Congenital Cerebral Palsy
Cerebral palsy (CP) is a disorder which originates in the brain and interferes with movement. Cerebral refers to the brain; palsy refers to the difficulty with movement. Ninety to ninety-five percent of cerebral palsy cases are congenital cerebral palsy; congenital means that a disorder was present at birth.
The remaining five percent or so of CP cases are acquired CP, meaning that they were acquired after birth as a result of infection, head trauma, or some other cause of brain damage. Congenital cerebral palsy occurs when the baby’s brain does not develop normally in the womb or when brain damage has occurred during development.
Causes of Congenital Cerebral Palsy
There are many causes of congenital cerebral palsy, some of which are not completely understood. Genetic abnormalities sometimes cause brain malformation, but the majority of congenital CP cases result from brain damage due to fetal stroke, or fetal or maternal infection. Good prenatal care can lower the risk of these conditions, but it cannot entirely prevent them.
Diseases such as rubella which cause birth defects can be prevented if the mother is vaccinated before getting pregnant. Rh incompatibility (conflict between the fetus’ blood type and the mother’s blood type) can cause brain damage if left untreated. Rh incompatibility is routinely monitored for in the U.S. Early treatment of Rh incompatibility protects the unborn baby from any harmful effects from the disorder.
Avoiding toxins can help prevent birth defects, including cerebral palsy. The unborn baby’s brain is most subject to damage from toxins during the first two trimesters of pregnancy, but damage can also occur in the final trimester.
Controlling the mother’s blood pressure can help prevent strokes in the unborn baby. Both high blood pressure and extremely low blood pressure in the mother can cause a fetal stroke. Strokes in unborn babies are generally the type which causes bleeding; intracranial hemorrhage (bleeding in the brain) can cause permanent brain damage. Sometimes unborn babies suffer ischemic strokes—strokes caused by blood clots which block blood flow.
Obstructed blood flow or bleeding in the brain are both conditions which can lead to CP, because they interfere with oxygen flow in the brain. Oxygen is vital to the all of the brain’s functions, including the functioning and production of neurotransmitters—the brain’s chemical messengers. Neurotransmitters relay messages from brain to the nervous system; these messages are necessary for muscle movement.
When a mother has inflammatory pelvic disease, her unborn child can be at higher risk of stroke. Trying to be infection-free before pregnancy can lower this risk, but it cannot always prevent problems. Other causes of congenital cerebral palsy are also not completely preventable. Intrauterine infections (infections in the baby while in the womb) are difficult to treat and newer methods of delivering antibiotics may not work as effectively as hoped.
At one time doctors believed that asphyxia (lack of oxygen) during a prolonged or difficult delivery was the cause of most cases of congenital cerebral palsy, but studies done during the 1980s proved that this was not the case. Less than 10 percent of congenital CP is caused by asphyxia during delivery. Lack of oxygen while the baby is still in the uterus is more likely to cause CP, because it is more prolonged than what occurs during labor. Accidents such as rupture of the uterus, problems with the umbilical cord, or detachment of the placenta can cause severe lack of oxygen in the unborn baby and lead to CP.
Symptoms of Congenital Cerebral Palsy
The symptoms of congenital cerebral palsy depend on the part of the brain affected and on the amount of damage done. Symptoms include:
• Stiff muscles and difficulty moving. Muscles may be so tight (spastic) that they draw up the limbs. These symptoms appear mainly in the three spastic forms of CP and in mixed CP.
• Loose, overly-relaxed, “floppy” muscles. This type of problem occurs in hypotonic cerebral palsy and in mixed CP.
• Writhing, involuntary movements. Most common in dyskinetic CP.
• Difficulty speaking. Difficulty understanding language.
• Difficulty swallowing.
• Mental retardation. Approximately half of CP patients have some form of mental impairment; others may be of normal intelligence or intellectually gifted. Because of communication difficulties, it is sometimes difficult to assess the IQ of CP patients.
Conditions Associated with Cerebral Palsy
Problems such as vision difficulties, hearing difficulties, and difficulties with nutrition are sometimes associated with congenital cerebral palsy. A common problem for CP patients is the condition popularly called crossed eyes; the muscles controlling eye movement are weak, making focusing difficult.
Complications of Congenital Cerebral Palsy
Nutrition difficulties occur when the patient cannot chew or swallow efficiently, making it difficult to obtain enough calories. Patients who experience involuntary movements need more calories because of the energy expended. Difficulty controlling bowel and bladder function can also be a problem for CP patients.
Spastic forms of CP can lead to muscle contractures; the muscles become so tight that they pull the bones or joints out of place. Ankle equinus, a condition in which the patient must walk on the toes is a common problem with CP. Foot drop, in which the person has difficulty raising the front of the foot is another common problem in congenital CP problem.
Age of Diagnosis
Most cases of congenital cerebral palsy are diagnosed before the child is three years old. Developmental delays are usually the first clues that the baby may have cerebral palsy. Symptoms such as overly stiff or overly relaxed muscles may not be apparent until some months after birth.
Treatments for Congenital Cerebral Palsy
The standard treatment for all forms of congenital cerebral palsy is physical therapy. Physical therapy strengthens weak muscles and helps prevent muscle contractures; many CP patients make substantial progress with physical therapy and become able to do a range of activities they would not have been able to have done without this extra help.
Medications are used to relax spastic muscles. Anti-seizure medicines are used to control seizures. Other medications are used to prevent or control other problems associated with CP, such as bowel problems.
Surgery may be needed to correct contractures or joint problems such ankle equinus. Braces can also help prevent or correct some joint problems. Other forms of orthopedic supports can make life easier for CP patients.
“Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web:http://www.marchofdimes.com/pnhec/4439_1208.asp#types
“Cerebral Palsy” MayoClinic.com Retrieved March 27, 2009 from the World Wide Web:http://www.mayoclinic.com/health/cerebral-palsy?DS00302
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