Cerebral Palsy

What Causes Cerebral Palsy?

Cerebral Palsy is caused by an abnormality or disruption in brain development, usually before a child is born. In many cases, the exact trigger is unknown. The severity of the symptoms depends primarily on the extent of the brain injury and its occurrence.

Factors that may lead to problems with fetal/infant brain development during or after pregnancy include:

• Mutations in genes that cause abnormal brain development.
• Infections in the mother’s body that affect the developing fetus.
• Disruption of blood supply to the fetus’s developing brain.
• Infections in the baby’s body that cause inflammation in or around the brain.
• Lack of oxygen to the brain (asphyxia) is related to a difficult labor or delivery. However, birth-related asphyxia is much less commonly a cause than historically thought.
• A traumatic head injury to an infant from a motor vehicle accident or fall.

Additional pregnancy or birth factors may be associated with increased risk, although each aspect may have a limited impact on its own:

• Breech births. Babies with CP are more likely to be in a feet-first position (breech presentation) at the start of labor versus being headfirst.
• Complicated labor and delivery. Babies who experience breathing or circulation problems during labor and delivery may have existing brain damage or abnormalities.
• Low birth weight. Babies weighing less than 5.5 pounds are at higher risk of developing CP. This risk increases as birth weight drops.
• Multiple babies. Risk increases with the number of babies sharing the uterus. Suppose one or more of the babies die, the chance that the survivors may have CP increases.
• Premature birth. A normal pregnancy lasts 40 weeks. Babies born less than 37 weeks into the pregnancy are at higher risk of CP.
• Rh blood type incompatibility between mother and baby. If a mother’s Rh blood type is incompatible with her baby’s, her immune system may reject the developing baby’s blood type. The mother’s body may start producing antibodies to attack and destroy her baby’s blood cells, which could cause brain damage.

Although the exact cause of a CP may be unknown, it’s estimated that between 10-15% of cases arise due to medical malpractice. These cases are attributed to negligence that occurs when a hospital, doctor, or other health care professional deviates from standards in his/her profession, thereby causing injury to a patient.

Is Cerebral Palsy Hereditary?

While CP is not a hereditary condition, researchers have discovered that certain genetic factors can predispose an individual to the disorder. There doesn’t seem to be a single gene mutation that results in CP, but certain environmental factors probably force several genes to react in a way that causes the disorder. This is called “complex inheritance” or “multifactorial inheritance.” The complex interaction of multiple genes and multiple external factors may explain why CP can run in families, a condition clinically referred to as “familial recurrence.”

Although familial CP represents only about 1.6% of all cases, a parent who has a child with the disorder has an increased risk of having a second child develop the condition. In these situations, molecular tests can identify the susceptible gene.

How is Cerebral Palsy Detected?

Signs and symptoms of cerebral Palsy appear during infancy or the preschool years. CP is typically suspected when a parent or caretaker notices developmental delays in skills such as rolling over, crawling, or walking. The first sign that something is wrong often comes when a child doesn’t reach these milestones or exhibits unusual behavior when attempting these movements.

Signs and symptoms can vary greatly, but in addition to developmental delays, other early indicators can include:

• Variations in muscle tone, such as being either too stiff or too floppy
• Favoring one side of the body, such as reaching with only one hand or dragging a leg while crawling
• Stiff muscles and exaggerated reflexes (spasticity) or muscle stiffness with normal reflexes (rigidity)
• Lack of muscle coordination (ataxia)
• Tremors or involuntary movements
• Slow, writhing movements (athetosis)

Brain abnormalities associated with CP also may contribute to other neurological problems such as:

• Difficulty with vision and hearing
• Intellectual disabilities
• Seizures
• Abnormal touch or pain perceptions
• Oral diseases
• Mental health (psychiatric) conditions
• Urinary incontinence

How is Cerebral Palsy Diagnosed?

A CP diagnosis is arrived at when symptoms are present and a brain injury is identified. Up to 70% of cases are diagnosed by a child’s first birthday. The more severe the symptoms, the earlier a diagnosis can generally be formed, with 43% of severe cases diagnosed in the first months of life.

If your family doctor or pediatrician suspects CP, he or she will evaluate your child’s signs and symptoms, review your child’s medical history, and conduct a physical evaluation. Your doctor may refer a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist).

