Cerebral palsy overview
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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
Historical Perspective
The first detailed medical descriptions for cerebral palsy dates back to the era of Hippocrates in his work “Corpus Hippocraticum”. Although there is lack of detailed medical descriptions from before the 19th century, mentions to cerebral palsy can be found in representational art, literary sources and paleopathology. In 1827, Jean Baptiste Cazauvieilh was the first to report cerebral atrophy in individuals with congenital paralysis and tried to distinguish between lesions in the developing brain with those related to trauma. In 1853, Little named spastic diplegia as Little's disease. In 1861, after twenty years of experience and nearly 200 cases, Little put forth a theory that asphyxia at birth could cause permanent central nervous system damage in cerebral palsy patients. Between 1891 and 1897, Sigmund Freud was the first to describe a classification system for cerebral palsy in his several volumes entitled “Cerebral Palsy”. In 1953, Virginia Apgar generated a scoring system, "APGAR" that forced obstetricians to examine the condition of newborns at birth and assess the need for treatment
Classification
Cerebral palsy can be classified based on number of limbs involved, physiologically and functionally. Based on number of limbs involved cerebral palsy can be classified into monoplegia, hemiplegia, diplegia, paraplegia and quadriplegia. Physiologically, cerebral palsy can be divided into a spastic type (pyramidal), and an extrapyramidal type. The extrapyramidal types of cerebral palsy include athetoid, choreiform, ataxic, rigid, and hypotonic. The Manual Ability Classification System (MACS) and the Gross Motor Function Classification System (GMFCS) are two most commonly employed systems for functional classification of cerebral palsy. The Manual Ability Classification System (MACS) classifies children with cerebral palsy into five levels. The levels are based on the children’s self-initiated ability to handle objects and their need for assistance or adaptation to perform manual activities in everyday life. The Gross Motor Function Classification System (GMFCS) also classifies children with cerebral palsy into five levels. The levels are based on self-initiated movement abilities, in particular sitting and walking.
Pathophysiology
Causes
Birth asphyxia is believed to be the principal etiology for cerebral palsy. However, recent studies demonstrated that 70% to 80% of cases of cerebral palsy are due to antenatal factors, while only 10% to 28% of cases are due to birth asphyxia in term and near-term infants. Causes of cerebral palsy are often multifactorial.
Differentiating Cerebral palsy from Other Diseases
Epidemiology and Demographics
The incidence of cerebral palsy is approximately 150-250 per 100,000 live births worldwide. Decline in the trends of cerebral palsy is due to advances in perinatal care. The prevalence of different motor patterns of cerebral palsy has remained remarkably static over the last 20 years. Most patients are identified by 2 years of age due to delayed motor milestones. Cerebral palsy usually affects individuals of the black non-Hispanic children race. White non-Hispanic children are less likely to develop cerebral palsy. Males are more commonly affected by cerebral palsy than females. The male to female ratio is approximately 1.5 to 1.
Risk Factors
Common risk factors in the development of cerebral palsy include prematurity, fetal birth asphyxia, multiple births, maternal illness, fetal brain malformation, maternal teratogen exposure, low socioeconomic status, nonvertex presentation, postmaturity, and head injury.
Screening
There is insufficient evidence to recommend routine screening for cerebral palsy. Serial follow-up exams of all newborns from neonatal intensive care are warranted until it is evident that there is no failure in developmental milestones or development of spasticity.
Natural History, Complications, and Prognosis
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, Scoliosis, Failure to thrive, dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia), increased risk of aspiration pneumonia, bronchiolitis/asthma, epilepsy, and mental retardation