Cerebral Palsy: causes, symptoms and treatment

Cerebral palsy (cerebral palsy) is the name of a whole group of neurological disorders that occur as a result of damage to brain structures in the child during pregnancy and in the first weeks life. The compulsory clinical component is motor disorders, except for which there are often speech and mental disorders, epileptic seizures and disturbances in the emotional-volitional sphere. Cerebral Palsy is not progressive, but its symptoms often remain with a person for life and cause disability. From this article you will learn about the causes, clinical manifestations and methods of treatment of cerebral palsy.

In children's cerebral palsy, there is always a structural and morphological lesion of the brain, that is, a clear anatomical basis of clinical symptoms. Such a zone arises as a result of the action of some causative factor and does not extend to other parts of the brain (in this case, in the case of cerebral palsy and speak of the non-progressive character of the course). Since a specific function is assigned to each zone of the brain, this function is lost during cerebral palsy.

Despite modern achievements in the field of medicine, the prevalence of cerebral palsy remains high and amounts to, 1000 newborns. The frequency of cerebral palsy among boys is slightly higher than among girls. The ratio is:.

Causes of cerebral palsy

At the heart of any case of cerebral palsy is the pathology of neurons, when they have structural disorders that are not compatible with normal functioning.

Cerebral Palsy can be caused by the action of adverse factors in the most varied periods of brain formation - with the very first day of pregnancy, during all 38-40 weeks of pregnancy and the first weeks of life when the child's brain is very We wound. According to statistics, in 80% of cases, the cause was affected in the intrauterine period and in childbirth, the remaining 20% ​​accounted for the period after childbirth.

So what can cause cerebral palsy? The most common reasons are:

• violation of the development of brain structures (as a result of genetic disorders that are transmitted from generation to generation, spontaneous mutations of genes);
• lack of oxygen (hypoxia of the brain): acute (asphyxia in childbirth, premature detachment of the placenta, rapid birth, umbilical cord entanglement) or chronic (insufficient blood flow in the vessels of the placenta due to fetoplacental insufficiency);
• in utero and in the first months of life infectious diseases (intrauterine infections, especially the TORCH group, meningitis, encephalitis, meningoencephalitis, arachnoiditis);
• toxic effects on the child (alcohol, smoking, drugs, potent medicines, occupational hazards, radiation);
• mechanical trauma (intracranial trauma in childbirth);
• incompatibility of the mother and fetus for various reasons (rhesus-conflict, conflict in the blood group with the development of hemolytic disease);
• chronic diseases of the mother (diabetes mellitus, bronchial asthma, heart defects).

Children who were born prematurely have a special risk. Among them, the prevalence of cerebral palsy is significantly higher compared with full-term children. Also, the risk is higher in children with birth weight less than 2000, in children from multiple pregnancies (twins, triplets).

None of the above reasons is not 100 per cent per se. This means that, for example, the presence of diabetes mellitus in a pregnant woman or a transferred flu will not necessarily lead to the development of an infantile cerebral palsy. The risk of having a baby with cerebral palsy is in this case higher than that of a healthy woman, but no more. Of course, a combination of several factors significantly increases the risk of pathology. In each individual case with cerebral palsy, it is seldom possible to detect the presence of only one weighty reason, more often in the history there are several factors.

Proceeding from the stated main causes of cerebral palsy, the following prophylaxis of this condition is recommended: pregnancy planning with sanation of chronic foci infection, competent management of pregnancy with a thorough and timely examination, and if necessary, treatment, individual tactics childbirth. These factors are the most effective measures to prevent cerebral palsy.

Symptoms

A child with cerebral palsy is characterized by a delay in motor development.

Symptoms of cerebral palsy are mainly motor impairments. And the type of such violations and severity varies depending on the age of the child. In connection with this, it is customary to distinguish the following stages of the disease:

• early - up to 5 months of life;
• Initial residual - from 6 months to 3 years;
• late residual - after 3 years.

In the early stage, the diagnosis is rarely exhibited, because there are very few motor skills at this age. But, nevertheless, there are certain signs that may be the first symptoms:

• retardation of motor development: there are average terms for the appearance of certain skills (ability keep the head, turn over from the stomach to the back, purposefully reach for the toy, sit, crawl, walk). Lack of these skills in the appropriate time interval should alert the doctor;
• children have unconditioned reflexes, which fade to a certain age. The existence of these reflexes after reaching such an age is a sign of pathology. For example, a grasping reflex (pressing on the palm of a child with a finger causes the capture of this finger, palm squeezing) in the norm after 4-5 months does not occur. If it is still revealed - this is the reason for a more thorough examination;
• violation of muscle tone: increased or decreased tone can identify a neurologist on examination. The result of changes in muscle tone may be excessive, aimless, sudden or slow, vermiform movements in the limbs;
• preferential use of one limb for carrying out actions. For example, normally a child reaches for the toy with both hands with the same zeal. And it does not depend on whether the child is right-handed or left-handed in the future. If he constantly uses only one hand, this should be alarming.

