July 6, 2020

Cerebral Palsy: Causes, Risk Factors, Diagnosis and Treatment

Cerebral palsy is a neurological disorder that appears in the infancy or early childhood and affects the child’s balance, body movement and also muscle coordination. There are various types of cerebral palsy and depending on the type the symptoms are portrayed. The disorder might occur during the child’s development in the mother’s womb, injury during birth or due to some infections during early childhood. Let us have a look at the causes, risk factors, diagnosis and treatment of the disorder.

Causes of Cerebral Palsy

A number of reasons during conception and at birth, and also post-birth complications can contribute to the development to this disorder. Here is a list of few factors that have been found to have a direct correlation with the condition:

  • Infections during Pregnancy:Infection of the mother during pregnancy might damage the developing nervous system and brain of the fetus. These infections viz., Rubella (German measles), Toxoplasmosis (a parasite infection commonly spread through cats’ feces or due to intake of meat that is inadequately cooked), Cytomegalovirus (a herpes-type virus) or Urinary Tract Infection increase the risk of cerebral palsy in the fetus. Other types of maternal infections may be there such as Cystitis, Vaginal yeast infections, Pyelonephritis, Genital warts, and Coughs that last for more than one week.
  • Insufficient oxygen reaching the fetus’ brain (Birth Asphyxia)
  • Low Birth weight (less than 2000gms)
  • Premature birth or birth before 32 weeks of gestational age
  • Severe jaundice, which is untreated can cause damage to the brain cells
  • Rh incompatibility between mother and the baby
  • Significant trauma to the head caused during labor and/or delivery.
  • Intracranial hemorrhage (Cerebral stroke caused by bleeding in the brain) in the unborn or after 1 month of age.
  • Genetic Abnormalities like maternal mental retardation, fetal congenital malformations, fetal microcephaly, genetically inherited thrombophilia’s, etc.
  • Maternal Age over 40 years
  • Low Placental Weight, placental abruptions or lesions
  • Type 1 Diabetes and Preeclampsia in the mother
  • Abnormal fetal positions
  • Hypoxemia (extremely low oxygen saturation in the blood)

Risk Factors of Cerebral Palsy

A number of cases of cerebral palsy occur due to brain damage post birth in the early few months or years from birth. The major causes are head injury, bacterial meningitis or viral encephalitis. However, there are also few risk factors which can contribute to the development of cerebral palsy. These include:

  • Breech Birth (feet, knees and buttocks coming out first during delivery)
  • Respiratory problems in the infant just after birth
  • Birth defects like spinal bone malformations, abnormally small jaw bone or groin hernias.
  • Low Apgar Score after 10-20 minutes of birth
  • Low Birth Weight (below 2500gms) or premature delivery (born before 37 weeks of pregnancy)
  • Seizures at birth or just after birth
  • Congenital Nervous system deformities like microcephaly
  • Being a twin or one of the multiple births.
  • Proteinuria in the later stages of pregnancy
  • Maternal Hyperthyroidism or hypothyroidism, seizure or mental retardation

However, it must be noted that these are risk factors which increases the chances of having the disorder; it does not guarantee that a child born with the conditions will have the disorder.

Diagnosis of Cerebral Palsy

Parents should pay special attention to their children especially during the early developmental years. This can helpin early diagnosis leading to early intervention, treatments, and will provide better outcome. During the first few months after birth, an infant suffering from cerebral palsy may be diagnosed by following symptoms:-

  • After birth, the infant may have delayed cry or excessive crying.
  • Repeated seizures or epilepsy after birth or it may occur after some months.
  • Problem in movement coordination, balance, controlling reflexes and posture.
  • Difficulty in Fine motor, gross motor, Oro-motor functions.
  • Delayed development.
  • Degenerative nervous disorders.
  • Delays in speech and difficulty in speaking simple sentences by 24 months.
  • Poor Feeding or swallowing difficulties.
  • Irritability or fussiness
  • There may be asymmetrical movements i.e., one side of the body move easily compared to the other.
  • Abnormal functions of the brain which does not get worse (static encephalopathy).

