Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Many (possibly most) children with cerebral palsy have multiple symptoms with
combinations of the various forms of cerebral palsy. For example, children with spastic
cerebral palsy
often continue to have a head lag, which is representative of hypotonia.
Children with choreoathetoid or hypotonic cerebral palsy often have increased deep tendon
reflexes, which are suggestive of some spasticity.
What other conditions are associated with
cerebral palsy?
Since cerebral palsy is indicative of damage to or malformation of the brain, it stands
to reason that other symptoms that are associated with brain dysfunction can be
present in children afflicted with cerebral palsy. In fact other disorders, besides the
motor dysfunctions already described, are almost always seen in these patients.
Some of them such as poor speech, swallowing disorders, drooling, and poor fine
or gross motor coordination are the result of the motor disorder affecting
specific muscles involved in those functions. Other conditions are the results
of simultaneous injuries in areas of the brain besides the motor areas.
Cognitive disabilities, sometimes referred to as developmental delay, is
often associated with cerebral palsy. Up to 50% of patients with cerebral palsy have
cognitive disabilities.
However, many of these children can be educated and lead productive lives. It is
also just as important to note that many children with severe motor impairment
due to cerebral palsy, as is the case with many children with the choreoathetotic or the
diplegic form of cerebral palsy, are only mildly or not at all intellectually impaired.
Virtually all testing of a young child's cognitive development involves some
sort of motor activity on the part of the child. If a child is capable of
complex thoughts, but incapable of motor activity, the observer will not be able
to detect his or her mental aptitude. Therefore, one must be very careful in
assigning labels to patients with cerebral palsy. Certain features, however, are more likely
to be associated with significant cognitive disabilities in the patient with
cerebral palsy.
These include extensive damage occurring on both sides of the brain, children
with spastic quadriplegia, microcephaly (small head size), a documented genetic
disorder, and a documented prenatal infection.
Seizures are a common finding in patients with cerebral palsy. Perhaps a third of all
cerebral palsy
patients have seizures. Seizures are caused by abnormal electrical activity of
the neurons in the brain. The damaged or malformed brain is more prone to
seizures. Moreover, cognitive disability is frequently associated with epileptic
seizures.
The symptoms of seizures can vary depending on where in the brain they
originate. Generalized seizures engage the entire cerebral cortex at once, while
partial seizures only involve part of the cerebral cortex. Often, generalized
seizures begin as partial seizures but spread throughout the brain rapidly.
Generalized seizures may take the form of true convulsions ("grand mal"), in
which the entire body jerks in a rhythmic fashion, or the form of absences
("petit mal"), which interrupt the patient's activities for a brief period, but
does not cause a fall.
Other forms of generalized seizures can occur in the
cerebral palsy
patient. Atonic seizures cause the patient to slump suddenly to the ground or
forward in their chair, resembling a marionette in which the puppeteer suddenly
cut the strings. Tonic seizures are just the opposite and cause the entire body
to suddenly stiffen. Both tonic and atonic seizures can result in drop attacks
in which the patient falls to the ground, often resulting in injury.
Partial
seizures may involve the jerking of the arm and leg on the same side of the
body. Alternatively, they may be associated with strange sensory phenomena, such
as flashing lights, or emotions, such as fear, depending on where in the brain
the seizure occurs.
Vision deficiencies are frequently seen. Some of them, for example,
strabismus ("lazy
eyes") can be corrected by surgical procedures in the muscles of the eyes. Some
can be corrected with eye glasses (that may be difficult to implement in
non-cooperative children). In other children the visual deficiencies are the
result of brain injuries to the areas of the brain that are associated with
vision, rendering the child blind ("cortical blindness") even if the eyes
themselves are perfectly normal. At the present time there is no treatment to
improve this condition.
Children with cerebral palsy can have speech disorders of many types. Some, like poor
word pronunciation (dysarthria), are the result of impairment of the peripheral
mechanism of speech (poor lips, tongue, or palate coordination). In another
circumstance there is brain injury in the gray matter of the brain that
controls the central mechanism of speech (aphasia).
It is difficult for children with cerebral palsy to gain weight and frequently have
delayed growth. This is the result of several factors including feeding
disorders, gastroesophageal reflux, and in some instances,
for example,
children with choreoathetotic disorders, excessive caloric consumption. On the
other, hand obesity could be a problem in those children with
cerebral palsy that have and
limited mobility.
Individuals with the choreoathetotic form of cerebral palsy might have compressed nerves
or damage to the neck bones that can lead to damage to the spinal cord.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Scoliosis causes an abnormal curvature of the spine. When the cause of scoliosis is unknown the disorder is described based on the age when the scoliosis develops (infantile, juvenile, or adolescent idiopathic scoliosis). In functional scoliosis, curvature develops due to a problem somewhere else in the body. With neuromuscular scoliosis, there is a problem when the bones of the spine are formed. Treatment typically involves observation, bracing, and surgery and is dependent upon the severity of the curvature.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Toxoplasmosis (toxo) is a parasitic infection that causes flulike symptoms, swollen lymph nodes, and muscle aches and pains that may last from a few days to several weeks. Toxoplasmosis can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces. Toxoplasmosis can also be contracted by eating raw or partly cooked meat, especially pork or lamb, or touching the hands to the mouth after contact with raw or undercooked meat.
Child abuse falls into four categories: neglect, physical abuse, sexual abuse, and emotional abuse. There are certain risk factors that predispose a child to being abused and an adult to abusing a child. Risk factors for children are age, children with learning disabilities, adopted and foster children, children with congenital abnormalities, and a past history of abuse. Parental risk factors include young or single parents, those who suffered abuse themselves, adults with substance-abuse problems or psychiatric disease, and those who didn't graduate from high school.
Aphasia is a condition that is the result of damage to portions of the brain. It can be caused by stroke, head injury, brain tumor, or infection. There are two types of aphasia, fluent and non-fluent. Some patients may fully recover from aphasia over time, while others may not.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Dystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Microcephaly is a genetic condition where the circumference of the head is smaller than normal due to underdeveloped brain. Microcephaly is caused by genetic abnormalities, or from abuse of alcohol, drugs, infection (for example, German measles or chickenpox), exposure to toxins, or PKU while the mother is pregnant. Symptoms of microcephaly depend upon the severity of the accompanying syndrome. There is not treatment for microcephaly.
Febrile seizures, or convulsions caused by fever in small children or infants can be frightening, however, in general are harmless. Febrile seizures is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Encopresis is a type of elimination disorder in which bowel movements are passed into places other than the toilet. Children with encopresis may have symptoms that include abdominal pain, watery stools, scratching the anal area or loss of appetite. Causes of encopresis may include a low-fiber diet, lack of exercise, fear of using unfamiliar bathrooms, or changes in bathroom routines. Treatment focuses on encouraging good bowel habits and preventing constipation.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Jaundice in infants occur when the baby's liver may not be developed enough to efficiently rid the body of bilirubin. Symptoms of jaundice include yellowish colored eyes, and yellowing of the skin. Some babies are more at risk to develop jaundice. Kernicterus is a type of brain damage that occurs when a baby has jaundice and is not treated. Treatment of infant jaundice is generally with phototherapy so that kernicterus should not develop.
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