Cerebral palsy

Description:

The Cerebral Palsy (CP) is the term used for group of not progressing motor disturbances and the bearings caused by pathological development or damage of a motorium of a brain. A cerebral palsy it is caused by influence of factors to, in time or after the delivery. Disturbance of muscular control which define cerebral palsy symptomatology  often is followed by other neurologic and physical deviations.
  Autokinesias (for example, walking, chewing, etc.) are generally carried out  by means of skeletal muscles. Skeletal muscles are controlled a cerebral cortex which makes the most part of a brain. For the description of muscular disturbances the term "paralysis" is used. Thus, the cerebral palsy covers any disturbances of movements caused  by dysfunction of a cerebral cortex.  The cerebral palsy does not include similar symptomatology because of the progressing disease or a degeneration of a brain. For this reason, a cerebral palsy also call the static (not progressing) encephalopathy.  Any muscular disturbances which arise in muscles and/or a peripheral nervous system are also excluded from the cerebral palsy group.
Classification of a cerebral palsy includes four main types: spastic, atetoidny, atactic and mixed. One more general classification describes spastic, diskinetichesky and atactic options of a cerebral palsy.  
The spastic cerebral palsy type affects upper and lower extremities as a hemiplegia.  Spasticity means existence of the raised muscle tone.
Dyskinesia treat the atypical movements caused by insufficient regulation of a tone of muscles and coordination. Atetoidny or choreoathetoid options of cerebral palsy enter category.
The atactic form belongs to  lacks of coordination of autokinesias and includes the mixed cerebral palsies forms.
Muscles which receive defective  impulses from a brain are in constant tension,  or experience difficulties with autokinesias (dyskinesia). Lack of balance and coordination of movements can be observed (ataxy).  
It is in most cases diagnosed the spastic or mixed cerebral palsy options.  Muscular disturbances  can vary from easy degree or partial paralysis (paresis) before total loss of control over a muscle or group of muscles (plegiya). The cerebral palsy is also characterized by number of the extremities involved in pathological process. For example, if damage of muscles is observed in one extremity, the monoplegia, in both hands or both legs -  a diplegia, both extremities on one side of a body - a hemiplegia, and in all four extremities -  a quadriplegia is diagnosed. Muscles of a trunk, a neck and the head can be affected.
About 50% of all cases of a cerebral palsy are diagnosed for premature children.  The less  gestational age at the time of the birth of the child and his weight, the is higher risk of a cerebral palsy. The risk of this disease  at the premature child (32-37 weeks) increases approximately five times in comparison with given rise in time. The birth in term till 28th week of a gestation causes 50% risk of development of cerebral palsy.
Premature children have 2 major factors of risk  on development of a cerebral palsy. First, premature children have higher risk of such complications as intracerebral bleeding, infections, breath disturbances. Secondly, premature births can be followed by complications which in the subsequent cause neurologic deficit in the newborn.  The combination of both factors can play a part in development of a cerebral palsy.

Reasons of Cerebral palsy:

The cerebral palsy is caused by a number of various factors which work during the different periods of life – during pregnancy, childbirth, in the early childhood. In most cases the cerebral palsy arises after  the brain injury received during the birth at asphyxia. Nevertheless, extensive researches in the 1980th years, showed that only from 5-10% of cases of a cerebral palsy are connected with a birth trauma. Other possible reasons include anomalies of development of a brain, prenatal factors which directly or indirectly damage neurons in the developing brain, premature births, brain injuries which occur in the first several years of life.

Prenatal reasons.
Development of a brain – very thin process which many factors can exert impact on. Foreign influence can result in structural anomaly of a brain, including the carrying-out system.  These damages can have hereditary character, but most often actual reasons are unknown.  
Infections of mother and fruit increase risk of cerebral palsy.  In this plan the rubella, a cytomegalovirus (TsMV) and a toxoplasmosis matter. Most of women have immunity to all three infections by the time of achievement of the genital period, and the immune status of the woman can be defined by the analysis on TORCH infection (toxoplasmosis, a rubella, a cytomegalovirus, herpes) to or during pregnancy.
Any substance which can influence development of a brain of a fruit, directly or indirectly, can increase risk of development of cerebral palsy. Besides, any substance which increases risk of premature births and low weight at the birth such as alcohol, tobacco or cocaine, can indirectly increases risk of a cerebral palsy.
Because the fruit receives all nutrients and oxygen from blood which circulates through a placenta, everything that prevents normal function of a placenta can negatively affect fetation, including his brain, or, perhaps, increase risk of premature births. Structural anomalies of a placenta, premature placental detachment from a wall of a uterus and placental infections represent a certain risk of a cerebral palsy.
Some diseases at mother during pregnancy can constitute danger to fetation.  At women with increase  in anti-thyroid or anti-phospholipidic  antibodies are in group of the increased risk on a cerebral palsy at the children. Also important factor which indicates high risk of this pathology is the high level of cytokines in blood. Cytokines are the proteins connected with an inflammation at infectious or autoimmune diseases, they can be toxic for fruit brain neurons.

