Cerebral palsy

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 27 Jun 2026

Last updated: 27 May 2026

CP is the most common cause of childhood disability, affecting around 2 per 1000 people in resource-rich countries.

All patients have motor impairment; 80% have spasticity. Other movement disorders observed are dystonia, athetosis, chorea (all of which are types of dyskinetic CP), and ataxia.

Other common problems for patients with CP include feeding difficulties, speech impairment, sialorrhea (drooling), intellectual disability, sleep disturbance, behavioral and mental health problems, epilepsy, urinary incontinence, and a variable sensory/proprioceptive loss.

Management is multidisciplinary and includes occupational, physical, and speech therapy; neurology and neurosurgery; psychiatry; urology; ophthalmology; and orthopedic, pediatric, dietary, and psychosocial services. Educational and vocational support is also needed.

Treatments for spasticity include oral pharmacotherapy, botulinum toxin and other injections, intrathecal baclofen, and selective dorsal rhizotomy.

Physical, occupational, and speech therapy address motor function, communication, and activities of daily living to prevent deformity and optimize independence and quality of life. Orthopedic interventions address contractures, scoliosis, hip subluxation, and extremity deformity.

Определение

Cerebral palsy (CP) is an umbrella term referring to a nonprogressive disease of the brain originating during the prenatal, neonatal, or early postnatal period (when brain neuronal connections are still evolving) that results in disorders of movement and posture development.[1] Secondary effects of spasticity on growth may, however, be progressive. All patients with CP have motor impairment, with spastic, dyskinetic, ataxic, and mixed subtypes. Complications of CP include: additional disturbances of sensation, perception, cognition, communication, and behavior; neurogenic bladder/bowel; GERD; sialorrhea (excessive secretion of saliva); feeding and swallowing difficulties; and epilepsy.

Анамнез и осмотр

Ключевые диагностические факторы

early general movement abnormalities
abnormal HINE scores
delay in motor development
delay in speech development
delay in cognitive/intellectual development
retention of primitive reflexes
lack of age-appropriate reflexes
spasticity/clonus
selective voluntary motor control impairment
toe walking/knee hyperextension
scissoring
crouched gait
contractures

Полная информация

Другие диагностические факторы

muscle weakness
joint instability/dislocation
dystonia
chorea
athetosis
ataxia
neonatal hypotonia
scoliosis

Полная информация

Факторы риска

prematurity
low birth weight
fetal birth asphyxia
multiple births
maternal illness
fetal brain malformation
major birth defects
familial metabolic/genetic disorder
neonatal complications
meningitis
maternal teratogen exposure
low socioeconomic status
nonvertex presentation
postmaturity
head injury

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

MRI brain

Полная информация

Исследования, проведение которых нужно рассмотреть

ultrasound/CT brain
coagulation studies
genetic testing
metabolic screen
x-ray of affected joint
instrumented gait analysis

Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

spastic hemiplegia

spastic diplegia

spastic quadriplegia

dyskinetic

ataxic

Составители

Авторы

UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, null

Los Angeles

Раскрытие информации

See individual author disclosures.

William L. Oppenheim, MD

Distinguished Professor Emeritus Pediatric Orthopedics

Margaret Jones Kanaar Chair, Cerebral Palsy

David Geffen School of Medicine at UCLA

Los Angeles

Раскрытие информации

WLO is an author of several references cited in this topic.

Loretta Staudt, MS, PT

Research Physical Therapist

UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy

David Geffen School of Medicine at UCLA

Los Angeles

Раскрытие информации

LS is a clinical evaluator for several sponsored clinical trials as part of her salaried employment at UCLA. She has received travel, meals, and accommodation to attend training meetings for some of these trials but does not receive any direct reimbursements or personal benefits from the companies, which include Pfizer, Sarepta, Audentes Therapeutics, Bristol-Meyers Squibb, Biogen, Santhera, Fibrogen, Cytokinetics, Italfarmaco, and AveXis. As part of her salaried employment at UCLA, LS is working on a project funded by the Cerebral Palsy Foundation. She is an author of several references cited in this topic.