Children who have been diagnosed with any minor violations during routine examination should be inspected every 2-3 weeks. At repeated examinations pay attention to the dynamism of the revealed changes (whether violations persist, increase or decrease), whether all motor skills are formed with a delay, or the delay of one of them was a variant of an individual development.

Most of the symptoms of cerebral palsy appear in the initial residual period, that is, after six months of life. Such symptoms include disorders of movement and muscle tone, speech, mental development, hearing and sight, swallowing, urination and defecation, the formation of contractures and skeletal deformities, convulsions. The kind of symptoms that will come to the fore depends on the clinical form of the disease. Let's get acquainted with the existing clinical forms of cerebral palsy.

There are four forms:

• spastic (spastic diplegia, spastic tetraplegia (double hemiplegia), hemiplegia);
• dyskinetic (hyperkinetic);
• ataxic (atonic-astatic);
• mixed.

Spastic form

This is the most common form. The main signs are the violation of muscle strength and tonus in the limbs. Depending on the number of involved limbs is divided into several subtypes.

Spastic diplegia (Little's disease)- characterized by the defeat of all four limbs, with the greatest degree of process in the legs, mental, mental and speech disorders. The symptoms most clearly manifest themselves by the end of the first year of life. Muscle tone is elevated in all limbs, but more in the legs (mainly in the flexor of the arms and extensor legs). This leads to the limitation of movements, to the formation of the forced position of the limbs. When you try to get up, your feet do not rest on the whole foot on the surface, but become on your toes, sometimes crisscross. Constant muscular tension eventually leads to the formation of contractures, as a result of which the joints change their configuration. This further complicates arbitrary movements. The heel tendon is shortened, the feet are deformed.

Tendon reflexes increase, pathological and carpal signs (Babinsky, Gordon, Zhukovsky, and others) are revealed.

Perhaps the emergence of involuntary movements (hyperkinesis) in the limbs, and more often they develop in the muscles of the face and hands. Sometimes it causes negative reaction of others, because, for example, hyperkinesis in the face can look like grimacing, teasing. Hyperkinesis increases with agitation, decrease in sleep.

Violations of speech are expressed in blur, fuzziness, logopedic defects. And with age without appropriate treatment this does not work.

Mental and mental problems are manifested by a violation of concentration, poor memory, emotional instability. Usually, mental disorders are not pronounced. Therefore, with good functioning of the upper limbs, such people are fully adaptable in society, acquire a profession and serve themselves.

Spastic tetraplegia or double hemiplegiacharacterized by a uniform defeat of all four limbs or a more pronounced violation of movements in the hands. This is the most severe form of cerebral palsy, because, as a rule, it is accompanied by severe mental, mental, speech disorders, convulsive syndrome. Mental disorders reach the degree of oligophrenia, speech can generally take the form of an inarticulate mooing. In addition, visual impairment is observed due to atrophy of the optic nerves (which can not be corrected by wearing glasses or lenses), strabismus, hearing impairment. Symptoms with this form of the disease are noticeable in the first months of life. Tendon reflexes are very high, many pathological signs are detected from feet and hands. Such children do not know how to sit and especially walk. Expressed motor disorders lead to the early formation of contractures of many joints, deformation of the spine. Patients require constant, lifelong extraneous care.

Hemiplegiameans the patient has muscle weakness on one side - left or right. That is, the paresis seizes the same arm and leg, often in the hand it is more pronounced than in the leg. Children with this form learn to sit and walk, master the skills of self-service, but much later than their peers. Since birth, the lagging of the affected limbs from the healthy is noticeable. When the child is already walking, a characteristic pose strikes the eye - the affected arm is bent and pressed against the body (the applicant's hand), and the leg is straightened and does not bend when moving. In addition to motor disorders in hemiplegia, convulsive seizures, moderate or insignificant mental disorders are found. If convulsive seizures occur frequently, they can cause a significant decrease in intelligence.

Dyskinetic (hyperkinetic) form

Characterized by the presence of involuntary movements - hyperkinesis. Usually these symptoms appear after a year. Movement can be very diverse: vermiform movements in the fingers, mahi and imitation of throws by hands, twisting the trunk around its axis, grimacing. Involuntary contraction of the larynx muscles can lead to uncontrolled sounds and cries. With emotional overstrain, hyperkinesia intensifies, in a state of rest and sleep disappear.

Hyperkinesis is accompanied by a decrease in muscle tone. Periodically, there are episodes of sudden increase in tone, in children of the first months of life this is called dystonic attacks.

There is a delay in the formation of motor skills: holding the head, turning over, sitting, crawling, walking becomes possible later than in peers. Nevertheless, such children eventually master skills of self-service and do not need outside help.

Speech can be disrupted in case of dyskinetic form. Usually words are pronounced slowly, not quite clearly, with violation of articulation.

Intellect practically does not suffer.