Perinatal reasons.
Among the perinatal reasons asphyxia, umbilical cord encirclement around a neck, placental detachment and its presentation has special value.
The infection at mother sometimes is not transmitted to a fruit through a placenta, but transmitted to the child at the time of delivery. The herpes infection can lead to heavy pathology of newborns that involves neurologic damages.

Puerperal reasons.
Other 15% of cases of a cerebral palsy are connected with a neurologic injury after the birth. Such cerebral palsies forms are called acquired.
Incompatibility of blood groups of Rh of mother and child (if the negative Rhesus factor, and the child positive has mother) can lead to heavy anemia at the child that attracts and itself heavy jaundice.
Serious infections which directly  influence a brain such as meningitis and encephalitis, can lead to irreversible injury of a brain and cerebral palsy.  Spasms at early age can lead to a cerebral palsy. Idiopathic cases are diagnosed not so often.
As a result of the tough treatment of the child, craniocereberal injuries, drowning, suffocation there is a physical injury of the child which is quite often leading a cerebral palsy. Besides, the use of toxics, such as lead, mercury, other poisons, or certain chemicals can cause neurologic damages. The accidental overdose of some medicines can also cause similar injuries of the central nervous system.

Symptoms of Cerebral palsy:

Symptoms of a cerebral palsy can vary on weight of manifestation. The easy cerebral palsy form is shown by insignificant difficulties with small motility.  The severe form can include considerable problems in muscles in all four extremities, mental retardation, spasms, difficulties with sight, the speech and hearing.
Though defect of function of a brain which is observed at a cerebral palsy  is not progressive, disease symptoms  often change eventually. The majority of symptoms belong to disturbance  of management of muscles. Weight of disturbances of motive function  is also the important characteristic. The spastic diplegia, for example, is characterized by a continuous muscle tension while atetoidny квадрапарез it is shown by the uncontrollable movements and muscular weakness in all four extremities. The spastic diplegia is shown  more often than atetoidny квадрапарез.
Spasticity of muscles can lead to serious problems of the orthopedic plan, including a rachiocampsis (scoliosis), dislocation of a hip or a contracture. The general manifestation of a contracture at most of patients of a cerebral palsy is horse or ekvinovarusny foot. Spasticity in hips leads to deformation of an extremity and disturbance of gait.  Any of joints in extremities can be blocked because of spasticity of the applying muscles.
Athetosis and dyskinesia often arise at spasticity, but not often meet it is isolated. The same treats also an ataxy.
Others to a neurologic basis symptoms can include the following:
- mental retardation
- behavioural frustration
-  spasms
- vision disorder
- hearing loss
- disturbance of the speech (dysarthtia)
These problems can have a greater influence on the child's life, than physical disturbances though not all children with a cerebral palsy suffer from the specified problems.

Diagnosis:

Symptoms of a cerebral palsy are usually not noticeable at the birth. Symptoms are shown within the first  18 months of life. More hard cases of a cerebral palsy it is, as a rule, diagnosed earlier, than others. Right after the birth carry out assessment on a scale Apgar.  Children who have low marks on a scale Apgar are exposed to the increased risk on a cerebral palsy. Existence of an abnormal muscle tone and movements can indicate cerebral palsy.  At some children can it is long to remain infantile reflexes. Visualization of a brain by means of ultrasound, X-ray, MPT and/or KT can reveal structural anomalies. Some damages of a brain connected with a cerebral palsy include hems, cysts, expansion of ventricles of a brain (hydrocephaly), a periventrikulyarny  leykomalyation, areas of a necrosis, intracerebral bleedings. Blood tests and urine, genetic tests can be used to exclude other possible reasons, including diseases of muscles, peripheral nerves, mitochondrial and metabolic pathology, and also other hereditary diseases.

Treatment of Cerebral palsy:

Treatment of the child with a cerebral palsy depends on severity, character  of muscular symptoms, and also any problems connected with it which can be present. Optimum care of the child with the easy cerebral palsy form can include regular interaction only with the physiotherapist and work therapies, and leaving for more seriously injured the child can include visit of several specialists doctors throughout all life. At the correct treatment and effective rehabilitation, most of people can conduct almost full-fledged life with a cerebral palsy.  
Spasticity, muscular weakness, lack of coordination, ataxy, scoliosis is considerable disturbances which influence a bearing and mobility of children and adults from a cerebral palsy. The doctor works with the patient and a family to maximize function of the affected extremities, to normalize a bearing.  Often auxiliary technologies, including wheelchairs, walkers, shoe inserts, crutches, special brackets are required. At disturbance of the speech consultation of the logopedist is necessary.  
For prevention of contractures and relaxation of muscles use such drugs as diazepam (Valium), дантролен (Dantrium) and Baclofenum (Lioresal). The positive effect gives introduction to the affected muscle of botulinum toxin (Botox). In the presence of sudrozhny attacks apply group of antikonvulsant, the athetosis is medicated such as trigeksifenidit HCl (Artane) and benztropine (Cogentin).
Treatment of contractures – first of all a surgical problem. The most often used surgical procedure is  the tenotomy.  The neurosurgeon can also execute a back rhizotomy – removal of a nervous root in a spinal cord to prevent stimulation of spastic muscles.