Cerebral Palsy

This essay covers the symptoms and diagnosis of a disorder named Cerebral Palsy. There is also content on treatment options and complications.

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Essay

“Cerebral palsy is a group of disorders which affect the cerebral motor complex of the brain resulting in mobility and motor impairments”

Cerebral Palsy is the most common motor disability for children. To understand it, ‘cerebral’ has to do with the brain while ‘palsy’ has to do with muscle problems. This essay will explore the group of disorders that affect someone's ability to move and to maintain balance and posture known as cerebral palsy (Center for Disease Control and Prevention).

All of the causes of cerebral palsy have to do with unusual brain development. When the genes FBX031 or RHOB mutate, they are known to be a cause of CP. Moreover maternal infections such as cytomegalovirus, German measles and herpes can sometimes cause abnormal brain development to the fetus. This also applies for infant infections when the inflammation is inside or around the brain. Other causes are fetal strokes which is when blood stops going to the fetus’s brain, bleeding the brain of the fetus or the new brown, or a traumatic head injury from a fall for instance. Some causes are less common like lack of oxygen of the newborn due to a difficult labor (Bower, James)

Cerebral Palsy can be separated into three main sections. The first being spastic CP which is the most common, affection 80% of all cerebral palsy patients. Spastic CP causes an increases muscle tone leading to stiff and poor movement. This type of cerebral palsy can further be sectioned into three. Spastic diplegia or diparesis is the conditions that mainly affected the legs. It makes it difficult for the person to walk as their hip and leg muscles are tight. Spastic hemiplegia or hemiparesis is the second type of spastic CP and it affects only one side of the body. The third type is spastic quadriplegia or quadripartite which is the most sever type of spastic cerebral palsy as it affects all 4 limbs, the chest and the face. With this condition it makes it increasingly difficult to walk and it is more likely for the person with this condition to have other development and intellectual difficulties.

The second main type of cerebral palsy is dyskinetic CP. Here the problem lies in controlling movements of the hand, arms, feet and legs. This makes it difficult to sit and walk and some people may have uncontrollable movements. The face and the tongue are also sometimes afflicted and this makes it complicated to swallow, suck and tongue. Another effect of dyskinetic CP is that unlike spastic CP where the muscle tone is increased, with this type the muscle tone changes from too tight to too lose sometimes multiple times per day.

The third and last type of cerebral palsy is atlaxic CP which creates a problem with balance and coordination. Hard and fast movements, and controlling movements such as reaching for something are a struggle (Center for Disease Control and Prevention).

All of these conditions not only come with these symptoms but also with others such as difficulty swallowing, drooling, constipation, epilepsy, sleep difficulties, involuntary movements and hearing or visual impairments. Additionally, there are complications that are likely to come with cerebral palsy. One of these is contracture which is the fixed tightening of muscles, tendons, ligaments and skin. It can hinder bone growth and it can cause joint deformities. Some patients who have difficulty swallowing are also at risk of malnutrition and might need feeding tubes. Due to the pressure and abnormal alignment of the joints it is more likely for people with cerebral palsy to develop osteoarthritis. Osteoporosis is another complication as malnutrition, lack of mobility and anti-epileptic drugs cause lower bone density. A last complication is that cerebral palsy makes it 2.6 times more likely to get a heart failure and 2.2 times more likely to get asthma (Jarvis, Hayley).

Diagnosing cerebral palsy is often first done with a cranial ultrasound scan. What this does is it emits sound waves around the child’s head to create an image of the brain. It can be found that a child with cerebral palsy is likely to have larger ventricles and darker areas which are actually damaged tissues filled with fluid (NeurologyToday). A second brain imaging which is more detailed is an MRI scan which uses magnetic fields and radio waves instead of sound waves. Here the lighter or darker spots show lesions which could show a sign of cerebral palsy. A last main brain imaging scan done is a CT scan which uses several x-ray pictures and this scan helps rule out other conditions and it could help find the cause of why the patient has cerebral palsy. Additional tests can be done to confirm the diagnosis, for instance an electroencephalogram (EEG) monitors the brain activity to try and find signs of epilepsy. Otherwise an electromyogram (EMG) can be done where tiny needles are placed in the muscles and the nerves to check how they are working. Blood tests can also rule out other possible diagnoses that cause similar symptoms to cerebral palsy (Nhs.Uk).