Once initial symptoms or developmental delays are recognized, the child’s doctor will run some diagnostic tests, such as an MRI, CT scan, EEG, or Ultrasound, to identify brain injury areas.

A pediatric neurologist may do testing to identify other problems that are often associated with CP, including:

• Hearing impairment
• Vision impairment
• Speech delays or impairments
• Cognitive function
• Movement disorders

How is Cerebral Palsy Treated?

Although there is no cure for Cerebral Palsy, treatments can improve the patient’s overall quality of life by managing symptoms and associated conditions.

Medications

Various medications can help to manage pain, reduce spasticity, and control seizures. Some medications commonly used to treat CP include:

• Baclofen. This drug provides long-term reductions in muscle spasticity.
• Dantrium/Dantrolene. These medications are used to treat severe spasms.
• Diazepam/Valium. These are general relaxants that can ease tension and may help with seizures.
• Botulinum toxin (Botox). When injected directly into affected muscles, this medication can ease spasticity.
• Flexeril. This muscle relaxant works by blocking nerve impulses sent to the brain.
• Depakene and Dilantin. These drugs are used to treat seizures.

Therapies

Therapy is one of the most common and effective treatments for improving quality of life and boosting independence. It is most useful when blended with other treatment options.

Specialized therapies can also be helpful by providing practical solutions for common problems. A variety of options are available, depending on the individual’s symptoms and needs:

• Speech therapy improves language skills and can help with eating and swallowing.
• Physical therapy can improve mobility and coordination.
• Occupational therapy helps an individual adjust to his or her home, school, or work environment.
• Behavioral therapy can help provide healthy coping mechanisms for emotional troubles.
• Recreational/music therapies build social skills and provide a creative outlet.

How does Cerebral Palsy Progress?

Cerebral Palsy is a lifelong condition, but it is not degenerative and will not worsen over time. Exact symptoms can change over a person’s lifetime. However, many children with CP can grow up and live independent and productive lives with treatment and therapeutic interventions. With the assistance of professional caregivers and familial help, many more can live well into adulthood.

An individual’s longevity and quality of life will depend primarily on the severity of symptoms and their response to treatment. For example, a person with severe CP might use special equipment and might need lifelong care, whereas a person with mild CP might walk a little awkwardly but might not need any special help.

How Can I Prevent Cerebral Palsy?

The causes of congenital CP aren’t entirely known, which means that currently, little can be done to prevent it. However, people can take proactive steps before, during, and after pregnancy to help reduce the risk of developmental problems, including CP.

Before Pregnancy:

• Be as healthy as possible before pregnancy. Ensure that any infections in the mother are treated and health conditions are under control, ideally before you become pregnant.
• Get vaccinated for diseases (such as chickenpox and rubella) that could harm a developing baby.
• If assistive reproductive technology (ART) infertility treatments are used to conceive, consider options to reduce the chance of multiple pregnancies (twins, triplets, or more), such as transferring only one embryo at a time.

During Pregnancy:

• Educate yourself about ways to ensure a healthy pregnancy, such as maintaining a nutritious diet, getting enough rest, and being physically active.
• Get early and regular prenatal care.
• Wash your hands often with soap and water to help reduce the risk of infections that might harm your developing baby.
• Contact your health care provider if you get sick, have a fever, or have other signs of infection during pregnancy.
• Get the flu shot. A flu shot can protect pregnant women and their unborn babies, both before and after birth, and has not been shown to cause harmful side effects.
• A difference in the blood type or Rh incompatibility between mother and baby can cause jaundice and kernicterus. Women should know their blood type and talk to their doctor about ways to prevent problems.
• If you are at risk for preterm delivery, talk to your doctor about ways to prevent problems.

After the baby is born:

Be diligent when it comes to child safety, especially the prevention of head injuries. Take the proper precautions such as using car seats, bike helmets, and safety rails on cribs or beds.

