Cerebral palsy - symptoms and signs, diagnosis
Symptoms and signs, diagnosis of cerebral palsy.
Children's cerebral palsy includes non-progressive syndromes, characterized by violation of voluntary movements or postures and are a consequence of prenatal malformations or perinatal or postnatal damage to the CNS. These syndromes are manifested up to 5 years of age. The diagnosis is clinical. Treatment may include physiotherapy and work-hardening, orthopedic corsets, drug therapy or botulinum-sine injections, orthopedic surgery, intrathecal baclofen or in some children dorsal rhizotomy.
Cerebral palsy is a group of syndromes that cause non-progressive muscle spasticity, ataxia, or involuntary movements; it is not a specific disease or a separate syndrome.Syndromes of cerebral palsy are observed in 0.1—0.2% of children, while among premature babies - in 15%.
Cerebral Palsy - Etiology
The etiology is multifactorial; it is often difficult to establish a specific cause. Prematurity, fetal abnormalities in the prenatal period, neonatal encephalopathy and nuclear jaundice are often important. Perinatal factors are likely to cause 15-20% of cases. Common combinations include spastic diplegia in preterm labor, spastic tetraparesis after endometrial asphyxia, and atetoid and dystonic forms after intranatal asphyxia or nuclear jaundice. CNS injuries or severe systemic illness in the first years of life can also cause cerebral palsy.
Cerebral palsy - symptoms and signs
There are 4 main categories of cerebral palsy: spastic, atetoid, ataksitazy, reduces the level of estradiol in serum and is effective in the treatment of girls with Mac-Coon-Albright syndrome; as an alternative, the estrogen antagonist tamoxifen may be effective.
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With GnRH-independent premature puberty in boys due to familial male go-nadotropin-independent premature puberty or Mac-Coon-Albright syndrome, androgen antagonists reduce the effect of an excess of androgens. The antifungal drug ketoconazole reduces testosterone levels in boys with familial male gonadotropin-independent premature puberty. Testolactone, the inhibitor is aromatic and mixed, isolated depending on which department of the CNS is damaged. Before the development of certain syndromes, symptoms include delayed motor development and often persistent reflexes of the neonatal period, hyperreflexia, and impaired muscle tone.
Associated problems are present in about 25% of patients, most often in spastic syndrome. Strabismus and other visual disturbances can develop. Children with athetosis due to nuclear jaundice often have deafness associated with damage to the auditory nerve, and paralysis gaze upward.Many children with spastic hemiplegia or paraplegia have normal intelligence; in children with spastic tetraplegi and mixed forms, there can be disabling mental retardation.
Athetoid, or dyskinetic, cerebral palsy syndromes
Spastic syndromes account for more than 70% of cases of cerebral palsy. Spasticity is a state of resistance to the passive volume of movements; resistance increases with increasing speed. It is associated with damage to the motor neurons and can cause mild or severe impairment of motor function. These syndromes can cause hemiplegia, tetraplegia, diplegia or paraplegia. Usually, in the affected limbs there is an increase in deep tendon reflexes, hypertonicity of muscles, voluntary movements are weak and poorly coordinated. Contractures and deformities of the joints develop. Characteristic hemiplegic gait and walking on socks. In mild cases, violations can occur only with certain types of movements. Often in tetrapia, there is a violation of the movements of the muscles of the mouth, tongue and palate, followed by the development of dysarthria.
Atetoid, or dyskinetic, syndromes develop in about 20% of cases of cerebral palsy and are a consequence of the defeat of the basal ganglia. These syndromes are determined by slow involuntary movements of the upper limbs and torso, often caused by attempts to make an arbitrary movement or by strong feelings. Sharp, steep distal movements may also be noted. These movements are aggravated by emotional stress and disappear in a dream. Dysarthria, often severe, develops.
Ataxic syndromes are less common than in 5% of cases of cerebral palsy and are the result of damage to the cerebellum or its pathways. Weakness, impaired coordination and tremor when one intends to make a movement causes instability of gait and difficulty in making fast or small movements, while walking the child spreads his legs wide.
Mixed forms are common - most often spasticity and athetosis.
Diagnosis of cerebral palsy
Cerebral palsy is rarely possible to confirm in the first months of life, and a specific syndrome can often not be described until 2 years of age. Children from the high-risk group should be supervised with frequent check-ups.
If you suspect cerebral palsy MRI of the brain; in most cases, it reveals deviations.
Cerebral Palsy should be differentiated from progressive hereditary neurological disorders, as well as disorders requiring surgical or other specific neurological treatment. Ataxic forms are particularly difficult to differentiate, and in many children with ataxia, eventually, a progressive cerebellar degenerative disease is identified as the cause. Athetosis and hyperuricemia in boys indicate Lesch-Nihan syndrome. Skin or ophthalmologic changes may indicate tuberous sclerosis, neuro-fibromatosis, ataxia-telangiectasia, von Hippel-Lindau disease or Sturge-Weber syndrome. With early muscle and muscular dystrophy atrophy associated with hypotension and hyporeflexia, there are few symptoms of brain damage. Adrenoleukodystrophy begins at a later age.
A laboratory study can exclude some progressive accumulation diseases, in which motor disorders are noted. Other progressive diseases can be suspected in the study of nerve conduction and electromyography, but they should be diagnosed clinically or morphologically.Children with apparent mental retardation and symmetrical movement disorders should be examined for amino acid metabolism disorders, as well as other metabolic disorders.
Children's age and cerebral palsy
Most patients experience childhood and become adults. Expressed limitations of sucking and swallowing, which may require feeding through a gastrostomy, reduce the likelihood of survival. The goal of treatment is to achieve maximum independence for children within their movement disorders and their attendant defects; With proper treatment and rehabilitation, many children, especially with spastic paraplegia or hemiplegia, can lead a near-normal life.
Usually, physiotherapy and occupational therapy are primarily used to stretch, strengthen muscles and form the right patterns of movement. Orthopedic corsets, medical therapy and surgical treatment are used to treat spastic syndrome. Botulinum toxin can be injected into the muscles to reduce their uneven effects on the joint and prevent the development of persistent contractures.Drugs such as baclofen, benzodiazepines, tizanidine and sometimes dantrolene can reduce spasticity. Orthopedic surgery can help reduce the limitations of movement in the joint and its even development. Intrathecal administration of baclofen is the most effective treatment for severe spastic syndrome. Selective dorsal rhizotomy can help some babies born premature if spasticity primarily covers the legs, and cognitive abilities are good.
If intellectual and physical limitations are not pronounced, children should attend regular school. At the same time, some children will need life-long observation and help. Speech and other forms of training may be required. Even for children with severe disabilities, it is helpful to participate in training sessions on skills needed in daily life, which increase their independence and significantly reduce the burden on family members or other people caring for patients with cerebral palsy.
Parents of a child with persistent restrictions need help and guidance in understanding the situation and potential of the child and how to cope with their own feelings of guilt, anger, denial and sadness.Such children reach their maximum potential only with the stable care of parents, as well as with the help of public and private agencies.
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