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At least 19 recordsLinked to original sources
PubMedDate not supplied

Risk factors for cerebral palsy.

Cerebral palsy is a major cause of crippling in children, but it's etiology is poorly understood. This case control study was done to assess some of the identified risk factors for cerebral palsy, 125 cerebral palsy cases selected from hospital clinic and 125 age and sex matched neighbourhood controls, all aged less than 5 years and residing in Delhi (India) were studied. Information regarding antenatal, natal and postnatal period was collected by mother's interview, and wherever available, from hospital records with the study subjects. Most common type of cerebral palsy was spastic (88%). Quadriplegia was the commonest topographical subtype (86.4%). Birth asphyxia was found to be present in only 25.6% of cases. The commonest risk factor amongst cases was low birth weight (28.8%). The multivariate odds ratios (confidence limits) for the risk factors found to be significantly associated with cerebral palsy were 36.1 (7.76-160) for birth asphyxia, 13.8 (4.95-38.3) for low birth weight, 37.4 (4.47-313) for neonatal convulsion, 23 (4.7-112) for neonatal jaundice, 14.4 (3.69-56.4) for neonatal infection, 24.9 (2.78-223) for instrument assisted delivery and 15.4 (1.57-152) for antepartum hemorrhage. Precipitate labour, caesarean section, twins, toxemia, breech delivery and head injury were not found to be significantly associated with cerebral palsy. Thus birth asphyxia, low birth weight, neonatal convulsions, neonatal jaundice, neonatal infection, instrument assisted delivery and antepartum hemorrhage are significant risk factors for cerebral palsy.

Analysis of Variance↗
PubMed2002

Public health issues related to infection in pregnancy and cerebral palsy.

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time.

Anti-Bacterial Agents↗
PubMed2003

Intrauterine infection and the development of cerebral palsy.

Cerebral palsy is a serious motor disorder that appears in early life. The expectation that improved obstetrical and neonatal care would decrease the rate of this condition has not been realised. Recent evidence indicates that white matter brain lesions, often termed periventricular leukomalacia (PVL), are the most important identifiable risk factors for the development of cerebral palsy. The hypothesis under examination is that inflammatory cytokines released during the course of intrauterine infection play a central role in the genesis of preterm parturition, fetal PVL, and cerebral palsy. We examined the relationship between umbilical cord plasma concentrations of cytokines at birth and the occurrence of PVL in preterm gestation and demonstrated that umbilical cord plasma concentrations of interleukin (IL)-6 was a significant independent predictor of PVL-associated lesions. We also demonstrated that preterm neonates born to mothers with elevated amniotic fluid concentrations of pro-inflammatory cytokines were at increased risk for the subsequent development of PVL and cerebral palsy. Histological chorioamnionitis and congenital neonatal infection-related morbidity were more common in neonates with PVL than those without PVL in this study. We have also been able to induce PVL-like brain white matter lesions in the fetal rabbit after experimental ascending intrauterine infection. In support of this hypothesis, we were able to demonstrate overexpression of tumour necrosis factor-alpha and IL-6 in histological sections of neonatal brains with PVL. Moreover, the presence of funisitis, a histological counterpart of the fetal inflammatory response syndrome, and elevated concentrations of amniotic fluid IL-6 and IL-8 were strong and independent risk factors for the subsequent development of cerebral palsy at the age of 3 years in our recent study. Therefore, clinical and experimental data provide strong support for the hypothesis. There are significant implications of our findings. First, cytokine determinations in amniotic fluid provide information about the risk of PVL and cerebral palsy before birth. Second, the process responsible for some cases of PVL and cerebral palsy begins during intrauterine life, implying that effective strategies for the prevention of cerebral palsy associated with PVL must begin in utero.

Cerebral Palsy↗
PubMedDate not supplied

[Oral health in children with cerebral palsy].

