This document defines cerebral palsy and provides details about its diagnosis and management. Cerebral palsy is defined as a permanent disorder of movement and posture due to non-progressive disturbances in the developing fetal or infant brain, causing functional limitations. Risk factors for congenital cerebral palsy include prematurity, low birth weight, infections, and genetic conditions. Acquired cerebral palsy occurs after 1 month of life due to events like infections, head trauma, or strokes. Diagnosis involves assessing history, physical exam, imaging, and ruling out genetic causes. Management is multidisciplinary and includes pharmacological, rehabilitative, and surgical approaches.

1. Cerebral Palsy
Dr N ANAND
DM Neurology Post Graduate

2. Definition
Defined as 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.

3. Patient must have-
1. A disorder of movement and posture (such as weakness, spasticity,
dystonia, ataxia, or choreoathetosis) with onset prior to age 1–2 years.
2. Reliable evidence that the disorder is due to a disturbance in the fetal
or infant brain.
3. No evidence to suggest progression or worsening over time.
4. Significant functional limitation in the performance of desired
activities.
5. Reasonable expectation that the disorder will persist throughout life.

4. Risk Factors for Congenital CP
1. Prematurity
2. Very low birth Weight(<2500g)
3. Mutliple Births -Twins, triplets, and other multiple births
4. Assisted reproductive technology (ART) infertility treatments
5. Twins, triplets, and other multiple births
6. Maternal and Fetal infections-chickenpox, rubella (german measles), and
cytomegalovirus (CMV),chorioamnionitis
7. Jaundice and kernicterus
8. Mothers with thyroid problems, intellectual disability, or seizures
9. Perinatal Asphyxia due to placental abruption or uterine rupture
10. Genetic Conditions

5. Acquired CP – due to cerebral injury after 1 month of
life
1. Perinatal Stroke – Ischemic,Hemorrhagic or thromboembolic
2. Infections – Meningitis or Encephalitis during infancy
3. Head Trauma

6. Diagnosis
History
Physical Examination
Imaging
Genetic Studies

7. History
Details of Pregnancy- gravidity,parity,mrdical illness of mother,exposure
to alcohol, cigarettes, illicit substances, prescription
medications,history of decreased fetal movements
Details of Birth- Prematurity,Birth Weight,labor and delivery,placental
abruption,need for emergency caesarean section,seizures,respiratory
failure,necrotizing enterocolitis,sepsis,meningitis,jaundice.
Details of delayed milestones-

8. Early Signs
Persistence of neonatal reflexes beyond the age of their disappearance
Persistent clonus, extreme irritability or crying
Failure to smile by 3 months
Poor head control after 3 months
Inability to sit up without support by 8 months
Preferential unilateral hand use before 18 months of age
Abnormal crawling or asymmetrical crawl
Abnormal posturing or hypotonia
Difficulty in chewing, swallowing and feeding

9. Physical Examination
Abnormalities of tone,reflexes,movements, posture and balance.
Any limb defromities,
Curvature of spine
Range of motion of joints
Abnormal Movements – systonia,chorea, athetosis
Abnormal Postures -
Gait abnormalities – toe walking,crouched gait,jump gait,scissor gait

12. CP Choreoathethoid

13. CP Dystonia

15. Classification
Depending upon type of motor involvement
1) Spastic CP – Spastic Diplegia, Spastic Hemiplegia and Spastic
quadriplegia
2) Dyskinetic CP - Uncontrolled Movements or Athetosis -
3) Hypotonic-Ataxia CP

16. - Functional Classification
Gross Motor Function Classification System(GMFS)
it is based on abilities and limitations in motor functioning

18. Screen for associated conditions-
1. Mental Retardation
2. Opthalmologic/Hearing impairments
3. Speech and language delay
4. Feeding/swallowing dysfunctin
5. History of seizures,obtain an EEG

19. Neuroimaging – CT/MRI Brain

22. Factors suggesting Genetic Conditions
Family History
Consanguineous Marriage
Regression of milestones
Normal MRI Brain
Hypotonia with weaknss,deterioration of neurologic signs and wide
fluctuation of symptoms
Predominant Ataxia,abnormal movements/oculomotor
abnormality/muscle atrophy/prominent sensory loss
Abnormal body odour/alopecia/skin lesiosn

26. Comorbidities Spectrum
1. Contractures and Pain
2. Intellectual Disability
3. Limb weakness
4. Hip Displacement
5. Epilepsy
6. Receptive and Expressive Language impairment
7. Behaviour disorder
8. Bladder Control problems
9. Sleep disorder
10. Visual impairment
11. Hearing Impairment
12. Feeding Diificulties

27. Management
• Multidisciplinary Approach
• Patient Centred Approach
• Treatment is divided in to 3 categories –
Pharmacological,rehabilitative and surgical

28. Spascticity
Oral Baclofen Start 5mg – 10-15mg/day 3 times a day Maximum
0.3mg/kg/day
Tizanidine 2-4mg /day
Benzodizepines –Clonazepam,Diazapem
Botulinum Injection every 4-6 months
Intrathecal Baclfen pump
Selective Dorsal Rhizotomy – Cutting dorsal rootlets

29. IBP SDR

30. Dystonia
Trihexyphenidyl start at a small dose of 1-2mg/day
Levodopa
Tetrabenazine
Botulinum Injection

31. Drooling of Saliva
Oral Physiotherapy
Oral Glycopyrrolate(0.5-2mg)
Hyoscine Patches

32. • Melatonin for Sleep problems
• Physiotherapy in preventing deformity and contractures and
promoting motor development
• Occupational Therapy
• Orthopaedic Procedures to correct scoliosis/hip
dislocation/subluxation
• Surgical Procedures to relieve contractures

33. Thank You