Cerebral Palsy in children

Cerebral Palsy is a condition characterized by :

• Worsening of muscle control.
• Stiffness.
• Paralysis.
• Impaired nerve function.

Cerebral Palsy is not a disease and is not progressive (getting worse). In infants and premature babies, the part of the brain that controls muscle movement is very susceptible to injury.

Cause.

Cerebral Palsy can be caused by brain injuries that occur when :

• The baby is still in the womb.
• The labor process is in progress.
• Newborn baby.
• Children less than 5 years old.

The cause is unknown, 10%-15% of cases occur due to birth injuries and reduced blood flow to the brain before, during and immediately after the baby is born. Premature babies are very susceptible to this possibility because blood vessels to the brain are not fully developed and are prone to bleeding or because they cannot drain oxygen in sufficient quantities to the brain.

Brain injury can be caused by :

• High levels of bilirubin in the blood (often found in newborns), can cause kernicterus and brain damage.
• Severe illness in the first year of a baby's life (encephalitis, meningitis, sepsis, trauma and severe dehydration).
• Head injury due to subdural hematoma.
• Blood vessel injury.

The symptoms.

• Symptoms can usually be seen before the child is 2 years old.
• In severe cases, appear when the child is 3 months old.

Symptoms vary, such as :

• Stiffness.
• A change in the shape of the arms and legs so the child must use a wheelchair.

Cerebral Palsy is divided into 4 groups. 

Spastic Type (50% of all cases of Cerebral Palsy) ➡ the muscles become stiff and weak. Stiffness that occurs can be :

• Quadriplegia (both arms and legs).
• Diplegia (both legs).
• Hemiplegia (arms and legs on one side of the body).

Diskinetic type (Koreoatetoid, 20% of all cases of Cerebral Palsy) ➡ arm, leg and body muscles spontaneously move slowly, stretched and out of control. Rough movements and seizures arise. Movement will disappear if the child sleeps.

Atactic type (10% of all cases of Cerebral Palsy) ➡ consists of :

• Tremor.
• A wobbly step with the legs apart.
• Impaired coordination and abnormal movements.

Mixed Type (20% of all cases of Cerebral Palsy) ➡ is a combination of 2 types of spastic and choreatoid types.

Other symptoms that can also be found :

• Sub-normal intelligence.
• Mental retardation.
• Seizures / epilepsy (especially in the spastic type).
• Smoking or eating disorders.
• Irregular breathing.
• Impaired development of motor skills (eg reaching for something, sitting, rolling, crawling, walking).
• Speech disorder (dysarthria).
• Vision loss.
• Hearing disorders.
• Joint contracture.
• Movement becomes limited.

Diagnosis.

• On examination will be found late development of motor skills.
• Infantile reflexes (eg sucking and being surprised) persist even though they should disappear.
• Muscle tremors or stiffness clearly visible.
• Children tend to fold their arms to the side, legs move like scissors or other abnormal movements.

Laboratory examination :

• MRI of the head shows structural and congenital abnormalities.
• Head CT scan shows structural abnormalities and congenital abnormalities.
• Hearing examination (to determine the status of hearing function).
• Vision examination (to determine the status of visual function).
• EEG.
• Muscle biopsy.

Treatment.

Cerebral Palsy is incurable and is a disorder that lasts a lifetime. But many things can be done so that children can live independently. Treatment is usually dependent on symptoms, such as :

• Physical therapy.
• Using braces.
• Use eye glasses.
• Use hearing aids.
• Special education and schools.
• Anti seizure medication.
• Muscle relaxants (to reduce tremors and stiffness).
• Occupational Therapy.
• Orthopedic Surgery.
• Speech therapy can clarify the child's speech.
• Overcoming the problem of eating.
• Treatment (for severe cases).

If there is no physical impairment and severe intelligence, many Cerebral Palsy children who grow up normally and go to normal school. Other children need extensive physical therapy, special education and always need help in carrying out their daily activities. In some cases, to release joint contractures that are getting worse due to muscle stiffness, surgery may be necessary. Surgery also needs to be done to install food tubes and to control gastroesophageal reflux.

Prognosis. 

• Prognosis usually depends on the type and severity of cerebral palsy.
• More than 90% of children with Cerebral Palsy can survive into adulthood.

Prevention.

Most cases of cerebral palsy cannot be prevented, despite the best efforts of parents and doctors.

Ways to stay healthy and minimize the chances of pregnancy complications :

• Immunization ➡ Immunization prevents infections that can cause fetal brain damage.
• Regular visits to the doctor to prevent premature birth, low birth weight and infection.