Cerebral Palsy (MPD) is also called Little's disease after the English physician William John Little. Cerebral palsy can be very different - the ailments that may be associated with it include, among others, movement disorders, muscle tension abnormalities and posture disorders. What may be the causes of cerebral palsy and what treatment is offered to those patients who develop this entity?
Cerebral palsy (MPD for short)is a unit known to mankind for centuries - various ancient works have been found many times, commemorating images of people with characteristic of MPD irregularities. Although the disease has been around for a long time, it was not fully described until the 19th century, when an English-born physician, John William Little, published his work on cerebral palsy. From his name, cerebral palsy is also known asLittle's disease . A long time has passed since the doctor's publication, during which the pathogenesis of the problem was understood, the related difficulties and new possibilities of its treatment were discovered.
The statistics on the incidence of MPD are different. Overall, it is estimated that 1.5 to 3 in 1,000 babies born alive suffer from them. According to estimates, each year in Poland over 1,000 children may be born in Poland, who will eventually be diagnosed with cerebral palsy.
Cerebral Palsy: Causes
Cerebral palsy occurs when there is some type of damage to the developing nervous system early in life. In general, the problems that can result in MPD can occur both in the prenatal and perinatal periods, or even after birth.
During pregnancy, a variety of factors may be associated with the later onset of MPD in the baby. They can be:
- use of psychoactive substances (drugs, alcohol) by a pregnant woman and smoking,
- infections during pregnancy (a particular risk of cerebral palsy is associated withtoxoplasmosis and rubella, cytomegalovirus infections are also dangerous),
- serological conflict,
- mother malnutrition,
- at risk of miscarriage (such as, e.g., premature detachment of the placenta, placenta previa).
Various complications that occur in the perinatal period are also of great importance in the pathogenesis of cerebral palsy. In this case, the possible causes of cerebral palsy include:
- hypoxic ischemic encephalopathy,
- intracranial bleeding,
- prematurity,
- severe hyperbilirubinemia,
- birth injuries.
Sometimes certain events that ultimately result in MPD occur after the baby is born into the world. Here you can mention such problems as:
- head injuries,
- central nervous system infections,
- hydrocephalus.
It is also necessary to emphasize that genetic determinants have a certain influence on the occurrence of cerebral palsy. It is sometimes also mentioned that children with multiple pregnancies, low birth weight and those with a low Apgar score immediately after delivery are at an increased risk of MPD.
Cerebral Palsy: Symptoms
MPD has a very different clinical picture - what ailments appear in a given patient depends on the exact area of his central nervous system in which some damage occurs. In general, the possible symptoms of cerebral palsy include:
- abnormalities in muscle tone (it can be both increased and weakened),
- speech development delay, difficulties with articulation,
- delayed crossing of subsequent developmental milestones (such as sitting, crawling or walking),
- ataxia,
- involuntary movements,
- gait disturbance,
- difficulty maintaining proper body posture,
- problems with chewing food,
- drooling.
It is worth emphasizing here that some symptoms of MPD are visible shortly after birth, while others become clearly noticeable only when the child reaches the age of several years. The parents are usually very concerned then, as they feel that their child's condition is deteriorating.
The truth in this case, however, is that cerebral palsy is caused by non-progressive damage to the central nervous system, and some of the ailments may only be noticed at a certain stage of development - e.g.a baby will not have a gait disturbance until it begins to walk.
Cerebral Palsy: types
Due to - as mentioned above - possible different course of MPD, several different forms of it are distinguished. One of them isbilateral spastic paralysis , in which the abnormalities mainly concern the lower limbs.
Patients may show an increase in muscle tension and an increase in tendon reflexes in the limbs (especially lower limbs), it is also characteristic here that while crawling on the ground, the child pulls both legs straightened.
Hemiplegia- another form of MPD - is usually diagnosed early, usually around 4-5. month of the baby's life. When a baby tries to roll over from belly to back, parents may notice rotation asymmetry. Increased tendon reflexes on one side of the body may also be associated with this type of cerebral palsy.
Bilateral hemiplegia is associated withtetraplegiaand is considered to be the most severe form of MPD. Usually, the paresis is more severe in the upper limbs. Walking and standing may not be possible due to postural disturbances. Problems with feeding the baby are common, followed by articulation disorders.
The cerebellar form of MPDis rare and is associated with the occurrence of ataxia, bilateral paralysis of the limbs and a decrease in muscle tone. Another rare form of the disease isthe extrapyramidal form , the most characteristic of which is the occurrence of involuntary movements (such movements can be dystonic, choreic, and athetotic movements).
There are also mixed forms, in which there may be compilations of symptoms of the previously described forms of MPD - most often mention is made of cerebral palsy with ataxia and cerebral palsy with stiffness.
Cerebral palsy: diagnosis
The diagnosis of cerebral palsy is usually made on the basis of the abnormalities identified in a neurological examination, and the history of the child's exposure to risk factors for MPD (such as, for example, perinatal hypoxia).
Imaging examinations are sometimes performed, such as trans-gland ultrasound, computed tomography or magnetic resonance imaging of the head (thanks to them, some damage to the central nervous system may be detected).
It's worth it hereemphasize that the diagnosis of cerebral palsy leads to the necessity to provide the child with multi-specialist care - not only in the early but also later years of life. Many patients suffering from this condition may develop epilepsy, and they are also quite common with visual disturbances and hearing disorders.
It happens that MPD is associated with intellectual disability, as well as with various posture defects (e.g. scoliosis). Due to the above-mentioned and other risks, a small patient with cerebral palsy should be under the care of, inter alia, a neurologist, ophthalmologist, orthopedist, but also a psychologist or speech therapist.
Cerebral Palsy: Treatment
In patients with cerebral palsy, physical therapy is the most important - regular rehabilitation is aimed at enabling the child to achieve maximum fitness, in addition, the earlier it is implemented, the greater the chances of not developing various complications of MPD (such e.g. fixed joint contractures).
Sometimes pharmacological treatment is used in patients with MPD - botulinum toxin injections may be used, for example, in patients with severe spasticity. In rare cases, surgical treatment is used in the treatment of cerebral palsy.
It is worth emphasizing once again that children with MPD require multi-specialist care. In the case of speech disorders, it is important for them - speech therapy with the participation of a speech therapist, but also the correction of possible vision or hearing defects.
Cerebral Palsy: prognosis
Cerebral palsy, unfortunately, is an incurable disease. The good news, however, is that, as in the past, the life expectancy of people suffering from it was shorter than that of the general population, but nowadays, thanks to advances in medicine, it is essentially similar to that of others.
- Muscular dystrophy - types of muscular dystrophies and their symptoms
- Cerebral palsy - types of cerebral palsy
- Myoclonus (involuntary movements): causes, symptoms, treatment