Upper motor neurone lesion.

Hemiplegia:UMNL of one side of body.

Diplegia:UMNL of all four limbs but legs more than arms. May be symmetric or asymmetric.

Quadriplegia:Equal involvement of arms and legs.

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:Quick jerky movements of trunk and prox, limb muscles.

Paraplegia:Legs involved only.

Double Hemiplegia:Bilateral UMNL. Arms and legs. Also pseudobulbar palsy.

Monoplegia:One Limb.

Cerebral Palsy RatesMultiple births7.5 / 1000 live births

Singletons2.1 / 1000 live births

1500gr or less80 / 1000

Types of Cerebral PalsySpasticHemiplegiaDiplegiaQuadriplegia

Ataxic

DyskineticDystonicHypokinesiaHypertoniaChored-AthetoidHyperkinesiaHypotonia

Dysequilibrium SyndromeDifficulty in maintaining an upright position and in experiencing the position of the body in space.

Autosomal recessive.

CEREBRAL PALSYHemiplegia.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 PalsyBirth HistoryPrematurity.Seizures.Low apgars.Intracranial haemorrhage.Periventricular leucomalacia.Delayed MilestonesAbnormal Motor PerformanceHandedness.Reptilian crawl.Toe waking.

Early Signs of Cerebral PalsyAltered Tone.

Persistence of primitive reflexes.

Abnormal posturing.

Prenatal Associations with Cerebral PalsyPlacental insufficiency.Brain malformation.Congenital infection.Chromosomal defects.Exposure to toxins.Abnormality of neuronal migration.

PLACENTACorrelation of placenta infarction or thrombosis with ischaemic lesions in the brains of babies who have suffered intrauterine or early neonatal deaths.

11 / 15 placental slices from 15 patients with Cerebral Palsy contained thrombosis.

THROMBOPHILIA & CEREBRAL PALSYThrombosis 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.

ANTENATALMaternal infection & cerebral palsy

Maternal fever> 38oc + Chorioamnionitis associated with risk of cerebral palsy.

Inflammatory markers in children with cerebral palsy.

Cerebral PalsyFall 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 >.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 PalsyFeeding Problems:Failure to suck.Tongue trusting, gagging and choking.Vomiting and regurgitation.Dribbling.Constipation.Crying, screaming and sleep disturbances.Chilblains and cold injury.Growth.

Treatment of Cerebral PalsyParent guidance.Physiotherapy-Bobath method.Peto.Doman-Delacato.Orthopaedic.Speech and Occupational Therapy.Medical.Psychiatric.

Management of Spasticity in Cerebral PalsyOral Medicines:BaclofenDiazepamTizanidineDantroleneIntrathecal Baclofen.Botulinum Toxin.Selective Posterior Rhizotomy.

Botulinum ToxinProduced 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.

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