Cerebral Palsy: Types, Symptoms, Diagnosis, Treatment
According to The Centers for Disease Control (CDC), an average prevalence of cerebral palsy is 3.3 children per 1000 live births.
When we talk about cerebral palsy (CP), we are referring to a group of lifelong conditions that affect coordination and movement. These lifelong conditions are caused by brain abnormalities that develop before, during or soon after birth.
- Cerebral’ refers to the brain.
- Palsy’ refers to the weakness or inability to use muscles.
The most prevalent cause of childhood disability is cerebral palsy. However, it does not necessarily lead to significant disabilities.
A child with severe cerebral palsy may be unable to walk and will require lifelong care, whereas a child with mild cerebral palsy may not require any particular support.
Cerebral palsy is not a progressive condition, and it does not worsen with time. Nonetheless, as the child ages, certain symptoms may become more or less apparent.
Types of cerebral palsy
There are 4 main types of cerebral palsy The types of cerebral palsy depend on the extent, location, and type of abnormalities.
Spastic cerebral palsy is the most common type of cerebral palsy. People with spastic cerebral palsy have increased muscle tone (hypertonia). Their muscles may be stiff and tight, resulting in a reduced range of movement.
Subtypes of spastic cerebral palsy:
- Diplegia: People with spastic diplegia may have walking difficulties due to tight hip and leg muscles. These tight muscles force their legs to pull together, turn inward, and cross at the knees (also known as scissoring).
- Hemiplegia: This condition affects one side of the body. The arm is often more affected than the leg.
- Quadriplegia: This is a severe form of spastic cerebral palsy that affects the face, limbs, and trunk. People with spastic quadriplegia are more likely to have significant intellectual disability, speech & visual impairment, epilepsy, feeding difficulties, or lung disease.
Dyskinetic or athetoid cerebral palsy is characterised by uncontrolled or involuntary muscle movements in hands, arms, feet, or legs that may be writhing and slow or rapid and jerky. The face and tongue are occasionally affected. The patient has difficulty sucking, swallowing, and speaking. The muscle tone might vary from day to day or even within a single day.
This is a rare type of cerebral palsy. People with ataxic cerebral palsy may have balance and coordination problems and need help with fast movements or movements that require a great deal of control, such as writing. They may have difficulty controlling their hands and arms when reaching for an object.
Mixed cerebral palsy is a condition whereby an individual exhibits symptoms of more than one type of cerebral palsy.
Symptoms of cerebral palsy
The symptoms of cerebral palsy are not typically obvious right after the baby is born. It only becomes apparent during the first 2 or 3 years.
Infants with cerebral palsy usually have delays in their developmental milestones, such as learning to roll over, crawl, sit or walk slower than their peers. Some infants have decreased or increased muscle tone, which can make them appear floppy or rigid.
Children with cerebral palsy may have an atypical posture or favour one side of the body when reaching, crawling, or moving. It is important to know that children without cerebral palsy may also exhibit some of these symptoms:
- Stiff or floppy muscles
- Lack of coordination (poor balance, poor eye-hand coordination)
- Weak legs or arms
- Tremors
- Exaggerated reflexes
- Muscle spasms
- Random and uncontrolled movements
Other symptoms include:
- Feeding and swallowing difficulty
- Delayed speech development
- Visual problems (for example, reduced vision or uncontrollable eye movements)
- Hearing loss
- Seizure or fits
- Difficulty walking or walking on tiptoes
- Hip that dislocates easily
- Scoliosis (abnormally curved spine)
- Urinary incontinence
- Difficulty falling asleep
- Intellectual disabilities
- Constipation
- Gastro-oesophageal reflux disease (GERD)
Causes of cerebral palsy
The cause of cerebral palsy is brain abnormality or damage to the parts of the brain that controls movement and this can occur before, during, or after birth.
Before birth:
- An infection acquired from the mother (for example, cytomegalovirus, chickenpox, rubella, toxoplasmosis)
- Stroke occurs when there is bleeding in the baby's brain or when the blood supply to the brain is blocked
- Head injury to an unborn infant
- Periventricular leukomalacia (PVL), a condition characterised by damage to the white matter of the brain, probably due to a decreased blood or oxygen supply to the brain
During or after birth:
- Asphyxiation during a difficult birth leading to a temporary lack of oxygen to the brain
- Brain infections (for example meningitis)
- Severe head injury
- Choking or near drowning, resulting in insufficient oxygen to the brain
- Stroke
- Extremely low blood sugar
Risk factors of cerebral palsy
The following factors can increase the risk of a baby being born with cerebral palsy:
- Premature birth (before 37 weeks); babies born at 32 weeks or earlier are particularly vulnerable
- Low birth weight
- Twin or triplet
- Assisted reproductive technology (ART)
- Infections during pregnancy
- Smoking, heavy consumption of alcohol and drugs by the mother during pregnancy
- The mother’s medical conditions, such as thyroid conditions, seizures, or intellectual disability
- Birth complications, such as uterine rupture, foetal distress
- Jaundice and kernicterus - Jaundice is characterised by the yellow discolouration of the skin of newborns. It is caused by the build-up of bilirubin in the baby’s blood. When a baby has an excess of bilirubin, the skin and whites of the eyes may appear yellow. This yellow discolouration is known as jaundice. When severe jaundice is left untreated for an extended period of time, it can result in kernicterus that can lead to cerebral palsy and other conditions.
