Cerebral Palsy- Introduction and types

Question 1

What is CP?

Answer 1

Cerebral Palsy (CP) is a permanent but non‐progressive neurological
impairment resulting from an injury/ brain lesion in an immature brain in utero, during birth, or with the first years after birth. It leads to motor dysfunction and clinical manifestations that change over the years.

It is the most common physical disability in childhood

It is alternatively called Little’s disease after William John Little, an English surgeon who wrote its first medical descriptions

Question 2

Chief cause of CP?

Answer 2

◦ First identified by English surgeon William
Little in 1860. (Little’s disease) ◦ Believed that
asphyxia during birth is chief cause but National Institute of Neurological Disorders &
Stroke (NINDS) in 1980s suggested that only a
small number of cases of CP are caused by lack of
oxygen during birth

Question 3

Epidemiolody of CP

Answer 3

between 1.5 and >4 of every 1,000 live births worldwide.
 In addition, some children develop CP as the
result of brain damage (e.g., due to
meningoencephalitis or traumatic brain injury)
in the first few months or years of life.
 The incidence is higher in males than in females

Question 4

3 Major periods CP occurs and distribution

Answer 4

Prenatal (70%)
Peri-natal (5-10%)
Post natal

Question 5

Prenatal risk factors of CP

Answer 5

Prematurity (< 36 weeks)
Low birth weight (less
than2500 g)
Maternal epilepsy
Infections (TORCH)
Severe toxemia,
Eclampsia
Multiple pregnancies
Rh incompatibility
Diabetes during pregnancy
Genetic causes
Exposure to radiations

Question 6

Perinatal risk factors of CP

Answer 6

Prematurity- immature respiratory
&cardiac function
Asphyxia
Maconeum aspiration
Birth trauma
Disproportion
Breech delivery
Rapid delivery
Coagulopathy

Question 7

Postnatal risk factors of CP

Answer 7

Brain damage secondary to cerebral
hemorrhage, trauma, infection
❑ CNS infection (encephalitis, meningitis)
❑ Neonatal hyperbilirubinemia
❑ Head trauma
❑ Shaken baby syndrome
❑ Seizures and Coagulopathies
◦ Kernicterus
 ◦ genetic causes

Question 8

What is kernicterus?

Answer 8

Bilirubin encephalopathy
in basal ganglia is seen
in athetoid CP following
a diagnosis of kernicterus

Question 9

TRADITIONAL/OLD CLASSIFICATIONS OF CP BASED
ON SINGLE CHARACTERISTICS

Answer 9

 Clinical classification (physiological classification ) : Spastic/Dyskinetic/ Ataxic

 Anatomical classification (Topographic): Monoplegia, Hemiplegia, Diplegia, Triplegia, Quadriplegia

 Supplemental

 Etiological : Pre-/Peri-/Post-natal

 Neuroanatomic (radiologic); Spastic-Cortex, Dyskinetic-Basal ganglia, Hypotonic/Ataxic- Cerebellum, Mixed- Diffuse areas

 Therapeutic

 Functional

Question 10

This is the most common form of CP. The projections to or from the
sensorimotor cortex or abnormalities or lesions of motor cortex induce hypertonus. Characterized by stiff, tight muscles and cerebral cortex damage

Answer 10

Spastic CP (70-80%)

Question 11

Cerebellum and related brain parts are involved. Balance and coordination are mainly
affected.

Charcterized by shaky movements, and affects proprioception

Answer 11

Ataxic (6%)

Question 12

(associated with kernicterus) Basal
ganglions are damaged. Tonus is changing. Characteized by involuntary, uncontrollable movements (dyskinesia)

What kind of CP is this and what are its subtypes?

Answer 12

Dyskinetic CP(6%)

Chorea,
athetoid, dystonic are subtypes of this type CP

Question 13

Characteristics and clasifications of spastic CP

Answer 13

 The cerebral cortex is affected
 Increase in the physiological
resistance of muscle to passive
motion(Spasticity)
 It is part of the upper Motor
neuron syndrome characterized
with Hyperreflexia, Clonus and Primitive reflexes

anatomically distributed into
➢ Hemiplegia
➢ Diplegia
➢ Quadriplegia

Question 14

Four extremities plus the
trunk, neck and face are affected

What type of spastic CP is this?

Answer 14

Quadriplegia

Question 15

Name some of the early signs of CP

Answer 15

• Stiff or floppy posture
• Excessive lethargy or irritability
• Poor head control
• Weak suck / tongue thrust / feeding
  difficulties
• Abnormal or prolonged primitive reflexes

Question 16

Current classification of CP by THE SURVEILLANCE FOR CEREBRAL PALSY IN EUROPE (SCPE) CLASSIFICATION

It combines the physiologic and anatomical(topographic) classification of traditional classification

Answer 16

4 subtype groups:
A. Spastic (bilateral and unilateral),
B. dyskinetic (dystonic and choreoathetotic),
C. Ataxic,
D. Non-classifiable.

Question 17

Commonality of all CP subtypes?

Answer 17

 All the CP subtypes listed have in common
an abnormal pattern of movement and
posture.