Cerebral Palsy
Medical Author: Norberto Alvarez, MD
Medical Editor: William C. Shiel,
Jr., MD, FACP, FACR
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Cerebral Palsy, What You Need To Know
Medical Author: Medical Author: Melissa Stoppler, M.D.
Medical Editor:
Barbara
K. Hecht, Ph.D.
While some people believe that the term "cerebral palsy"
(CP) refers to a specific disease, it actually refers to a range of disorders
involved the control of muscles. Cerebral palsy can be caused by many different
problems. About half a million people in the US have some form of cerebral
palsy.
Cerebral palsy is usually congenital and becomes evident
early in life. However, it can be acquired later, for example, as a result of a
head injury. Researchers now believe that congenital cerebral palsy is caused by
faulty cell development in the embryo in the
early stages of pregnancy. Maternal infection with the rubella virus (German
measles) during pregnancy and severe jaundice of the newborn (as from
untreated Rh incompatibility) are some of the conditions that have been
associated with the development of cerebral palsy.
Children with cerebral palsy usually show symptoms within
the first three years of life.
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What is cerebral palsy?
Cerebral palsy (CP) is an abnormality of motor function (as opposed to mental
function) and postural tone that is acquired at an early age, even before birth.
Signs and symptoms of cerebral palsy usually show in the first year of life.
This abnormality in the motor system is the result of brain lesions that are
non-progressive. The motor system of the body provides the ability to move and
control movements. A brain lesion is any abnormality of brain structure or
function. "Non-progressive" means that the lesion does not produce ongoing
degeneration of the brain. It is also implies that the brain lesion is the
result of a one-time brain injury, that will not occur again. Whatever the brain
damage that occurred at the time of the injury is the extent of damage for the
rest of the child's life.
Cerebral palsy affects approximately one to three out of every thousand children born. However,
it is much higher in infants born with very low weight and in premature infants.
Interestingly, new treatment methods that resulted in an increased survival
rate of low-birth weight and premature infants actually resulted in an overall
increase number of children with cerebral palsy. The new technologies, however, did not
change the rate of cerebral palsy in children born full term and with normal weight.
What are causes of cerebral palsy?
The term cerebral palsy does not indicate the cause or prognosis of the child
with cerebral palsy. There are many possible causes of cerebral palsy.
In full term infants the cause of cerebral palsy is usually prenatal and not related to
events at time of delivery; in most instances it is related to events that
happened during the pregnancy while the fetus is developing inside the mother's
womb.
Premature birth is a risk factor for cerebral palsy. The premature brain is at a high
risk of bleeding, and when severe enough, it can result in cerebral palsy. Children that are
born prematurely can also develop serious respiratory distress due to immature
and poorly developed lungs. This can lead to periods of decreased oxygen delivered to
the brain that might result in cerebral palsy. A poorly understood brain process observed in some premature infants is called periventricular leukomalacia. This
is a disorder in which holes form in the white matter of the premature infant's
brain. The white matter is necessary for the normal processing of signals that
are transmitted throughout the brain, and from the brain to the rest of the body.
White matter abnormalities are observed in many cases of cerebral palsy. Nevertheless, it is
important to recognize that the vast majority of premature infants, even those
born very prematurely, do not suffer from cerebral palsy. There have been many advances in
the field of neonatology (the care and study of problems affecting newborn
infants) which have enhanced the survival of very premature infants.
Other important causes of cerebral palsy include accidents of brain development,
genetic
disorders, stroke due to abnormal blood vessels or blood clots, or infections of
the brain.
Even though it is widely believed that the most common cause of cerebral
palsy is a lack
of oxygen to the brain during delivery (birth asphyxia), it is actually a very
rare cause of cerebral palsy. When cerebral palsy is the result of birth asphyxia, the infant almost
always suffers severe neonatal encephalopathy with symptoms during the first few
days of life. These symptoms include:
- seizures,
- irritability,
- jitteriness,
- feeding and
respiratory problems,
- lethargy, and
- coma depending on the severity.
In rare
instances, obstetrical accidents during particularly difficult deliveries can
cause brain damage and result in cerebral palsy. Conversely, it is very unlikely that
cerebral palsy
symptoms would develop after a few years of age as a result of obstetrical
complications.
Child abuse during infancy can cause significant brain damage which, in turn,
can lead to cerebral palsy. This abuse often takes the form of severe shaking from a
frustrated parent or caregiver, causing hemorrhage in or just outside the brain.
To further compound the problem, many children with developmental abnormalities
are at risk for being abused. Thus, a child with cerebral palsy may be made significantly
worse or even killed by a single incident of abuse.
Despite the diversity of causes of cerebral palsy, many cases remain without a defined
cause. However, the enhanced ability to see the brain structure with
magnetic resonance imaging (MRI) and
CT
scans as well as improved diagnostic capabilities for genetic disorders has made
the number of such cases much lower.
Next: What are the types of cerebral palsy? »
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