Ataxic Cerebral Palsy
There are nine forms of cerebral palsy—a condition in which brain abnormalities or damage interfere with the normal relaying of nerve messages from the brain to the nervous system. Ataxic cerebral palsy is one of the rarer forms of cerebral palsy (CP); fewer than one in ten people with CP have the ataxic form.
The term ataxic comes ataxia, a medical term referring to loss of muscle coordination, particularly in the limb. Ataxic cerebral palsy is less disabling than some of the other forms of cerebral palsy, but it has a significant impact on patients’ lives.
Distinct Symptoms of Ataxic Cerebral Palsy
Depth perception and balance are affected by ataxic cerebral palsy. People with ataxic CP have difficulty with coordination; some must walk by planting their feet an unusual distance apart. Quick movements are difficult. So are activities which require precision movements, such as putting a coin in a slot.
Some people with ataxic cerebral palsy experience a symptom called an intention tremor. This means that when they are deliberately reaching for something their hand or hands begin to tremble. The tremble worsens the nearer they come to the object they are reaching for.
Ataxic cerebral palsy can cause mental retardation, but generally intelligence is unaffected by this form of CP. All forms of CP can sometimes affect vision and/or hearing.
Causes of Ataxic Cerebral Palsy
Like the other, less rare forms of CP, ataxic cerebral palsy is caused by abnormal brain development or by brain damage. Infections in either the mother or the unborn baby and exposure to toxins can cause the fetal brain to not develop properly. During the first two trimesters, the fetal brain is particularly vulnerable to developing abnormally.
Ataxic cerebral palsy may be caused by lesions (holes) in the brain’s white matter; these are called periventricular leukomalacias. Damage to the white matter affects the entire body because this part of the brain sends signals to the entire nervous system, as well as signals within the brain. The brain’s white matter is especially vulnerable during the third trimester.
Bleeding in the unborn baby’s brain can lead to brain damage. Bleeding in the brain is generally caused by strokes. Most fetal strokes are the type which causes bleeding; they may be due to mal-formed or weak brain blood vessels. Occasionally blood clots form in the placenta, causing ischemic strokes by obstructing the baby’s circulation.
When a mother has high blood pressure her unborn baby is at greater risk of stroke. High blood pressure during pregnancy is common, since the growing baby is putting extra stress on the woman’s system. Blood pressure should be carefully checked during pregnancy to assure a healthy outcome for both mother and child. Infections in the mother are yet another cause of stroke in the unborn baby; inflammatory pelvic disease is especially risky for the fetus.
The womb and the placenta may be infected by maternal viral infections. During an infection the body produces more cytokines (a type of immune cell) which in turn produce inflammation. Inflammation fights infection, but it may damage the fetal brain.
Fetal brain damage also occurs if the brain is deprived of oxygen for any length of time. When cerebral palsy was originally described in the 1800s, it was thought that oxygen deprivation during a difficult delivery caused most incidents of the disorder. Today, scientists believe that fewer than ten percent of cerebral palsy cases are due to oxygen deprivation during delivery. Oxygen deprivation can happen at any time during the pregnancy; babies are more likely to be harmed by it when in the womb. Tearing or rupturing of the uterus can cause oxygen deprivation, so can damage to the placenta or umbilical cord. Lack of oxygen is also caused when the mother’s blood pressure drops too low.
Possible Complications from Ataxic Cerebral Palsy
In ataxic cerebral palsy there is a risk that some muscles will not get sufficient use, causing atrophy and possible contractures (rigid muscles that can cause the attached bone to be deformed). However, the risk of contractures is much less than in the spastic forms of CP.
Malnutrition can also be a problem with ataxic cerebral palsy, since the patient may have difficulty feeding him or herself. In addition, coordinating chewing and swallowing sometimes is difficult.
Age of Diagnosis
Although in some forms of CP, the baby show symptoms at birth, ataxic cerebral palsy is usually diagnosed later. Developmental delays and awkward movements generally cause parents to suspect a problem when the child is between three and eighteen months old. Regular visits to the pediatrician are especially important for children under three years old, so that any developmental problems may be treated early.
Treatments for Ataxic Cerebral Palsy
Physical therapy is the gold standard of treatment for all forms of cerebral palsy. It can help people with ataxic cerebral palsy develop better balance and reflexes. It also helps prevent unused muscles from atrophying (growing weak and shrinking).
An alternative form of physical therapy called conductive therapy or conductive education has been successfully used by some CP patients. Conductive therapy can improve the fine motor skills as well as the gross motor skills, thus it may be especially suited to people with ataxic cerebral palsy. Conductive education is done in a group setting using songs and games to encourage the children. While standard physical therapy is sometimes given only two or three times a week, conductive education is done for several hours five days a week.
Patients with ataxic cerebral palsy may also need medications for problems that develop from their condition, but generally the need for medicine in this form of cerebral palsy is not as great as in the spastic forms.
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