CEREBRAL PALSY CEREBRAL PALSY None progressive static disorder

CEREBRAL PALSY

CEREBRAL PALSY None progressive, static disorder of the tone, posture or movement, due to lesion in developing brain. But symptoms may change

Cerebral Palsy Rates Multiple births Singletons 1500 gr or less 7. 5 / 1000 live births 2. 1 / 1000 live births 80 / 1000

RISK FACTORS ASSOCIATED WITH CEREBRAL PALSY GENERAL • Gestational age < 32 weeks • Birth weight <2500 g MATERNAL HISTORY • Mental retardation • Seizure disorder • Hyperthyroidism • Two or more prior fetal deaths • Sibling with motor deficits DURING GESTATION • Twin gestation • Fetal growth retardation • Third-trimester bleeding • Premature placental separation FETAL FACTORS • Abnormal fetal presentation • Fetal malformations • Fetal bradycardia • Neonatal seizures Chorionitis Low placental weight

CP: ETIOLOGY l Majority is idiopathic (thought to present prenatally) l PRENATAL PERIOD- wherein most causes of CP occur. v TORCH infections v Intrauterine stroke v Genetic malformations l The most common currently understood causes are related to brain injury occurring in children born prematurely.

Prenatal Associations with Cerebral Palsy l Placental insufficiency. l Brain malformation. l Congenital infection. l Chromosomal defects. l Exposure to toxins.

Types of Cerebral Palsy Spastic Hemiplegic Diplegic Quadriplegic Ataxic Dyskinetic Dystonic Chored-Athetoid Mixed Hypokinesia Hypertonia Hyperkinesia Hypotonia

Spastic: Hemiplegia: UMNL one side of body. Diplegia: UMNL of legs more than arms. Quadriplegia: Equal involvement of arms and legs.

l l l l l Diplegic CP : The most common type 30% Speech / cognitive function : normal. no Epilepsy. UL : gross motor (Normal) LL : spastic Infant ( commando crawl by hand), Delay sitting. O/E Scissoring position, hyper-reflexia knee & ankle, Bilateral Babinski sign. Child, Delay walking, walk on tiptoe O/E disuse atrophy hip: flexion, adduction, int. rotation knee: flexor / extensor spasticity /or equal ankle: equinovarous. foot: pes valgus Most walk independently by 4 years

Immature Fragile brain musculature Physical stresses of prematurity Compromised cerebral blood flow ( blood vessels in the water shed zone next to lateral ventricles in the capillaries of the germinal matrix)

l Hemiplegic CP : 25 % of all CP l One side affection, upper > lower extremity l 25 % mentally retarded l 33 % seizures l Infant: Hand preference l Child: Circumductive gait, hyper-reflexia Cause : Thromboembolism

Spastic Quadriplegia (Most severe)20% l All four limbs involved – and trunk- UMNL l Often with MR & seizures l Most ( 80 % ) non walkers l Swallowing difficulty & Aspiration pneumonia due to Pseudo-bulbar palsy. Speech &visual abn. l Flexion contracture of knee & elbow, scissoring posture. l Hypertonia, hyper-reflexia. l

Dyskinetic CP l Less common than spastic CP. 15%. l Infant is hypotonic, head lag then rigidity& dystonia(mov. Disorder that persons muscle contract uncontrollably, repetitive mov. ). l Feeding and speech are typically affected. l Cause : birth asphyxia. , kernicterus, metabolic disease that effect basal ganglia.

Diagnosis of CP 1. Birth History a) b) c) d) e) 2. 3. Prematurity. Seizures. Low apgars. Intracranial haemorrhage. Periventricular leucomalacia. Delayed Milestones Abnormal Motor Performance a) Handedness. b) Reptilian crawl. (abdomen) like snake c) Toe waking.

Early Signs of Cerebral Palsy Altered Tone. Persistence of primitive reflexes. Abnormal posturing. Inv. : MRI of brain, Test for vision & hearing Genetic evaluation

Cerebral Palsy Associated Disabilities Mental retardation 1/3 N. 1/2 I. Q. < 55. Epilepsy 25% > generalised. Speech disorders 50% delay/dysarthria. Vision and hearing 25%. Behaviour abnormalities. Learning difficulties.

Common Management Problems in Cerebral Palsy 1. Feeding Problems: Failure to suck. Tongue trusting, gagging and choking. Vomiting and regurgitation. 2. 3. 4. 5. Dribbling. Constipation. Crying, screaming and sleep disturbances. Growth.

Treatment of Cerebral Palsy 1. 2. 3. 4. 5. 6. Parent guidance. Physiotherapy Orthopaedic: scoliosis, contractures, deformities. Speech and Occupational Therapy. Medical. Psychiatric.

Management of Spasticity in Cerebral Palsy Oral Medicines: Baclofen, Diazepam, Dantrolene 2. Intrathecal Baclofen. 3. Botulinum Toxin. (to affected muscle) 4. Selective dorsal Rhizotomy on spinal n. for severe spasticity. 5. Tenotomy of Achilles tendon Hemiplegic : constrained the affected side Rigidity, dystonia Levodopa-carbidopa (Sinemet) 1. Dystonia : carbamazepine.