Cerebral Palsy Update

Cerebral palsy (CP) is the most common childhood disability, according to the website cerebral palsy.org. Around 1,000,000 people in the United States have the condition. It is considered to be a movement disorder caused by abnormalities in the areas of the brain that control muscle movement. Most children with cerebral palsy are born with the condition, but it may not be diagnosed until months or even years after birth. It can be the result of damage that occurs in the developing infant brain during pregnancy, birth or immediately after birth. It cannot be cured, although treatment can improve a patient’s functioning.

Signs and Symptoms of Cerebral Palsy

The most common sign that a child has cerebral palsy is a lack of muscle coordination. This shows itself in a variety of ways: stiff gait, spasticity, dragging one foot, walking on the toes and muscle tone that is either too stiff or too relaxed. It can also affect posture and balance in many cases. There are significant differences in the severity of the condition. Some children may be unable to walk and require significant care. Others may be mildly affected and able to live fully. Some may have cognitive impairments, while others are very good at school. Some have seizures, while others do not. In short, each case is unique in its symptoms and the degree to which they cause disability.

Causes of Cerebral Palsy

Cerebral palsy was once thought to be caused by complications during birth. Birthing complications do indeed result in cerebral palsy, but today we know that only a percentage of cerebral palsy cases are the result of birth injuries. The condition can be the result of disturbances in brain cell development in utero, poor insulation of nerve cell fibers that restricts transmission of signals, perinatal brain cell death usually caused by complications during birth and post-natal trauma that disrupts brain signals. All of these factors can result in the brain damage that causes cerebral palsy.

Four types of brain damage are associated with cerebral palsy:

• Periventricular leukomalacia (PVL) involves damage to the white matter of the brain that can lead to the death of injured cells and cause empty areas in the brain. This area of the brain is responsible for transmitting nerve impulses that control motor function. At a minimum, 60 percent of infants with PVL are diagnosed with cerebral palsy. PVL is thought to be a consequence of a disruption in fetal development. Infants born prematurely are also at higher risk for PVL.
• Intraventricular hemorrhage (IVH), also known as a brain bleed, causes brain tissue to swell, resulting in a hematoma. This can damage or kill adjoining tissue because the swelling reduces the blood supply. It is most common among premature babies who have experienced other trauma such as respiratory distress syndrome, collapsed lung or high blood pressure. Babies placed on ventilators are particularly vulnerable. Risk factors include maternal high blood pressure, maternal infection, placental blood clots, pelvic inflammatory disease (PIV) and head injury.
• Hypoxic-ischemic encephalopathy (HIE) is caused by oxygen deprivation to the brain. If the oxygen deprivation is lengthy, the brain is damaged. Consequences of this type of brain damage include severe developmental and cognitive delays, motor muscle impairment and epilepsy. This is the most common result of complications during birth, as opposed to problems in utero. Causes can include failure to monitor the baby’s oxygen levels, breech birth, uncorrected umbilical cord problems and failure to perform a caesarean section soon enough.
• Cerebral dysgenesis is a type of abnormal brain development. It is also known as brain malformation and is different from the other three causes of CP that result from some type of injury. It can be caused by genetic mutations, infections such as rubella (German measles) and herpes, fever, and trauma during vulnerable stages of brain development. The consequences of cerebral dysgenesis can include seizures, developmental delays, poor motor control, failure to thrive and decreased muscle tone.

Preventing Cerebral Palsy

There are ways to reduce the risk of having a baby with CP. These include:

• Obtain prenatal care as early as possible.
• Avoid using substances such as alcohol, cigarettes and street drugs that can lead to premature birth.
• Get tested for rubella (German measles) and if you have not had the disease, get a vaccination before you become pregnant.
• Get tested for the RH blood factor that can sometimes cause brain damage and resulting CP.
• Get prescribed immunizations to prevent serious infections that can cause brain damage.
• Make sure your baby always rides in a properly installed car seat.

Treating Cerebral Palsy

There is no cure, but appropriate and early treatment can reduce symptoms and disability. Children can be taught to use adaptive equipment and participate in physical therapy. Treatment may also include injections of anti-spasticity medications. Other types of treatment include occupational therapy, speech and language therapy, glasses, and medication to treat symptoms such as seizures and feeding problems. Children with developmental disabilities can benefit from special educational services.

The Future of Cerebral Palsy

Researchers continue to investigate the causes of cerebral palsy. One important area of research is identifying genetic defects, which can be responsible for abnormal brain development that results in CP. Another area of interest is identifying the traumatic incidents that can lead to a brain bleed or damage to the brain’s white matter, which is the most common cause of CP.

An important area of research is regenerative medicine. A study is underway to test cord blood as a way to repair brain cells. Researchers are narrowing their focus on risk factors for CP. Research on CP also benefits from investigations into other conditions such as multiple sclerosis (MS), Alzheimer’s disease, amyotrophic lateral sclerosis (ALS) and other conditions that are the result of changes in certain parts of the brain. Although there are no answers yet, our understanding of how the brain works is growing rapidly and people with cerebral palsy can be hopeful.