pediatrics
Cerebral Palsy (CP)
Symptoms and Signs of Cerebral Palsy
Before a specific type develops, symptoms include lagging motor development and often persistent infantile reflex patterns, hyperreflexia, and altered muscle tone. CP is categorized mainly as one of the following, depending on which parts of the CNS are malformed or damaged ( Symptoms and signs references , 80% of cases ( Symptoms and signs references ). Spasticity is a state of resistance to passive range of motion; resistance increases with increasing speed of that motion. It is due to upper motor neuron involvement and may mildly or severely affect motor function. Spastic CP may cause hemiplegia, quadriplegia, diplegia, or paraplegia. Usually, deep tendon reflexes in affected limbs are increased, muscles are hypertonic, and voluntary movements are weak and poorly coordinated. Joint contractures develop, and joints may become misaligned. A scissors gait and toe walking are typical. In mild cases, impairment may occur only during certain activities (eg, running). Corticobulbar impairment of oral, lingual, and palatal movement, with consequent dysarthria or dysphagia, commonly occurs with quadriplegia. Athetoid CP or dyskinetic CPis the second most common type. It occurs in about 15% of cases and results from basal ganglia involvement. Athetoid or dyskinetic CP is defined by slow, writhing, involuntary movements of the proximal extremities and trunk (athetoid movements), often activated by attempts at voluntary movement or by excitement. Abrupt, jerky, distal (choreic) movements may also occur. Movements increase with emotional tension and disappear during sleep. Dysarthria occurs and is often severe. Ataxic CPis rare and results from involvement of the cerebellum or its pathways. Weakness, incoordination, and intention tremor cause unsteadiness, a wide-based gait, and difficulty with rapid or fine movements. Mixed CPis common—most often with spasticity and athetosis. A tool called theGross Motor Function Classification System–Expanded and Revised (GMFCS–E&R)can be used to describe the gross motor function of children with CP. The system categorizes gross motor function into 5 different groups. It provides a description of current motor function that helps identify current and future needs for mobility aids. About 25% of patients, most often those with spasticity, have other manifestations. Strabismus and other visual defects may occur. Children with athetosis due to kernicterus commonly have nerve deafness and upward gaze paralysis. Many children with spastic hemiplegia or diplegia have normal intelligence; children with spastic quadriplegia or mixed CP may have severe Intellectual Disability . 1.Wimalasundera N, Stevenson VL: Cerebral palsy.Pract Neurol16(3):184–194, 2016. doi: 10.1136/practneurol-2015-001184 2.Monbaliu E, Himmelmann K, Lin JP, et al: Clinical presentation and management of dyskinetic cerebral palsy.Lancet Neurol16(9):741–749, 2017. doi: 10.1016/S1474-4422(17)30252-1 