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Cerebral Palsy

Synonyms of Cerebral Palsy

  • Cerebral Diplegia
  • CP
  • Infantile Cerebral Paralysis
  • Little Disease
  • Palsy

Disorder Subdivisions

  • Ataxia Cerebral Palsy
  • Athetoid Cerebral Palsy
  • Congenital Cerebral Palsy
  • Diplegia of Cerebral Palsy
  • Hemiparesis of Cerebral Palsy
  • Hemiplegia of Cerebral Palsy
  • Postnatal Cerebral Palsy
  • Quadriparesis of Cerebral Palsy
  • Quadriplegia of Cerebral Palsy
  • Spastic Cerebral Palsy

General Discussion

Cerebral Palsy is a neurological movement disorder characterized by the lack of muscle control and impairment in the coordination of movements. This disorder is usually a result of injury to the brain during early development in the uterus, at birth, or in the first two years of life. Cerebral Palsy is not progressive.

Symptoms

Infants with Cerebral Palsy have muscle weakness, a lack of muscle tone and, later, muscle spasticity and lack of coordination. They may experience developmental delays during the first or second year of life. Cerebral Palsy can affect people mildly, moderately, or severely.

As a child with Cerebral Palsy grows, other symptoms may include drooling, speech impairment, difficulty maintaining bladder and/or bowel control, convulsive seizures, hand tremors, and the inability to identify objects by touch. Children with this disorder may experience an impairment in vision more often than other children. Typically children with Cerebral Palsy may have average or above average intelligence. However, there may be mild or severe intellectual impairment in some patients.

Cerebral Palsy is classified according to the limbs that are affected and the characteristics of the movement disturbance. If both legs are affected, the condition is called Diplegia. If the Cerebral Palsy affects both the arms and the legs, then the condition is termed Quadriplegia.

Spastic Cerebral Palsy is characterized by involuntary contractions of the muscles in the arms and legs and an awkward "scissor" gait. The lower legs may turn in and cross at the ankle. In some cases, the long muscles on the back of the legs (extensors) are so tightly contracted that the heels of the feet do not touch the floor and the child walks on tiptoe.

Athetoid Cerebral Palsy is characterized by involuntary weaving movements of the body (athetosis). These muscle movements may be accompanied by facial grimacing, abnormal tongue movements, and/or drooling. Involuntary flailing of the arms and legs and/or jerking motions may also occur.

In Ataxic Cerebral Palsy, the primary symptom is a lack of balance and coordination while standing and/or walking. People with this form of Cerebral Palsy may sway when standing, have trouble maintaining balance, and may walk with their feet spread wide apart to avoid falling.

Causes

Cerebral Palsy is a neurological movement disorder that can be caused by injury to the brain at birth, during the early stages of development in the womb, or during the first two years of life. The injury may result from bleeding into the brain, lack of oxygen at birth, or an infection affecting the mother and the developing fetus. Infants who are born prematurely or with low birth weight are especially susceptible to this disorder.

Cerebral Palsy also may be acquired after birth (postnatally). Head injuries, infections such as meningitis, and other forms of brain damage occurring in the first months or years of life are the main causes of acquired Cerebral Palsy.

Affected Populations

Cerebral Palsy is a relatively rare disorder that affects males and females in equal numbers. The United Cerebral Palsy Association estimates that between 1 in 1000 and 3 in 1000 infants develop Cerebral Palsy each year in the United States. There are approximately 9000 new cases of this disorder reported each year.

Related Disorders

Symptoms of the following disorders can be similar to those of Cerebral Palsy. Comparisons may be useful for a differential diagnosis:

Kernicterus is a rare neurological disorder of infancy characterized by abnormally high levels of bilirubin in the blood. This disorder can occur in the developing fetus, a premature infant, or a very sick newborn. The early symptoms of this disorder may include poor feeding habits, vomiting, generalized weakness, upward gaze to the eyes, convulsions, and/or muscle rigidity. Other neurological symptoms may develop later and may include hearing loss, learning disorders, and mental retardation. (For more information on this disorder, choose "Kernicterus" as your search term in the Rare Disease Database.)

Phenylketonuria (PKU) is a rare metabolic disorder of infancy caused by a deficiency of the liver enzyme phenylalanine hydroxylase. Impairment in the metabolism of the amino acid phenylalanine results in excess accumulation of phenylalanine in the fluids of the body. PKU is a severe progressive disorder that can produce mental retardation if it is not treated early. With a carefully controlled diet, individuals affected by PKU can avoid irreversible mental retardation. PKU is inherited as an autosomal recessive genetic trait. (For more information on this disorder, choose "Phenylketonuria" as your search term in the Rare Disease Database.)

Standard Therapies

An important part of rehabilitation for people with Cerebral Palsy is physical therapy that consists of a supervised program of exercises and activities. Therapy is designed for each patient to increase the function of those parts of the nervous system that are not affected by the Cerebral Palsy.

