Cerebral palsy is a nonprogressive neuromotor disorder that is caused by injury to the cerebral cortex of the brain during fetal development. The condition affects muscle control, balance, and posture.
Cerebral palsy is caused by abnormal brain development and is often seen at birth where there is a history of complicated labor. However, various factors play a role in the development of the condition.
4 main causes of cerebral palsy
1. Premature birth
Premature birth is a major risk factor for cerebral palsy. Babies who are more susceptible to the disease include those born before 28 weeks of gestation and to mothers with preeclampsia. This is because brain development is accelerated from 24 weeks to the term of pregnancy with a five-fold volume increase and a 30-fold expansion of its surface area.
Premature babies have a low birth weight and are at risk of having spontaneous hemorrhage in the area near the ventricles of the brain, leading to a condition called periventricular leukomalacia.
Three main factors in pre-term babies include poorly developed vasculature, a pressure passive blood circulation, and increased vulnerability of oligodendrocyte progenitors to oxidative damage that contributes to the ischemic or hemorrhagic cerebellar injury or underdevelopment. The fluids that leak out due to bleeding suppress the normal growth of neurons, leading to neuronal degeneration. These complications can cause irreversible and lasting brain damage.
Children present with gross motor impairments, cognitive impairments and intellectual abilities, visual impairment, social affective disturbance, and epilepsy.
2. Hypoxic ischemic encephalopathy
Hypoxic ischemic encephalopathy (HIE), commonly called intrapartum asphyxia, can occur in full-term infants when the brain does not receive enough oxygen or blood flow for a period of time, leading to oxygen deprivation, ischemia, and brain dysfunction.
The condition can develop during pregnancy, labor, delivery, or the postnatal period. The newborn’s body cannot compensate if the asphyxia lasts too long and leads to apoptotic death of brain tissue. This can lead to severe and permanent disability, such as developmental delays, motor impairments, epilepsy, or cognitive impairment.
3. Bilirubin-induced neurologic dysfunction (BIND) or kernicterus
Newborns are at an increased risk of developing this condition because their liver is not fully developed at birth. The risk increases with elevated serum or plasma concentrations of unconjugated bilirubin. Extremely elevated levels of serum bilirubin (TSB) levels can lead to chronic bilirubin encephalopathy.
Kernicterus results from an untreated severe injury to the brain in areas that are susceptible to bilirubin staining, including the bilateral globus pallidus, subthalamic nuclei, brainstem, and cerebellum. This type of brain injury results in severe quadriplegic cerebral palsy CP with the classic extrapyramidal signs of choreoathetosis and dystonia.
4. TORCH Infections
Toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus (TORCH) infections are the main cause of neurologic and neurosensorial disorders in a fetus. Exposure to certain toxins during pregnancy can significantly increase the risk of having a baby with cerebral palsy.
Inflammation due to infection or fever releases a huge amount of cytokines that can lead to the damage of an unborn baby's developing brain. The most common congenital infections of pregnancy are known causes of long-term neurodevelopmental disabilities.
What are the main types of cerebral palsy?
- Spastic cerebral palsy: Muscles are stiff and tight, making it difficult to move with limited range of motion.
- Dyskinetic cerebral palsy: Muscles alternate between stiffness and floppiness, causing uncontrolled body movements.
- Ataxic cerebral palsy: Causes balance and coordination issues, resulting in unstable movements.
- Mixed cerebral palsy: Occurs when there are symptoms of more than one type of cerebral palsy.
How is cerebral palsy treated?
Treatment for cerebral palsy depends on the severity of the symptoms and which body parts are affected. Even though the underlying damage to the brain cannot be reversed, early treatment may help improve overall brain function:
- Physical therapy and rehabilitation: Physical therapy includes activities and exercises that can maintain or further develop muscle strength, balance, and movement.
- Orthotic gadgets: Supports, braces, and casts can be set on the affected limbs and help movement and balance.
- Assistive devices: Special CP-based communication machines, Velcro-affixed shoes, or braces can help make daily life easier.
- Medications: Certain medications can help relax stiff or overactive muscles and decrease abnormal movements. Prolonged medication may be needed to manage epilepsy, bedwetting, and other disorders.
- Surgery: Surgery may be required if symptoms are severe or if the child has seizures that do not respond to medications.
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Abdel-Hamid HZ. Cerebral Palsy. Medscape. https://emedicine.medscape.com/article/1179555-overview