Cerebral Palsy

Question 1

What is cerebral palsy?

Answer 1

Cerebral palsy is a disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain.

Question 2

How common is cerebral palsy?

Answer 2

It affects 2 in 1,000 live births and is the most common cause of major motor impairment.

Question 3

What are the causes of cerebral palsy?

Answer 3

Causes include:
- Antenatal (80%): e.g. cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
- Intrapartum (10%): birth asphyxia/trauma
- Postnatal (10%): intraventricular haemorrhage, meningitis, head-trauma

Question 4

What are possible manifestations of cerebral palsy?

Answer 4

Possible manifestations include:
- Abnormal tone early infancy
- Delayed motor milestones
- Abnormal gait
- Feeding difficulties.

Question 5

What non-motor problems are associated with cerebral palsy?

Answer 5

Children with cerebral palsy often have associated non-motor problems such as:
- Learning difficulties (60%)
- Epilepsy (30%)
- Squints (30%)
- Hearing impairment (20%)

Question 6

What are the classifications of cerebral palsy?

Answer 6

Classification includes:
- Spastic (70%): subtypes include hemiplegia, diplegia, or quadriplegia; increased tone from damage to upper motor neurons
- Dyskinetic: caused by damage to the basal ganglia and substantia nigra; includes athetoid movements and oro-motor problems
- Ataxic: caused by damage to the cerebellum with typical cerebellar signs
- Mixed

Question 7

What is the management approach for cerebral palsy?

Answer 7

A multidisciplinary approach is needed. Treatments for spasticity include:
- Oral diazepam
- Oral and intrathecal baclofen
- Botulinum toxin type A
- Orthopaedic surgery
- Selective dorsal rhizotomy
- Anticonvulsants and analgesia as required.