Introduction

NEUROLOGICAL DISORDERS CEREBRAL PALSY

It is Chronic disability of central nervous system origin characterised by aberrant control of movement of posture, appearing early in life and not the result of progressive neurological disease. Its an upper motor neurone lesion. Muscle tone is increased in the involved group of muscles. This is the reason, these children are also called as Spastic Children. Mental retardation is a usual accompaniment. Hence, usual diagnosis labelled is MRCP (mental retardation and cerebral palsy)

Types of Cerebral Palsy

Spastic: Hemiplegia, Diplegia, Paraplegia, Quadriplegia

Ataxic

Dyskinefic               

Dystonic                              Hypokinesia, Hypertonia

Chored-Athetoid                 Hyperkinesia, Hypotonia

Clinical Features

Usually history of late cry after birth can be elicited and sometimes there is history of some infection of the brain at or after birth

Early Signs of Cerebral Palsy:

1.                Birth History

·       Prematurity.

·       Seizures.

·       Low apgars.

·       Intracranial haemorrhage.

·       Periventricular leucomalacia.

2.                Delayed Milestones

3.                Abnormal Motor Performance. Muscles are spastic. Reflexes' are increased.

•           Handedness.

•           Reptilian crawl.

•           Toe waking.

•           Scissoring gait

4.                Altered Tone.

5.                Persistence of primitive reflexes.

6.                Abnormal posturing

7.                Maternal fever> 38°c + Chorioamnionitis associated with increased risk of cerebral     palsy.

Prevalence and incidence of cerebral palsy

·       In Low Birth Weight Babies.

·       More in Males (<58%).

·       Incidence of Dyskinetic Cerebral Palsy.

·       In Lowest Socio-economic Groups.

·       Maternal Age and Parity.

·       U Shaped Curve <20 Years -> 34 Years.

·       4 Children or >.

·       Breach Delivery

Cerebral Palsy Associated Disabilities

·       Mental retardation 1/3 N.1/2 I.Q. <55.

·       Epilepsy 20-50 %> generalised.

·       Speech disorders 50% delay/dysarthria.

·       Vision and hearing 25%.

·       Behaviour abnormalities.

·       Learning difficulties.

Common Management Problems in Cerebral Palsy

·       Feeding Problems: Failure to suck.

·       Tongue trusting, gagging and choking.

·       Vomiting and regurgitation.

·       Dribbling.

·       Constipation.

·       Crying, screaming and sleep disturbances.

·       Chilblains and cold injury.

·       Growth.

Treatment of Cerebral Palsy

1.        Parent guidance.

2.        Physiotherapy

3.        Orthopaedic correction of the deformities

4.        Speech and Occupational Therapy.

5.        Medical.

6.        Psychiatric

Management of Spasticity in Cerebral Palsy

·       Oral Medicines:

·       Baclofen

·       Diazepam

·       Tizanid

·       Dantrolene

·       Intrathecal Baclofen.

·       Botulinum Toxin.

·       Selective Posterior Rhizotomy.

Prevention

1.   Antenatal and Neonatal care.

2.   Early detection and advice.

3.   Drugs.

4.   Immunization and screening

5.   Genetic counselling.
6.   Health education