Cerebral palsy (CP) is a disease that appears in childhood and manifests with the non-progressive impairment of postural and motor function. The condition is influenced by injury to the brain that mostly happens before, during, or just after delivery (Gilson, Davis, Reddihough, Graham & Waters, 2014). CP affects the central nervous system (CNS) and has a serious impact on the way the body moves and operates. In a few words, CP is unprogressive, non-communicable, and incurable. However, through learning, therapy, and applied internventions people suffering from the disease can lead a productive life (Sehrawat, Marwaha, Bansal & Chopra, 2014). This paper aims at discussing cerebral palsy, its causes, symptoms, and treatment options.
Causes of CP
CP has been associated with various factors which are grouped as affecting the prenatal, perinatal, or postnatal period. Notably, more than 70 to 80% of the individuals suffering from the disease have been influenced by prenatal factors with birth asphyxia affecting a sizable portion of them (Sehrawat, Marwaha, Bansal & Chopra, 2014). The prenatal factors include hypoxia, genetic and metabolic disabilities, several conceptions, intrauterine teratogenic exposure, maternal fever, and being exposed to contaminants. The perinatal factors include asphyxia, premature birth, blood mismatch, contagion, unusual fetal appearance, and placental abruption. The postnatal causes comprise asphyxia, seizures, brain infarction, sepsis, breathing distress disease, meningitis, head injury, and postnatal exposure to steroids (Sehrawat, Marwaha, Bansal & Chopra, 2014).
In recent years, there has been an increasing body of evidence associating CP with long-standing intrauterine pathologies, such as genetic mutations and the possibility of environmental initiators like bacterial and viral intrauterine infections (Lim, 2016). Furthermore, intrauterine growth inhibitor, antepartum hemorrhage, constricted nuchal cord, and threatened miscarriage have been similarly associated with CP. However, a problem with this line of researches is centered on the fact that it can be cumbersome to identify adverse pregnancy factors in retrospect, many years after delivery, which individually or collectively might have cause the development of neuropathology.
Premature birth is one of the highest causal risk factors for CP, and it is observed in approximately 35% of all the cases reported. Tellingly the more the risk increases, the more the viable gestational age lessens. In essence, the risk of subsequent CP for newborns below 33 weeks of gestation is 30 times larger than those that are delivered at term and is measured to be about 70/1000 births (Lim, 2016). The factors conducive to the development of CP are distinct among the term babies, including infections, genetic variance, and various growth constraints.
Incidence and Statistics
A Population-based analysis from the United States indicated a relatively stable percentage of CP, ranging from 1.86/1000 in the year 1995 to 1.76/1000 in 2002. The study reported racial differences in the incidence of CP during that period. For instance, among the non-Hispanic White population, the degree of occurrence decreased from 1.65/100 in 1985 to 1.34/1000 at the end of 2002 (Stavsky, Mor, Mastrolia, Greenbaum, Than & Erez, 2017). However, the frequency of the condition increased in non-Hispanic Blacks from 2.29/1000 in 1985 to 2.34/1000 in 2002.
A similar survey conducted between 2011 and 2013 reported a CP prevalence that stretched from 2.6 to 2.9 per 1000 live births.
A population- based research study conducted in Iceland indicated that the prevalence of the condition per 1000 live births did not change substantially from 1990 to 2003 as it remained between 2.2 and 2.3 (Stavsky, Mor, Mastrolia, Greenbaum, Than & Erez, 2017).
Nevertheless, the disease rate decreased from 1.5 to 0.9/1000 live deliveries for kids born at term, remained stable for those born at preterm, and rose from 33.7 to 114.6/1000 live births for very preterm births. Significantly, a report by the Australian Cerebral Palsy Register detailing informative material for the period from 1993 to 2006 showed a CP occurrence of 2.1 per every 1000 lives (Stavsky, Mor, Mastrolia, Greenbaum, Than & Erez, 2017). The total number of new CP cases is comparatively stable; however, the rate of early births and its consequent negative influence on the prevalence of the disorder is rising because of improvements in obstetrics and neonatal care.
