Cerebral palsy

* Definition:-
Cerebral palsy (CP) is a diagnostic term which can be defined as
a persistent, but not necessarily unchanging, disorder of movement
and posture due to a non-progressive insult of the immature brain.

* Causes:-
a) prenatal :
1- cerebral malformation due to disorder of neuronal migration
2- genetic
3- congenital infections
4- intrauterine growth retardation
5- alcohol and substance abuse
 b) perinatal :
1- hypoxic ischemic encephalopathy
2- ventricular hemorrhage
3- hypoglycemia
4- indirect hyperbilirubinemia
c) postnatal :
1- meningitis
2- encephalitis
3- head injury

* Types:-
a) spastic CP :
1- hemiplegic
one side is affected, weakness is more distally
 2- diplegic
the limbs on both sides are affected, legs > arms, more common in
preterm and LBW infants
3- quadriplegic
all limbs are affected, bulbar muscles are involved, many affected
patients are microcephalic
b) ataxic
mainly cerebellar ataxia, usually diagnosed late and other causes of
ataxia should be excluded.
c) dyskinetic
include choreoathetotic and dystonic CP.
d) mixed.
-:Associated non-motor problems *
visual impairment 4- epilepsy -1
hearing impairment 5- speech disorder -2
learning difficulties 6- behavioral disorder -3
feeding problems -7

-:Useful investigation *
TORCH screen 2- CT, MRI -1
metabolic screen 4- EEG -3
chromosomal and genetic studies -5
ophthalmologic and hearing tests -6
But on top careful perinatal and developmental history together with
.full clinical examination are very important
* Clinical diagnosis:-
usually CP is not diagnosed until several months after birth.
It should be suspected in the following clinical situations :
1- floppy infant at birth or in early infancy
2- delayed motor development
3- persistence of primitive reflexes

- clinical diagnosis should include :

1- type of CP
2- degree of functional disability
3- possible associated problems
4- cause of CP if possible
* Differential diagnosis:-
CP should not confused with :
1- other causes of floppy infants
2- degenerative brain disorder
3- other causes of ataxia

* Management:-
Involves a multidisciplinary team, usually with a child development unit.
1- Pediatrician : play a coordinating role.
2- Physiotherapist : should be involved from an early stage, helps in
preventing severe contracture and deformities.
3- Communication therapist :
• providing help with feeding problems, speech
 • encourage parents to stimulate their children and help them to
develop as much communication as possible.
4- Occupational therapist :
helps in adapting the environment to aid child's functioning.
5- Social worker : provides support for family at periods of stress.
6- Others : as orthopedic, ophthalmologist, dietician
7- Drugs : used in severe spasticity
• Baclofen
• Dantrolene sodium
• Botulinum toxin