Cerebral palsy are not progressive syndromes which are characterized by an impaired voluntary movement or posture due to a prenatal development malformation or perinatal or postnatal damage of the central nervous system. The syndromes manifest before the age of 2. The diagnosis is made clinically. The treatment can, include physiotherapy occupational therapy rails, medication or botulinum toxin orthopedic surgery, intrathecal baclofen or in some cases a dorsal rhizotomy.
Cerebral Palsy (CP) are a group of syndromes that cause non-progressive spasticity, ataxia or involuntary movements that are not specific to a particular disorder or individual syndromes. Cerebral palsy occur in 0.1-0.2% of children, affecting up to 15% of premature babies.
Cerebral palsy are not progressive syndromes which are characterized by an impaired voluntary movement or posture due to a prenatal development malformation or perinatal or postnatal damage of the central nervous system. The syndromes manifest before the age of 2. The diagnosis is made clinically. The treatment can, include physiotherapy occupational therapy rails, medication or botulinum toxin orthopedic surgery, intrathecal baclofen or in some cases a dorsal rhizotomy. Cerebral Palsy (CP) are a group of syndromes that cause non-progressive spasticity, ataxia or involuntary movements that are not specific to a particular disorder or individual syndromes. Cerebral palsy occur in 0.1-0.2% of children, affecting up to 15% of premature babies. Etiology The etiology is multifactorial and a specific cause is sometimes difficult to find. Often wear prematurity, disorders in utero, neonatal encephalopathy and kernicterus in it. Perinatal factors (such as perinatal asphyxia, sleep attack, CNS infections) cause 15-20% of cases. Examples of types of CP are spastic diplegia after premature birth spastic quadriplegia after perinatal asphyxia Athetoid and dystonic forms after perinatal asphyxia or kernicterus Also CNS trauma or serious system disease (eg., Stroke, meningitis, sepsis, dehydration) (in early childhood before the age of 2 years), a CP syndrome can cause. Symptoms and complaints Before a specific syndrome developed are symptoms such as lack of motor development and often persistent primitive reflex forms, hyperreflexia and altered muscle tone present. Categories of Zerebralparesesyndroms The syndromes are mainly categorized as follows, depending on which parts of the central nervous system are corrupted or damaged: Spastic syndromes occur in> 70% of the cases. Spasticity is a state that occurs in the resistance to passive movement, and the resistor with the speed of movement increases. It is due to a disorder of supraspinal motor neurons and motor function may be easy or difficult to compromise. The syndrome can cause hemiplegia, quadriplegia, diplegia or paraplegia. Usually the deep tendon reflexes are increased in the affected limbs, the muscles hypertonic and coordinates the voluntary movements weak and poor. Joint contractures develop and the joints are badly positioned. Typical is a scissor or toe walking. In mild forms the impairment can happen (in the race for. B.) only during certain activities. A corticobulbar impaired oral, lingual and palatal movements with a consistent dysarthria often happens in quadriplegia. Athetoid or dyskinetic syndromes occur in about 20% of cases and based on a participation of the basal ganglia. The slow, worm-like, involuntary movements can affect the limbs and trunk (athetoid movements) and are often triggered by attempts at voluntary movement or excitement. Abrupt, convulsive, jerky, distal (choreatic) movements may also occur. The movements are stronger in emotional stress and disappear during sleep. Dysarthria often occurs and can be very severe. Ataxic syndromes occur in <5% of cases and are caused by a disorder of the cerebellum or its pathways. Weakness, incoordination and intention tremor cause an unsafe state, wide-legged swaying gait and difficulty in fast and precise movements. Mixed syndromes are often - usually with spasticity and athetosis. Findings that are associated with cerebral palsy About 25% of patients, mostly those with spasticity, have other forms. Strabismus or other visual disturbances may occur. Children with athetosis due to kernicterus often have nerve deafness and palsy upwards. Many children with spastic hemiplegia or paraplegia have normal intelligence; Children with spastic quadriplegia or a mixed syndrome usually have severe mental retardation. Cranial magnetic resonance imaging diagnosis Sometimes tests for EXCLUSION hereditary metabolic or neurological disorders If CP is suspected, it is important to identify the underlying disease. The history may indicate a cause. cranial magnetic resonance imaging is performed, which will also show abnormalities in the most cases. Rarely cerebral palsy can be confirmed in early childhood, and a specific syndrome can not be defined before 2 years of age usually. High-risk children (eg. B. with asphyxia, stroke, periventricular abnormalities in the cranial ultrasound of prematurity, jaundice, meningitis, neonatal seizures, hypertension, hypotension or Reflexsuppression) should be closely monitored. A differential diagnosis cerebral palsy should be distinguished from a progressive hereditary neurological disorder and disorders that require surgical or other specific neurological treatment. Atactic forms are particularly difficult to distinguish. In many children with a persistent ataxia, a progressive cerebellar degenerative disease is ultimately