Infantile cerebral palsy (ICP) is brain damage that can occur before birth, during the birth process, and afterward. Symptoms are varied, and a cure is not possible. However, the symptoms can be mitigated by early use of various therapies.
What is infantile cerebral palsy?
Infantile cerebral palsy is a postural and movement disorder caused by brain damage in early childhood. The damage can be caused before birth, but it can also occur during the birth process and in the first year after birth. Infantile means “pertaining to the child, childlike,” cerebral comes from the Latin term cerebrum for “brain,” and paresis is the medical term for “paralysis.” The disorders of infantile cerebral palsy are very diverse, depending on which region in the brain is damaged. Typical symptoms are excessive muscle tension and lack of coordination of movement. Seizures are common, and sometimes there is a decrease in intelligence and abnormalities in behavior. Infantile cerebral palsy is rather rare, only about 0.5% of newborns are affected. It occurs more often in boys than in girls; premature infants are at increased risk for infantile cerebral palsy.
Causes
Infantile cerebral palsy can be caused by a variety of causes, but the exact processes that led to the brain damage are not always known. Prenatal (before birth) causes of infantile cerebral palsy include poisoning from increased alcohol or medication consumption by the mother, infectious diseases such as toxoplasmosis or rubella, blood group incompatibility between mother and child, a supply deficiency of the placenta, or metabolic disorders. Perinatally (during birth), infantile cerebral palsy can be caused by a lack of oxygen, for example, if the umbilical cord is squeezed. But infantile cerebral palsy can also result from brain hemorrhage, which can occur during difficult births. Detachment of the placenta is also a possible cause of infantile cerebral palsy. After birth (postnatal), infections or brain trauma (injury to the brain) can cause the condition.
Symptoms, complaints, and signs
Infantile cerebral palsy (ICP) is characterized by various movement and postural abnormalities. Weak muscles and slowed motor function are characteristic of the condition. Depending on the localization of the brain damage, other symptoms and complaints may be added. In most cases, there are involuntary movements, coordination disorders and seizures. Furthermore, the affected children suffer from reduced intelligence, resulting in learning disabilities and psychological complaints. Often the patients show behavioral problems, for example aggression or strong fears. As a result of the individual movement disorders, there may be permanent damage to muscles, bones and joints. In severe cases, bones and joints become deformed, which usually leads to further health problems. Typical for ICP is a pointed foot, i.e. a foot with toes pointing upwards. The severely shortened Achilles tendon can also lead to chronic pain and an unusual gait. Curvature of the spine is also characteristic of infantile cerebral palsy. In addition, hip deformities and shortening of the limbs may occur. Finally, the disease causes spastic syndromes. The muscles are permanently tense, resulting in cramps and pain. Accompanying the muscle paralysis, stiffening of the joints may occur. Paralysis symptoms occur mainly in the legs and feet. ICP symptoms can vary widely, and most patients experience a mixed form of the aforementioned signs of the disease.
Diagnosis and course
The most common symptoms of infantile cerebral palsy are postural and movement disorders. However, far more and very different symptoms occur with the disease, depending on which areas of the brain are affected by the damage. Doctors speak here of different syndromes of infantile cerebral palsy, that is, of several symptoms occurring together. The most common is the spastic syndrome, in which muscle tension is increased, spasms develop and paralysis may occur. In the hypotonic syndrome of infantile cerebral palsy, mainly the cerebellum is damaged.This results in very low muscle tone with hyperextended joints; the children often suffer from mental retardation and sometimes epileptic seizures occur. In the congenital (congenital) ataxia syndrome of infantile cerebral palsy, children have difficulty controlling and coordinating their movements. They have balance problems, paralysis and are slowed in their movement development. Finally, dyskinetic syndrome is characterized by changing muscle tension, spastic paralysis and so-called athetoses (uncontrolled violent movements of the limbs). Since movement and posture disorders can also be triggered by other causes, the doctor must examine the affected child closely and take a detailed medical history. Only through the results of all examinations and close observation of the child, he can safely make the diagnosis for infantile cerebral palsy.
Complications
In this disease, there is severe damage to the brain. It is usually not possible to treat this condition causally, so only symptomatic therapy is available for the affected person. Patients suffer from severe disturbances of movement and concentration. Equilibrium disorders can also occur, which significantly restrict the daily life of the affected person. Muscle movement is also restricted in the patient and convulsions or epileptic seizures occur. These can also lead to death. In some cases, patients also suffer from paralysis or spasticity. Children in particular can become victims of bullying or teasing as a result. The child’s general development is significantly disturbed and limited by the disease. It is possible that the affected person will be dependent on the help of other people in adulthood. Likewise, visual disturbances may occur. The patient’s intelligence is also reduced in most cases. Treatment is aimed primarily at reducing the symptoms. However, in many cases, psychological treatment of the parents or relatives is also necessary.
When should one go to the doctor?
