Cerebral palsy natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Although the neurologic deficit is permanent and non-progressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient. Cerebral palsy affects multiple systems. Common complications include contractures, hip dislocation, [[ | Although the neurologic deficit is permanent and non-progressive, if cerebral palsy is left untreated it can have a dynamic effect on [[growth]] and [[development]] of the patient resulting in [[gait]] abnormalities. Cerebral palsy affects multiple systems. Common complications include contractures, [[hip dislocation]], [[scoliosis]], [[failure to thrive]], [[dental caries]] ([[enamel dysgenesis]], [[malocclusion]], and [[gingival hyperplasia]]), increased risk of [[aspiration pneumonia]], [[bronchiolitis]]/[[asthma]], [[epilepsy]], and [[mental retardation]]. | ||
==Natural History== | ==Natural History== | ||
*Although the neurologic deficit is permanent and nonprogressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient. | *Although the neurologic deficit is permanent and nonprogressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient. | ||
*Growth, along with altered muscle function across joints, can lead to progressive loss of motion, contracture, and eventually joint subluxation or dislocation, resulting in degeneration that may require orthopedic intervention.<ref name="pmid10868725">{{cite journal |vauthors=Ando N, Ueda S |title=Functional deterioration in adults with cerebral palsy |journal=Clin Rehabil |volume=14 |issue=3 |pages=300–6 |year=2000 |pmid=10868725 |doi=10.1191/026921500672826716 |url=}}</ref><ref name="pmid12198474">{{cite journal |vauthors=Bell KJ, Ounpuu S, DeLuca PA, Romness MJ |title=Natural progression of gait in children with cerebral palsy |journal=J Pediatr Orthop |volume=22 |issue=5 |pages=677–82 |year=2002 |pmid=12198474 |doi= |url=}}</ref> | *Growth, along with altered muscle function across joints, can lead to progressive loss of motion, [[contracture]], and eventually [[joint subluxation]] or [[dislocation]], resulting in [[degeneration]] that may require orthopedic intervention.<ref name="pmid10868725">{{cite journal |vauthors=Ando N, Ueda S |title=Functional deterioration in adults with cerebral palsy |journal=Clin Rehabil |volume=14 |issue=3 |pages=300–6 |year=2000 |pmid=10868725 |doi=10.1191/026921500672826716 |url=}}</ref><ref name="pmid12198474">{{cite journal |vauthors=Bell KJ, Ounpuu S, DeLuca PA, Romness MJ |title=Natural progression of gait in children with cerebral palsy |journal=J Pediatr Orthop |volume=22 |issue=5 |pages=677–82 |year=2002 |pmid=12198474 |doi= |url=}}</ref> | ||
*Injury to the developing brain can occur at any time and can result in delayed development and may affect cognition, vision, hearing, language, cortical sensation, attention, vigilance, and behavior. | *Injury to the developing brain can occur at any time and can result in delayed development and may affect [[cognition]], [[vision]], [[hearing]], [[language]], [[cortical sensation]], [[attention]], [[vigilance]], and [[behavior]]. | ||
==Complications== | ==Complications== | ||
Cerebral palsy affects multiple systems. Common complications include:<ref name="pmid25195946">{{cite journal |vauthors=Peterson M |title=Physical inactivity and secondary health complications in cerebral palsy: chicken or egg? |journal=Dev Med Child Neurol |volume=57 |issue=2 |pages=114–5 |year=2015 |pmid=25195946 |pmc=4863451 |doi=10.1111/dmcn.12578 |url=}}</ref><ref name="pmid20425296">{{cite journal |vauthors=Foster T, Rai AI, Weller RA, Dixon TA, Weller EB |title=Psychiatric complications in cerebral palsy |journal=Curr Psychiatry Rep |volume=12 |issue=2 |pages=116–21 |year=2010 |pmid=20425296 |doi=10.1007/s11920-010-0096-8 |url=}}</ref><ref name="pmid19462122">{{cite journal |vauthors=Mello SS, Marques RS, Saraiva RA |title=[Respiratory complications in patients with cerebral palsy undergoing general anesthesia.] |language=Portuguese |journal=Rev Bras Anestesiol |volume=57 |issue=5 |pages=455–64 |year=2007 |pmid=19462122 |doi= |url=}}</ref> | Cerebral palsy affects multiple systems. Common complications include:<ref name="pmid25195946">{{cite journal |vauthors=Peterson M |title=Physical inactivity and secondary health complications in cerebral palsy: chicken or egg? |journal=Dev Med Child Neurol |volume=57 |issue=2 |pages=114–5 |year=2015 |pmid=25195946 |pmc=4863451 |doi=10.1111/dmcn.12578 |url=}}</ref><ref name="pmid20425296">{{cite journal |vauthors=Foster T, Rai AI, Weller RA, Dixon TA, Weller EB |title=Psychiatric complications in cerebral palsy |journal=Curr Psychiatry Rep |volume=12 |issue=2 |pages=116–21 |year=2010 |pmid=20425296 |doi=10.1007/s11920-010-0096-8 |url=}}</ref><ref name="pmid19462122">{{cite journal |vauthors=Mello SS, Marques RS, Saraiva RA |title=[Respiratory complications in patients with cerebral palsy undergoing general anesthesia.] |language=Portuguese |journal=Rev Bras Anestesiol |volume=57 |issue=5 |pages=455–64 |year=2007 |pmid=19462122 |doi= |url=}}</ref> | ||
