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Cerebral palsy in children

Background
Definition
Non-progressive lesion of motor pathways in brain, presenting in infancy (<2 years).
Causes a disorder of movement and posture – a motor developmental delay – and may affect other developmental domains – a global developmental delay.
Causes and risk factors
In-utero (80%): vascular occlusion, cortical malformation, maternal infection, prematurity, low birth weight.
Birth (10%): hypoxic injury.
Neonatal (10%): infection, kernicterus.
Sub-types
3 sub-types, though can be mixed:

Spastic CP (80%): may have initial hypotonia, then spastic hemiplegia, quadriplegia, or diplegia (usually in legs).
Ataxic hypotonic CP: initial hypotonia, then incoordination, intention tremor, and ataxic gait.
Dyskinetic CP: chorea, athetosis.
Signs and symptoms
General:

Neonate with abnormal tone or posture.
Persistent primitive reflexes.
Missed motor milestones.
Hyper-reflexia.
Legs:

Abnormal gait.
Tiptoe walking.
Leg scissoring.
Hands:

Asymmetric hand function under 12 months.
Hand fisting.
Later signs:

Joint contractures.
Hip subluxation.
Scoliosis
Other problems:

Intellectual disability (50%).
Epilepsy (40%).
Strabismus (30%) and visual impairment.
ENT: speech problems (30%), hearing impairment (10%), drooling.
GI and GU: feeding difficulty (slow eating, gagging), GORD, vomiting, bowel and bladder dysfunction.
Psychological: sleep problems, mental health problems.
Investigations
Diagnosis is clinical, but MRI may be used if cause is unclear.

Management
Supportive:

Child development MDT inc. physio, OT, and speech and language.
Aids and adaptations e.g. wheelchairs, hoists, orthoses, feeding tubes.
Medical:

Manage most problems (e.g. epilepsy, GI and GU dysfunction, visual problems) as in any child.
Spasticity: baclofen (PO or intrathecal), diazepam PO, or botulinum toxin type A IM.
Drooling: anti-cholinergics e.g. glycopyrronium bromide PO.
Surgical:

Release of fixed contractures.
Selective dorsal rhizotomy – division of sensory nerve roots – for lower limb spasticity.
Labels: health tips, disease condition

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