Occupational therapy can help children with Cerebral Palsy learn how to dress, comb their hair, clean their teeth, and to hold a cup or a pencil. For adults with severe Cerebral Palsy, therapy may involve vocational training or learning how to shop, cook, or keep house.

Certain drugs are useful in treating the complications of Cerebral Palsy. If a person with Cerebral Palsy suffers with seizures (epilepsy), anticonvulsant drugs are usually prescribed. Diazepam and other muscle relaxant drugs can sometimes relieve the tension of spastic muscles. Other prescribed drugs which act upon the nervous system, such as Botox and intrathecal Baclofen, may help children with Cerebral Palsy.

In some cases, surgery may be performed to lengthen and transfer tendons in patients who have severe muscle contractions associated with Cerebral Palsy. This procedure may be done in several areas of the body including the elbows, shoulders, and the back of the heel.

Children with Cerebral Palsy may experience difficulty with urinary control due to uncontrolled contractions of the bladder. The administration of anti-cholingeric drugs, such as imipramine, may help to control urinary incontinence.

Investigational Therapies

Functional electrical stimulation of muscles is under investigation as a possible aid in the treatment for Cerebral Palsy. This technique involves the use of electrical stimulating devices applied locally to muscles in affected arms or legs. These devices would then stimulate the nerves important in motor coordination and control. More research is needed to determine the long-term safety and effectiveness of this therapy in the treatment of Cerebral Palsy.

The orphan drug Botulinum Toxin Type A (Botox) is being tested for the treatment of spastic muscles associated with Cerebral Palsy. In initial studies, the drug has been effective in treating abnormal gait due to a foot deformity (i.e., talipes equinus) in children with cerebral palsy. In talipes equinus, affected children walk on their toes because the foot is abnormally flexed. More research is necessary to determine the long-term safety and effectiveness of this potential treatment for equinus gait. The product is manufactured by Allergan, Inc.

On February 13th of 2008, the The Food and Drug Administration said it is reviewing the safety of Allergan Inc.'s popular Botox and a rival product after reports of deaths and breathing problems in people who had received the drugs.

The FDA is focused largely on pediatric patients who were being treated for symptoms of cerebral palsy.

Allergan, Inc.
2525 Dupont Drive
P.O. Box 19534
Irvine, CA, 92713-9534

The orphan drug baclofen is under investigation as a treatment for muscle spasticity. This drug is administered through an implanted computerized pump that is manufactured by Medtronic Neurological of Minneapolis, Minnesota.

Surgical procedures are being investigated as possible treatments for selected Cerebral Palsy patients. One surgical procedure involves dividing the root of the spinal nerves (rhizotomy). This procedure has produced some improvement in certain patients with severe diplegia but it is used only on a selected basis when conservative measures have proven ineffective.

A variety of other intervensions with as yet unproven effectiveness are sometimes used in treatment. These include conductive education, hyperbaric oxygen, and the Adeli suit.

Researchers are studying the drug modafinil for the treatment of spasticity in individuals with Cerebral Palsy. Initial results suggest that modafinil appears effective for this purpose, but more research is necessary to determine the long-term safety and effectiveness of this therapy.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Cerebral Palsy

References

TEXTBOOKS
Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:2416-18.

Behrman RE, ed. Nelson Textbook of Pediatrics, 15th ed. Philadelphia, PA: W.B. Saunders Company; 1996:1713-14.

Menkes JH, au., Pine JW, et al., eds. Textbook of Child Neurology, 5th ed. Baltimore, MD: Williams & Wilkins; 1995:345-53.

Adams, RD, et al., eds. Principles of Neurology. 6th ed. New York, NY: McGraw-Hill, Companies; 1997:1025-27.

JOURNAL ARTICLES
Hurst DL, et al. Use of modafinil in spastic cerebral palsy. J Child Neurol. 2002;17:169-72.

Koman LA, et al. Botulinum toxin type A neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics. 2001;108:1062-71.

Stevenson CJ, et al. Cerebral palsy - the transition from youth to adulthood. Developmental Medicine and Child Neurology. 1997;39:336-42.

Albright AL. Neurosurgical treatment of spasticity: selective posterior rhizotomy and intrathecal baclofen. Stereotact Funct Neurosurg. 1992;58:3-13.

Steinbok P. Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases. Pediatr Neurosurg. 1992;18:24-42.

Koman LA, et al. Cerebral palsy. Management of the upper extremity. Clin Orthop. 1990;235:62-74.

Brundage et al. Submandibular gland resection and bilateral parotid duct litigation as a management for chronic drooling in cerebral palsy. Plast Reconstr Surg. 1989;83:443-46.

Hugenholtx H, et al. Cervical spinal cord stimulation for spasticity in cerebral palsy. Neurosurgery. 1988;22:707-14.

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Report last updated: 2008/02/12 00:00:00 GMT+0

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