*Decubitus ulcers and sores | *[[Decubitus ulcers]] and [[sores]] | ||
*Contractures | *[[Contractures]] | ||
*Hip dislocation | *[[Hip dislocation]] | ||
*[[Scoliosis]] | *[[Scoliosis]] | ||
*Failure to thrive due to feeding and swallowing difficulties secondary to poor oromotor control | *[[Failure to thrive]] due to feeding and swallowing difficulties secondary to poor [[oromotor]] control | ||
*Obesity | *[[Obesity]] | ||
*Gastroesophageal reflux | *[[Gastroesophageal reflux]] | ||
*Constipation | *[[Constipation]] | ||
*Dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia) | *[[Dental caries]] ([[enamel dysgenesis]], [[malocclusion]], and [[gingival hyperplasia]]) | ||
*Increased risk of aspiration pneumonia | *Increased risk of [[aspiration pneumonia]] | ||
*Bronchiolitis/asthma | *[[Bronchiolitis]]/[[asthma]] | ||
*Epilepsy | *[[Epilepsy]] | ||
*Hearing loss | *[[Hearing loss]] | ||
*Visual-field abnormalities due to cortical injury | *Visual-field abnormalities due to cortical injury | ||
*Strabismus | *[[Strabismus]] | ||
*Mental retardation | *[[Mental retardation]] | ||
*Attention-deficit/hyperactivity disorder | *[[Attention-deficit]]/[[hyperactivity disorder]] | ||
*Learning disabilities | *[[Learning disabilities]] | ||
==Prognosis== | ==Prognosis== | ||
*Prognosis of cerebral palsy depends on the type and severity of motor impairment.<ref name="pmid18981805">{{cite journal |vauthors=O'Shea TM |title=Diagnosis, treatment, and prevention of cerebral palsy |journal=Clin Obstet Gynecol |volume=51 |issue=4 |pages=816–28 |year=2008 |pmid=18981805 |pmc=3051278 |doi=10.1097/GRF.0b013e3181870ba7 |url=}}</ref> | *Prognosis of cerebral palsy depends on the type and severity of [[motor impairment]].<ref name="pmid18981805">{{cite journal |vauthors=O'Shea TM |title=Diagnosis, treatment, and prevention of cerebral palsy |journal=Clin Obstet Gynecol |volume=51 |issue=4 |pages=816–28 |year=2008 |pmid=18981805 |pmc=3051278 |doi=10.1097/GRF.0b013e3181870ba7 |url=}}</ref> | ||
*Average life expectancy of patients with cerebral palsy is 44% of normal. | *Average life expectancy of patients with cerebral palsy is 44% of normal. | ||
*The strongest predictors of early mortality are immobility and impaired feeding ability.<ref name="pmid1123119">{{cite journal |vauthors=Bleck EE |title=Locomotor prognosis in cerebral palsy |journal=Dev Med Child Neurol |volume=17 |issue=1 |pages=18–25 |year=1975 |pmid=1123119 |doi= |url=}}</ref> | *The strongest predictors of early [[mortality]] are [[immobility]] and impaired feeding ability.<ref name="pmid1123119">{{cite journal |vauthors=Bleck EE |title=Locomotor prognosis in cerebral palsy |journal=Dev Med Child Neurol |volume=17 |issue=1 |pages=18–25 |year=1975 |pmid=1123119 |doi= |url=}}</ref> | ||
*Retention of asymmetric and symmetric tonic neck reflex, | *Retention of asymmetric and symmetric tonic [[neck reflex]], [[moro reflex]], [[neck righting reflex]], and presence of lower-extremity extensor thrust response in early infancy are associated with poor prognostic factors for the development of independent walking | ||
*Long-term monitoring depends on the degree of involvement:<ref name="pmid18611196">{{cite journal |vauthors=Strauss D, Brooks J, Rosenbloom L, Shavelle R |title=Life expectancy in cerebral palsy: an update |journal=Dev Med Child Neurol |volume=50 |issue=7 |pages=487–93 |year=2008 |pmid=18611196 |doi=10.1111/j.1469-8749.2008.03000.x |url=}}</ref><ref name="pmid18317270">{{cite journal |vauthors=Liptak GS |title=Health and well being of adults with cerebral palsy |journal=Curr. Opin. Neurol. |volume=21 |issue=2 |pages=136–42 |year=2008 |pmid=18317270 |doi=10.1097/WCO.0b013e3282f6a499 |url=}}</ref> | *Long-term monitoring depends on the degree of involvement:<ref name="pmid18611196">{{cite journal |vauthors=Strauss D, Brooks J, Rosenbloom L, Shavelle R |title=Life expectancy in cerebral palsy: an update |journal=Dev Med Child Neurol |volume=50 |issue=7 |pages=487–93 |year=2008 |pmid=18611196 |doi=10.1111/j.1469-8749.2008.03000.x |url=}}</ref><ref name="pmid18317270">{{cite journal |vauthors=Liptak GS |title=Health and well being of adults with cerebral palsy |journal=Curr. Opin. Neurol. |volume=21 |issue=2 |pages=136–42 |year=2008 |pmid=18317270 |doi=10.1097/WCO.0b013e3282f6a499 |url=}}</ref> | ||
**Patients with a gross motor function classification system (GMFCS) level of I or II need less monitoring. | **Patients with a gross motor function classification system (GMFCS) level of I or II need less monitoring. | ||
Latest revision as of 16:14, 6 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Although the neurologic deficit is permanent and non-progressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient resulting in gait abnormalities. Cerebral palsy affects multiple systems. Common complications include contractures, hip dislocation, scoliosis, failure to thrive, dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia), increased risk of aspiration pneumonia, bronchiolitis/asthma, epilepsy, and mental retardation.
