Cerebral palsy

Definition of cerebral palsy:--

Cerebral palsy (CP) is a group of disorders of movement and posture caused by a nonprogressive lesion of the developing brain . Clinical features such as spasticity change over time  .It (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems. Cerebral palsy is the most common cause of motor disability in childhood, affecting about 2 per 1000 live births in high resource settings. Over the past few decades, there have been major changes and advances in obstetric and neonatal care, with a decline in neonatal mortality. The prevalence of CP has been shown to be constant over time by several studies; however, the at-risk population and subtypes observed appear to have changed. The pooled prevalence of CP across studies from North America, Europe, and Australia is 2.11 per 100 live births (95% CI 1.98–2.25)

A)             Epidemiology: Cerebral palsy may be difficult to diagnose before 1 year of age and, in some children, prior to 2 years. Pathophysiology

B)              Site wise symptoms nad signs: Why & how it happens?? Cerebral palsy results from an insult to a part of the brain associated with motor control, with the region affected determining the clinical signs and classification. Thus, with spastic cerebral palsy, the brain areas most affected are the cerebral cortex and corticospinal tracts. In this condition, spasticity occurs because of hyperactivity of the stretch reflexes that result from the lesions of the corticospinal tract that cause uncontrolled facilitatory input at the spinal reflex arc.

The basal ganglia is the brain area most affected in dyskinetic cerebral palsy. This brain region is a major component of the extrapyramidal system that plays a role in controlling automatic movements, movements associated with posture, and fine digital movements. Basal ganglia lesions result in abnormal involuntary movements such as athetosis and dystonia. CP may be of Neonatal hyperbilirubinemia can cause dyskinetic cerebral palsy through the neurotoxic action of unconjugated bilirubin on the basal ganglia.

The cerebellum, which coordinates movement, or its associated pathways are most affected in ataxic cerebral palsy. Lesions in this area result in ataxia, difficulty with balance and proprioception, intention tremors, and dysmetria.