Cerebral palsy is one of the commonest children's physical handicaps with frequency of 1.5-3/1000. Beside many other disturbances, these children may have serious disorders caused by dental diseases. Concerning this fact, the objective of our study was to examine children with cerebral palsy in our contry and determine condition of dental health and suggest adequate protective measures. A total of 116 children, 3-18 years old, with cerebral palsy were examined and the results were compared to the control group of healthy children of the same age. Among healthy children, 7-10 years old, 66.3% had healthy parodontium, while none of children with cerebral palsy had healthy parodontium. Children, 11-14 years old with cerebral palsy had higher percentage of untreated caries, but lower percentage of filled teeth (18.7%) compared to healthy children (55.0%). Children, 15-18 years old with cerebral palsy had significantly higher percentage of extracted teeth (10.6%) than healthy children (4.1%) and more often orthodontic anomalies (70.6%), compared to healthy children (46.9%). Results of these study indicate that children with cerebral palsy need special and planned dental care.

Adolescent↗
PubMed2003

The epidemiology and causes of cerebral palsy.

Cerebral palsy is the commonest physical disability in childhood, occurring in 2.0 to 2.5 per 1000 live births. Although the total number of children with cerebral palsy has remained stable or increased slightly since 1970, there has been a consistent rise in the proportion of cerebral palsy associated with preterm and very preterm births. Known causes of cerebral palsy--whether prenatal, perinatal or postnatal--must be distinguished from risk factors or associations. Much is known about such risk factors which, alone or in combination, may indirectly result in cerebral palsy. Causes and risk factors implicated in cerebral palsy are discussed in detail, together with directions for future research.

Asphyxia Neonatorum↗
PubMed2002

Application of Fitts' law to individuals with cerebral palsy.

Cerebral palsy is a condition that results in motor abnormalities as a direct consequence of injury to the developing brain. Fitts' law, which describes a speed-accuracy tradeoff in visually guided movements, has been shown to characterize the motor behavior of normal subjects during aiming tasks. To assess whether Fitts' law can also describe the aimed movements of persons with cerebral palsy, eight cerebral palsied adults participated in an aimed movement study. 12 targets were used with Indices of Difficulty ranging from 2.19 to 6.00 bits. The impact of Gan and Hoffmann's 1988 ballistic movement factor, square root(A) , and Fitts' 1954 Index of Difficulty on subject's movement and reaction times was examined using multivariate linear models. The analysis of the full data set yielded a significant effect of square root(A) on movement times and no significant adherence to Fitts' law. However, high error rates that could be the result of oculomotor problems among the subject group were noted, and the method of handling errors had a large effect on the results. Tracking eye position during a Fitts' law task would provide information regarding the effect of oculomotor difficulties on aiming tasks in the cerebral palsied subject group.

Adult↗
PubMed2006

Life expectancy in severe cerebral palsy.

Cerebral palsy comprises an important component of paediatric and obstetric practice and has major medico-legal implications. The prognosis for survival in cerebral palsy determines the financial provision made in cases that come to litigation. Issues of data quality and estimation methods are critical. Estimating the probability of survival in cerebral palsy based on clinical experience is liable to serious error unless numerical data can be produced. Only an actuarial analysis based on a standard life table of cases of cerebral palsy will enable a valid estimate of survival. Construction of the table requires a total cohort of cases of cerebral palsy with their date of birth. Each case must conform to a specified definition of the syndrome. Notification of all those who die, with their date of death is mandatory. Estimating the probability of survival according to the severity of functional disability requires specific definitional criteria for each severity category and for those categories to be mutually exclusive. Survival is significantly poorer in those with severe disability. Severe cognitive, motor (manual and ambulatory), and visual disabilities have independent effects on the probability of survival. Severe hearing disability does not add additional information when the other four functional disability categories are included.

Adolescent↗
PubMed2003

Etiology of cerebral palsy.

Cerebral palsy has a complex and multifactorial etiology. Approximately 5%-10% of cases can be ascribed to perinatal hypoxia, but the vast majority of cases are caused by the interplay of several risk factors and antenatal, perinatal, and neonatal events. The strongest risk factors include prematurity and low birth weight. The prevalence of cerebral palsy has remained constant despite improvements in obstetric and neonatal care. For a long time, the only causal factors explored to account for risk for cerebral palsy were complications of labor and delivery. As other periods have been investigated, new associations have come to light. The current understanding of contributors to the risk for cerebral palsy is still incomplete. Multiple causes may interact by way of excitotoxic, oxidative, or other converging pathophysiologic pathways. A single factor, unless present to an overwhelming degree, often may be insufficient to produce cerebral damage, whereas two or three interacting pathogenic assaults may overwhelm natural defenses and produce irreversible brain injury. The low prevalence of cerebral palsy makes the formal testing of preventative strategies difficult. There is a need for such strategies to be carefully assessed in well designed, multicenter, randomized, controlled trials before becoming part of clinical practice, however, so that the balance between harm and benefit is known in advance.