Natural History
- Although the neurologic deficit is permanent and nonprogressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient.
- Growth, along with altered muscle function across joints, can lead to progressive loss of motion, contracture, and eventually joint subluxation or dislocation, resulting in degeneration that may require orthopedic intervention.[1][2]
- Injury to the developing brain can occur at any time and can result in delayed development and may affect cognition, vision, hearing, language, cortical sensation, attention, vigilance, and behavior.
Complications
Cerebral palsy affects multiple systems. Common complications include:[3][4][5]
- Decubitus ulcers and sores
- Contractures
- Hip dislocation
- Scoliosis
- Failure to thrive due to feeding and swallowing difficulties secondary to poor oromotor control
- Obesity
- Gastroesophageal reflux
- Constipation
- Dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia)
- Increased risk of aspiration pneumonia
- Bronchiolitis/asthma
- Epilepsy
- Hearing loss
- Visual-field abnormalities due to cortical injury
- Strabismus
- Mental retardation
- Attention-deficit/hyperactivity disorder
- Learning disabilities
Prognosis
- Prognosis of cerebral palsy depends on the type and severity of motor impairment.[6]
- Average life expectancy of patients with cerebral palsy is 44% of normal.
- The strongest predictors of early mortality are immobility and impaired feeding ability.[7]
- Retention of asymmetric and symmetric tonic neck reflex, moro reflex, neck righting reflex, and presence of lower-extremity extensor thrust response in early infancy are associated with poor prognostic factors for the development of independent walking
- Long-term monitoring depends on the degree of involvement:[8][9]
- Patients with a gross motor function classification system (GMFCS) level of I or II need less monitoring.
- Patients with level III should be monitored every other year.
- Patients with level IV or V need assessment every year during active growth.
References
- ↑ Ando N, Ueda S (2000). "Functional deterioration in adults with cerebral palsy". Clin Rehabil. 14 (3): 300–6. doi:10.1191/026921500672826716. PMID 10868725.
- ↑ Bell KJ, Ounpuu S, DeLuca PA, Romness MJ (2002). "Natural progression of gait in children with cerebral palsy". J Pediatr Orthop. 22 (5): 677–82. PMID 12198474.
- ↑ Peterson M (2015). "Physical inactivity and secondary health complications in cerebral palsy: chicken or egg?". Dev Med Child Neurol. 57 (2): 114–5. doi:10.1111/dmcn.12578. PMC 4863451. PMID 25195946.
- ↑ Foster T, Rai AI, Weller RA, Dixon TA, Weller EB (2010). "Psychiatric complications in cerebral palsy". Curr Psychiatry Rep. 12 (2): 116–21. doi:10.1007/s11920-010-0096-8. PMID 20425296.
- ↑ Mello SS, Marques RS, Saraiva RA (2007). "[Respiratory complications in patients with cerebral palsy undergoing general anesthesia.]". Rev Bras Anestesiol (in Portuguese). 57 (5): 455–64. PMID 19462122.
- ↑ O'Shea TM (2008). "Diagnosis, treatment, and prevention of cerebral palsy". Clin Obstet Gynecol. 51 (4): 816–28. doi:10.1097/GRF.0b013e3181870ba7. PMC 3051278. PMID 18981805.
- ↑ Bleck EE (1975). "Locomotor prognosis in cerebral palsy". Dev Med Child Neurol. 17 (1): 18–25. PMID 1123119.
- ↑ Strauss D, Brooks J, Rosenbloom L, Shavelle R (2008). "Life expectancy in cerebral palsy: an update". Dev Med Child Neurol. 50 (7): 487–93. doi:10.1111/j.1469-8749.2008.03000.x. PMID 18611196.
- ↑ Liptak GS (2008). "Health and well being of adults with cerebral palsy". Curr. Opin. Neurol. 21 (2): 136–42. doi:10.1097/WCO.0b013e3282f6a499. PMID 18317270.