Def : Disorder of MOVEMENT and POSTURE due to a non-proggresive lesion of motor pathways in the developing brain.
It is the most common cause of motor impairment in children, affecting about 2 per 1000 live births. In addition to disorders of movement and posture, children with cerebral palsy often have other problems reflecting more widespread brain dysfunction. These include:
- Learning difficulties (about 60%)
- Epilepsy (40%)
- Squints (30%)
- Visual impairment from errors of refraction and cortical damage (20%)
- Hearing impairment (20%)
Causes
- 80% is antenatal in origin due to vascular occlusion, cortical migration disorders or even structural maldevelopment of the brain during gestation
- 10% due to hypoxic-ischaemic injury at birth
- 10% postnatal in origin. Preterm infants are especially vulnerable to brain damage from periventricular leucomalacia (PVL) secondary to ischaemia and/or severe intraventricular haemorrhage.
Clinical Presentation
Early features of CP include
- Abnormal limb tone and limb and/or trunk posture in infancy with delayed motor milestone; may be accompanied by slowing of head growth
- Feeding difficulties, with oromotor incoordination, slow feeding, gagging and vomiting
- Abnormal gait once walking is achieve
- Asymmetric hand function before 12 months of age.
There are 3 main clinical types of CP, namely spastic (70%), ataxic hypotonic (10%), dyskinetic (10%) and mixed pattern (10%)
A. Spastic (3 main types)
Hemiplegia : Unilateral involvement of the arm and leg, with the face spared. Affected children often presented at 4-12 months of age with fisting of the affected hand, a flexed arm, a pronated forearm, asymmetric reaching or hand function. Subsequently a tiptoe walk on the affected side may be evident
Quadriplegia : All 4 limbs are affected, often severly. The arms may be affected more than the legs. The trunk is involved with extensor posturing and poor head control. This form of CP is often associated with seizures, microcephaly and moderate/severe intellectual impairment
Diplegia : All 4 limbs, but the legs are affected to a much greater degree than the arms, so that hand function may appear relatively normal. Walking is abnormal
B. Ataxic hypotonic CP
Signs are relatively symmetrical. There is early trunk and limb hypotonia, poor balance and delayed motor development. Incoordinate movement, intention tremor and an ataxic gait may be evident later.
C. Dyskinetic CP
Dyskinesia (fluctuating tone) leading to frequent involuntary movements (generally of all 4 limbs) especially evident with movement/stress. These involuntary movement may be…
Chorea : irregular, sudden and brief non-repetitive movements
Dystonia and athetosis : Simultaneous and sustained contraction of agonist and antagonist muscles involving the trunk and proximal limbs (dystonis) or distal part of the limbs (athetosis)
Ref : Illustrated Textbook of Paediatrics
