Doctor's Notes on Cerebral Palsy
Cerebral palsy is a condition of impaired muscle coordination and/or other disabilities, usually caused by damage to the brain before or at birth. Signs and symptoms may include lack of muscle coordination, impaired or involuntary movements, abnormal reflexes, exaggerated movements, abnormal walking and posture, difficulty with speech and swallowing, drooling, eye muscle problems and body rigidity or floppiness. Other signs and symptoms that may be present are mental disorders and disabilities, abnormal touch, pain, hearing and vision and urinary incontinence. However, many cerebral palsy patients have some symptoms but can have normal mental capacity that may be difficult to appreciate because of their physical limitations that can interfere with communication.
The cause of cerebral palsy is damage to the developing brain in pregnancy (about 70-80%) and/or during birth or even in the first few years of life. Factors linked to the condition include birth defects, brain damage due to head injury, meningitis, lack of oxygen, severe jaundice, premature birth, multiple births (twins), low birth weight, problems in the mother (infections, seizures, thyroid problems, for example) and complications during labor and delivery.
Cerebral Palsy Symptoms
The signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child's nervous system matures. Early signs include the following:
- Delayed milestones such as controlling head, rolling over, reaching with one hand, sitting without support, crawling, or walking
- Persistence of "infantile" or "primitive reflexes," which normally disappear 3 to 6 months after birth
- Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side, which may be an early sign of CP.
Problems and disabilities related to CP range from very mild to very severe. Their severity is related to the severity of the brain damage. They may be very subtle, noticeable only to medical professionals, or may be obvious to the parents and other caregivers.
- Abnormal muscle tone: Muscles may be very stiff (spastic) or unusually relaxed and "floppy." Limbs may be held in unusual or awkward positions. For example, spastic leg muscles may cause legs to cross in a scissor-like position.
- Abnormal movements: Movements may be unusually jerky or abrupt, or slow and writhing. They may appear uncontrolled or without purpose.
- Skeletal deformities: People who have cerebral palsy on only one side may have shortened limbs on the affected side. If not corrected by surgery or a device, this can lead to tilting of the pelvic bones and scoliosis (curvature of the spine).
- Joint contractures: People with spastic cerebral palsy may develop severe stiffening of the joints because of unequal pressures on the joints exerted by muscles of differing tone or strength.
- Mental retardation: Some, although not all, children with cerebral palsy are affected by mental retardation. Generally, the more severe the retardation, the more severe the disability overall.
- Seizures: About one-third of people with cerebral palsy have seizures. Seizures may appear early in life or years after the brain damage that causes cerebral palsy. The physical signs of a seizure may be partly masked by the abnormal movements of a person with cerebral palsy.
- Speech problems: Speech is partly controlled by movements of muscles of the tongue, mouth, and throat. Some individuals with cerebral palsy are unable to control these muscles and thus cannot speak normally.
- Swallowing problems: Swallowing is a very complex function that requires precise interaction of many groups of muscles. People with cerebral palsy who are unable to control these muscles will have problems sucking, eating, drinking, and controlling their saliva. They may drool. An even greater risk is aspiration, the inhalation into the lungs of food or fluids from the mouth or nose. This can cause infection or even suffocation.
- Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. The child may not respond to sounds or may have delayed speech.
- Vision problems: Three-quarters of people with cerebral palsy have strabismus, which is the turning in or out of one eye. This is due to weakness of the muscles that control eye movement. These people are often nearsighted. If not corrected, strabismus can lead to more severe vision problems over time.
- Dental problems: People with cerebral palsy tend to have more cavities than usual. This results from both defects in tooth enamel and difficulties brushing the teeth.
- Bowel and/or bladder control problems: These are caused by lack of muscle control.
Cerebral Palsy Causes
Cerebral palsy results from damage to certain parts of the developing brain.
- This damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life.
- In many cases, the exact cause of the brain damage is never known.
At one time, problems during birth, usually inadequate oxygen, were blamed for cerebral palsy.
- We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal).
- In fact, current thinking is that cases of cerebral palsy begin before birth (prenatal).
- Some cases begin after birth (postnatal).
- In all likelihood, many cases of cerebral palsy are a result of a combination of prenatal, perinatal, and postnatal factors.
Risk factors linked with cerebral palsy include the following:
- Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother
- Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism
- Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus (Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.)
- Certain hereditary and genetic conditions
- Complications during labor and delivery
- Premature birth
- Low birth weight (especially if less than 2 pounds at birth)
- Severe jaundice after birth
- Multiple births (twins, triplets)
- Lack of oxygen (hypoxia) reaching the brain before, during, or after birth
- Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding
There are so many childhood diseases, infectious and noninfectious, that it would be impossible to list them all here. However, we will introduce some of the most common ones, including viral and bacterial infections as well as allergic and immunologic illnesses.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.