A group of diseases which affects the progress of development of movement & posture due to a non-progressive disease of the developing brain of an infant or child is called Cerebral Palsy. The pattern & severity of the movement disorder evolves during the childhood which mimics a progressive neurological disorder.
There are various reasons why Cerebral Palsy could happen e.g,
• Prenatal factors (premature birth, placental insufficiency, antepartum haemorrhage, twin pregnancy, maternal infection during pregnancy, cytogenetic disorders etc)
• Peri/Neonatal factors (e.g, hypoxic insult to brain at birth, meningitis, severe jaundice, intracranial haemorrhage)
• Post-natal factors (e.g, meningo-encephalitis, trauma, hypoxic events near-drowning, severe hypotension, stroke-like condition etc).
Obtaining good detailed history suggesting the above mentioned factors & lack of unusual clinical findings often helps identifying the diagnosis & cause of cerebral palsy, thus avoiding expensive investigations & directing the money & resource to appropriate supportive management of this condition.
Patterns of cerebral palsy:
Spastic Hemiplegia (upper limb more stiff than lower limbs) – 33-38%
Spastic Diplegia (stiffness of both lower limb) – 35-43%
Spastic Quadriparesis (stiffness of total body & all limbs) – 6%
Dystonic & Athetoid (fluctuating & uncontrollable movements) – (7-15%)
Ataxic (problem in balance, extremely shaky) – 6%
Worster-Drought type (oral, speech & behaviour & intellectual problem)
Monoplegia (stiffness of one limb only)
MRI of Brain is the single most useful investigation which helps in diagnosis & prognosis & EEG (electrical waves of brain activity) also is another one. We must also remember that 10% of children with cerebral palsy do not have any brain lesion. Most common brain lesions are fluid-filled small lesions in brain tissue, lack of fatty insulating layer in the brain, shrunk & burnt out portions in different parts of brain or the entire brain appears generally shrunk.
Majority of children with cerebral palsy survive into adulthood as long as the motor & cognitive disability is not so severe that it would cause difficulty in body function. 50% children survive to adulthood if I.Q < 20 & survival increases 95% if I.Q > 85.
Motor disability, lack of progress in intellectual development, epilepsy are the major morbidities in them. Respiratory infections, aspiration of vomitus or food items & chocking particularly if associated with convulsion, prolonged convulsion, severe dehydration & Urine infection & other types of infections are main causes of death.
Essential Health Care:
Social warmth, tender love and care, support for their mobility & posture are all that are most essential items these children need. Parents or carers should show social respect to them, repeatedly stimulate their senses, praise all the good things they can do, promote learning as much as possible. Parents should make sure that children maintain symmetrical posture while sitting or standing, use splints, special shoes or braces & appropriate wheelchair if necessary. Carer should try to protect them from injuries to their body parts. Medical attention is needed mostly for common medical reasons e.g, convulsion, chest infections or other medical illnesses as appropriate.