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Anaesthesia => Nervous System => Cerebral Palsy
Cerebral Palsy
Cerebral Palsy, broad term for various nonprogressive disorders of motor function in people, resulting from brain damage at around the time of birth. Between 0.1 and 0.2 per cent of children have some form of cerebral palsy; up to 1 per cent of premature babies or those small for their gestational age are afflicted. The specific cause of most cases of cerebral palsy is unknown. Damage to the brain could occur before, during, or shortly after birth. Prenatal causes include maternal infection (especially German measles), radiation, anoxia (oxygen deficiency), toxaemia, and maternal diabetes. Causes at the time of birth include trauma in delivery, anoxia, prematurity, and multiple birth (especially for infants born last in a multiple birth). Causes during infancy include brain infection, head trauma, anoxia, brain tumour, and cerebral vascular lesions.
Cerebral palsies have been divided into four main categories: spastic,athetoid,ataxic, and mixed forms. Spastic syndromes, in which the muscles become stiff or paralysed, represent about 70 per cent of cases; common forms are hemiplegia, which involves all the limbs to a similar degree, and diplegia, which involves all the limbs but affects the legs more severely. In children who are only mildly affected, impairment may be seen only during certain activities, such as running. Athetoid syndromes occur in about 20 per cent of those with cerebral palsy. Slow, writhing, involuntary movements may affect the extremities or the trunk and upper parts of the limbs. In some cases abrupt, jerky movements, resembling the movements of people with chorea, may also occur. All these movements increase with emotional tension and may disappear during sleep. Ataxic syndromes are uncommon (about 10 per cent of cases) and involve weakness and problems with balance and coordination. Mixed forms of cerebral palsy, with combinations of syndromes, are common. Defects in vision, convulsive seizures, and mental underdevelopment, may also be present.
The chief goal in treating cerebral palsy is for patients to develop maximal independence within the limits of their individual motor and associated disabilities. Usually the extent of damage cannot be fully assessed until the child is about two years old. Drugs can sometimes be helpful; for example, seizure can be controlled with anticonvulsants. Physical therapy, occupational therapy, the use of braces or other mechanical devices, orthopaedic surgery, and speech training may all be required. With proper treatment, many people with cerebral palsy are able to lead lives that are not significantly different from those of people who are not afflicted.
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