Cerebral Palsy

“Cerebral” means anything related to the brain, and “palsy” means a weakness or problem in muscles. Cerebral palsy (CP) is a group of conditions affecting movement and posture caused by damage to the developing brain, even before birth.

In India, cerebral palsy is estimated to be around 3 cases per 1000 live births or around 25 lakh cases as per statistics.

What are the types of Cerebral Palsy?

There are mainly four types of Cerebral Palsy, based on the movement; that is –

• Spastic cerebral palsy – stiff or tight muscles, or muscle spasms occur
• Dyskinetic cerebral palsy – too tight or too loose muscle tone causing uncontrolled movements
• Ataxic cerebral palsy – Rare, causing problems in balance and coordination
• Mixed cerebral palsy – More than one type of CP

What are the symptoms of Cerebral Palsy?

Symptoms of cerebral palsy can vary greatly because the type of CP ranges from very mild to very severe. Many time, there are delay in the baby milestones that are linked to functions where muscles are involved. However, it is not necessary that delays in milestones points to CP. Cerebral Palsy may or may not affect the whole body.

General symptoms

Movement and coordination

• Stiff muscles and exaggerated reflexes(spasticity).
• Stiff muscles with regular reflexes (rigidity).
• Lack of balance and muscle coordination(ataxia).
• Uncontrollable Jerky movements (tremors).
• Slow, writhing movements.
• Favoring one side of the body (using one particular hand for reaching a toy, or crawling using one leg)
• Trouble walking.
• Trouble with fine motor skills, such as buttoning clothes or picking up utensils.
  
  

Speech and eating

• Delays in speech development.
• Trouble speaking.
• Trouble with sucking, chewing or eating.
• Drooling or trouble with swallowing.

Developmental symptoms:

• Delays in reaching motor skills milestones, such as sitting up or crawling.
• Learning disabilities.
• Intellectual disabilities.
• Delayed growth

Based on the age of the child, following symptoms could be present –

In babies younger than 6 months –

• Poor head control while sleeping (Head falls backward while picking up baby up from sleep)
• Feeling stiff or floppy.
• Extending the back and neck, like pushing away from the person cradling them in the arms
• Scissor (legs getting stiff and crossing over each other when picked up)

In babies older than 6 months –

• Can’t roll over.
• Can’t clap or bring their hands together.
• Unable to bring hands to mouth
• Reaching only with one hand, while other staying in fist.

In babies older than 10 months –

• Using only one hand and one leg while crawling
• Hopping on their knees.

A baby who is 1 year old and and cannot stand or crawl without support, are possible signs of CP.

What are the causes and risk factors of Cerebral Palsy?

Cerebral Palsy is caused by damage to the brain or problems in brain development usually happening before a child birth,  but can also occur at birth or in early infancy. The reason for this is not known, but some of factors can damage the brain or disrupt its growth include:

• Bleeding in the brain during pregnancy (while baby is in the womb) or afterward.
• A lack of blood flow to important organs including brain (Stroke)
• Seizures at birth or in the first month of life
• Some genetic conditions
• Infections occurring in the mother, affecting the child’s brain
• Traumatic brain injuries
• Rarely, lack of oxygen to the brain during a hard labor or delivery

Risk factors associated with cerebral palsy

• Maternal health – Exposure to certain infections or toxic substances during pregnancy
• Infant illness – llnesses in a newborn baby
• Pregnancy and birth factors –
  
  • Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms)
  • Multiple babies.
  • Premature birth – baby born earlier than the due date.
  • Delivery complications.

How is Cerebral Palsy diagnosed?

The doctor checks about developmental milestones at every scheduled visit of the baby.  The doctor measures gradual changes over time, but a diagnosis still might not be made from a few months to a year after birth. It is difficult for the doctor to conclude for sure if a 8-month-old has a developmental delay compared to a 2½-year-old, because it’s more likely that an earlier delay will be less obvious than a later one.

A series of tests to make a diagnosis and rule out other possible causes. These are:

Brain scans like MRI, Cranial Ultrasound – could reveal areas of damage or irregular brain development

Electroencephalogram (EEG) – in case of seizures

Laboratory tests – for genetic conditions

What are the treatment options for Cerebral Palsy?

There is no cure for cerebral palsy, but many treatment options aid in improving the child’s daily functioning.

Children and adults with cerebral palsy may require lifelong care and monitoring under a team of doctors including a physical medicine and rehabilitation specialist, pediatric neurologist, therapists, and mental health specialists. Early treatment helps build better outcomes.

Treatment options can include medicines, therapies, surgical procedures and other treatments as needed.

Can Cerebral Palsy be prevented?

It is completely possible to prevent CP, but a pregnant woman should keep following things in mind to minimize pregnancy complications:

• Vaccination: Make sure to get fully vaccinated before pregnancy. Getting vaccinated against diseases such as rubella might prevent an infection.
• Stay health: Healthier the pregnancy, lesser the risk of developing an infection resulting in cerebral palsy.
• Prenatal care: Regular check-ups are vital to reduce health risks in pregnancy and for the unborn baby.
• Avoid alcohol, tobacco and illegal drugs as they are said to be linked to cerebral palsy.
• It rarely occurs that CP is caused by brain damage occurring in childhood. However, good general safety should be practiced. Prevent head injuries by providing the child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.

References:

1. Vyas AG, Kori VK, Rajagopala S, Patel KS. Etiopathological study on cerebral palsy and its management by Shashtika Shali Pinda Sweda and Samvardhana Ghrita. Ayu. 2013 Jan;34(1):56-62.
2. Cerebral Palsy. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
3. What Is Cerebral Palsy? WebMD. May 2024. https://www.webmd.com/children/understanding-cerebral-palsy-basic-information