Definition and Characteristics
- Cerebral palsy (CP) is a disorder characterized by abnormal tone, posture, and movement. It is clinically classified based on the predominant motor syndrome, including spastic hemiplegia, spastic diplegia, spastic quadriplegia, and extrapyramidal or dyskinetic.
- The incidence of CP is 2–3 per 1,000 live births.
Risk Factors
- Prematurity and low birthweight are significant risk factors for CP.
- Other associated risk factors include maternal infections, multiple gestation, maternal-fetal infections, in utero or perinatal stroke, kernicterus, neonatal seizures, neonatal sepsis or meningitis, and more.
Pathology
- In most cases of CP, the initial injury to the brain occurs during early fetal brain development.
- Intracerebral hemorrhage and periventricular leukomalacia are the primary pathologic findings in preterm infants who develop CP.
Diagnosis
- The diagnosis of CP is primarily based on clinical findings.
- Early diagnosis is possible through a combination of clinical history, standardized neuromotor assessment, and findings on magnetic resonance imaging (MRI).
- In most clinical settings, CP is more reliably recognized by 2 years of age.
Management
- CP is associated with multiple associated and secondary medical conditions, requiring a multidisciplinary team approach for its management.
- Most children with CP grow up to be productive adults.
Introduction
- CP is primarily a neuromotor disorder affecting the development of movement, muscle tone, and posture.
- The underlying pathophysiology is an injury to the developing brain in the prenatal through the neonatal period.
- CP is characterized by heterogeneity in risk factors, clinical features, severity of functional limitations, treatment options, and the evolution of the condition over the individual's lifespan.
Prevalence
- The prevalence of CP for all live births ranges from 1.5 to 3 per 1,000 live births. The prevalence varies between high-income and low to middle-income countries and by geographic region.
Clinical Findings
- The neurologic impairment of the motor system in children with CP is characterized by spasticity, dyskinesia, hypotonia, and ataxia. Mixed presentations are also common.