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Key Features

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Essentials of Diagnosis
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  • Describes a chronic, static impairment of muscle tone, strength, coordination, or movements

  • Condition is nonprogressive

  • Originates from some type of cerebral insult or injury before birth, during delivery, or in the perinatal period

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General Considerations
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  • Depending on the type and severity of the motor deficits, associated neurologic deficits or disorders may occur

    • Seizures in up to 50%

    • Mild mental retardation in 26%

    • Severe retardation in up to 27%

  • Disorders of language, speech, vision, hearing, and sensory perception are found in varying degrees and combinations

  • Blindness, deafness, or epilepsy often coexist

  • Some form of cerebral palsy occurs in about 0.2% of neonatal survivors

  • The fundamental course, severity, precise manifestations, and prognosis vary widely

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Clinical Findings

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Symptoms and Signs
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  • Most common forms of cerebral palsy (75% of cases) involve spasticity

  • Ataxia

    • Second most common form of cerebral palsy

    • Accounts for about 15% of cases

    • Frequently affects fine coordinated movements of the upper extremities, but may also involve lower extremities and trunk

  • Choreoathetosis or dystonia accounts for 5% of cases

  • Persistent hypotonia without spasticity for 1% of cases

  • Microcephaly is frequently present

  • In patients with hemiplegia, the affected arm and leg may be smaller and shorter than the unaffected limbs

  • Cataracts, retinopathy, and congenital heart defects may be indicative of congenital infections such as cytomegalovirus and rubella

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Differential Diagnosis
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  • Intrauterine hypoxia

  • Intrauterine bleeding

  • Infections

  • Toxins

  • Congenital brain malformations

  • Obstetric complications (including birth hypoxia)

  • Kernicterus

  • Neonatal hypoglycemia

  • Metabolic disorders

  • Small number of genetic syndromes

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Diagnosis

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  • Appropriate laboratory studies depend on the history and physical findings

  • MRI scans may be helpful in understanding the full extent of cerebral injury

  • Neuroimaging results occasionally suggest specific etiologies (eg, periventricular calcifications in congenital cytomegalovirus infections or brain malformations such as pachygyri or lissencephaly)

  • Genetic and metabolic testing should be targeted based on history or MRI findings

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Treatment

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  • Therapy is directed at assisting the child to attain maximal neurologic functioning, with appropriate physical, occupational, and speech therapy

  • Orthopedic monitoring and intervention and special educational assistance may contribute to an improved outcome

  • Spasticity and seizures can be managed with medications or botulinum toxin

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Outcome

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Prognosis
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  • Depends on the child's IQ, severity of the motor deficits, etiology of cerebral palsy, and degree of incapacity

  • In severely affected children, aspiration, pneumonia, or other intercurrent infections are the most common causes of death

  • Patients with mild cerebral palsy may improve with age

  • Some patients experience resolution of motor deficits by age 7 years

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References

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Blair  E: Epidemiology of the cerebral palsies. OrthopClin North Am 2010;41:441–455
[PubMed: 20868877] .
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Delgado  MR  et al: Practice parameter: pharmacologic treatment ...

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