identified as the cause. Athetosis, self-mutilation and hyperuricemia in boys indicate a Lesch-Nyhan syndrome. Cutaneous signs or disorders of the eye suggest a tuberous sclerosis, neurofibromatosis, ataxia telangiectasia-include von Hippel-Lindau syndrome or Sturge-Weber syndrome. An infantile spinal muscular atrophy, muscular and neuromuscular junction disorders that are associated with hypotension and hyporeflexia, usually lack the signs of cerebral disease. A adrenoleukodystrophy begins later in childhood, but other leukodystrophies begin earlier and can initially be confused with cerebral palsy. Clarification of cause, when the history and / or MRI of the brain to identify any clear cause, laboratory tests should be performed to certain progressive storage diseases which affect the motor system (z. B. Tay-Sachs disease, metachromatic leukodystrophy, mucopolysaccharidoses) and (organic acid or amino acid metabolism disorders z. B.) exclude metabolic disorders. Other progressive disorders such as infantile neuroaxonal dystrophy can be suspected on the basis of studies of nerve conduction and electromyography. These and many other brain disorders that cause CP (and other manifestations), are increasingly being identified with genetic tests that are carried out to check on a particular disease or to screen for many disorders (microarray and testing of the entire genome testing) , Prognosis Most children survive into adulthood. Children with severe limitations in sucking and swallowing that make nutrition via a gastrostomy necessary, have a lower life expectancy. The goal is that the children achieve the greatest possible autonomy within the limits of their motor skills and the resulting composite end deficits. With a corresponding organizational effort, many children, especially those with spastic paraplegia or hemiplegia, can lead an almost normal life. Treatment physical and occupational therapy support treatment, restriction therapy, drug therapy or surgical procedures for the treatment of spasticity Intrathecal injections of botulinum toxin Baclofen auxiliary devices physiotherapy and occupational therapy are initially used for stretching, starches and facilitating movement patterns and continued later. Supportive treatment, restriction therapy and medications can be added. Botulinum toxin can be injected into the muscles in order to avoid an uneven load on the joints and prevent fixed contractures. Baclofen, benzodiazepines (e.g., diazepam), Tizanid dantrolene and sometimes may reduce spasticity. Intrathecal administration of Baclofen (with a subcutaneous pump and catheter) is the most effective therapy for severe spasticity. Orthopedic procedures (eg. As muscle tendon relaxation or -transfer) can help lessen limited joint movement and joint deformities. Selective dorsal rhizotomy performed in neurosurgery, can help some few children when spasticity affects only the legs and cognitive skills are good. If the intellectual limitations are not severe, children can attend regular classes and participate in customized training programs and even competitions. Speech therapy and other forms of communication relief may be necessary to improve interactions. Some severely affected children can benefit from the practice of simple daily activities that promote independence benefit (eg. As washing, dressing, eating). This promotes their independence and self-esteem and reduces the burden on the family and carers. Assistive devices can improve mobility and communication, they can help and facilitate the daily activities of everyday life in the maintenance of mobility. Some children need - to varying degrees - a lifelong monitoring and assistance. Many facilities for children set up transitional programs for patients when they grow up and have less support that will help them with their specific needs. In all chronically disabled children, the parents permanent help and advice need to understand the condition and capabilities of their child and to deal with their own feelings of guilt, anger, denial and sadness (children with chronic diseases: impact on the family ). These children can make their maximum possible only with a stable and sensitive parental care and with the help of public and private support reach (community workers, support groups, rehabilitation groups such as United Cerebral Palsy Association-s. UCP.org). Important points Cerebral palsy is a syndrome (no specific disease), the nonprogressive spasticity, ataxia and / or involuntary movement includes. The etiology is often multifactorial and sometimes unclear, but includes pre- and perinatal factors associated with malformation or damage to the CNS connected (eg. As genetic diseases and those in the womb, premature delivery, kernicterus, perinatal asphyxia, stroke, CNS infections) are. Mental retardation and other neurological manifestations (eg. B. strabismus, numbness) are not part of the syndrome, but may be present depending on the cause. The syndromes manifest before the age of 2 years; A later start similar symptoms indicative of another neurological disorder. An MRI of the brain is performed and, if necessary, testing for hereditary metabolic and neurological disorders. Treatment depends on the type and degree of disability, but physiotherapy and occupational therapy are usually used; Some children benefit from braces, botulinum toxin, benzodiazepines, other muscle relaxants, intrathecal baclofen and / or surgery (eg. as muscle Sehnenfreseitzung or -transfer rarely dorsal rhizotomy). More information United Cerebral Palsy Association