cerebral

1. CEREBRAL PALSYCEREBRAL PALSY

2. CEREBRAL PALSYCEREBRAL PALSY
Chronic disability of central nervous system
origin characterised by aberrant control of
movement of posture, appearing early in life
and not the result of progressive
neurological disease.

3. Spastic: Upper motor neurone lesion.
Hemiplegia: UMNL of one side of body.
Diplegia: UMNL of all four limbs but legs more
than arms. May be symmetric or
asymmetric.
Quadriplegia: Equal involvement of arms and legs.

4. Rigidity: ↑ tone throughout range of movement.
Dyskinesia: Involuntary movements and changes in muscle
tone. Damage to basal ganglia and
extraphyomides pathways.
Athetosis: Slow writhing movements of limbs. Extension
and fanning of fingers and extension of wrist.
Chorea: Quick jerky movements of trunk and prox, limb
muscles.

5. Paraplegia: Legs involved only.
Double Hemiplegia: Bilateral UMNL. Arms and
legs. Also pseudobulbar
palsy.
Monoplegia: One Limb.

6. Cerebral Palsy RatesCerebral Palsy Rates
Multiple births 7.5 / 1000 live births
Singletons 2.1 / 1000 live births
1500gr or less 80 / 1000

7. Types of Cerebral PalsyTypes of Cerebral Palsy
Spastic Hemiplegia
Diplegia
Quadriplegia
Ataxic
Dyskinetic Dystonic Hypokinesia
Hypertonia
Chored-Athetoid Hyperkinesia
Hypotonia

8. Dysequilibrium SyndromeDysequilibrium Syndrome
1. Difficulty in maintaining an upright
position and in experiencing the
position of the body in space.
2. Autosomal recessive.

9. CEREBRAL PALSYCEREBRAL PALSY
1. Hemiplegia.
2. Double Hemiplegia.
3. Diplegia (hypotonic, dystonic,
spasticity, ataxic).
4. Ataxia.
5. Dysequilibrium Syndrome.
6. Dyskinetic.
7. Mixed.

17. Of 229 children ∆ cerebral palsy at 1
year of age, more than ½ were free of
motor handicap at 7 years.
COLLAB, Perinatal Project

18. Early Signs of Cerebral PalsyEarly Signs of Cerebral Palsy
1. Birth History
a) Prematurity.
b) Seizures.
c) Low apgars.
d) Intracranial haemorrhage.
e) Periventricular leucomalacia.
2. Delayed Milestones
3. Abnormal Motor Performance
a) Handedness.
b) Reptilian crawl.
c) Toe waking.

19. Early Signs of Cerebral PalsyEarly Signs of Cerebral Palsy
4. Altered Tone.
5. Persistence of primitive reflexes.
6. Abnormal posturing.

20. Prenatal Associations withPrenatal Associations with
Cerebral PalsyCerebral Palsy
Placental insufficiency.
Brain malformation.
Congenital infection.
Chromosomal defects.
Exposure to toxins.
Abnormality of neuronal migration.

21. PLACENTAPLACENTA
1. Correlation of placenta infarction or
thrombosis with ischaemic lesions in
the brains of babies who have
suffered intrauterine or early neonatal
deaths.
2. 11 / 15 placental slices from 15
patients with Cerebral Palsy contained
thrombosis.

22. THROMBOPHILIA &THROMBOPHILIA &
CEREBRAL PALSYCEREBRAL PALSY
a) Thrombosis in placental circulation.
b) Coagulation abnormalities in mother and foetus
– Factor V Leiden Mutation which is responsible
for activated protein C resist (APCR).
c) Foetal and neonatal stroke have been reported
in presence of maternal anticardiolipin
antibodies.
d) 20 / 31 children with cerebral palsy had one or
more disorders of coagulation in neonatal blood
spot analysis.

23. ANTENATALANTENATAL
Maternal infection & cerebral palsy
a) Maternal fever> 38o
c + Chorioamnionitis
associated with ↑ risk of cerebral palsy.
b) ↑ Inflammatory markers in children with
cerebral palsy.

24. Cerebral PalsyCerebral Palsy
1. Fall in incidence of Cerebral Palsy in low birth
weight babies.
2. ⇧ in incidence in babies 2.5-4kg (2/3 of cases).
3. Excess boys (C58%).
4. ⇩in incidence of dyskinetic cerebral palsy.
5. ⇧in lowest socio-economic groups.
6. Maternal age and parity.
U shaped curve < 20 years - > 34 years.
4 children or >.
7. Breach delivery.

25. Cerebral Palsy AssociatedCerebral Palsy Associated
DisabilitiesDisabilities
Mental retardation 1/3 N. 1/2 I.Q. < 55.
Epilepsy 20-50% > generalised.
Speech disorders 50% delay/dysarthria.
Vision and hearing 25%.
Behaviour abnormalities.
Learning difficulties.

26. Common ManagementCommon Management
Problems in Cerebral PalsyProblems in Cerebral Palsy
1. Feeding Problems:
Failure to suck.
Tongue trusting, gagging and choking.
Vomiting and regurgitation.
2. Dribbling.
3. Constipation.
4. Crying, screaming and sleep disturbances.
5. Chilblains and cold injury.
6. Growth.

27. Treatment of Cerebral PalsyTreatment of Cerebral Palsy
1. Parent guidance.
2. Physiotherapy - Bobath method.
Peto.
Doman-Delacato.
3. Orthopaedic.
4. Speech and Occupational Therapy.
5. Medical.
6. Psychiatric.

28. Management of Spasticity inManagement of Spasticity in
Cerebral PalsyCerebral Palsy
1. Oral Medicines: Baclofen
Diazepam
Tizanidine
Dantrolene
2. Intrathecal Baclofen.
3. Botulinum Toxin.
4. Selective Posterior Rhizotomy.

29. Botulinum ToxinBotulinum Toxin
1. Produced by bacterium clostridium Botulinum.
2. Blocks release of Acetylcholine from
cholinergic nerve terminals.
3. Duration of effects, 3-4 months.
4. Adverse effects: muscle weakness.
Allergic reaction – rare.
Autonomic Dysfunction.
Occasional flu like symptoms.
Antibody development.

30. PreventioPreventio
1. Antenatal and Neonatal care.
2. Early detection and advice.
3. Drugs.
4. Immunization and screening.
5. Genetic counselling.
6. Health education.