If your baby has a higher risk of developing cerebral palsy, your doctor may recommend regular check-ups throughout the first two years to look for symptoms.
Cerebral palsy diagnosis
It is necessary to have a timely diagnosis of cerebral palsy to provide early intervention for your child. Your doctor may assess your child’s medical history and developmental milestones, cerebral palsy symptoms, your child’s movement, coordination and learning abilities.
Your doctor may request several tests to look for cerebral palsy or other possible causes of their symptoms, such as:
- Cranial ultrasound scan
- Magnetic Resonance Imaging (MRI) that uses radio waves and magnetic fields to produce an enhanced image of the brain
- Computed Tomography (CT) scan that takes multiple X-ray pictures for a detailed image of the brain and skull
- Electroencephalogram (EEG) that monitors brain activity and looks for signs of seizures
- Electromyogram (EMG) that checks the muscle and nerve function
- Blood tests to rule out other conditions
The doctor may also consult other specialists to check for associated conditions such as:
- Vision impairment
- Hearing impairment
- Speech delays
- Intellectual disorders
- Feeding issues
Cerebral palsy and age
Cerebral palsy is caused by a brain abnormality that happens before, during, or after birth. Therefore, this condition is not progressive. However, as the child becomes older, certain symptoms may become more pronounced, such as:
- Increased muscle stiffness or atrophy because the muscles may not be able to keep up with the bone growth causing muscular contractures
- Bone contractures due to lack of movement
- Shortened and spastic muscles may pull bony structures such as the spine and this leads to scoliosis
- Pain in the spastic muscles
Parents and caregivers need to understand that regular therapy and strength exercises go a long way in maintaining the range of motion for patients with cerebral palsy.
Treatment options for cerebral palsy
There is no cure for cerebral palsy, therefore the goal is to improve the patient's mobility and condition and prevent further complications.
These may include the use of eyeglasses and other visual aids, body and limb braces, walking and mobility aids like walkers, wheelchairs, and hearing aids.
Various therapies that children with cerebral palsy may need for good improvements include:
- Speech therapy
- Occupational therapy
- Physical therapy
- Neurodevelopmental Therapy (NDT)
- Sensory integration therapy
- Vision therapy
- Recreation therapy
- Psychotherapy
- Medications help treat muscle stiffness and other related conditions such as epilepsy. Muscle relaxants such as baclofen, and tizanidine, may be given orally whereas Botox (botulinum toxin type A) can be injected into tight muscles to provide temporary relief.
- Intrathecal baclofen is a technique where an implantable pump is placed within the body to deliver the medication.
- Trihexyphenidyl which is usually used to treat the symptoms of Parkinson's is used in combination with other medicines to control involuntary movements.
Surgeries may be performed to improve the patient’s mobility. They include:
- Bone and joint surgeries to improve contractures
- Spine surgeries to correct scoliosis
- Percutaneous myofascial release surgery to release tight muscles
- Selective Dorsal Rhizotomy (SDR) surgeries that include sectioning nerves near the spinal base that cause excessive spasticity to a muscle group
Advanced, new-age treatment modalities are being tested, including stem cell therapy. However, the therapy’s potential to cure cerebral palsy is currently being researched
Cerebral palsy prognosis
The life expectancy of cerebral palsy patients depends on a few factors and coexisting conditions, which include:
- Cerebral palsy type
- Cognitive impairment
- Respiratory issues
- Difficulty swallowing and eating
- High-degree scoliosis, which may lead to the compression of organs
- Sleep apnoea
An NCBI study reported that the 30-year survival rate in cerebral palsy patients is approximately 87%.
Advancements in medicinal research and new therapeutic approaches indicate a positive future for cerebral palsy patients and they are bound to receive better care and facilities in the future.
Make an appointment at Gleneagles Hospitals
Gleneagles Hospital works with neurologists and paediatrics neurologists to assist patients through cerebral palsy treatment. Our caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.
Get in touch with us at your nearest Gleneagles Hospital.
