Cerebral Palsy

Question 1

What is cerebral palsy?

Answer 1

Chronic condition of posture and movement caused by non-progressive CNS lesions sustained before 2 years of age. Learning disability and epilepsy are also often involved.

Question 2

What can cause cerebral palsy?

Answer 2

Preterm increases risk
Antenatal 80% - cerebral malformation and congenital infections such as rubella, toxoplasmosis and CMV
Intrapartum 10% - birth asphyxia/trauma
Postnatal 10% - intraventricular haemorrhage, meningitis and head trauma

Question 3

What clinical features do people with cerebral palsy have?

Answer 3

Weakness
Paralysis
Language problems
Early development of hand preference
Hyperreflexia
Aspiration pneumonia if swallowing problems from retrobulbar palsy
Urinary incontinence (many will eventually gain this over time)
Children with cerebral palsy often also have learning difficulties, epilepsy, squints and hearing impairments.

Question 4

What is the most common type of cerebral palsy?

Answer 4

Spastic CP 90%
Can be unilateral - hemiplegia (arms more than legs) or bilateral – diplegia (legs more than arms). In diplegia child looks normal until picked up and then legs scissor with hip flexion, adduction and internal rotation. Spastic quadriplegia is the most severe and is associated with seizures and low IQ.

Question 5

What is dyskinetic or athetoid cerebral palsy?

Answer 5

Dyskinetic (athetoid) CP 6%
Problems in the basal ganglia and extra pyramidal areas. Uncontrolled movements, spasticity, hypotonia, poor movement flow, poor posture and reduced hearing. Commonly associated with kernicterus.

Question 6

What is ataxic cerebral palsy?

Answer 6

Ataxic CP 4%
Problems in the cerebellum. These are uncommon and can be hypotonic or hypertonic. Movement bay be shaky and uncoordinated. Often problems with depth perception.

Mixed CP – mixture of the 3

Question 7

What are the 5 classes of gross motor ability used for cerebral palsy?

Answer 7

I Walks without limitations 
II walks with limitations 
III walks with handheld mobility device
IV self-mobility with limitations 
V transported in manual wheelchair

Question 8

How are patients with cerebral palsy managed?

Answer 8

MDT approach with large input from speech and language, physiotherapy and occupational therapy. Epilepsy should be treated as normal
Spasticity treated with oral diazepam, oral and intrathecal baclofen, botulin toxin type A, orthopaedic surgery and selective dorsal rhizotomy (severing nerve roots).
Anticonvulsants and analgesia given as required
Epidural cord electrostimulation