Treatment of Cerebral Palsy

Conventional Methods of Treatment:These include-

  • Medicine:Medicines for Cerebral Palsy helps the infant to control body movement and helps to minimize symptoms and other associated problems. Some of the common medicines used are:
  1. Medicines for Involuntary Movements for Individuals with Cerebral Palsy: The common movements used for managing uncontrolled movements are Benztropinemesylate, Carbidopa-levodopa (Sinemet), Glycopyrrolate (Robinul), Procyclidine hydrochloride (Kemadrin), Trihexyphenidyl hydrochloride.
  2. Anti-convulsant Medicines for Individuals with Cerebral Palsy:Gabapentin (Neurontin),Lamotrigine (Lamictal), Oxcarbazepine (Trileptal), Topiramate (Topamax) Zonisamide (Zonegran) are some of the medicines used as anticonvulsants (seizure medication).
  3. Anti-depressants for People suffering from Cerebral Palsy: It is often seen that individuals suffering from cerebral palsy suffers from depression due to the extreme physical condition. To treat depression,Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloffis)are used as antidepressants.
  4. Muscle Relaxant Medicines for Individuals suffering from Cerebral Palsy: The most common symptom of cerebral palsy is muscle spasticity which makes it difficult for the individual to move. The spasticity also leads to problems like muscle pain or even difficulty to chew food. The common medicines given to relax the spastic muscles are Baclofen (Botulinum toxin, or Botox(R)), Diazepam (Valium(R),Dantrolene, Flexeril (Cyclobenzadrine), Dantrium (Dantrolene), Intrathecal Baclofen, Tizanidine.
  5. Anti-inflammatory medicines for Individuals suffering from Cerebral Palsy: Due to the spastic muscles and also weakness of muscles, patients often suffer from pain. The common anti-inflammatory medicines and medicines used for treating the pain are Aspirin, Corticosteroids, and Steroids.
  • Surgical Corrections for Cerebral Palsy:Surgeryhelpsto reducespasticity, physical impairments (Bony dislocations),muscles stiffness, correct curvatures and postures. These help in compensatinguneven growth, correct limb positioning, facilitate sitting, walking and standing,initiate hand usage, and minimizing tremors as much as possible in children with cerebral palsy. Common surgeries are there such as Gastroenterology surgery, Hearing correction surgery, Orthopedic surgery for bony dislocations, Neurosurgery, Vision correction surgery, and surgery for muscle release.

Alternative and Complimentary Therapies: Apart from medicine and surgery, some therapies are essential for increasing mobility. These include:

  • Physiotherapy: Proper exercise helps to increase strength, flexibility, and coordination that help to reduce spasticity and increase mobility.
  • Occupational Therapy: It helps to maintain adequate daily living skills by modifying the tasks so that the individual can easily adapt with their environment.
  • Aqua Therapy:Aqua therapy helps in reducing spasticity and improves body movement in an easy manner as moving under water is easier due to the defiance of gravity. The water of the pool has a usual temperature 92 and 96 degrees which further helps in muscle relaxation and reducing pain.
  • Play Therapy: This helps in increasing physical, mental and social development.
  • Speech and Language Therapy: It aims to develop communication among children to express their thoughts and valuable ideas. Children with cerebral palsy are often found to have difficulty in speaking due to spasticity. Speech therapy helps in dealing with that and also for severe cases they are taught sign languages.
  • Music Therapy:Music therapy helps in releasing the emotional difficulties and also promotes overall wellbeing as there is a relaxing component attached to the therapy. Playing different kinds of instrument also helps in improving flexibility and dexterity of the body.
  • Dance Therapy: Dance therapy being a holistic therapy comprises many techniques to help the child overcome the problem. It serves as a medium of emotional release for the individual along with decreasing spasticity with the help of massage and manipulation techniques and also promotes coordinated movements of the limbs and body. It also helps to increase hand and eye coordination.
  • Behavioral Therapy:It improves the quality of life by developing various skills such as how to cope with stressful situation by avoiding negative outcomes such as frustration, aggression, depression, etc.
  • Acupuncture and Acupressure: Acupuncture and acupressure are used for treating various disorders. It helps in dealing withserious disorders that involve brain damage, such as Stroke, Alzheimer’s disease, Mental retardation, Attention deficit disorder, Tourette’s syndrome, Manic-depressive syndrome, Cerebral palsy, and Schizophrenia. It also reduces pain and inflammation in the body.

Herbal Remedies for Cerebral Palsy

  • Echinacea: Sometime natural herbs can help to reduce the symptoms of cerebral palsy. Echinacea, also known as the American coneflower, helps to improve immune system, blood circulation, and mobility and protects from pain, cold and flu.
  • Fish Oil: Fish oil is an important source of omega-3 fat. It benefits the eye and brain development of the child which is more required for a child with cerebral palsy.
  • Ginger: Ginger is considered as a herb that helps improve blood circulation, boosts the oxygen levels in the brain and increases availability of nutrients to cells.

Most children with cerebral palsy live happy, long, quality and quantity lives if early intervention and proper medical facilities are provided. The child might require surgery, assisted device, special education, behavior modification and full parental along with other family members support to reach a state of good living depending on the level they are affected by the condition.

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