Cerebral Palsy

Overview

Cerebral palsy is a developmental disorder that occurs because of a brain injury sustained during birth or fetal development. It is the leading cause of disability in young children.

The condition affects movement, muscle tone, and motor skills among affected children. It also affects other body functions that involve muscles and motor skills such as bladder and bowel control, breathing, talking, and eating.

Signs and symptoms of cerebral palsy appear during infancy or preschool years. Overall, the condition causes impaired movement associated with floppiness, abnormal reflexes, or rigidity of the trunk and limbs, and involuntary movements, among others.

Cerebral palsy is prevalent worldwide. In Europe, an average rate of 2.08 per 1000 children has cerebral palsy. In the US, cerebral palsy affects about 764, 000 individuals with about 8,000 babies and between 1,200 and 1,500 preschool children diagnosed every year.

In the developing world, cerebral palsy affects a rate of between 1.5 and 5.6 people in every 1000. In Kenya, an estimated 3 in 100 children are living with cerebral palsy, and the full-time care they require means mothers mostly quit or are fired from their jobs leaving them with very little protection or support from the government.

Symptoms

Signs and symptoms of cerebral palsy vary from one person or baby to another. Coordination and movement problems associated with the condition include:

  • Stiff muscles and exaggerated reflexes (spasticity)
  • Variations in muscle tone such as being too floppy or too stiff
  • Stiff muscles with normal reflexes (rigidity)
  • Slow, writhing movements (athetosis)
  • Tremors or involuntary movements
  • Lack of muscle coordination (ataxia)
  • Delays in reaching motor skills milestones such as sitting up alone, pushing up on arms, or crawling
  • Difficulty with sucking or eating
  • Difficulty walking such as a crouched gait, walking on toes, a scissors-like gain with knees crossing, and asymmetrical gait or a wide gait
  • Favoring one side of the body such as dragging a leg while crawling or reaching with only one hand
  • Problems with swallowing or excessive drooling
  • Delays in speech development
  • Difficulty speaking
  • Difficulty with specific motions such as picking up a spoon or a crayon
  • Seizures

The brain disorder that causes cerebral palsy does not change with time, which means that symptoms normally do not worsen with age. The brain abnormalities associated with the condition may contribute to other neurological problems such as:

  • Intellectual disabilities
  • Difficulty with hearing and vision
  • Seizures
  • Oral diseases
  • Abnormal pain or touch perceptions
  • Mental health (psychiatric) conditions
  • Urinary incontinence

Causes

Cerebral palsy is majorly caused by disruption or abnormality in brain development, normally before childbirth. In numerous instances, the actual trigger is not known. However, factors that may lead to problems with brain development include:

  • Maternal infections that affect the developing fetus
  • Mutations in genes that lead to abnormal brain development
  • Fetal stroke: A disruption of blood supply to the developing brain
  • A traumatic head injury to the infant from a fall or motor vehicle accident
  • Infant infections that cause inflammation in or around the brain
  • Lack of oxygen to the brain (asphyxia) related to a difficult delivery or labor (This form of asphyxia is a much less common cause of CP compared to historically thought)

Risk Factors

Risk factors are mostly associated with infant illness, maternal health, and other factors of pregnancy and birth.

Maternal Health

Certain health problems or infections during pregnancy can highly increase the risk of cerebral palsy to the baby. Infections of concern include:

  • Herpes infection during pregnancy
  • Chickenpox (varicella) during pregnancy
  • German measles (rubella)
  • Cytomegalovirus may lead to birth defects
  • Syphilis: A very dangerous STI transmitted by a bacterium
  • Toxoplasmosis caused by a parasite found in contaminated food, feces of infected cats, and soil.
  • Exposure to toxins such as methyl mercury
  • Zika virus infection causes microcephaly
  • Other conditions include intellectual disabilities, thyroid problems, or seizures

Infant Illness

Illnesses in newborn babies that may highly increase the risk of CP include:

  • Viral encephalitis: Causes inflammation in the membranes that surround the spinal cord and the brain
  • Bacterial meningitis: An infection that causes inflammation of the membranes that surround the brain and spinal cord
  • Severe or untreated jaundice

Other factors of birth or pregnancy associated with increased risk of CP include low birth weight, breech births, multiple babies, premature births, complicated delivery or labor, and Rh blood type incompatibility between mother and child.

Diagnosis

Diagnosing cerebral palsy at an early age is significant to the wellbeing of children and their families. Diagnosing CP takes some steps:

  • Developmental monitoring/surveillance: Tracking a child’s growth and development over time.
  • Developmental screening: A Short test is given to see if the child has particular developmental delays.
  • Developmental and Medical Evaluations: It helps to diagnose the specific type of disorder that affects a child.

Treatment

Note that there is no cure for cerebral palsy. However, resources and therapies can help children grow and develop to their greatest potential.

  • As soon as cerebral palsy is diagnosed, a child may begin therapy for motion and other areas that require assistance, such as speech, learning, hearing, and social and emotional development.
  • Surgery can assist in fixing dislocated scoliosis (curved spine) and hips, which are common in children with cerebral palsy. Leg braces help with walking.
  • The medicine helps children who have muscle stiffness and pain. Medicine is taken by mouth or through a pump (baclofen pump) placed under the skin.
  • Children can enhance their bone health through eating diets rich in vitamin D, calcium, and phosphorous. The nutrients keep bones strong.

Prevention

Note that cerebral palsy cannot be prevented. The only thing you can do is to minimize the risks. If you are pregnant or planning to become pregnant, take the following steps to keep healthy, and reduce pregnancy complications. 

  • Ensure that you are vaccinated against diseases such as rubella to prevent an infection.
  • Take care of yourself: The healthier you are heading into a pregnancy, the less likely you will be to develop an infection that may lead to CP.
  • Seek early and continuous prenatal care
  • Practice good child safety such as providing your child with a car seat, safety rails on beds, bicycle helmet, etc.

For more information on treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.

Sources

https://www.researchgate.net/figure/Worldwide-prevalence-of-cerebral-palsy_tbl3_264091647

https://www.medicalnewstoday.com/articles/152712.php

https://www.newsdeeply.com/womensadvancement/articles/2018/02/21/in-kenya-having-a-child-with-cerebral-palsy-can-mean-losing-your-job

www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999

https://kidshealth.org/en/parents/cerebral-palsy.html