Cerebral Palsy↗
PubMed2003

Stem cell therapy for cerebral palsy.

Cerebral palsy is a group of brain diseases which produce chronic motor disability in children. The causes are quite varied and range from abnormalities of brain development to birth-related injuries to postnatal brain injuries. Due to the increased survival of very premature infants, the incidence of cerebral palsy may be increasing. While premature infants and term infants who have suffered neonatal hypoxic-ischaemic (HI) injury represent only a minority of the total cerebral palsy population, this group demonstrates easily identifiable clinical findings, and much of their injury is to oligodendrocytes and the cerebral white matter. While the use of stem cell therapy is promising, there are no controlled trials in humans with cerebral palsy and only a few trials in patients with other neurologic disorders. However, studies in animals with experimentally induced strokes or traumatic injuries have indicated that benefit is possible. The potential to do these transplants via injection into the vasculature rather than directly into the brain increases the likelihood of timely human studies. As a result, variables appropriate to human experiments with intravascular injection of cells, such as cell type, timing of the transplant and effect on function, need to be systematically performed in animal models with HI injury, with the hope of rapidly translating these experiments to human trials.

Animals↗
PubMed1997

Cerebral palsy.

Cerebral palsy is caused by a static lesion to the cerebral motor cortex that is acquired before, at, or within 5 years of birth. Multiple causes for the condition exist and include cerebral anoxia, cerebral hemorrhage, infection, and genetic syndromes. Cerebral palsy is commonly classified according to the type of movement problem that is present (spastic or athetoid) or according to the body parts involved (hemiplegia, diplegia, or quadriplegia). To care for children with cerebral palsy, a team approach is most effective; the team should include the pediatrician and orthopedist, among others. In the nonambulatory patient, good sitting posture, the prevention of hip dislocation (spastic hip disease), and the maintenance of proper custodial care are prime concerns. Careful monitoring and treatment of spastic hip disease and the correction of scoliotic spinal deformity are also important. In the ambulatory patient, the main goal is to maximize function. Computerized gait analysis in patients with complex gait patterns helps to show whether orthotic or surgical treatment is indicated. In this paper, we also review both the proper indications for orthopedic intervention in patients with upper extremity involvement and recent methods to control spasticity, such as selective dorsal rhizotomy and administration of botulinum toxin or intrathecal baclofen.

Cerebral Palsy↗
PubMed1990

Selective dorsal rhizotomy: neurosurgical treatment of cerebral palsy.

Cerebral palsy is a syndrome characterized by abnormal motor function, with spasticity being one of the most crippling manifestations. Selective dorsal rhizotomy, a neurosurgical procedure, has successfully decreased the degree of spasticity for the child with cerebral palsy. The utilization of this procedure may enable the child with cerebral palsy to demonstrate improved motor function, creating an exciting nursing challenge. This article describes dorsal rhizotomy and the nursing care involved. The protocol of treatment and care provided at Texas Children's Hospital is also described.

Cerebral Palsy↗
PubMed1991

Appropriateness of intrapartum fetal heart rate management and risk of cerebral palsy.

Cerebral palsy affects 2 in 1000 infants in the United States, and the intrapartum period is frequently scrutinized as the etiologic source. In a matched group of 49 infants with cerebral palsy at 1 year of age and 49 controls, no difference in the incidence of inappropriate intrapartum fetal heart rate pattern management was detected. This supports the conclusions of others that the intrapartum period is an infrequent source of cerebral palsy.

Apgar Score↗
PubMed2006

[Drug treatment for children with cerebral palsy].