Rachel Thompson, MD

Assistant Professor-in-Residence, Department of Orthopaedic Surgery

Associate Residency Program Director, Department of Orthopaedic Surgery

Director, UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy

William and Patricia Oppenheim Presidential Chair in Pediatric Orthopaedics

David Geffen School of Medicine at UCLA

Los Angeles

Раскрытие информации

RT declares that she has no competing interests.

Marcia Greenberg, MS, PT

Physical Therapist

UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy

David Geffen School of Medicine at UCLA

Los Angeles

Раскрытие информации

MG is a consultant for the NGO, UCP Wheels for Humanity, teaching physical therapists in developing countries. She is an author of several references cited in this topic.

Eileen Fowler, PhD, PT

Professor

Department of Orthopaedic Surgery

Director of Research and Education

UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy

Peter William Shapiro Chair

David Geffen School of Medicine at UCLA

Los Angeles

Раскрытие информации

EF receives grant funding from the Cerebral Palsy Foundation. She is a member of the Scientific Advisory Committee of the Cerebral Palsy Foundation. She is an author of several references cited in this topic.

Выражение благодарностей

Dr William L. Oppenheim, Loretta Staudt, Dr Rachel Thompson, Marcia Greenberg, and Dr Eileen Fowler wish to gratefully acknowledge Dr Albert Stroberg, Dr Erika Hassan, Dr Rebecca Hanson, Dr Joan Earle Hahn, Dr Tien T. Nguyen, and Dr Sarah Copeland, previous contributors to this topic.

Раскрытие информации

AS, EH, RH, JEH, TTN, and SC declare that they have no competing interests.

Рецензенты

Hank Chambers, MD

Clinical Professor

Department of Orthopaedic Surgery

University of California at San Diego

Medical Affairs Officer

Rady Children's Hospital

San Diego

Раскрытие информации

HC is an author of a number of references cited in this topic. HC has received research support from the National Institutes of Health greater than 6 figures USD.

Michael Sussman, MD

Orthopaedic Surgeon

Shriners Hospital for Children

Portland

Раскрытие информации

MS declares that he has no competing interests.

Charles Fairhurst, MBBS MSc

Consultant in Paediatric Neurodisability

Evelina Children's Hospital

Guy's & St Thomas' NHS Foundation Trust

London

Раскрытие информации

CF declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007 Feb;109:8-14. Аннотация

Noritz G, Davidson L, Steingass K, et al. Providing a primary care medical home for children and youth with cerebral palsy. Pediatrics. 2022 Nov 21;e2022060055.Полный текст Аннотация

Shepherd E, Salam RA, Middleton P, et al. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2017 Aug 8;(8):CD012077.Полный текст Аннотация

Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020 Feb 21;20(2):3.Полный текст Аннотация

Shepherd E, Salam RA, Middleton P, et al. Neonatal interventions for preventing cerebral palsy: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev. 2018 Jun 20;(6):CD012409.Полный текст Аннотация

Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907. Аннотация

American Academy of Neurology. Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy. Jan 2010 [internet publication].Полный текст

Fehlings D, Brown L, Harvey A, et al. Pharmacological and neurosurgical interventions for managing dystonia in cerebral palsy: a systematic review. Dev Med Child Neurol. 2018 Apr;60(4):356-66.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Cerebral palsy

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

spastic hemiplegia

spastic diplegia

spastic quadriplegia

dyskinetic

ataxic

Составители

Авторы

UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, null

Раскрытие информации

William L. Oppenheim, MD

Раскрытие информации

Loretta Staudt, MS, PT

Раскрытие информации

Rachel Thompson, MD

Раскрытие информации

Marcia Greenberg, MS, PT

Раскрытие информации

Eileen Fowler, PhD, PT

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Hank Chambers, MD

Раскрытие информации

Michael Sussman, MD

Раскрытие информации

Charles Fairhurst, MBBS MSc

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice