Cerebral palsy

  • Definition
    • Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking.

      There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.

      Central nervous system and peripheral nervous system
  • Alternative Names
    • Spastic paralysis; Paralysis - spastic; Spastic hemiplegia; Spastic diplegia; Spastic quadriplegia

  • Causes
    • Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb. But they can happen at any time during the first 2 years of life, while the baby's brain is still developing.

      In some people with cerebral palsy, parts of the brain are injured due to a low level of oxygen (hypoxia) in those areas. It is not known why this occurs.

      Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy as a result of several conditions, including:

      In some cases, the cause of cerebral palsy is never determined.

  • Symptoms
    • Symptoms of cerebral palsy can be very different between people with this group of disorders. Symptoms may:

      • Be very mild or very severe
      • Only involve one side of the body or both sides
      • Be more pronounced in either the arms or legs, or involve both the arms and legs

      Symptoms are usually seen before a child is 2 years old. Sometimes symptoms begin as early as 3 months. Parents may notice that their child is delayed in reaching developmental stages such as sitting, rolling, crawling, or walking.

      There are several different types of cerebral palsy. Some people have a mix of symptoms.

      Spastic cerebral palsy is the most common type. Symptoms include:

      • Muscles that are very tight and do not stretch. They may tighten even more over time.
      • Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes
      • Joints are tight and do not open all the way (called joint contracture)
      • Muscle weakness or loss of movement in a group of muscles (paralysis)
      • Symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs

      The following symptoms may occur in other types of cerebral palsy:

      • Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
      • Tremors
      • Unsteady gait
      • Loss of coordination
      • Floppy muscles, especially at rest, and joints that move around too much

      Other brain and nervous system symptoms may include:

      • Learning disabilities are common, but intelligence can be normal
      • Speech problems (dysarthria)
      • Hearing or vision problems
      • Seizures
      • Pain, especially in adults, which can be difficult to manage

      Eating and digestion symptoms:

      • Difficulty sucking or feeding in infants, or chewing and swallowing in older children and adults
      • Vomiting or constipation

      Other symptoms:

  • Exams and Tests
    • The health care provider will perform a full neurologic exam. In older people, testing cognitive function is also important.

      Other tests may be performed as needed, most often to rule out other disorders:

  • Treatment
    • There is no cure for cerebral palsy. The goal of treatment is to help the person be as independent as possible.

      Treatment requires a team approach, including:

      • Primary care doctor
      • Dentist (dental check-ups are recommended around every 6 months)
      • Social worker
      • Nurses
      • Occupational, physical, and speech therapists
      • Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist

      Treatment is based on the person's symptoms and the need to prevent complications.

      Self and home care include:

      • Getting enough food and nutrition
      • Keeping the home safe
      • Performing exercises recommended by the providers
      • Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
      • Protecting the joints from injury

      Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

      The following may help with communication and learning:

      • Glasses
      • Hearing aids
      • Muscle and bone braces
      • Walking aids
      • Wheelchairs

      Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed to help with daily activities and care.

      Medicines may include:

      • Anticonvulsants to prevent or reduce the frequency of seizures
      • Botulinum toxin to help with spasticity and drooling
      • Muscle relaxants to reduce tremors and spasticity

      Surgery may be needed in some cases to:

      • Cut certain nerves from the spinal cord to help with pain and spasticity
      • Place feeding tubes
      • Release joint contractures
  • Support Groups
  • Outlook (Prognosis)
    • Cerebral palsy is a life-long disorder. Long-term care may be required. The disorder does not affect expected length of life. The amount of disability varies.

      Many adults are able to live in the community, either independently or with different levels of help.

  • Possible Complications
    • Cerebal palsy may lead to the following health problems:

      • Bone thinning or osteoporosis
      • Bowel obstruction
      • Hip dislocation and arthritis in the hip joint
      • Injuries from falls
      • Pressure sores
      • Joint contractures
      • Pneumonia caused by choking
      • Poor nutrition
      • Reduced communication skills (sometimes)
      • Reduced intellect (sometimes)
      • Scoliosis
      • Seizures (in about half of the people who are affected by cerebral palsy)
      • Social stigma
  • When to Contact a Medical Professional
    • Call your provider if symptoms of cerebral palsy develop, especially if you know that an injury occurred during birth or early infancy.

  • Prevention
    • Getting the proper prenatal care may reduce the risk of some rare causes of cerebral palsy. In most cases though, the injury causing the disorder is not preventable.

      Pregnant mothers with certain medical conditions may need to be followed in a high-risk prenatal clinic.

  • References
    • Colver A, Fairhurst C, Pharoah POD. Cerebral palsy. Lancet. 2014;583(9924):1240-1249. PMID: 24268104

      Johnston MV. Encephalopathies. In: Kliegman RM, Stanton BF, St. Geme, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 598.

      Nass R, Ross G. Developmental disabilities. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 61.

      Noritz GH, Murphy NA; American Academy of Pediatrics Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics. 2013;131:e2016-2027. PMID: 23713113