Cerebral palsy is a diagnosis that has had a constantly evolving definition since it was first mentioned in the medical literature as “cerebral paralysis” by Dr. William Little in 1843. Currently, the most widely accepted definition, from a 2004 international workshop in Bethesda, Maryland, is that cerebral palsy “describes a group of permanent disorders of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, behavior, by epilepsy and by secondary musculoskeletal problems.”
Static encephalopathy, although commonly used as a synonym for cerebral palsy, is actually a broader term including all individuals with a static injury of the central nervous system. For example, an individual with intellectual disability possessing no fine or gross motor deficits would have a diagnosis of static encephalopathy but not cerebral palsy. Cerebral palsy is, therefore, a subgroup of static encephalopathy, including only patients who have accompanying motor system deficits.
EPIDEMIOLOGY OF CEREBRAL PALSY
Infants with very low birth weight have a significant increase in the risk of cerebral palsy compared to normal birth weight children. Very premature infants (< 28 weeks) are also much more likely to have cerebral palsy than term infants, which is thought to be related to the immature germinal matrix leading to increased risk of ischemic or hemorrhagic injury.
Risk factors for the development of cerebral palsy can be divided into categories based on timing: preconception (maternal), prenatal, perinatal, and postnatal. The diagnosis of cerebral palsy usually is limited to individuals younger than 3 years of age, as after this time, the manifestations of brain injury will present differently (Table 547-1).
TABLE 547-1RISK FACTORS FOR CEREBRAL PALSY ||Download (.pdf) TABLE 547-1RISK FACTORS FOR CEREBRAL PALSY
|Maternal ||Prenatal ||Perinatal ||Postnatal |
Advanced maternal age
Low socioeconomic status
History of premature delivery
History of multiple miscarriages
Poor fetal growth
Maternal disease during pregnancy (diabetes, thyroid disease, epilepsy)
Poor prenatal care
High or low amniotic fluid
Low Apgar scores
Abusive head trauma
It is important when considering a diagnosis of cerebral palsy to assess the understanding of the family and the patient of the reason for evaluation and the meaning of the possible diagnosis. Reinforcing the nature of cerebral palsy (static, nonprogressive lesion but with physical manifestations that evolve over time) typically must be done several times to ensure understanding.
The history should include a detailed ...