Cerebral palsy and how to prevent and overcome on it

Definition

  Cerebral palsy is defined as a non-progressive disorder of cerebral function involving posture and movement, dating to events in the prenatal, natal, or neonatal period. It is often associated with epilepsy and abnormalities of speech, vision and intellect resulting from a lesion or defect of the developing brain.

The incidence of cerebral palsy is 4 /1000 population.

Causes of cerebral palsy

1- Antenatal causes

  a- Intra-uterine infections: TORCH.

  b- Fetal anoxia, maternal hemorrhage, placental insufficiency.

  c- Maternal irradiations of the pelvis.

  d- Congenital malformations of brain or vascular occlusion.

2- Intranatal causes

  a- Birth injury: intracranial hemorrhage, cerebral trauma.

  b- Cerebral anoxia.

  c- Marked low birth weight infants and prematurity.

3- Postnatal causes

  a- Intra-cranial infections: meningitis, encephalitis, brain abscess.

  b- Neonatal asphyxia.

  c- Kernicterus.

  d- Hypoglycemia.

Types of cerebral palsy

1- Spastic cerebral palsy

      a- Spastic hemiplegia

      b- Spastic diplegia

      c- Spastic quadriplegia

      d- Spastic monoplegia and paraplegia

2- Extrapyramidal cerebral palsy

3- Ataxic cerebral palsy

4- Mixed types

Diagnosis

Thorough history and physical examination should be performed to eliminate progressive disorders of the CNS.

· A baseline electroencephalogram (EEG) and CT scan may be indicated

Prevention

· Tests of hearing and visual function should be performed.

Prevention

Prevention of cerebral palsy is the ideal approach of this problem and is accomplished through:

1- Prevention of maternal irradiation and unnecessary drug intake.

2- Antenatal monitoring to prevent intrapartum asphyxia.

3- Prevention of birth trauma and perinatal asphyxia.

4- Prevention of hypoglycemia.

5- Prevention of low birth weight and its complications.

6- Proper management of neonatal jaundice.

 Early diagnosis is necessary in order to try to prevent secondary positional deformities.

Treatment

· Physiotherapy: prevents gross contractures. Serial plastering and splinting are required to treat positional deformity.

· Reducing abnormal muscle tone: small regular doses of benzodiazepine may be useful in reducing the severity of spasticity.

· Surgical procedures: to improve the mobility.

· Speech therapy and hearing aids may be useful if there is deafness.