Cerebral palsy is a disorder of movement and posture caused by a non-progressive brain insult during fetal or infant development. It has an incidence of 1 in 500 births and is a major cause of childhood disability. The majority of cases are caused by prenatal factors. While there is no cure, prevention through proper antenatal care and fetal monitoring is key. Cerebral palsy manifests through increased muscle tone, involuntary movements, poor coordination, and other motor impairments depending on the type and severity. Treatment requires a multidisciplinary approach focusing on stimulation, nutrition, therapy, and managing comorbidities like seizures.

1. Cerebral Palsy
Dr Venkatesh C
Assistant Professor of Pediatrics

2. Introduction
• Major cause of disability in children
• Incidence 1 in 500 births
• 70-80% are due to prenatal factors
• No known cure, Prevention is the key.

3. Antenatal Brain Growth

4. Postnatal Brain Growth
• Brain growth continues postnatally well into
adolescence
• More than 90% Brain growth is complete by 2
years
• As age advances, myelination increases with
pruning of synapses

5. Definition
• Disorder of movement and posture
• Non-progressive insult
• growing brain
• Dynamic manifestations

6. Aetiology
• Antenatal- Extreme prematurity, Multiple
gestation, IEM, Genetic diseases, Brain
malformation, Congenital infection, maternal
toxemia, placental abnormalities,
coagulopathy, Heamorrhage
• Birth- Low birth weight, MSL, Infection,
trauma, Kernicterus
• Postnatal- infection, trauma, toxins

7. Pathology

8. Pathology

9. Pathology

10. Pathology

11. Types
• Spastic
• Dyskinetic
• Hypotonic/ataxic
• Mixed

12. Spastic CP
• 70-80% of CP
• Increased muscle tone- clasp knife type
• Increased reflexes, clonus, contractures
• Scissoring and toe walking
• Difficulty changing diapers
• Seizures & mental retardation
• Feeding difficulty

13. Types based on limb involvement

14. Hyperkinetic/athetoid
• 10-20% of CP
• Involuntary movements of hands, feet, arms,
muscles of face/tongue
• Movements increased by stress, decreased by
sleep
• Mental retardation

15. Hypotonic/ataxic
• Least common type
• Floppy infant
• Poor coordination
• Unsteady gait
• Difficulty in performing rapid movements

16. Mixed
• Combination of above
• Spastic and athetoid most common
• Hypotonic and athetoid
• Variable frequency of seizures, MR

17. Functional Classification

18. Early markers
• Persistent fisting/ cortical thumb
• Persistent primitive reflexes
• Irritability
• Delayed development
• Early hand preference

19. Asymmetric tonic neck reflex

20. Diagnosis
• Good history and physical examination
• Neuroimaging CT/MRI
• IU infection screen
• Metabolic & genetic testing
• Coagulation studies
• Screening for co-morbidity – vision, hearing,
seizures

21. Treatment
• Multi-disciplinary approach
• Early stimulation
• Monitoring growth, nutrition
• Vision and hearing assessment
• Control of seizures
• Reduce spasticity and contractures
• Promote self care

22. Prognosis
• No head control by age 1- unlikely to walk
• Not sitting by 4 yrs- 99% will not walk
• Sits unsupported by 2 yrs- 100% will walk

23. Prevention
• Proper antenatal care and fetal monitoring
• Hypothermia
• Magnesium sulphate