Cerebral palsy

An umbrella term referring to a non-progressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still evolving.

Most common cause of childhood disability affecting 2.5 per 1000 individuals in the industrialised world.

All patients present with motor impairment; 80% have spasticity. Other movement disorders observed are dystonia, athetosis, chorea, and ataxia.

Other common problems include feeding difficulties, speech impairment, intellectual deficits, 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 orthopaedic, paediatric, dietary, and psychosocial services. Educational and vocational support is also needed.

Spasticity can be treated with oral medications, botulinum toxin and other injections; intrathecal baclofen; or selective posterior rhizotomy.

Physical, occupational, and speech therapy address motor function, communication, and activities of daily living to prevent deformity and optimise independence and quality of life. Orthopaedic interventions address contractures, scoliosis, subluxing hips, and extremity deformity.

Cerebral palsy (CP) is an umbrella term referring to a non-progressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still evolving.[1]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. http://www.ncbi.nlm.nih.gov/pubmed/17370477?tool=bestpractice.com Secondary effects of spasticity on growth may, however, be progressive. There may be additional disturbances of sensation, perception, cognition, communication, and behaviour; neurogenical bladder/bowel; GORD; sialorrhoea (excessive secretion of saliva); feeding and swallowing difficulties; and/or epilepsy. CP is also known as Little's disease.[2]Little WJ. Deformities of the human frame. 1843. Clin Orthop Relat Res. 2007 Mar;456:15-9. http://www.ncbi.nlm.nih.gov/pubmed/17496748?tool=bestpractice.com [3]Little, WJ. On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformities. Clin Orthop Relat Res. 1966 May-Jun;46:7-22. http://www.ncbi.nlm.nih.gov/pubmed/5950310?tool=bestpractice.com