Cerebral palsy

This article was written by Dr. Aursulesei Ruxandra, pediatric neurologist specialist with extensive experience in diagnosing and treating neurological conditions. Pediatric neurology plays an important role in the periodic neurological evaluation of premature infants, as well as of all newborns at risk of developing neurological sequelae, with the goal of early detection and treatment of any impairment of the nervous system.

What is cerebral palsy (CP)?

Cerebral palsy is a term that describes a group of permanent disorders of motor function, which are caused by non-progressive lesions of a developing or immature brain.

What causes cerebral palsy?

CP occurs as a result of:

• ischemic strokes and anoxic lesions, intracerebral or intraventricular hemorrhages; 
• infections affecting the central nervous system - prenatal, perinatal, postnatal;
• brain damage caused by craniocerebral trauma;
• severe neonatal hyperbilirubinemia, severe neonatal hypoglycemia;
• malformations of the nervous system; 

Centrokinetic is prepared for this specialization with a team of experienced doctors and the necessary equipment for diagnosis, monitoring and treatment. Find out more about pediatric neurology and book an appointment at Centrokinetic here.

What are the risk factors for the occurrence of CP?

• Premature birth
• Intrauterine growth restriction
• Multiple pregnancy
• Intrauterine infections
• Genetic or chromosomal abnormalities of neuronal proliferation, migration or organization
• Asphyxia causing clinical encephalopathy with/without neonatal seizures
• Severe neonatal hypoglycemia
• Hyperbilirubinemia 
• Periventricular leukomalacia, cerebral infarction, definite thalamic lesions, shown by cranial ultrasound (ETF)
• Neonatal or post-neonatal meningoencephalitis
• Traumatic brain injury
• Post-neonatal hypoxic events
• Ischemic or hemorrhagic strokes

Are there several types of cerebral palsy?

Yes, 3 types of CP can be found:

• Spastic CP, characterized by the dominant presence of pyramidal syndrome, is the most common, accounting for 85-90% of cases;
• Dyskinetic CP, in which extrapyramidal syndrome is dominant, and which can be hyperkinetic (with involuntary choreo-athetotic movements) or dystonic; it is found in approximately 7% of cases; 
• Ataxic CP, dominated by the presence of cerebellar ataxic syndrome; it is found in approximately 4% of cases;  

Approximately 4% of CP cases cannot be definitively classified.

What dysfunctions are associated with it?

It is associated with pain, intellectual disability, inability to walk independently, lack of verbal language, active epilepsy, behavioral impairment, sphincter disorders, pathological sleep disturbance, drooling, visual impairment (functionally blind), a nasogastric tube or gastrostomy in order to be fed, and hearing impairment (deafness).

How is cerebral palsy treated?

• Treatment of motor impairment:

Physiotherapy: exercises to stimulate muscle strength and motor skills. Occupational therapy to stimulate manual skills is also very important.

Orthopedic treatment: preventing muscle contractures with the help of orthotic devices. Regular orthopedic evaluation. Orthopedic interventions sometimes necessary: correcting contractures that have already formed through tendon lengthening, stabilizing unstable joints through arthrodesis, transplanting certain muscles, which will take on a new role, selective dorsal rhizotomy. 

• Treatment of abnormal muscle tone: Diazepam, Baclofen, Botulinum toxin, Dantrolene, Chlorzoxazone.
• Medication treatment for epileptic seizures.
• Addressing communication problems. Developing alternative means of communication: drawing, using a computer (voice synthesizer), sign language.
• Feeding problems: nasogastric tube, gastrostomy.
• Learning problems: schooling in special schools.
• Behavioral problems: education within the family, psychotherapy for family members. ("Pediatric Neurology", Assoc. Prof. Dr. Dana Craiu)

Centrokinetic is prepared for this specialization with a team of experienced doctors and the necessary equipment for diagnosis, monitoring and treatment. Find out more about pediatric neurology and book an appointment at Centrokinetic here.