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.
What are specific treatment plans for cerebral
palsy?
After the initial evaluation, specific treatment plans are outlined for each
child:
Seizure medication
If the child has seizures, the treatment is based on the
type and frequency of the seizures. Complete seizure control can often be
achieved using a single medication, but some children with cerebral palsy have particularly
difficult-to-control seizures. Medication can have side effects affecting the
brain, ranging from sedation to hyperactivity. They can also affect liver
function, white and red blood cells, and bone metabolism. Side effects are usually
not harmful and resolve when the offending medication is discontinued. The goal
of the treating physician should be for the child to become seizure free with
few or no side effects. It must be noted that it is of no benefit to the child
to be seizure-free but significantly impaired by medication side effects.
Medications for spasticity: The treatment of spasticity can involve multiple
health professionals. Treatments involve the use of medications and surgical
procedures to decrease the spasticity, facilitate movement, and prevent
contractions. Among the most commonly medications are
dantrolene sodium
(Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant and a
sedative. Baclofen (Lioresal)
can be taken by mouth or infused continuously with an
implanted pump (intrathecal infusion) directly in the cerebrospinal fluid (the
liquid that bathe the spinal cord and the brain). This treatment might be
specifically useful for patients with spasticity in the lower legs. The most
common complications with these medications are drowsiness, sleepiness, some
degree of weakness. The sedative side effects of such medications often limit
their usefulness. In the case of the baclofen pump the most common complication
seen in small number of patients is the infection of the catheter. Additionally,
a muscle relaxing agent called botulinum toxin can be injected into tight
muscles to relax them. When used prudently, this procedure may prevent surgical
intervention.
Surgery
Surgery for spasticity: In the case of severe muscle spasticity, surgery may
be a valuable option. Tendon release procedures, usually performed by an
orthopedic surgeon, allow improved range of motion in some cases. Such
procedures are usually performed on the muscles of the calf or inner thigh. A
less commonly used procedure, is the dorsal rhizotomy. During this operation,
the surgeon cuts some of the nerve roots that send sensory information from the
muscles to the spinal cord and brain. This procedure relieves some of the
spasticity and thereby helps the child walk with a more normal gait. Most
neurosurgeons performing dorsal rhizotomies very carefully select only those
patients whom they feel may be helped by the surgery. From time to time, other
surgical interventions are required in children with cerebral palsy. In very rare cases of
choreoathetoid cerebral palsy, in which the writhing movements severely limit the ability of
the child to function, highly selective neurosurgical techniques can curtail
these movements without significantly harming other functions.
Other surgical procedures
Ophthalmologists (eye specialists) can help strabismus by operating on the
muscles that control the movement of the eye or to correct some other
complications such as cataracts.
Neurosurgeons can treat intractable seizure control. Operations such as
callosotomy, hemispherectomy, focal resections of areas of abnormal brain tissue
responsible for the seizures, might be indicated in some cases. An alternative
procedure for the treatment of epilepsy is the vagal nerve stimulation, an
implantable device, that can be useful in selected patients with difficult to
control seizures.
Scoliosis, or curvature of the spine, is often the result of severe
hypotonia. This condition can create discomfort for the patient and difficulty
for caregivers in performing the activities of daily living. Furthermore, severe
scoliosis may actually restrict a patient's ability to breathe. Several surgical
procedures are available in specialized centers for the correction of scoliosis.
Children who are unable to take adequate calories by mouth may require the
placement of a feeding gastrostomy tube (PEG tubes) directly into the stomach.
Therapy
The treatment of spasticity can involve multiple allied healthcare professionals.
Physical and occupational therapists play an important role.
Physical therapy: The extent of physical therapy depends on the degree of
spasticity, hypotonia, and motor impairment. The main therapeutic effect of
physical therapy is maintaining range of motion at the joints, thereby
preventing contractures. Some scientists and therapists feel that physical
therapy actually helps maintain the connections in the brain, although this is
controversial. Other skills, such as improved gait, stance, and balance can be
helped by physical therapy. A strong, proactive physical therapy program greatly
aids in the life of a child with cerebral palsy.
Occupational therapy: Occupational therapy assists children with the skills
needed for day-to-day life in school and at home, including eating, writing, and
work skills. In early infancy, occupational therapists can provide assistance in
feeding a child with a poor or uncoordinated sucking response.
Speech therapy: Speech and language pathologists are involved with the
development and improvement of speech production. Using different techniques the
speech pathologist helps to improve the quality and the quantity of the speech
production. The role of these specialists is not limited to speech production
alone, but they also teach the patients other communication techniques (sign
language, use of communication boards) to facilitate the communication
abilities.
Medical care
Medical care of children with cerebral palsy is often seriously hampered by
the inability of the child to communicate his or her needs and sensations.
Relatively common childhood illnesses in children with cerebral palsy, such as ear
infections, urinary tract infections, and appendicitis, which are easily
treatable in most children, may prove to be life-threatening due to delayed
recognition on the part of caregivers and physicians. Each child with cerebral
palsy should
have a primary care practitioner that is experienced with the special medical
needs of affected children.
Because physicians have offered limited hope in curing cerebral palsy, many families have
turned to alternative methods in the treatment of their children. Such therapies
may include diets, herbal remedies, aromas, play with animals, and hyperbaric
oxygen. The scientific evidence supporting the use of diets is inadequate.
Some of them such as hyperbaric oxygen therapy, which is delivered in
specialized centers, can be quite expensive and has not been scientifically
proven to help children with cerebral palsy. Other remedies must be investigated on a
case-by-case basis. Hopefully, the family of the affected child will be able to
approach their physician regarding these alternative treatments.
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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