Understanding Cerebral Palsy: Symptoms, treatments, and future research

Cerebral Palsy (CP) is a brain disorder present at birth affecting movement, muscle tone or posture. It is defined as brain damage occurring before 2 years of age. It is due to abnormal brain development, often before birth. It is non-progressive.

Symptoms of CP include exaggerated reflexes, floppy / rigid limbs & involuntary movements. These are apparent prenatally or by early childhood.

Symptoms:Muscular: walking difficulty, difficulty in movements / abnormal movements, rigidity, difficulty in coordination, overactive reflexes, muscle weakness, spasms, or paralysis of one side of body, scissor gait, seizures, teeth grinding, tremors.

Developmental: failure to thrive, learning disability, slow / retarded growth, speech delay / stuttering

Also common: constipation, swallowing difficulty, drooling, hearing loss, leaking of urine

Treatments used presently:Self-care

• Physical exercise - aerobic 20-30 mins a day 5 days a week and Special education - focusing on addressing unique needs.
• Orthotics to control limb positioning
• Mechanical aids

Therapies
Occupational Therapy - improves daily living , work skills ; Stretching improves flexibility and physical functioning and ; Physical Therapy improves muscle strength , functioning

Medications
Muscle relaxant reduces muscle tension and alleviates pain and Sedatives cause drowsiness, calmness, but may become addictive

Botulinum toxin injection to reduce muscle spasticity and rigidity are useful

Surgery
Gastrostomy Is Surgical insertion of tube through the abdomen into stomach to help feeding and provide nutrition

CP is a difficult condition to treat and an even harder one to fully comprehend.

The hope for a cure (though far away) lies in getting a better understanding of CP & to know that the current goal of most research is to learn new ways to reduce symptoms and limit brain damage.

Future of treatment:1. Functional Electrical stimulation (FES) helps in reduction of stiffness / spasticity, increasing range of limb movements, muscle strengthening improved walking, better coordinated movements.

2. Stem cell transplantation is a regenerative therapy that has potential to replace the damaged and non-functional cells in the brains, as well as to provide support to the remaining neurons and oligodendrocytes. There are many kinds of stem cells used each with different and unique characteristics.⁠

Many clinical trials are testing umbilical cord blood stem cell infusions. Cord blood has been successfully used to treat blood diseases, such as leukemia, but hasn’t been deemed useful for other types of diseases yet.

3. Scientists are studying nerve cells to find a way to stop any activity that disrupts the neuron’s normal function within the brain. Also they are scrutinizing white matter damage around the ventricles within the brain. White matter damage remains one of the most common causes of cerebral palsy.
4. genes are being studied that may cause malformations in some regions of the brain.
5. brain chemicals in many acquired brain conditions are being studied as these may become toxic, which can lead to conditions such as cerebral pals⁠⁠y
6. ⁠Constraint induced therapy (CIT)
7. ⁠Systemic hypothermia

Author: Dr. Manish Chhabria, Consultant, Neurology, Sir H.N. Reliance Foundation Hospital