Definition

Cerebral palsy (CP) is a disorder affecting movement, muscles, and posture. 'Cerebral' refers to the brain, while 'palsy' refers to weakness or muscle problems. Cerebral palsy is caused by damage to specific areas of the brain that control muscle movement. CP can occur when these areas do not develop properly during pregnancy or experience damage, usually occurring before or during the birthing process. CP is static and non-progressive, meaning it does not worsen over time.

The prevalence of cerebral palsy is about 2-3 cases per 1000 live births, and this prevalence tends to increase.

Causes

Cerebral palsy is caused by brain-development disturbances or damage to the developing brain. This generally happens before birth but can also occur during infancy. The specific causes of cerebral palsy are not known, but there are several factors suspected to contribute to disruptions in brain development, including:

• Genetic mutations that cause genetic problems or abnormal brain development.
• Maternal infections that occur during pregnancy.
• Fetal stroke, which is a decrease in blood flow to the developing baby's brain.
• Fetal brain hemorrhage during pregnancy or shortly after birth.
• Infections that cause inflammation in the brain.
• Head injuries due to traffic accidents, domestic violence, or the birthing process.
• Lack of oxygen flow to the baby's brain caused by difficult labor or problems during pregnancy.

Risk factor

Some risk factors that may increase the risk of cerebral palsy in infants include:

• Maternal health: A history of miscarriage, stillbirth, or family history of cerebral palsy can increase the risk of a baby having cerebral palsy. Infections during pregnancy or exposure to toxic substances during pregnancy can also increase the risk of CP. Infections such as:
• Cytomegalovirus (CMV), a viral infection with flu-like symptoms that can cause congenital abnormalities in babies.
• Rubella (German measles), a viral infection that can be prevented with a vaccine.
• Herpes, a viral infection that can be transmitted from mother to child during pregnancy, affecting the fetus and placenta.
• Syphilis, a sexually transmitted infection caused by bacteria.
• Toxoplasmosis, an infection caused by a parasite found in contaminated food, soil, and cat feces.
• Pregnancy: Some conditions that occur during pregnancy, such as low birth weight, maternal bleeding, twins, and maternal hyperthyroidism, can be risk factors for a child developing cerebral palsy.
• Neonatal period: When a baby is born, events such as sepsis (severe infection), neonatal seizures, and complicated deliveries can increase the risk of a child developing CP.

Symptoms

Signs and symptoms of cerebral palsy can vary between individuals. CP can affect the entire body or be limited to the limbs, or even affect only one side of the body. However, generally, CP consists of problems with movement and coordination, speech and eating abilities, and development.

Early signs of cerebral palsy appear before the age of 3. This can be observed through disrupted motor development, such as:

• Delayed crawling, sitting, crawling, and walking
• Child's muscles appear stiff or too floppy
• Body posture is not like peers of the same age
• Coordination disorders
• Feeding difficulties (difficulty sucking, swallowing, and chewing)
• Delayed motor development
• Constipation or urinary incontinence (bedwetting)
• Excessive drooling
• Recurring seizures, vision impairment, or hearing impairment

Diagnosis

Signs and symptoms of CP may become more apparent with age, but a diagnosis of CP cannot be established until one year after birth. Your doctor will ask you some questions about your pregnancy and delivery process, any infections during pregnancy, or certain medications taken, and whether there are any family members with similar complaints. After that, the doctor will perform a physical and neurological examination to look for signs of muscle stiffness and motor development disorders in the child. Several examinations need to be done to establish a diagnosis of cerebral palsy, including:

• Radiology: An MRI of the head is needed to find the cause of developmental disorders in children. This examination is not painful, but the child may be uncomfortable during it.
• Laboratory tests include a complete blood count and urine to look for metabolic disorders.
• Specialist doctors conduct additional examinations to assess vision, hearing, speech, cognitive function, and child development.

The type of cerebral palsy will be determined by the symptoms and motor problems experienced by the child. The most common type of cerebral palsy is spastic type (stiff) where there is muscle stiffness and increased reflexes.

Management

Children and adults with CP require long-term treatment and a specialized team to manage cerebral palsy. This team consists of pediatricians, medical rehabilitation doctors, and neurologists. Cerebral palsy cannot be cured, but many treatment options, including medications, therapy, and surgery, can improve a child's function.

• Medications: Muscle relaxants or botox injections are medications used to manage symptoms in cerebral palsy. Discuss these treatment options and their risks with your doctor.
• Physical therapy: Muscle exercises can improve strength, flexibility, and balance. Your doctor may provide aids such as braces or leg tapping to help the child walk.
• Occupational therapy: Occupational therapy aims to help children become independent by helping them perform daily activities at home and school.
• Speech therapy: aims to help your child communicate using sign language or other communication aids such as computers. Therapists can also help your child eat and swallow.
• Surgery: Some surgeries may be performed as indicated. These include orthopedic surgery to address contractures and bone deformities to improve the child's mobility.

Complications

Complications of cerebral palsy are related to muscle stiffness and coordination problems that cause several complications for the child, including:

• Contractures: Contractures are conditions of muscle tissue shortening due to severe muscle contraction. This can cause 'spastic' or stiff muscle conditions. Muscle contractures can inhibit bone growth and cause 'folded' bones, deformities, leading to dislocations, scoliosis, and other bone problems.
• Malnutrition: Children's swallowing and eating problems can lead to inadequate nutrient intake. This can affect the growth of the child's muscles and bones. Some children and adults with cerebral palsy may require nasogastric tube feeding (NGT) to help with their nutrition.
• Mental health conditions: Individuals with CP may experience mental health disorders such as depression. Social isolation and difficulty living with disabilities can lead to depression.
• Lung disease: Individuals with CP may experience lung and respiratory abnormalities, increasing the risk of aspiration. If it occurs, pneumonia can develop.
• Osteoporosis: Bone fractures can occur due to low bone density resulting from lack of mobility, inadequate nutrition, and use of anticonvulsant medications.
• Other complications such as difficulty sleeping, chronic pain, skin problems, and oral health issues can also occur.

Prevention

The occurrence of cerebral palsy cannot be prevented, but you can reduce the risk of this condition. If you are pregnant or planning to become pregnant, you can take the following steps to reduce the risk of pregnancy complications:

• Undergo preconception health checks: Comprehensive health checks can provide an overview of your condition. Consult with your doctor based on the results of these checks to determine steps that can be taken. Make sure your body is ready for pregnancy.
• Vaccination: Vaccinating against diseases like rubella can prevent infections during pregnancy and fetal brain development disorders.
• Undergo routine antenatal examinations: Regular check-ups with your obstetrician during pregnancy can reduce health risks for both you and your baby. Regular prenatal care can prevent premature birth, low birth weight, and infections.
• Avoid alcohol, smoking, and illegal drugs: Consumption of these substances has been shown to increase the risk of cerebral palsy.

When to see a doctor?

Issues with a child's motor development need to be diagnosed and managed promptly. Visit the nearest healthcare facility immediately if you notice episodes of unusual movements in your child, changes in muscle tone, coordination disturbances, swallowing problems, or other developmental issues. Monitor your child's development using the Mother and Child Health Booklet (KIA) as a guide to track gross motor, fine motor, and speech development.

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