Cerebral palsy is the main cause of immobility in children. This motor dysfunction is caused by several motor components such as weakness, lack of motor control and muscle hypertonia. Drug treatment, delineated in this review, mainly addresses the latter. Recently, new definitions for clinical features of hypertonia in children were published, assisting the distinction between the two common motor symptoms in cerebral palsy, spasticity and dystonia. The main functional symptoms disrupt functional daily life, dictating the overall approach and the specific drug treatment. There are an increasing number of treatments for this distressing disorder. For general spasticity, treatments provided include Baclofen. If symptoms are local, either dystonia, or spasticity, Botulinum toxin is the revolutionary drug used with significant success and relatively few side effects. For generalized dystonia, a trial of both Dopamine and Trihexyphenidyl should be considered. Cerebral palsy, like other complex disorders, requires individualized decision-making and a team approach. Drug therapy is only one aspect of treatment, yet sometimes it may serve as a window of opportunity to facilitate better motor control.

Anti-Dyskinesia Agents↗
PubMed2005

[Comparative analysis of prognostic value of epileptic encephalopathies and symptomatic epilepsy in children with cerebral palsy].

Cerebral dysfunction due to epilepsy is not currently well-understood and needs to be further investigated. We have observed patients with static encephalopathy (cerebral palsy) of nearly equal severity with epileptic encephalopathy and symptomatic epilepsy and have had carried out comparative analysis of prognosis among these groups. The work is based on the results of investigation of 121 patients admitted to the Center of child neurology and neurorehabilitation during the period 2000-2005. 69 patients with epileptic encephalopathies were included into the study groups according to following criteria: I group -- cases with early starting seizures (before 1 year of life) and II group -- starting seizures after 1 year of life. The control group involved 52 patients with associated cerebral palsy of different severity and symptomatic epilepsy. The study and control groups were compared prognostically. According to our data, prognosis and outcome of epilepsy was closely associated with the time of onset of epilepsy syndromes: early started (within the first year) epileptic encephalopathies display the highest correlation with poor prognosis; the risk of development of epileptic encephalopathies is the highest in patient with cerebral palsy and early starting of seizures.

Brain↗
PubMed2004

Cerebral palsy.

Cerebral palsy, a range of non-progressive syndromes of posture and motor impairment, is a common cause of disability in childhood. The disorder results from various insults to different areas within the developing nervous system, which partly explains the variability of clinical findings. Management options include physiotherapy, occupational and speech therapy, orthotics, device-assisted modalities, pharmacological intervention, and orthopaedic and neurosurgical procedures. Since 1980, modification of spasticity by means of orally administered drugs, intramuscular chemodenervation agents (alcohol, phenol, botulinum toxin A), intrathecally administered drugs (baclofen), and surgery (neurectomy, rhizotomy) has become more frequent. Family-directed use of holistic approaches for their children with cerebral palsy includes the widespread adoption of complementary and alternative therapies; however, the prevalence of their use and the cost of these options are unknown. Traditional medical techniques (physiotherapy, bracing, and orthopaedic musculoskeletal surgery) remain the mainstay of treatment strategies at this time. This seminar addresses only the musculoskeletal issues associated with cerebral palsy and only indirectly discusses the cognitive, medical, and social issues associated with this diagnosis.

Cerebral Palsy↗
PubMed1999

Diagnosis and Management of Orthopedic Problems in Children with Cerebral Palsy.

Cerebral palsy is a term applied to a variety of clinical syndromes that have as a common feature the abnormal control of motor function by the brain, resulting in disorders of movement and posturing. Sensory function is often affected as well. Cerebral palsy afflicts the immature brain (under 2 years of age) and usually produces neuropathologic changes that do not progress with increasing age. Because myelination of the brain is a progressive process that begins late in the third trimester and continues into adolescence in a well defined pattern, only after the neuronal pathways from brain lesions have become myelinated and the pattern of abnormality determined, can the brain lesions forming the basis of cerebral palsy be detected.

Journal Article↗
PubMed2001

Botulinum toxin type A management of spasticity in the context of orthopaedic surgery for children with spastic cerebral palsy.

Cerebral palsy is the most common cause of physical disability affecting children in developed countries. Although cerebral palsy is, by definition, a 'static encephalopathy' the associated musculoskeletal pathology is progressive and current definitions are therefore somewhat inadequate. Understanding the stages of the musculoskeletal pathology is fundamental to understanding current management strategies, including spasticity management, strengthening programmes and deformity correction by orthopaedic surgery. In this review, a number of new management strategies are described, in which spasticity management by intramuscular injections of botulinum toxin type A and deformity correction, by orthopaedic surgery, are combined.

Animals↗