Cerebral Palsy

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DESCRIPTION

Cerebral palsy (CP) is a group of clinical syndromes characterized by motor and postural dysfunction due to permanent nonprogressive disruptions in the developing brain. Motor impairment resulting in activity limitation is necessary for this diagnosis. CP is classified by the nature of the movement disorder and its functional severity.

EPIDEMIOLOGY

Incidence

  • Most common cause of childhood disability
  • Overall, 1.5 to 2.5/1,000 live births

Prevalence

  • Prevalence increases as gestational age (GA) at birth decreases:
    • 146/1,000 for GA of 22 to 27 weeks
    • 62/1,000 for GA of 28 to 31 weeks
    • 7/1,000 for GA of 32 to 36 weeks
    • 1/1,000 for GA of ≥37 weeks
  • Prevalence increases as birth weight decreases (1).

ETIOLOGY AND PATHOPHYSIOLOGY

  • Multifactorial; CP results from static injury or lesions in the developing brain, occurring prenatally, perinatally, or postnatally.
  • Cytokines, free radicals, and inflammatory response are likely contributing factors.
  • Spastic CP is most common, usually related to premature birth, with either periventricular leukomalacia or germinal matrix hemorrhage.

Genetics

There are reports of associations between CP and polymorphisms of certain genes: thrombophilic, cytokines, and apolipoprotein E.

RISK FACTORS

  • Prenatal: congenital anomalies, multiple gestation, in utero stroke, intrauterine infection (cytomegalovirus [CMV], varicella), intrauterine growth retardation (IUGR), clinical and histologic chorioamnionitis, antepartum bleeding, maternal factors (cognitive impairment, seizure disorders, hyperthyroidism), abnormal fetal position (e.g., breech)
  • Perinatal: preterm birth, low-birth weight, periventricular leukomalacia, perinatal hypoxia/asphyxia, intracranial hemorrhage/intraventricular hemorrhage, neonatal seizure or stroke, hyperbilirubinemia
  • Postnatal: traumatic brain injury or stroke, sepsis, meningitis, encephalitis, asphyxia, and progressive hydrocephalus

GENERAL PREVENTION

  • Prenatal: routine prenatal care; magnesium sulfate for preterm deliveries and preeclampsia; corticosteroids during preterm delivery
  • Perinatal: delayed cord clamping, therapeutic hypothermia in the setting of hypoxic brain injury within 6 hours of delivery
  • Postnatal: treatment of group B streptococcus, routine vaccinations, safety measures regarding car seating, swimming pools, and shaking of the baby (2)[A]

COMMONLY ASSOCIATED CONDITIONS

  • Epilepsy
  • Intellectual, speech, and language impairments
  • Behavioral and sleep disorders
  • Hearing and visual impairments
  • Gait disorders
  • Thyroid dysfunction (2)[A]
  • Feeding impairment, swallowing dysfunction, and aspiration
  • Poor dentition
  • GI conditions: constipation, vomiting, gastroesophageal reflux
  • Osteopenia
  • Urologic conditions (incontinence, neurogenic bladder)
  • Orthopedic disorders(contractures, hip subluxation/dislocation, foot deformities, scoliosis)

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