What is cerebral palsy?
Cerebral palsy is not a disease in the true sense of the word, but rather a group of symptoms associated with early childhood damage to the developing brain. The extent of the impairment depends on which areas of the brain have suffered. Around 3,000 children and 12,000 adults with cerebral palsy live in Switzerland. This form of brain damage cannot be cured, but symptoms can be alleviated and improvements achieved with multidisciplinary therapeutic measures.
Cerebral palsy was first described in the 19th century by the English orthopaedic surgeon William John Little, which is why experts also refer to it as Little Desease. This term covers damage that occurs when the early childhood brain is impaired in its development. The movement region in the cerebral cortex is usually affected. The clinical picture of cerebral palsy cannot be uniformly defined; movement disorders are the most common, but behavioral abnormalities, epilepsy and mental impairments can also be included. The symptoms can be grouped and summarized into so-called syndromes:
- spastic syndromes with severe cramps, uncontrollable movements and paralysis due to excessive muscle tension
- dyskinetic syndromes with involuntary and uncontrolled movements
- Congenital (from birth) ataxia syndromes with low motor skills
- Hypotonia syndromes with low muscle tone, which can lead to tendon, muscle, bone and joint deformities.
The brain lesion can have various causes. Harmful events during pregnancy, the birth process or after birth include
- Complications with the umbilical cord
- Infections or illnesses
- Brain hemorrhages
- Oxygen deficiency
- Accidents
The entire body is usually affected by the movement disorder (tetraparesis), but only one half of the body can be affected (hemiparesis) or only one part of the body (diparesis). The physical impairments can range from mild motor difficulties to severe limitations. Some children with cerebral palsy also have intellectual disabilities, visual or hearing impairments or exhibit behavioral problems. Cerebral palsy lasts a lifetime, but the movement disorders can be alleviated by appropriate therapies.
Cerebral palsy: causes and risk factors
Cerebral palsy can develop as a result of various events that occur during pregnancy (prenatal), at birth (perinatal) or after birth (postnatal). Pregnancy complications that can trigger cerebral palsy are:
- Insufficient oxygen supply (hypoxia)
- Poisoning from medication, alcohol, carbon dioxide
- Infectious diseases such as rubella, toxoplasmosis, Zika virus
- Placental insufficiency
- Blood group incompatibility
- genetic disorders
During the birth phase, the baby’s brain can be damaged by
- Placental abruption
- Premature birth
- Oxygen deficiency
- Birth trauma and cerebral hemorrhages
- Umbilical cord problems
Premature babies, in whom the delicate blood vessels in the brain bleed easily, have a higher risk of developing cerebral palsy than children born at term. Other causes occur after birth:
- Vascular occlusions due to infections
- Meningitis (inflammation of the meninges)
- Craniocerebral trauma
- Sepsis (blood poisoning)
The manifestations of cerebral palsy can vary greatly depending on which region of the brain has been damaged. Cerebral palsy cannot really be prevented. In any case, it is important that you attend all check-ups during your pregnancy so that any potential malnutrition of the embryo can be detected and treated as early as possible. You should also not consume any alcohol during pregnancy and breastfeeding to avoid damaging the baby’s brain development.
Symptoms: Cerebral palsy
Symptoms of cerebral palsy include motor disorders and associated postural disorders. In infants, movement deficits are often not yet noticeable; low body tension can be an initial indication. The disease is usually only recognized when the children start to move and crawl or sit up. Due to the pathologically altered muscle tone, they are severely restricted in their movement patterns. They can hardly learn to crawl and walk because they are unable to perform controlled and coordinated movement patterns.
The movement disorder can be spastic, with high, rigid muscle tension, or hypotonic, with flaccid muscle posture. It can also be associated with movement disorders (athetosis) or the children have coordination difficulties (ataxia). In the case of a spastic restriction of movement, for example, the muscles pull the legs inwards very strongly, as a result of which the foot is strongly overstretched and the typical pointed foot position develops.
In addition to movement disorders, there are a number of other symptoms that may indicate or be associated with cerebral palsy:
- Visual and perceptual disorders
- Delayed speech development
- limited fine motor skills
- Epilepsy (seizures)
Mental development may be impaired alongside motor development, but not necessarily. A good half of the children affected have normal or only reduced intelligence and can often – with appropriate support – attend a mainstream school.
Cerebral palsy is also typically characterized by inwardly rotated arms, legs and hips. Unmotivated spasmodic movements are also part of this. Speaking can be difficult because children have insufficient control over the muscle groups required for this. Over time, the overstretched muscles cause the joints to stiffen and the spine to become curved.
Diagnosis of cerebral palsy
In suspected cases, we will first clarify whether the cerebral palsy is due to an illness, injury or disorder or whether a carcinoma, inflammation or metabolic disorder is possibly causing the movement disorders. The results of regular check-ups can also provide neurological and orthopaedic clues, as can the description of pregnancy and birth. We will observe the child closely, its posture and movement patterns, and we will ask the mother to describe its crying, feeding and social behavior. An imaging examination of the skull can provide further clarification. Brain waves can also be measured with an EEG if seizures occur. Neurological and neuro-orthopaedic examinations can supplement the diagnosis.
Cerebral palsy - Treatment
The treatment of cerebral palsy is always multidisciplinary. Although the damage to the brain region cannot be reversed or the interrupted development made up for, targeted therapies can ensure the best possible development and quality of life.