1. CEREBRAL
PALSY

2. Definition & Epidemiology
A group of non progressive disorders of movement and posture caused by abnormal development or damage to parts of brain that control muscle movements.
Prevalence2-2.5/1000 live birth
Its more common in Prematures and twins

3. 50% of CPs have-not any detectable risk factor
Risk factors
Prenatal & Perinatal
Low socioeconomic situation
Prematurity
IUGR/VLBW
Maternal seizure disorders
Hormone Therapy :Thyroid- Estrogen or progesterone
Pregnancy complications
Maternal Fever
Hyperbilirubinemia
Asphyxia
Congenital malformations
Acquired(post neonatal) (10%)
Meningitis
Head Trauma
Stroke
50% of CPs have-not any detectable risk factor

4. Sometimes there are many co morbidities as:
Diagnosis
Children with CP usually present with delay in reaching early developmental milestones and diagnosed up to 18 month by
Asymmetric movement
Spasticity
Hypotonia
Sometimes there are many co morbidities as:
Seizure
Learning disorders
Behavioral disorders
Sensory disorders

5. Classification of CP based on Type of disability
Spastic :
The most common type (70-80%)-Upper motor pyramidal-At least two of these:
Abnormal movement pattern
Hyper tonicity
Pathologic reflexes
Dyskinetic:
10-15% of Cases - Abnormal motor pattern+ uncontrolled and repetitive motion
Ataxic:
Less than 5%-Cerebelluar injury-abnormal posture-movement nad or muscular disproportion
Dystonic:
Hypokinesia-Hypotonia
Chorea- Atetoide:
Hyperkinesia-Hypotonia
Mixed:
10-15% cases-Complications are more common as sensory involvement-Seizure-

6. Classification of CP based on anatomic involvement
Hemiplegia
Diplegia: More severe in lower extremities
Quadriplegia: Lower and upper extremities

7. Therapy Physiotherapy Botolinum Toxin Baclofen pomp (intratechal)
Anticonvulsants ……

8. Floppy baby

9. The Floppy infants Presenting features
Hypotonia
Posture(Frog leg)
Range of motion
Diminished resistant to passive movement(Scarf sign-Pull to sit)
Delayed in Motor milestones

10. Diagnostic Studies Look for Sepsis
Perform complete Physical examination
Upper motor neuron lesion
Lower motor neuron lesion
Undescending testis-High arc palate- Hypo mobility in uterine
Head CT
Head MRI
Electromyogram (EMG)
Nerve Conduction Studies
Look
for
Sepsis

12. Causes of Floppy Infant Syndrome
Central nervous system
Perinatal asphyxia
Encephalopathy
Kernicterus
Cerebral palsy (atonic type)
Intracranial hemorrhage
Chromosomal anomalies
Inborn errors of metabolism
Spinal cord lesions
Anterior horn cell disease
werdnig Hoffman
Poliomyelitis
Peripheral nervous
Acute polyneuropathy
Familial dysautonomia
Congenital sensory neuropathy
Myoneural junction
Neonatal myasthenia gravis
Infantile botulism
Following antibiotic therapy.

13. Causes of Floppy Infant Syndrome(Cnt)
Muscles
Muscular dystrophies
Congenital myotonic dystrophies
Congenital myopathies
Polymyositis
Glycogen storage disease
Arthrogryposis multiplex congenital
Miscellaneous
Protein energy malnutrition
Rickets
Prader willi syndrome
Malabsorption syndromes
Ehler-Danlos syndrome
Cutis laxa
Cretinism

14. Classification Hypotonia with weakness Hypotonia without weakness
Neuromuscular disorders
Hypotonia without weakness
CNS
Metabolic
Chromosomal

15. Proximal vs. distal weakness
Differentiating Features of a Floppy Infant according to Site of Involvement
Site of involvement
Extent to weakness
Proximal vs. distal weakness
Face
Arms
Legs
Central - +
> or =
Anterior horn cell
++++
Peripheral nerve
+++
<
Neuromuscular junction =
Muscles
Variable ++
>

16. Differentiating Features of a Floppy Infant according to Site of Involvement (Contd.)
Deep tendon reflexes
EMG
Muscle biopsy
Central
Normal or increased
Normal
Anterior horn cell
Absent
Fasciculation / fibrillation
Denervation pattern
Peripheral nerve
Decreased
Fibrillation
Neuromuscular junction
Decremental / incremental
Muscle
Short duration small amplitude potential
Characteristic

17. Diagnostic Studies Labs: initial Labs: Test as indicated
Serum electrolytes
Serum Calcium
Serum Glucose
Creatine Phosphokinase (CPK)
Toxic scan
Blood Culture
Lumbar Puncture with Cerebrospinal Fluid Examination
Thyroid Function Tests
Labs: Test as indicated
Toxicology screen
Serum Ammonia and Venous pH
Serum amino acids
Urine amino acids and organic acid
Karyotype
TORCH Virus Screening

18. Neurology Chapter of IAP

20. Neurology Chapter of IAP