Cerebral Palsy And Spasticity

Question 1

Cerebral palsy is a group of ___________, ________________ abnormalities of the developing fetal or neonatal brain that lead to movement and posture disorders, causing activity limitation and functional impact

Answer 1

Permanent

Non-progressive

Question 2

Cerebral palsy is a group of permanent, non-progressive abnormalities of the developing fetal or neonatal brain that lead to ___________ and ____________ disorders, causing activity limitation and functional impact

Answer 2

Movement

Posture

Question 3

Cerebral palsy is a group of permanent, non-progressive abnormalities of the developing ________ or __________ brain that lead to movement and posture disorders, causing activity limitation and functional impact

Answer 3

Fetal

Neonatal

Question 4

What are the accompanying clinical and developmental comorbidities associated with cerebral palsy? (7)

Answer 4

Disturbances of…

1. Sensation
2. Perception
3. Cognition
4. Communication
5. Behavior

As well as…

6. Epilepsy
7. Secondary MSK problems (such as muscle contracture and abnormal torsion)

Question 5

Is cerebral palsy curable?

Answer 5

No

Question 6

What is the level of independence in patients with cerebral palsy?

Answer 6

wide range of abilities — from full independence in everyday life to requiring 24 hour care and attention;

It is therefore important that patients and their family and carers are provided with information about the network of general and specialised adult services available, to ensure their changing needs are met

Question 7

What are the possible causes of cerebral palsy? (4)

Answer 7

MRI-identified abnormalities:

• white matter damage (45%)
• BG or deep grey matter damage (13%)
• congenital malformation (10%)
• focal infarcts (7%)

Question 8

What are the antenatal risk factors for cerebral palsy? (3)

Answer 8

1. Preterm birth
2. Chorioamnionitis
3. Maternal resp or GI/GU infection treated in hospital

Question 9

What are the perinatal risk factors for cerebral palsy? (5)

Answer 9

1. Low birth weight
2. Choriomanionitis
3. Neonatal encephalopathy
4. Neonatal sepsis (particularly with a birth weight below 1.5 kg)
5. Maternal resp or GI/GU infection treated in hospital

Question 10

What is the major postnatal risk factor for cerebral palsy?

Answer 10

Meningitis

Question 11

When assessing the likely cause of cerebral palsy, recognise that basal ganglia or deep grey matter damage is mostly associated with _________ cerebral palsy.

Answer 11

dyskinetic

Question 12

Neonatal encephalopathy can result from various pathological events, such as a _____________ or __________, and if there has been more than 1 such event they may interact to damage the developing brain.

Answer 12

hypoxic–ischaemic brain injury

sepsis

Question 13

What are the causes of cerebral palsy acquired after the neonatal period? (3)

Answer 13

1. Meningitis (20%)
2. Other infections (30%)
3. Head injury (12%)

Question 14

What are the early motor features in the presentation of cerebral palsy? (4)

Answer 14

1. Unusual fidgety movements or other abnormalities of movement including asymmetry or paucity of movement
2. Abnormalities of tone including hypotonia (floppies), spasticity (stiffness), or dystonia (fluctuating tone)
3. Abnormal motor development, including late head control, rolling, and crawling
4. Feeding difficulties

Question 15

What are some of the treatable/reversible causes of pain, discomfort, and distress in children and young people with cerebral palsy? (7)

Answer 15

1. Spasticity
2. Constipation
3. GORD
4. Headache
5. Low back pain and sciatica
6. Urinary incontinence
7. UTI

Question 16

What is the first line management for spasticity in children with cerebral palsy? (18 yo or under)

Answer 16

Physical therapy

Question 17

If PT fails, what drugs can be used in the management of spasticity in children with CP? (2)

Answer 17

1. Oral diazepam
2. Oral baclofen

• think about stopping the treatment whenever the child or young person’s management programme is reviewed and at least every 6 months; if adverse effects (such as drowsiness) occur with oral diazepam or oral baclofen, think about reducing the dose or stopping treatment.
  https: //pathways.nice.org.uk/pathways/spasticity-in-children-and-young-people#path=view%3A/pathways/spasticity-in-children-and-young-people/pharmacological-therapies-for-children-and-young-people-with-spasticity.xml&content=view-node%3Anodes-oral-drugs

Question 18

If PT fails, what drugs can be used in the management of spasticity with significant dystonia in children with CP? (3)

Answer 18

In children and young people with spasticity in whom dystonia is considered to contribute significantly to problems with posture, function and pain, consider a trial of oral drug treatment

1. Trihexylphenidyl
2. Levodopa
3. Baclofen

Question 19

When should oral diazepam or baclofen be used in the treatment of CP? (3)

Answer 19

If spasticity is contributing to one or more of the following:

1. Discomfort or pain
2. Muscle spasms (eg night-time)
3. Functional disability

https://pathways.nice.org.uk/pathways/spasticity-in-children-and-young-people#path=view%3A/pathways/spasticity-in-children-and-young-people/pharmacological-therapies-for-children-and-young-people-with-spasticity.xml&content=view-node%3Anodes-oral-drugs

Question 20

Diazepam is particularly useful if a rapid effect is desirable in the treatment of CP, as in ____________

Answer 20

pain crisis

Question 21

Baclofen is particularly useful if a __________ effect is desired

Answer 21

sustained long-term; for example to relieve continuous discomfort or to improve motor function

Question 22

What is the mechanism of action of baclofen?

Answer 22

GABA agonist with primary site of action at the spinal cord; reduces the release of excitatory NTs and substance P from pre-synaptic neurons by binding GABA-B receptors