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Cerebral palsy

Definition

Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking.

There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.

Alternative Names

Spastic paralysis; Paralysis - spastic; Spastic hemiplegia; Spastic diplegia; Spastic quadriplegia

Causes

Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb. But they can happen at any time during the first 2 years of life, while the baby's brain is still developing.

In some people with cerebral palsy, parts of the brain are injured due to a low level of oxygen (hypoxia) in the area. It is not known why this occurs.

Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy as a result of several conditions, including:

In some cases, the cause of cerebral palsy is never determined.

Symptoms

Symptoms of cerebral palsy can be very different between people with this group of disorders. Symptoms may:

  • Be very mild or very severe
  • Only involve one side of the body or both sides
  • Be more pronounced in either the arms or legs, or involve both the arms and legs

Symptoms are usually seen before a child is 2 years old. Sometimes symptoms begin as early as 3 months. Parents may notice that their child is delayed in reaching developmental stages such as sitting, rolling, crawling, or walking.

There are several different types of cerebral palsy. Some people have a mixture of symptoms.

Symptoms of spastic cerebral palsy, the most common type, include:

  • Muscles that are very tight and do not stretch. They may tighten up even more over time.
  • Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes
  • Joints are tight and do not open up all the way (called joint contracture)
  • Muscle weakness or loss of movement in a group of muscles (paralysis)
  • The symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs

The following symptoms may occur in other types of cerebral palsy:

  • Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
  • Tremors
  • Unsteady gait
  • Loss of coordination
  • Floppy muscles, especially at rest, and joints that move around too much

Other brain and nervous system symptoms:

  • Decreased intelligence or learning disabilities are common, but intelligence can be normal
  • Speech problems (dysarthria)
  • Hearing or vision problems
  • Seizures
  • Pain, especially in adults (can be difficult to manage)

Eating and digestion symptoms:

  • Difficulty sucking or feeding in infants, or chewing and swallowing in older children and adults
  • Problems swallowing (at all ages)
  • Vomiting or constipation

Other symptoms:

Exams and Tests

A full neurological exam is critical. In older people, testing cognitive function is also important.

The following other tests may be performed:

Treatment

There is no cure for cerebral palsy. The goal of treatment is to help the person be as independent as possible.

Treatment requires a team approach, including:

  • Primary care doctor
  • Dentist (dental check-ups are recommended around every 6 months)
  • Social worker
  • Nurses
  • Occupational, physical, and speech therapists
  • Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist

Treatment is based on the person's symptoms and the need to prevent complications.

Self and home care include:

  • Getting enough food and nutrition
  • Keeping the home safe
  • Performing exercises recommended by the health care providers
  • Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
  • Protecting the joints from injury

Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

The following may help with communication and learning:

  • Glasses
  • Hearing aids
  • Muscle and bone braces
  • Walking aids
  • Wheelchairs

Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed to help with daily activities and care.

Medications may include:

  • Anticonvulsants to prevent or reduce the frequency of seizures
  • Botulinum toxin to help with spasticity and drooling
  • Muscle relaxants to reduce tremors and spasticity

Surgery may be needed in some cases to:

  • Control gastroesophageal reflux
  • Cut certain nerves from the spinal cord to help with pain and spasticity
  • Place feeding tubes
  • Release joint contractures

Support Groups

Stress and burnout among parents and other caregivers of cerebral palsy patients is common. Seek support and more information from organizations that specialize in cerebral palsy.

Outlook (Prognosis)

Cerebral palsy is a lifelong disorder. Long-term care may be required. The disorder does not affect expected length of life. The amount of disability varies.

Many adults are able to live in the community, either independently or with different levels of help.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if symptoms of cerebral palsy develop, especially if you know that an injury occurred during birth or early infancy.

Prevention

Getting the proper prenatal care may reduce the risk of some rare causes of cerebral palsy. In most cases though, the injury causing the disorder is not preventable.

Pregnant mothers with certain medical conditions may need to be followed in a high-risk prenatal clinic.

References

Johnston MV. Encephalopathies. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 591.

Murphy KP. The adult with cerebral palsy. Orthop Clin N Am. 2010;41:595–605.

Nass R, Ross G. Developmental disabilities. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 61.

Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74:336-343.


Review Date: 8/22/2013
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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