Cerebral Palsy Introduction

 Introduction

The information on this page has developed for you from the expert work of Roelie Wolting alongside the Enablement Cerebral Palsy Project and Handicap International Group.

This page will provide you with information on Cerebral Palsy (CP) such as definitions, causes, epidemiology and aetiology. This page will provide you with knowledge and better understanding of CP and how it affect children and their families.

Definition 

Cerebral Palsy (CP) is a disorder of movement and posture that appears during infancy or early childhood resulting from damage to the brain.The damage to the brain is permanent and cannot be cured but the earlier we start with intervention the more improvement can be made.Any non-progressive central nervous system (CNS) injury occurring during the first 2 (some say 5) years of life is considered to be CP.

There are several definitions of Cerebral Palsy within the literature, although these may all vary slightly in the way they  are worded they are all similar and can be summerised to:

Cerebral Palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain.

This definition specifically excludes progressive disorders of motor function, defined as loss of previously acquired skills in the first 5 years of life.

Time Frame of Brain Injury

We only talk about cerebral palsy if the brain damage arises during one of the following periods:

Prenatal period:

• Conception to the onset of labor

Perinatal period:

• 28 weeks intrauterine to 7 days
  

Postnatal period : 

• First two (and some say five) years of life

After the age of 5 we speak of stroke or traumatic brain injury.

Epidemiology

The incidence of CP has not declined despite the improved perinatal and obstetric care. Even at centres where optimal conditions exist for perinatal care and birth asphyxia is relatively uncommon, the incidence of CP in term babies has remained the same.

The overall prevalence, all over the world, increased during the last decades, because of increased survival.Here are some facts on the epidemiology of CP:

• The incidence is 2-2,5/1000 live births in Western Countries.
• Some affected children do not survive.
• The prevalence varies between 1-5/1000 babies in different countries.
• There are no reliable statistics from Asian countries.

Etiology

Improved medical care have decreased the incidence of CP among some children, medical advances have also resulted in the survival of children who previously would have died at a young age.
The type of cerebral palsy has also changed:

• In the 60’s around 20% of children with CP had athetoid/dyskinetic cerebral palsy.
• Today only 5 or 10% have this type and 80-90% have spastic CP. 
• This decrease is mainly due to advances in the treatment of hyperbilirubinamia.
• The increase of spastic cerebral palsy is because of higher survival rates for (very small premature) babies.
• The most common cause is idiopathic, which means that the cause of damage to the brain during pregnancy is not known.

Risk Factors

There are different risk factors for each stage at which a child might develop CP. These can be broken down into; Prenatal, Perinatal and Postnatal. 

Prenatal:

• Prematurity (gestational age less than 36 weeks)
• Low birth weight (less than 2500 g), which could be due to poor nutritional status of the mother
• Maternal epilepsy
• Hyperthyroidism
• Herpes simplex virus
• Infections (TORCH = toxoplasmosis, rubella, cytomegalovirus
• Severe toxemia, eclampsia
• Drug abuse
• Trauma
• Multiple pregnancies
• Placental insufficiency

Perinatal:

• Premature rupture of membranes
• Prolonged and difficult labor
• Vaginal bleeding at the time of admission for labor
• Bradycardia

Postnatal (0-2 years):

• Central Nervous System infection (encephalitis,meningitis)
• Hypoxia
• Seizures
• Coagulopathies
• Neonatal hyperbilirubinemia
• Head trauma

There is no way to predict which children’s brain will be damaged by one of these factors, or to what the extent of the damage will be. None of these factors always results in brain damage; and even when brain damage occurs, the damage does not always result in CP.

For example: Some children may have an isolated hearing loss from their meningitis, others will have severe intellectual disability, and some will have CP.