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Cerebral Palsy is an umbrella term, describing conditions with abnormalities of tone, posture or movements caused by damage to the developing brain. It is the most common cause of disability in children worldwide. In India, about three out of 1,000 children have cerebral palsy. It is estimated that about 25 lakh people live with the disorder in India.
The condition can occur due to insults occurring to the brain of children during pregnancy, during birth or after birth. Infections during pregnancy, poor maternal nutrition, maternal hypertension, uncontrolled diabetes, thyroid disorders, exposure to smoking, alcohol, genetic disorders etc are the causes during pregnancy that lead to cerebral palsy.
Prematurity, low birth weight, delayed cry after birth, head trauma during delivery, infections or meningitis during neonatal period, reduced blood sugar, neonatal jaundice etc are the causes during birth. Head trauma, meningitis, bleeding in the brain, near drowning etc can cause cerebral palsy after birth.
It can be classified into four types, based on the tone abnormalities.
Spastic Celebral Palsy can be again classified into quadriplegic Celebral Palsy, if all four limbs are involved, hemiplegic if upper limbs and lower limbs of one side only are affected or diplegic if both lower limbs are involved.
It is associated with many comorbidities like seizures, intellectual disability, hearing and vision abnormalities, behavioral issues like hyperactivity or autism, drooling of saliva, feeding difficulties, constipation, sleep disturbances and growth retardation.
MRI of the brain is done to assess the extent of damage. Other investigations are directed towards recognizing the comorbidities like EEG for detecting seizures, BERA for hearing loss etc.
It needs multidisciplinary management involving pediatrician, physiotherapist, neurologist, developmental physician, orthopedician and psychologist. Interventions should be started early to prevent permanent damages. Physical therapy involves stretching and strengthening of muscles and correct positioning to improve mobility and prevent contractures. Occupational therapy involves teaching the activities of daily living like feeding, going to the toilet etc.
Anti-spasticity drugs like tizanidine, baclofen and anti-dystonia drugs like trihexyphenidyl are used to reduce general stiffness. Botulinum toxin A injections are used to reduce stiffness of individual limbs. For children with lower limb predominant stiffness, surgical options like selective dorsal rhizotomy (SDR) or intrathecal baclofen pump can be used. For older children with permanent joint contractures, orthopedic procedures like tendo achilles lengthening, orthopedic selective spasticity control surgery (OSSCS) or single event multilevel surgery (SEMLS) may be performed.
Proper evaluation and management of the seizures are also of utmost importance. Most of the patients with epilepsy may need anti epileptic drugs . However , some of the resistant seizures may get cured from surgical procedures. Stimulation techniques and play therapy are employed for overall social and cognitive development.
As mentioned, the reason for Celebral Palsy is a one-time insult and usually there will be no progression of difficulties unless there are uncontrolled seizures or improper therapy. Though there is no complete cure for it, care under a multi-disciplinary team including pediatric neurologists, physiatrists, rehab experts and orthopedicians will help the children reach their full functional potential.
Early identification of at-risk children along with appropriate developmental interventions through well-equipped child development centres will also help reduce the burden of this disability in the community.