To this day, no cure exists for cerebral palsy however therapies, medications and surgeries exist to reduce the symptoms caused by this group of conditions. To start off, physiotherapy can be used to prevent contracture which is a complication discussed earlier. Physiotherapy can also help stop the muscles from becoming too weak by encouraging movement.

A speech and language therapist is often needed to either find an alternative method to communicate like a device that generates speech or simply to practice communicating and speaking. This depends on the type of gravity of cerebral palsy the person has.

Another type of therapy is occupational therapy which is used to learn how to do everyday tasks. Occupational therapists can immensely help someone with cerebral palsy gain more independence which would in turn help reduce the probability of mental health conditions developing.

The next treatment options are medications. Though a person is not likely to take all of these medications, they can each treat different symptoms. One of the biggest symptoms is muscle stiffness which can be treated with medications such as diazepam or baclofen. The way these medicines work is that they increase the affinity of GABA for its receptors. GABA are amino acid neurotransmitters. To explain more simply, the medicines ease muscle tension. Another option to relax certain muscles is botulinum toxin injections which work for months at a time. These injections can also be given to the saliva glands to reduce drooling. Another option to help with the drooling is anticholinergic medicine which reduces the amount of saliva produced. Melatonin pills can be given for the sleep difficulty symptom. Melatonin works as it is a natural hormone in the pineal glands in the brain that control sleep cycle which some people need a supplement of. Other extra medications include laxative for constipation, painkillers to manage the pain and anti-seizure medicine for epilepsy (Nhs.Uk).

A final treatment option is surgery. Gastroenterology surgeries are different surgeries which help improve sucking, chewing, digesting, and food processing. An example is fundoplication which is a procedure where a valve is implanted at the top of the stomach to reduce vomiting and chest infections. Some people with cerebral palsy who have hearing impairments may need a cochlear implant of radio aides as this would not only help their hearing but subsequently their language and communication development. A third type of surgery that might be needed is to facilitate constant doses of medicine or for chronic pain. For example, the medicine previously mentioned, baclofen, can be first injected in the spinal canal as a test, this is called a lumbar puncture. If the medicine is supported a baclofen pump can be inserted in the abdomen and connected to the spinal cord which would make it easier to deliver the medicine (Cerebralpalsy.Org).

To summarize, cerebral palsy is a group of disorders which affect the cerebral motor complex of the brain resulting in mobility and motor impairments. Cerebral palsy is always caused by abnormal brain development, although it can be separated into spastic CP, Dyskinetic CP, and Ataxic CP based on which part of the body is affected. Therapies, medications and surgeries are three types of treatment options given to people with cerebral palsy as a cure does not exist for these conditions.

Bibliography

1. Bower, James. "Cerebral Palsy". Mayo Clinic, 2022, https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999.

2. "Cerebral Palsy – Diagnosis". Nhs.Uk, 2020, https://www.nhs.uk/conditions/cerebral-palsy/diagnosis/.

3. “Cerebral Palsy — Treatment”. Nhs.Uk, 2020, https://www.nhs.uk/conditions/cerebral-palsy/treatment/

4. “Head Ultrasound in NICU Can Predict Cerebral Palsy”. NeurologyToday, 2008, https://journals.lww.com/neurotodayonline/fulltext/2008/12040/Head_Ultrasound_in_NICU_Can_Predict_Cerebral_Palsy.2.aspx

5. Jarvis, Hayley. "Heart And Lung Disease Risk Doubles For Cerebral Palsy Patients". Brunel.Ac.Uk, 2019, https://www.brunel.ac.uk/news-and-events/news/articles/Heart-and-lung-disease-risk-doubles-for-cerebral-palsy-patients.

6. "Types Of Surgeries''. Cerebralpalsy.Org, 2022, https://www.cerebralpalsy.org/about-cerebral-palsy/treatment/surgery/types-of-surgeries.

7. "What Is Cerebral Palsy?". Centers For Disease Control And Prevention, 2021, https://www.cdc.gov/ncbddd/cp/facts.html.