Cerebral palsy (CP) is a group of neurological disorders caused by a non-progressive brain injury or malformation that occurs while a child’s brain is developing. The symptoms manifest in infancy or early childhood and permanently affect body movement and muscle coordination.
The condition can occur if the brain develops abnormally or is damaged before, during or shortly after birth. The term cerebral refers to the brain; palsy refers to the loss or impairment of motor function.
Why it happens
The cause of CP in most cases is unknown, but possible causes include mutations in the genes responsible for brain growth, premature birth, low birth weight, severe bleeding inside the baby’s brain, an infection caught by the mother during pregnancy, difficult delivery (complications during child birth is responsible for CP in less than 10 percent of cases).
The brain of preterm babies is very sensitive to injuries and variations such as blood pressure abnormalities, infections, breathing difficulties and all these can lead to damage to the brain tissue and bleeding inside the brain. Multiple births such as twins, triplets, are also associated with increased risk of CP. Jaundice in newborns is a normal phenomenon, but if it is severe and not treated, then it can cause CP. Recurrent and untreated seizures in early infancy can also lead to CP.
How it manifests
Babies with CP usually present developmental delay and abnormal muscle tone. These babies are slow to achieve developmental milestones such as sitting without support and walking.
The muscle tone is abnormal in most babies and some have decreased muscle tone, so they feel floppy. Some have increased muscle tone, which make them stiff and when they are picked up, their legs cross (appear like scissors). Stiffness can make sitting, standing and walking difficult. Approximately 50 percent of babies with CP have seizures and learning difficulties.
Many children with CP have hearing and vision impairment. These children have higher risk of recurrent infections. The severity of clinical manifestations varies greatly from mildly affected children to very severely affected child. CP is classified into four major groups, of which spastic diplegia is the most common and is usually seen in preterm babies. It is also the most severe form as it affects both hands and legs. In this form, the tone is increased in legs, which make walking difficult. These babies usually have normal intelligence. Hemiplegic CP, spastic quadriplegia and extra pyramidal CP are the other types.
Diagnosis
To look for any abnormalities in the brain and to diagnose CP, MRI and CT scans are employed. EEG is needed for children with seizures and blood tests also need to be done. The paediatrician will ask about your child's medical history and development. They will also study your child’s reflexes, posture, movements and muscle tone.
Management
CP is not curable, but with proper and early treatment, a child’s functional abilities can be improved. With proper physiotherapy and occupational therapy, muscle strength can be improved and contractures can be prevented. Speech therapy can improve the child’s ability to speak.
There are also many medications available in the market, which are used to control muscle stiffness. Sometimes, devices and orthopaedic surgeries are needed to improve mobility. Stem cell therapy for CP is advocated by few specialists, as the research is in early stages and no clinical trials have been done. If at any point, you do have any concerns about your child’s development, you should get in touch with the paediatrician.
(The author is consultant, neonatology, Jaypee Hospital, Noida)
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