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The most common cause of crippling in children, cerebral palsy comprises a group of neuromuscular disorders resulting from prenatal, perinatal, or postnatal central nervous system (CNS) damage. Although nonprogressive, these disorders may become more obvious as an affected infant grows older.

Cerebral palsy (say: seh- ree -brel pawl -zee) is a condition that affects thousands of babies and children each year. It is not contagious, which means you can't catch it from anyone who has it. The word cerebral means having to do with the brain . The word palsy means a weakness or problem in the way a person moves or positions his or her body.

Three major types of cerebral palsy occur-spastic, athetoid, and ataxic­ sometimes in mixed forms. Motor impairment may be minimal (sometimes apparent only during physical activities such as running) or severely disabling. Associated defects, such as seizures, speech disorders, and mental retardation, are common.

Causes

Conditions that result in cerebral anoxia, hemorrhage, or other CNS damage are probably responsible for cerebral palsy.

Prenatal causes Prenatal causes include maternal infection (especially rubella), radiation, anoxia, toxemia, maternal diabetes, abnormal placental attachment, malnutrition, and isoimmunization. Perinatal and birth difficulties Examples of these causes include forceps delivery, breech presentation, placenta previa, abruptio placentae, depressed maternal vital signs from general or spinal anesthetic, and prolapsed cord with delay in the delivery of the head. Premature birth, prolonged or unusually rapid labor, and multiple birth(especially infants born last in a multiple birth) may also cause cerebral palsy.

Infection or trauma during infancy

Cerebral palsy may follow kernicterus resulting from erythroblastosis fetalis, brain infection, head trauma, prolonged anoxia, brain tumor, cerebral circulatory anomalies causing blood vessel rupture, and systemic disease resulting in cerebral thrombosis or embolus.

Signs and symptoms

Each type of cerebral palsy typically produces a distinctive set of clinical features, although some children display a mixed form of the disease.

Spastic cerebral palsy

Most children with cerebral palsy have spastic cerebral palsy. This form of the condition causes muscles to stiffen, which makes movement difficult. It can affect both legs (spastic diplegia), or it can affect one side of the body (spastic hemiplegia). In the most severe cases, all four limbs and the trunk are affected (spastic quadriplegia).

Athetoid cerebral palsy

Affecting about 20% of patients, this form causes involuntary movements­grimacing, wormlike writhing, dystonia, and sharp jerks that impair voluntary movement. Usually, these involuntary movements affect the arms more severely than the legs; involuntary facial movements may make speech difficult. These athetoid movements become more severe during stress, decrease with relaxation, and disappear entirely during sleep.

Ataxic cerebral palsy

Roughly 10% of patients have this form of the disease. Its characteristics include disturbed balance, incoordination (especially of the arms), hypoactive reflexes, nystagmus, muscle weakness, tremor, lack ofleg movement during infancy, and a wide gait as the child begins to walk. Ataxia makes sudden or fine movements almost impossible.

Mixed form

Mixed CP involves two or more types of cerebral palsy. While any mix of types and subtypes can occur, the most common are athetodic-spastic-diplegic and athetoid-spastic-hemiplegic; the least common is athetoid-ataxic. It is possible to have a mix of all three (spastic-athetoid-ataxic).

Diagnosis

An early diagnosis is essential for effective treatment and requires careful clinical observation during infancy and precise neurologic assessment. Suspect cerebral palsy whenever an infant:

• has difficulty sucking or keeping the nipple or food in his mouth
• seldom moves voluntarily or has arm or leg tremors with voluntary movement .
• crosses his legs when lifted from behind rather than pulling them up or "bicycling" like a normal infant
• has legs that are hard to separate, making diaper changing difficult
• persistently uses only one hand or, as he gets older, uses his hands well but not his legs.

Infants at particular risk include those with low birth weight, low Apgar scores at 5 minutes, seizures, and metabolic disturbances. However, all infants should have a screening test for cerebral palsy as a regular part oftheir 6-month checkup.

Treatment

• braces or splints and special appliances, such as adapted eating utensils and a low toilet seat with arms, to help these children perform activities independently
• an artificial urinary sphincter for the incontinent child who can use the hand controls .
• range-of-motion exercises to minimize contractures
• orthopedic surgery to correct contractures
• phenytoin, phenobarbital, or another anticonvulsant to control seizures
• sometimes muscle relaxants or neurosurgery to decrease spasticity.

Children with milder forms of cerebral palsy should attend regular school;severely afflicted children need special education classes.

Prevention

Most cases of cerebral palsy can't be prevented, despite the best efforts of parents and doctors. But, if you're pregnant, you can take these steps to keep healthy to minimize the possibility of pregnancy complications:

• Make sure you're immunized. Immunization against diseases such as rubella may prevent an infection that could cause fetal brain damage.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that may result in cerebral palsy.

You can help prevent cerebral palsy before and during your pregnancy by adopting and maintaining healthy habits.

• Eat nutritious foods.
• Do not smoke.
• Avoid exposure to harmful substances.
• See your health professional regularly.