Cerebral Palsy

Question 1

What is this describing?
A group of conditions that affects movement, posture and coordination. Results from an insult to the developing brain (not associated with developmental regression).

Answer 1

Cerebral palsy

Question 2

What are the prenatal causes of cerebral palsy?

Answer 2

APH and hypoxia, alcohol, infection, rhesus disease, brain malformation, placental insufficiency (IUGR), twins, prematurity.

Question 3

What are the perinatal causes of cerebral palsy?

Answer 3

Birth trauma, meconium aspiration, birth asphyxia, hypoglycaemia, kernicterus.

Question 4

What are the postnatal causes of cerebral palsy?

Answer 4

Physical brain trauma, meningitis, hypoxia, cerebral vein thrombosis (from dehydration).

Question 5

What is this a presentation of?
Permanent increase in muscle tone, UMN signs with hyperreflexia. Can be spastic diplegia, spastic hemiplegia, or spastic quadriplegia.

Answer 5

Spastic cerebral palsy (75-80%) - cortical/pyramidal tract lesions

Question 6

What is this a presentation of?

Involuntary movements, variable tone, extrapyramidal tract motor dysfunction.

Answer 6

Dyskinetic cerebral palsy (15%) - basal ganglia

Question 7

What is this a presentation of?

Unsteadiness, clumsiness, poor spatial awareness. Newborn.

Answer 7

Ataxic cerebral palsy (4%) - cerebellum

Question 8

What are the effects of a child with cerebral palsy?

Answer 8

Epilepsy, learning difficulties, visual and hearing problem, feeding difficulties, incontinence, poor sleep, developmental delay.

Question 9

How is cerebral palsy diagnosed in children?

Answer 9

1. Clinical, may be suspected early.
2. Confident diagnosis not possible until later infancy/early childhood (GMFCS classification).
3. MRI brain
4. Hearing tests
5. Videofluroscopy swallow test to assess swallow and aspiration risk.

Question 10

What are the pharmaceutical treatments for cerebral palsy?

Answer 10

1. IM botox or PO baclofen to reduce spasticity
2. Melatonin for sleeping difficulties
3. AED for epilepsy

Question 11

What is the non-pharmaceutical management of cerebral palsy?

Answer 11

1. Community paediatrician, physio, SALT
2. NG or gastrostomy tube
3. Orthopaedic surgeons - scoliosis and hip dislocation
4. Lengthening ankle tendon may aid walking
5. Consider a selective dorsal rhizotomy

Question 12

What is the prognosis for cerebral palsy?

Answer 12

1. Mild - can stay in mainstream school

2. Severe - dependent, often die in childhood from complications