CEREBRAL PALSFIRY-1andtheavailability.pptx

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1. CEREBRAL PALSY MICHELE OGINA – HSM201-0137/2018 SUPERVISOR – DR. SHITSAMA

2. CEREBRAL PALSY (Little Disease) Definition – a group of often changing motor impairment syndromes secondary to non progressive brain lesions that occurred before, during or after birth for up to 3yrs. WHY? Leading cause of disability in children & early diagnosis and multidiscplinary approach will ensure better intergration academically and socially.

3. Associations Mental retardation – up to 50% Epilepsy – up to 60% Impaired hearing Impaired vision supra nuclear bulber palsy > feeding and speech disorders Persistence of primitive reflexes

4. Causes Pre-natal TORCH infections Cerebral dysgenesis Fetal irradiation Placental dysfunction Maternal drugs eg estrogen

5. Cont`d NATAL Birth asphyxia(HIE) Birth trauma POST NATAL Intraventricular hemorrhage Meningitis & encephalitis Metabolic eg phenyl ketonuria & hypoglycemia Hyperbilirubinaemia Hydrocephalus CVA Head injury

6. Presentation Delayed motor milestones Feeding difficulties Abnormal gait

7. Distribution of motor defects Monoplegia – only one limb is affected Hemiplegia – upper and lower limb on one side Paraplegia – only both lower limbs are affected Diplegic – all limbs are affected but the lower more than the upper Quadriplegic – all four limbs are affected

8. Pathophysiology Germinal matrix hemorrhage Peri-ventricular leukomalacia

9. Clinical types Spastic cerebral palsy: the most common form, 70-80%. It results from injury to the upper motor neurons of the pyramidal tract. It may occasionally be bilateral. It is characterized by at least 2 of the following: abnormal movement pattern, increased tone, or pathologic reflexes (e.g., Babinski response, hyperreflexia).

10. Cont`d NON-SPASTIC Dyskinetic cerebral palsy: occurs in 10-15% of cases. It is dominated by abnormal patterns of movement and involuntary, uncontrolled, recurring movements. Ataxic cerebral palsy: accounts for <5% of cases. This form results from cerebellar injury and features abnormal posture or movement and loss of orderly muscle coordination or both. Dystonic cerebral palsy: It is characterized by reduced activity and stiff movement (hypokinesia) and hypotonia.

11. Cont`d Choreoathetotic cerebral palsy: rare now that excessive hyperbilirubinemia is aggressively prevented and treated. This form is dominated by increased and stormy movements (hyperkinesia) and hypotonia. Mixed cerebral palsy: accounts for 10-15% of cases. This term is used when more than one type of motor pattern is present and when one pattern does not clearly dominate another. It typically is associated with more complications, including sensory deficits, seizures, and cognitive-perceptual impairments

12. Investigations CT & MRI – to detect degree of brain atrophy and cause eg brain malformations TORCH screen Metabolic screen For associations: audiometry, fundoscopy, EEG

13. Treatment Psychosocial support Nutritional support Physiotherapy Anti spastic drugs eg dantrolene sodium, baclofen Anti convalsants for epilepsy Walking assistance: walkers, motorized wheelchair Orthopedics review for dislocations, contractures and scoliosis