Cerebral Palsy

1. Cerebral Palsy
Ade Wijaya, MD – April 2020

2. Introduction
 A neurodevelopmental condition that affects muscle tone, movement and
motor skills
 Not a single disease but rather a heterogeneous clinical syndrome resulting
from injury to the developing brain
 Although the disorder itself is non-progressive, the clinical expression
changes over time as the brain matures
 The motor disorders of CP are often accompanied by disturbances of
sensation, perception, cognition, communication, and behavior, by epilepsy
and by secondary musculoskeletal problems.
 Prevalence: 2 per 1000 live births
Aisen ML, Kerkovich D, Mast J, et al. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurol. 2011;10:844–52.
Van Naarden BK, Doernberg N, Schieve L, Christensen D, Goodman A, Yeargin-Allsopp M. Birth prevalence of cerebral palsy: a population-based study. Pediatrics. 2016;137.

3. Definition
 The current definition of CP, as adopted by the International consensus in
2005 is:
‘Cerebral palsy describes a group of permanent disorders of the development
of movement and posture, causing activity limitation, that are attributed to
non-progressive disturbances that occurred in the developing fetal or infant
brain’
The Definition and Classification of Cerebral Palsy. Dev Med Child Neurol. 2007;49:1–44.

4. Etiology
SewellMD, Eastwood DM,Wimalasundera N. Managing common symptoms of cerebral palsy in children. BMJ. 2014;349:g5474.

5. Early Signs
 Neurobehavioral signs: excessive irritability, lethargy, sleeps poorly, vomits
frequently, is difficult to handle and cuddle, and has poor visual attention
 Developmental reflexes: Delay in disappearance or exaggeration of a
developmental reflex
 Motor tone and posture: Poor head control, persistent or asymmetric hand
fisting, and abnormal oromotor patterns (tongue thrusting/ grimacing)
 Motor milestones
Noritz GH, Murphy NA, Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics. 2013;131:e2016–27.
Gulati S, Sondhi V. Cerebral palsy: an overview. The Indian Journal of Pediatrics. 2018 Nov 1;85(11):1006-16.

6. Gulati S, Sondhi V. Cerebral palsy: an overview. The Indian Journal of Pediatrics. 2018 Nov 1;85(11):1006-16.

7. Gulati S, Sondhi V. Cerebral palsy: an overview. The Indian Journal of Pediatrics. 2018 Nov 1;85(11):1006-16.

8. Co-morbidities
Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130:e1285–312.

9. Investigation
Gulati S, Sondhi V. Cerebral palsy: an overview. The Indian Journal of Pediatrics. 2018 Nov 1;85(11):1006-16.

10. Management
 Management of physical impairment: physical therapy
 Management of spasticity
 Surgical Therapy
 Dystonia and Mixed Movement Disorders: botox
 Feeding and Nutrition
 Drooling: pharmacotherapy (anticholinergic drugs (trihexphenidyl or
glycopyrrolate; act by decreasing flow of saliva), and BTX-A injection into
salivary glands, behavior-therapy, and surgery.
 Social supports
Gulati S, Sondhi V. Cerebral palsy: an overview. The Indian Journal of Pediatrics. 2018 Nov 1;85(11):1006-16.

11. Tilton A. Management of spasticity in children with cerebral palsy. Semin Pediatr Neurol. 2009;16:82–9.
Tickner N, Apps JR, Keady S, Sutcliffe AG. An overview of drug therapies used in the treatment of dystonia and spasticity in children. Arch Dis Child Educ Pract Ed. 2012;97:230–5.

12. Prognosis
 A majority of children with CP survive to adulthood (87-94%)
 Survival was related to severity of impairment, birth weight, and
socioeconomic status
 Functional outcome in CP depends on multiple factors besides motor
function. These include intelligence, physical function, ability to
communicate, and personality attributes. Social (e.g., family support) and
environmental factors and the availability of specialist medical care play an
important role
Hemming K, Hutton JL, Colver A, Platt MJ. Regional variation in survival of people with cerebral palsy in the United Kingdom. Pediatrics. 2005;116:1383–90.

13. Prognosis
Poor walking prognosis
 Do not achieve head balance by 20 months
 Retain primitive reflexes, or have no postural reactions by 24 mo
 Do not crawl by approximately 5 years of age
Good walking prognosis
 Sit by 2 years
 Crawl before 30 months of age.
da Paz Junior AC, Burnett SM, Braga LW. Walking prognosis in cerebral palsy: a 22-year retrospective analysis. Dev Med Child Neurol. 1994;36:130–4.

14. Summary
 A neurodevelopmental condition that affects muscle tone, movement and
motor skills
 Heterogeneous clinical syndrome resulting from injury to the developing
brain
 Multidisciplinary approach

15. THANK YOU