Infantile cerebral palsy is usually diagnosed immediately after birth and treated while still in the hospital. Affected children suffer from a variety of symptoms and must be closely monitored and treated by a doctor. For this reason, the child must be taken to a specialist several times a week, who can clarify the current state of health and adjust the medication if necessary. If serious complications develop, the emergency medical services must be called. Especially in case of recurring muscle spasms, spastic seizures or signs of paralysis, immediate medical help is necessary due to the risk of accidents and falls. In addition to the family doctor, various physicians must be consulted. Postural impairments require physical and occupational therapy, while speech disorders need to be treated by a speech therapist. Neurologists and internists are responsible for complaints such as epilepsy, developmental disorders and abnormal reflexes. Parents of affected children should first talk to their family doctor or pediatrician and decide together whether and which specialists need to be involved in the therapy.
Treatment and therapy
Infantile cerebral palsy requires extensive treatment with therapies from different areas. Success is largely dependent on early initiation of treatments. Infantile cerebral palsy cannot be cured, but the affected child can be given the best possible support in his or her development and abilities. As a rule, a therapy plan is drawn up and followed. The children are supported by speech therapy, physiotherapy and occupational therapy. This improves their mobility, their ability to speak and their ability to cope with everyday life. In addition, neuroleptics (calming the nerves) and antispasticity drugs (against cramping of the muscles) can support the therapy. Functional splints, walking aids and other aids can be used to achieve better mobility. In the case of severely shortened tendons, excessive misalignment of joints or if the spine is very curved, surgical interventions are also performed in infantile cerebral palsy. This involves lengthening tendons; cutting nerves to relax cramped muscles; repositioning bones to return joints to the anatomically correct position or stiffening unstable (loose) joints.
Outlook and prognosis
The disease has an unfavorable prognosis. Despite all efforts and various therapeutic approaches, irreparable damage to the brain is present. These do not allow recovery or complete freedom from symptoms with current medical options. The assessment of a prospect of alleviation of symptoms is made individually immediately after birth or in the further course of the child’s development. Only then is it possible to foresee the extent of the cerebral injuries. The aim of treatment is to reduce existing impairments and improve the general quality of life. Movement capabilities are trained and cognitive performance is to be optimized in individual exercises. The social integration of the affected person into the environment is monitored, as behavioral problems often occur that trigger interpersonal disorders. Despite a comprehensive and multi-layered therapy plan, the patient is in many cases dependent on the daily help and support of relatives or a care team. In particularly difficult situations, an inpatient stay becomes necessary. The language ability as well as the intelligence do not correspond to the competences of a healthy person. This makes it difficult to lead an independent life. By means of various tests, an assessment of the existing possibilities is made. Subsequently, forms of treatment are initiated as quickly as possible. The sooner therapy can begin, the better the prospects for improved quality of life and relief from symptoms.
Prevention
Infantile cerebral palsy cannot be prevented, but with regular examinations during pregnancy, abnormal processes can be detected early and possibly treated. If a child has infantile cerebral palsy, there is no cure, but symptoms and disabilities can be lessened by starting treatment early.
Follow-up
Infantile cerebral palsy is a disability that occurs primarily in children. In Germany, 195,000 children are affected, which conversely means that one in 500 children develops cerebral palsy. The term is made up of the words “cerebrum” (Latin for “brain”) and “paresis” (Latin for “paralysis”). However, it is not a paralysis of the brain, but damage to it that results in physical paralysis. The exact cause cannot be determined in about half of the cases, but it can be stated that oxygen deficiency is the most common cause of infantile cerebral palsy. Disabilities or damage can occur within three different stages: Before birth (prenatal), during birth (perinatal), and after birth (postnatal). The disability can manifest itself in several different ways. If the body is paralyzed on one side, it is called hemiplegia, including spastic hemiparesis. If only the lower limbs are affected, it is called paraplegia including spastic paraparesis. If all four limbs are paralyzed, the diagnosis is tetraplegia including spastic tetraparesis. Frequently, there is an increased muscle tone in connection with involuntary wrong movements, so-called athetoses. Once an organism exhibits infantile cerebral palsy, it can no longer be eliminated. For this reason, at-risk groups should receive appropriate preventive treatment during pregnancy. For example, if an expectant mother consumes a lot of alcohol or various substances, it is important for professionals to provide appropriate medical care and act preventively, such as through education. If infantile cerebral palsy nevertheless occurs, the balance between socio-legal assistance (severe disability certificate, remedies (medications), aids (devices), care needs, financial support) and psycho-social assistance (acceptance of the disease or disability, effects on the social life situation, effects on the family system, empowerment) must be considered.
What you can do yourself
The first priority is to maintain mobility. This avoids pain and contractures (restricted movement of joints). If affected limbs can be moved voluntarily, this mobility should also be encouraged.Therefore, it is important to perform everyday activities such as dressing, washing and eating as independently as possible. Often, this is only possible with aids or small changes. For example, a patient can pull up his trousers but cannot close the trouser button. Trousers with an elastic waistband, on the other hand, can be pulled on without any problems. Or: A fork with a thickened handle can be held and brought to the mouth much more securely than a normal fork when hand dexterity is limited. Another important point for maintaining the ability to move is self-stretching. Hypertonic muscles, muscles with increased tension, are stretched to prevent shortening and joint restriction. For example, the healthy hand can stretch and flex the fingers of the affected hand. The movements during self-mobilization should be very slow and steady, so the muscle tension can decrease. Also, a pleasant temperature bath or rocking in a hammock, can help relax the muscles.