Cerebral palsy (CP) is the name for a condition which impairs movement by impairing the ability of the brain to send the proper nerve signals to the muscles. Doctors classify individual cases of CP as one of nine different forms of the disorder; some cases are a mixture of the forms. Spastic hemiplegia is a relatively common form of CP. Spastic hemiplegia means that movement on one side of the body is affected. Hemi comes from the Greek for half, while plegia is from the Greek for forms of paralysis. A similar term, spastic hemiparesis, means that one half of the body is afflicted with weakness, but is not paralyzed. Spastic hemiplegia is caused by brain damage which occurred in the womb or during birth; it can also occur shortly after birth. In most people, one hemisphere (side) of the brain controls the opposite side of the body. So if the left side of the brain experiences damage, the symptoms will appear on the right side of the body and vice-a-versa.
Distinct Symptoms of Spastic Hemiplegia
Someone with spastic hemiplegia may have a wide-range of difficulties; not all spastic hemiplegia patients experience every problem related to the condition. Some people are affected relatively mildly, while others are severely affected.
It is important to note that sometimes spastic hemiplegia may be temporary. Spastic hemiplegia can cause trouble with walking; a patient may have difficulty with balance. Tasks using the hands such as writing, or sewing may be difficult. The muscles on one side of the body may be stiff and weak (this is the most common symptom).
Children with spastic hemiplegia may be developmentally delayed; they may not sit up, crawl, walk or talk as soon as other children do (this is another very common symptom). Some individuals with spastic hemiplegia may experience seizures. This form of CP can also affect the intelligence. Approximately a quarter of all children with spastic hemiplegia have an IQ below 70 (mental retardation).
Causes of Spastic Hemiplegia
Spastic hemiplegia has several causes. A stroke of any type can cause spastic hemiplegia. Many people do not realize that children can suffer strokes; unborn babies and newborns can have strokes which cause brain damage and lead to cerebral palsy. Other causes include the following:
- Head injuries and brain tumors
- Sturge-Weber Syndrome, a congenital condition characterized by vascular problems and facial birth marks known as port wine stains
- Migraine syndrome—a collection of symptoms, including headache, vision disturbances, and nausea, related to nerve and vascular changes, can sometimes cause a temporary form of spastic hemiplegia Todd’s Paralysis, which affects some epilepsy patients, is also known to occasionally cause temporary spastic hemiplegia.
- Meningitis, encephalitis, and other brain infections: Infections in the mother during pregnancy can cause brain damage to the unborn child and lead to any form of CP including spastic hemiplegia.
- Multiple sclerosis and its associated disorder myelitis may lead to spastic hemiplegia as well. Vasculitis—inflammation of the blood or lymph vessels is also sometimes the source of this problem.
- Occasionally spastic hemiplegia is caused by a complication from diabetes, known as nonketotic hyperosmolar coma.
- Some cases of spastic hemiplegia are caused by hereditary diseases known as leukodystorphies.
- In addition, if malformations of the arteries and veins called arterovenous malformations (AVM) are present in the brain they can cause spastic hemiplegia; arterovenous malformations may occur anywhere in the body and are present at birth. Only rarely do AVM cause noticeable symptoms, such as spastic hemiplegia.
Possible Complications from Spastic Hemiplegia
Spastic hemiplegia can lead to limb deformities. A common problem in this type of CP is known as equinus ankle. Because of the spastic muscles, the foot is not able to flex normally and is drawn into a position which leads to toe walking. Healthy toddlers sometimes exhibit toe walking, but this is a condition which should be outgrown by the time the child is six. Children with toe walking caused by spastic hemiplegia do not out grow the problem and it can lead to an increasingly awkward gait, as well displacement of the hip joints and a tendency to fall.
A related problem known as foot drop can also lead to gait problems in children with spastic hemiplegia. Foot drop (or drop foot, as it also called) means that the individual has difficulty lifting the front part of the foot. Surgery, physical therapy, and orthopedic devices, such as braces can help correct or prevent limb deformities.
Vision problems may also be present in children with spastic hemiplegia. Although doctors can detect the damage which is causing the mobility problems of spastic hemiplegia from a CAT scan of the brain, detecting vision problems using this test is more difficult. Children with spastic hemiplegia should have a thorough vision screening by an ophthalmologist familiar with brain damage.
Seizures are sometimes present in spastic hemiplegia, and various medications can help this problem.
Age at Diagnosis
Babies who appear normal at birth may sometimes be diagnosed with spastic hemiplegia when they are around four or five months old. Because voluntary hand use takes this long to fully develop, the signs of hemiplegia may not be noticeable before this time. Awkward hand movements and developmental delay are two signs parents should look for if they suspect their baby may have spastic hemiplegia.
Treatments for Spastic Hemiplegia
Physical therapy is the standard treatment for spastic hemiplegia, as it is for other forms of cerebral palsy. There are many methods of this therapy, which is aimed at strengthening the muscles and preventing further muscle stiffening.
Medication to relax spastic muscles is used in spastic hemiplegia. Medicines are also used to treat seizures and other complications from this form of CP. Surgery may be helpful in cases of limb deformities, but the best treatment for this type of problem is prevention. Braces and other orthopedic devices can support movement and help prevent deformed limbs.
Researchers are continually seeking to improve treatment of spastic hemiplegia and to prevent its occurrence. Alternative treatments such as massage and yoga help some spastic hemiplegia patients to relax, but they cannot cure CP. If you have spastic hemiplegia or are caring for a loved one who does, be sure to explore all of your treatment options; while there is no cure for any form of CP, many treatments can provide significant relief.