CEREBRAL PALSY Kate Morton

CEREBRAL PALSY Disorder of movement and posture Most common cause of motor impairment in children Due to a non-progressive lesion of the motor pathways in the developing brain Clinical manifestations can change as the cerebrum matures Most common cause of motor impairment in children Associated conditions Learning impairment (60%) Visual impairment (20%) Squints (30%) Hearing loss (20%) Speech and language disorders Behaviour disorders Epilepsy (40%)

CAUSES OF CP ANTENATAL (80%) Cerebral dysgenesis Cerebral malformation Congenital infection INTRAPARTUM (10%) Birth asphyxia/trauma POSTNATAL (10%) Intraventricular haemorrhage/ ischaemia Meningitis/ encephalitis/ encephalopathy Head trauma/ NAI Symptomatic hypoglycaemia Hydrocephalus Hyperbilirubinaemia

PRESENTATION Abnormal tone and posturing Feeding difficulties Delayed motor milestones Abnormal gait once walking Developmental delay – language/ social skills Other signs: Hand preference under 12m Persistence of primitive reflexes (should disappear by 12m)

CLINICAL TYPES Spastic (70%) - damage to UMN pathway Increased limb tone Brisk tendon reflexes, extensor plantar response Different distributions possible – hemiplegia, diplegia, quadriplegia Ataxic hypotonic (10%) – usually genetic cause Usually symmetrical Early hypotonia, poor balance, delayed motor development Followed by incoordinate movements, intention tremor Dyskinetic (10%) – damage to basal ganglia or extrapyramidal pathway Constant involuntary movements Poor postural control Floppiness and delayed motor development Intellect relatively intact

MANAGEMENT Importance of child health surveillance MDT approach Give parents as much information as possible Medical treatments for muscle spasm– baclofen, dantrolene, diazepam Surgical – scoliosis, hip reduction, tendon lengthening, osteotomy Others – mobility aids; botulinus toxin; heat, cold and vibration for spasticity; splinting Management of associated conditions eg epilepsy, learning disability, dental problems, aspiration pneumonia