Cerebral palsy

Background

  • Leading cause of childhood disability effecting function and development.
  • Defined as a group of disorders involving motor or postural abnormalities that are noted during early development[1]
    • Injury occurs during fetal or neonatal period up to 3 yrs. Official diagnosis may not be made until 3 years of age[2]
  • Associated with

Classification[3]

  • Spastic cerebral palsy is the most common type, ~80% of cases

Spastic diplegia (30-40%)

  • Bilateral lower extremities effected more than upper extremities or sole involvement of lower extremities.

Spastic hemiplegia (20-30%)

  • One side of the body effected, including an upper and lower extremity
  • Upper extremity spasticity effected more than lower extremity
    • Double hemiplegia: when both arms are more involved than the legs

Spastic quadriplegia (10-15%)

  • Cerebral palsy affecting all 4 extremities and the trunk (full body)

Dyskinetic cerebral palsy

  • Athetoid, choreoathetoid, and dystonic
  • Extrapyramidal signs characterized by abnormal movements; hypertonicity

Mixed cerebral palsy

  • Mixture of spastic and dyskinetic components without predominant area

Hypotonic cerebral palsy

  • Rare: Truncal and extremity hypotonia with hyperreflexia and persistent primitive reflexes

Monoplegia

  • Rare: One limb involved, either an arm or a leg
  • Must rule out other causes.

Clinical Features

  • Abnormal muscle tone (most common)
    • Hypertonia > hypotonia
  • Intellectual disability (30-50%)[4]
  • Speech and language impairment
  • Ophthalmologic impairment
  • Hearing impairment
  • Oromotor dysfunction
  • Epilepsy
  • Disease classified according to resting tone and limb involvement

Differential Diagnosis

Weakness

Evaluation

References

  1. Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV. Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51.
  2. Shevell MI, Bodensteiner JB. Cerebral palsy: defining the problem. Semin Pediatr Neurol. 2004 Mar. 11(1):2-4.
  3. Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. London, United Kingdom: MacKeith Press; 2000
  4. Russman BS, Ashwal S. Evaluation of the child with cerebral palsy. Semin Pediatr Neurol. 2004 Mar. 11(1):47-57.
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