|
Cerebral palsy
Cerebral palsy or CP is a group of permanent disorders associated with
developmental brain injuries that occur during fetal development, birth,
or shortly after birth. It is characterized by a disruption of motor skills,
with symptoms such as spasticity, paralysis, or seizures. Cerebral palsy
is a form of static encephalopathy. One form of it, spastic diplegia,
is sometimes known as Little's disease in the United Kingdom. Properly
speaking, the fact that CP does not get better or worse implies that it
is a 'condition' (chronic nonprogressive neurological disorder) rather
than a 'disease.' The incidence is about 1.5 to 4 per 1000 live births.
There is no cure, but therapy has been shown to be helpful in the maintainance
of motor functions. While severity varies widely, cerebral palsy ranks
among the most costly congenital conditions to manage.
Cerebral palsy develops while the brain is under development. 80% of
all cases occur before the baby reaches 1 month old, however this disorder
can occur within about the first 5 years of life. It is a nonprogressive
disorder; once damage to the brain occurs, no additional damage occurs
as a result of this condition. Cerebral palsy neither improves nor worsens,
though symptoms may seem to increase with time, likely due to the aging
process.
History
Cerebral palsy, then known as "Cerebral Paralysis", was first
identified by a British surgeon named William Little in 1860. Little raised
the possibility of asphyxia during birth as a chief cause of the disorder.
It was not until 1897 that Sigmund Freud suggested that a difficult birth
was not the cause but rather only a symptom of other effects on fetal
development. Modern research has shown that asphyxia is not found during
birth in at least 75% of cases. Such research also shows that Freud's
view was correct, even though during the late 19th century and most of
the 20th century Little's view was the traditional explanation. ("Conditions",
9)
Cause
Since cerebral palsy refers to a group of disorders, there is no exact
known cause. Some major causes are asphyxia, hypoxia of the brain, birth
trauma or premature birth, genetic susceptibility, certain infections
in the mother during and before birth, central nervous system infections,
trauma, and consecutive hematomas. In most people with CP, the cause is
unknown. After birth, the condition may be caused by toxins, physical
brain injury, incidents involving hypoxia to the brain (such as drowning),
and encephalitis or meningitis. Despite all of these causes, the cause
of many individual cases of cerebral palsy is unknown.
Recent research has demonstrated that asphyxia is not the most important
cause as it was once considered to be, though it still plays a role, probably
accounting for about 10% of all cases. The research has shown that infections
in the mother, even infections that are not easily detected, may triple
the risk of the child developing the disorder.
Premature babies have a higher risk because their organs are not yet
fully developed. This increases the risk of asphyxia and other injury
to the brain, which in turn increases the incidence of cerebral palsy.
Incidence and prevalence
The incidence is about 1.5 to 4 per 1000 live births. This amounts to
approximately 5,000-10,000 babies born with cerebral palsy each year in
the United States. Each year, around 1,500 preschoolers are diagnosed
with the disorder. In around 70% of all cases, cerebral palsy is found
with some other disorder, the most common being mental retardation.
Overall, advances in care of pregnant mothers and their babies has not
resulted in a noticeable decrease in cerebral palsy. Only the introduction
of quality medical care to locations with less than adequate medical care
has shown any decreases. The incidence increases with premature or very
low-weight babies regardless of the quality of care. Twins are also four
times more likely to develop cerebral palsy than single births, and triplets
are more likely still to develop it.
Despite medical advances, the incidence and severity of cerebral palsy
has actually increased over time. This may be attributed to medical advances
in areas related to premature babies or the increased usage of artificial
fertilization techniques.
Types
Based on the group of muscles involved (typically only used to further
describe spastic CP):
Tetraplegia or Quadriplegia : Involvement of the four limbs, the trunk
and the head. The great majority of these individuals will not be able
to stand up or walk.
Diplegia: The four limbs are affected, but lower limbs are more involved
than upper limbs. Some of the people with diplegia will be able to walk
alone, with orthosis, or by the use such as crutches or walkers.
Hemiplegia: Only the right side or the left side of the body is involved.
People with hemiplegia are the most likely to walk, even though people
with the above two types can often walk without assistance, if severity
allows.
NOTE: These are not the only 3 types of spastic CP. Occasionally, terms
such as monoplegia, paraplegia, triplegia and pentaplegia may be used.
Ataxia: Persons with ataxia have damage to their cerebellum which results
in problems with balance, especially while walking. It is the most rare
type, occurring in at most 10% of all cases.
Athetoid or dyskinetic: Persons with this type generally have involuntary
body movements. The damage occurs to the extrapyramidal motor system and/or
pyramidal tract and to the basal ganglia. It occurs in ~20% of all cases.
Spastic: Persons with this type have damage to the corticospinal tract,
motor cortex, or pyramidal tract. It occurs in ~70% of all cases.
These three types may be found together. In 30% of all cases of cerebral
palsy, the spastic form is found with the one of the other types. There
are a number of other minor types of cerebral palsy, but these are the
most common.
Presentation (signs and symptoms)
All types of cerebral palsy are characterized by abnormal muscle tone,
posture, reflexes, or motor development and coordination. The classical
symptoms are spasticity, paralysis, seizures, unsteady gait, and dysarthria.
While mental retardation and cerebral palsy do not cause each other, the
two disorders are found together in approximately 20%-30% of all persons
with cerebral palsy. CP symptomology is as diverse as the individuals
who have it. Secondary symptoms can include rigidity of limbs, bladder
control issues, and impaired tongue movement.
Prognosis
Cerebral Palsy is not a progressive disorder. A person with the disorder
may improve somewhat during childhood, if they receive extensive care
from specialists. Some individuals with the disorder will need to stay
under the immediate care of another person for their entire lives, while
others have a mild enough case to pursue fully independent lives.
Treatment
There is no cure for cerebral palsy, but various forms of therapy can
help a person with the disorder to function more effectively. Nevertheless,
there is only some benefit from life-long care. The treatment is usually
symptomatic and focuses on helping the person to develop as many motor
skills as possible or to learn how to compensate for the lack of them.
The disorder does not affect the expected length of life so treatment
focuses on quality of life issues. Non-speaking people with cerebral palsy
are often successful availing of Augmentative and Alternative Communication
systems such as Blissymbols.
|
 |
