Cerebral palsy

Last reviewed: September 2018

Last updated: May 2018

Summary

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.

Definition

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] 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] [3]

History and exam

Key diagnostic factors

presence of risk factors
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

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Other diagnostic factors

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

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Risk factors

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

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Diagnostic investigations

1st investigations to order

MRI brain

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Investigations to consider

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

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Treatment algorithm

ONGOING

spastic hemiplegia

spastic diplegia

spastic quadriplegia

dyskinetic

ataxic

Contributors