Ataxic form

This form arises with the primary lesion of the connections of the cerebellum or frontal lobes. Since birth, muscle tone is reduced. All motor skills are formed with a significant delay. Coordination and accuracy of movements are violated. The walk is unsteady, attempts to take anything end in a miss and a passing. Perhaps trembling in the limbs. Sometimes with this form there are hyperkinesis. Mental abilities can not be violated, but can reach a different degree of oligophrenia.

Mixed form

This form is diagnosed in the presence of symptoms characteristic of two or more clinical forms (described above).

Treatment

Exercising physical therapy is an important component of treatment of cerebral palsy.

Treatment of cerebral palsy is a complicated and very long process. The effect depends on the severity of the lesion of the nervous system (clinical form of the disease), the period of diagnosis of the disease, the complexity of the treatment methods, perseverance and perseverance of the parents of the sick child.

In cerebral palsy, the primary role is played by non-drug treatment methods, which are based on establishing muscular stereotype, correct posture by stimulating the remaining nerve structures of the head the brain.

The state of cerebral palsy itself is not curable, that is, it is impossible to restore the destroyed neurons to the present day. But it is possible to "teach" the remaining neurons intact so that a person can live in the society fully, without feeling his own defectiveness.

Among all treatment methods, the following should be noted:

• massage;
• physiotherapy;
• Voight-therapy, Bobat-therapy;
• the use of load (training) suits - "Adele "Gravistat" and others;
• classes with speech therapist and psychologist;
• drug treatment;
• operative orthopedic help;
• symptomatic neurosurgical intervention.

About the methods of massage, features of its use in cerebral palsy, you can learn from the article of the same name.

Therapeutic gymnastics is used either alone or in combination with Voight- and Bobat-therapy. LFK complexes are developed individually, aimed at relieving muscle tension, training coordination and maintaining balance, eliminating muscle weakness. The condition for achieving the effect is the regularity and systematic nature of the classes.

Voight- and Bobat-therapy are also types of therapeutic gymnastics. At the origins of these techniques is the stimulation of motions on the basis of existing congenital reflexes. That is, training in new motor skills is due to those reflexes that the patient has. The goal of therapy is to maximally approximate the patient's motor activity to the norm, to form a motor stereotype, even on the basis of pathological reflexes.

Using training suits "Adeli "Gravistat" allows you to eliminate the vicious positions of various parts of the body, to normalize muscle tone by stretching the muscles. The correct position of the body is attached to limbs and the trunk with the help of locks, shock absorbers, special clothes, in which the child stays for a while and even carries out separate movements. Treatment is carried out by courses, gradually increasing the time spent in the suit.

Classes with a speech therapist and a psychologist allow you to correct communication with others, to adapt the child socially, to expand the scope of his life.

Of the medicines, the focus is on the use of drugs that reduce muscle tone - Baclofen, Midokalm, Sirdalud. For the same purpose, injections of botulinum toxin (Botox, Dysport) into the muscles are used.

It is possible to use drugs that improve the metabolism of the brain and its blood circulation, but some doctors are skeptical about such measures without seeing the results of such treatment.

Operative orthopedic help consists in the elimination of deformities of limbs and joints in order to facilitate movement and self-service. For example, the plasticity of the Achilles tendon promotes the correct support position of the foot.

Neurosurgical intervention implies the elimination of pathological impulses in the brain, which underlies spasticity and hyperkinesis. The operations consist either in the destruction of individual brain structures (responsible for the production of "incorrect" signals), or in implanting devices that suppress pathological impulses.

A special role in the treatment of cerebral palsy is played by the use of auxiliary devices (technical means rehabilitation), which not only make life easier for the patient, but also carry out training muscles. These include wheelchairs, walkers, verticals (a device for giving the body a vertical position), seat-chairs for baths, toilets, special bicycles and trainers for patients with cerebral palsy, orthoses, tutors for correct joint position and much other.

Most methods are used both in special medical institutions for patients with cerebral palsy and at home. Favorable influence is rendered by sanatorium-and-spa treatment. Special sanatoriums, oriented to patients with cerebral palsy, are equipped with a large number of necessary adaptations and allow to carry out a complex effect on the pathological process. The combination of physiotherapy techniques with massage, exercise therapy, water procedures has a tangible curative effect.

From non-traditional methods of treatment in patients with cerebral palsy they use animal therapy - treatment with the help of animals. More often horses and dolphins are used for this purpose.

The effectiveness of stem cell treatment in cerebral palsy is currently not proven.

Children's cerebral palsy is a complex of various neurological symptoms, which are headed by motor disorders. May be accompanied by mental and speech disorders. It can be very difficult, but it's not always a verdict. Complex application of various methods of treatment promotes formation of motor skills, adaptation of the patient to existence in society, provides the opportunity for learning and the acquisition of professional skills, and thus, makes life high-grade.

TVC, the program "Doctors" on "Children's cerebral palsy: on symptoms and prevention"