Signs and Symptoms
The degree of disease severity varies among patients with some experiencing intense symptoms immediately after birth while others exhibiting a milder effect. As a result, it is essential to understand the various signs and symptoms that are associated with the disease to facilitate its management. For instance, the disease is normally accompanied by a disruption of consciousness, reasoning, communication, conduct, and epilepsy (Sewell, Eastwood & Wimalasundera, 2014). Associated conditions like sensory impairment, seizures, and learning challenges frequently occur to individuals suffering from CP. A number of symptoms are not easily visible at early age except in severe cases and may be seen within the first three to five years of life (Sewell, Eastwood & Wimalasundera, 2014).
The most deceptive symptoms of CP include delays in attaining growth milestones like rolling, sitting, crawling, and walking. Furthermore, physicians look for signs like unusual muscle tone, abnormal posture, and premature growth of hand preference. Additionally, joints that are effectively joined – and thus deter proper motion – along with hypotonia or hypertonia, depending on age and the form of CP, are some of the indicators (Sewell, Eastwood & Wimalasundera, 2014).
Treatment and Prognosis
Determining the prognosis of children affected by CP is always difficult since the condition varies among patients. However, the disease is non-progressive and does not worsen during development; thus, patients have chances of living a productive and fulfilling life. Nevertheless, there are various elements that parents need to put into consideration when dealing with the prognosis and life expectancy of children suffering from the disorder (Sewell, Eastwood & Wimalasundera, 2014). Unfortunately, there are a myriad of factors that can impede the prognosis of an infant with the disease such as percentage of impairment, degree of severity, presence of seizures, vision difficulties, respiratory functions, and intellectual abilities.
Cerebral palsy is an incurable condition that can only be managed as a result of its complexity and the lack of a cure. However, early diagnosis is essential to enhance the optimization of therapeutic interventions. Some of the treatment methods are physiotherapy, orthotics, venomous botulinum inoculations, oral medications, and neurosurgical operations in severe cases (Sewell, Eastwood & Wimalasundera, 2014).
CP is a disorder of central nervous system that affects the ability to move, organize movements, and assume a healthy posture, and reflects an abnormality in the development of the brain. The disease is associated with various factors classified into prenatal, perinatal, and postnatal depending on the time of incidence. Some of the possible causes include premature birth, blood mismatch, contagions, and unusual fetal appearance. The signs and symptoms associated with the condition comprise communication disruption, stiffness, motor impairment, and epilepsy. Unfortunately, CP cannot be completely cured but only be managed due the amount of damage incurred to the brain.
Gilson, K. M., Davis, E., Reddihough, D., Graham, K., & Waters, E. (2014). Quality of life in children with cerebral palsy: implications for practice. Journal of child neurology, 29(8), 1134-1140. Retrieved from: http://journals.sagepub.com/doi/abs/10.1177/0883073814535502
Lim, W. H. (2016). Cerebral palsy: Causes, pathways, and the role of genetic variants. American Journal of Obstetrics & Gynecology, 214(5), 670-671. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0002937815005104
Sehrawat, N., Marwaha, M., Bansal, K., & Chopra, R. (2014). Cerebral palsy: a dental update. International journal of clinical pediatric dentistry, 7(2), 109. Retrieved from: https://www.researchgate.net/publication/267734217_Cerebral_Palsy_A_Dental_Update
Sewell, M. D., Eastwood, D. M., & Wimalasundera, N. (2014). Managing common symptoms of cerebral palsy in children. bmj, 349, g5474. Retrieved from: https://www.bmj.com/content/349/bmj.g5474.full
Stavsky, M., Mor, O., Mastrolia, S. A., Greenbaum, S., Than, N. G., & Erez, O. (2017). Cerebral Palsy—Trends in Epidemiology and Recent Development in Prenatal Mechanisms of Disease, Treatment, and Prevention. Frontiers in Pediatrics, 5, 21. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304407/