Cerebral Palsy Caregiver Tips

It is normal to go through a painful period of adjustment when your child is diagnosed with cerebral palsy. Here are a few tips that might be helpful:

• Grieve the loss of the life you expected or dreamed about for your child. A CP diagnosis can alter the path your child’s life will take, and it is normal for you to struggle with that realization. However, taking time to grieve can help you begin developing new dreams for the child you have.
• Encourage independence. Focus on how achieving small tasks will help your child become more self-reliant and thus more confident. For example, rather than hand your child an item, put it slightly out of reach so that they have to move to get it. Though it may take slighter longer, actions like this can stimulate movements and coordination, further building independence.
• Advocate for your child. Your child’s team may consist of numerous doctors, therapists, and other medical professionals. As the treatment program moves from one practitioner to another, you are the common thread that will keep your child’s interests at the forefront. Be informed throughout the process, and make sure you’re entirely comfortable with all actions taken. Then, speak up when you’re not.
• Seek support. Whether it’s a therapist, support group, friends, or family, you must have your own network of people to rely on and trust.

Many people with cerebral palsy also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with CP:

• People with CP are at significantly greater risk for depression and anxiety.
• Adult men with CP are about four times more likely than the general population to develop schizophrenia.
• CP also increases the risk of alcoholism and opioid use disorders in adult men.
• Personality disorders are more common in men with CP.

Children with CP are at increased risk for attention-deficit/hyperactivity disorder (ADHD).

Cerebral Palsy Brain Science

Although the cause of cerebral palsy may vary from case to case, all of them seem to stem from an incident or injury that causes damage to parts of the brain that control movement. Scientists are trying to pinpoint the causes of these injuries to develop effective treatments to prevent them.

The types of brain injury that are likely causes of CP include:

• Damage to the brain’s “white matter.” This type of brain tissue helps transmit signals from the brain to the rest of the body, and damage here could result in motor control difficulties. Damage to the white matter is called periventricular leukomalacia (PVL). The fetal brain seems to be particularly vulnerable to PVL between 24 and 36 weeks of pregnancy.
• Abnormal brain development. A combination of genetic and environmental factors (infections, injuries, etc.) may cause problems in developing the areas of the brain that control muscle movement.
• Bleeding in the brain. A lack of proper blood supply to the fetus’ brain (a fetal stroke) can cause brain damage. The mother’s high blood pressure may cause a fetal stroke, a blood clot from bleeding in the placenta, infections in the mother, or abnormal blood vessel development in the fetus.
• Oxygen deprivation. Brain damage can also occur when the fetal brain is deprived of oxygen for an extended time. Oxygen deprivation can happen due to the mother’s low blood pressure, injuries to the uterus or placenta, problems with the umbilical cord, or injury during delivery.

Cerebral Palsy Research

Title: Effects of Treadmill Training and Whole-body Vibration in Children With Cerebral Palsy

Stage: Recruiting

Principal investigator: Jianhua Wu, PhD 

Georgia State University

Atlanta, GA

Whole-body vibration (WBV) and treadmill training (TT) are commonly-utilized rehabilitation interventions for children with neuromotor disorders. WBV has been shown in the literature to positively affect gait and lower body spasticity in this population. However, the effects of a single session of WBV are generally transient, lasting between ten minutes and two hours. Thus, it may be necessary to combine WBV with another intervention to reinforce improved movement patterns and maximize its potential benefits. Therefore, this study aims to investigate the effects of the addition of a single bout of WBV to a single bout of TT on the lower extremity spasticity and gait parameters of ambulatory children with CP.

Title: Locomotor Learning in Infants at High Risk for Cerebral Palsy

Stage: Recruiting

Principal investigator: Laura Prosser, PhD 

Children’s Hospital of Philadelphia

Philadelphia, PA

This project aims to characterize the evolution of locomotor learning over the first 18 months of life in infants at high risk for Cerebral Palsy (CP). To characterize how locomotor skill is learned (or not learned) during this critical period, the investigators will combine established protocols using robust, unbiased robotic and sensor technology to longitudinally study infant movement across three consecutive stages during the development of impaired human motor control – early spontaneous movement, prone locomotion (crawling), and upright locomotion (walking).

Title: Dopamine and Motor Learning in Cerebral Palsy

Stage: Recruiting

Principal investigator: Diane L Damiano, PhD 

National Institutes of Health Clinical Center

Bethesda, MD

Cerebral Palsy (CP) is the most common childhood motor disability. The neurotransmitter dopamine (DA) is important in cognition and emotions/behavior. DA may also be necessary for motor skill learning. Genes related to DA function may affect a person s ability to learn new cognitive or motor skills. Some children with CP can learn motor skills easily, while others have trouble. Researchers want to find out if DA gene variations cause some of this variability.

Objectives: To learn more about how DA and its related genes affect motor and cognitive learning in people with and without CP.