Cerebral Palsy

Intro & Causes - Brain's Early Hiccups

• Cerebral Palsy (CP): Permanent, non-progressive motor disorders.

• Affects movement, tone, posture. From insult to developing fetal/infant brain.

• Incidence: ~2-3/1000 live births. Most common childhood motor disability.

• Etiology (Brain Insult Timing):

  • Prenatal (70-80%):
    • Intrauterine infections (TORCH)
    • Maternal: thyroid, toxins, trauma
    • Congenital malformations
    • Multiple gestation
  • Perinatal (10%):
    • Birth asphyxia (HIE)
    • Prematurity (<32 wks, <1500g), IVH, PVL
    • Birth trauma
  • Postnatal (10%):
    • CNS infections (meningitis, encephalitis)
    • Head trauma (NAI)
    • Kernicterus
    • Near-drowning

⭐ Periventricular Leukomalacia (PVL) is the most common ischemic brain injury in premature infants leading to CP, particularly spastic diplegia.

CP Types - Movement Mayhem Map

Cerebral Palsy manifests in several primary forms, categorized by movement disorder and affected brain regions. 📌 Mnemonic: Some Days Are Mixed (Spastic, Dyskinetic, Ataxic, Mixed).

Signs & Dx - Spotting the Signals

• Key Indicators (Red Flags):
  • Delayed motor milestones (e.g., no head control by 4 months, not sitting by 9 months).
  • Abnormal muscle tone: spasticity (clasp-knife), hypotonia, dystonia, athetosis.
  • Persistent primitive reflexes (e.g., Moro, ATNR > 6 months).
  • Early asymmetric hand function or preference (< 1 year).
  • Feeding/swallowing difficulties.
• Diagnostic Approach:
  • Clinical diagnosis: history (perinatal risk factors), neurodevelopmental exam.
  • MRI brain: preferred imaging to identify structural lesions (e.g., PVL, HIE changes).
  • Standardized assessments: HINE, GMFCS (I-V).

⭐ Asymmetric tonic neck reflex (ATNR) persisting beyond 6 months is a strong predictor of CP.

Treatment & Co-issues - Care & Companions

• Multidisciplinary Team (MDT): CRUCIAL
  • Pediatrician, Neurologist, Orthopedician.
  • Physio (PT), Occupational (OT), Speech-Language Therapist (SLT).
  • Psychologist, Social worker.
• Spasticity Management:
  • PT: Stretching, ROM exercises.
  • Oral: Baclofen, Diazepam, Tizanidine.
  • Focal: Botulinum Toxin A (BoNT-A) injections.
  • Severe/Generalized: Intrathecal Baclofen (ITB), Selective Dorsal Rhizotomy (SDR).
• Orthopedic Care:
  • Braces, splints, casting.
  • Surgery: Contractures, deformities (tendon release, osteotomy).
  • Hip surveillance (risk of dislocation).
• Addressing Co-morbidities:
  • Epilepsy (~40%): Antiepileptics.
  • Pain: Identify source, manage.
  • Feeding difficulties/GERD: Nutritional support, G-tube if severe.
  • Drooling: Glycopyrrolate, Salivary BoNT-A.
  • Sensory: Vision/hearing aids.
  • Cognitive/Behavioral: Early intervention, education support.
  • Sleep disturbances.
• Family Support & Education: Counseling, respite care.

⭐ Regular hip surveillance (X-ray) is vital in non-ambulant CP children (GMFCS IV-V) to detect hip displacement/subluxation early.

High‑Yield Points - ⚡ Biggest Takeaways

• Cerebral Palsy (CP): non-progressive motor disorder from early brain injury (prenatal/perinatal/postnatal).
• Spastic CP is most common; presents with UMN signs (hypertonia, hyperreflexia).
• Major risk factors: prematurity, low birth weight, birth asphyxia, intrauterine infections.
• Associated co-morbidities: seizures (most common), intellectual disability, visual/hearing issues.
• Diagnosis is clinical; MRI brain confirms structural lesions, rules out progressive disorders.
• Management: multidisciplinary team approach (physio, OT, speech), symptomatic treatment (e.g., baclofen).