Cerebral palsy

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Cerebral palsy (CP) is a group of permanent movement and posture disorders resulting from non progressive damage to the developing brain, affecting muscle tone, coordination, and motor function.

Aetiology

1. Prenatal Causes (Most Common):

  • Maternal infections: TORCH infections (Toxoplasmosis, Other [syphilis], Rubella, Cytomegalovirus, Herpes).
  • Hypoxic-ischemic injury: placental insufficiency, birth asphyxia.
  • Genetic abnormalities: rare genetic mutations linked to CP.

2. Perinatal Causes:

  • Preterm birth: intraventricular haemorrhage, periventricular leukomalacia.
  • Low birth weight: increased risk of brain injury.
  • Birth trauma: prolonged labour, instrumental delivery.

3. Postnatal Causes:

  • Neonatal infections: meningitis, encephalitis.
  • Head trauma: non accidental injury, accidents.
  • Severe jaundice: kernicterus leading to brain damage.

Pathophysiology

  • Damage to the motor cortex, basal ganglia, or cerebellum disrupts normal movement control.
  • Disruptions in myelination affect coordination and muscle control.
  • Impaired oxygen or blood supply leads to permanent neural damage.

Risk factors

  • Prematurity (<37 weeks gestation).
  • Low birth weight (<2.5 kg).
  • Perinatal hypoxia.
  • Maternal infections.
  • Multiple births (twins, triplets).
  • Severe neonatal jaundice.

Signs and symptoms

Motor Impairments:

  • Delayed milestones: sitting, crawling, walking.
  • Abnormal muscle tone: hypertonia (stiffness) or hypotonia (floppiness).
  • Spasticity: increased muscle tone and reflexes.
  • Involuntary movements: athetosis, dystonia.
  • Poor coordination and balance.

Associated Features:

  • Intellectual disability: variable severity.
  • Speech and swallowing difficulties.
  • Seizures: common in severe cases.
  • Hearing and vision impairments.
  • Orthopaedic problems: scoliosis, contractures.

Investigations

  • Clinical diagnosis: based on history and examination.
  • Neuroimaging:
    • Brain MRI – preferred to assess structural abnormalities.
    • Cranial ultrasound – for preterm infants.
  • Genetic testing: if associated syndromes are suspected.
  • Metabolic screening: if an underlying metabolic disorder is suspected.

Management

1. Supportive Care:

  • Multidisciplinary approach (physiotherapists, occupational therapists, speech therapists).
  • Regular developmental monitoring.

2. Physiotherapy and Occupational Therapy:

  • Muscle strengthening and stretching exercises.
  • Use of orthotic devices (e.g., braces) to prevent contractures.

3. Pharmacological Management:

  • Muscle relaxants: baclofen, diazepam, antiepileptics.
  • Antiepileptics: for seizure control.
  • Analgesia: for pain associated with muscle stiffness.

4. Surgical Management:

  • Tendon lengthening procedures for contractures.
  • Selective dorsal rhizotomy for severe spasticity.

5. Refferal:

  • Referral to a paediatric neurologist or specialist for further evaluation and diagnosis.
NeurologymypanotesCerebral palsy