Cerebral Palsy
By Drs.Li-Ke Wu, Xiaojuan Wang, Bo Cheng, Susan Chu, Xinrui Xi and Shuangshuang Liu
Wu Medical Center, Bejing, China
About CP
Cerebral Palsy (CP) is a nervous system developmental disease. Usually CP is referred to as a central movement disorder; which is caused by non-progressive cerebral injury or encephalodysplasia during pregnancy during childbirth or after birth up to about one month due to many reasons. The incidence of CP is about 1.2-2.5%, clinical features are abnormal in posture and muscular tension, involuntary movement and ataxia, which are usually associated with sensory disturbance, cognitive dysfunction, behavioral disorder, secondary skeletal muscle abnormalities and epileptic seizures. The non-progressive central movement disorders, which are also called acquired cerebral palsy, are caused by many reasons one month after birth. Approximately 10% of CP cases include: the cause of congenital brain disorder etiology, premature matrix hemorrhage, periventricular leukomalacia, hypoxic ischemic injury, spastic diplegia, infantile hemiplegia, paraplegia and quadriplegia, extrapyramidal syndrome, hands athetosis, bilirubin encephalopathy, neonatal congenital ataxia, bridge cerebella dysplasia, flaccid paralysis, which all belong to the acquired development diseases. The diseases of intrauterine infection caused by intrauterine and neonatal infection, result in cerebral malformations and anomalies, that belong to infectious development diseases. Those patients show more or less symptoms of mental retardation.
Pathogenesis
There are many causes for CP, such as: genetic diseases, infectious diseases, cerebral dysplasia, cerebral ischemia and hypoxia, brain injury, cerebral hemorrhage, etc. Though prematurity and intrauterine growth retardation are not the direct causes of CP, they are still the most important high risk factors.
Pathology
The pathogenic factors in early trimester of pregnancy cause neuronal proliferation and migration anomalies and may cause agyria, pachygyria, polymicrogyria, schizencephaly and neuronal heterotopia. The most common pathological changes are periventricular leukomalacia and periventricular hemorrhagic infarction. Pathological changes are during development of the infant and there are many which show to be complex and are related to hypoxic ischemic brain damage. The marble state is caused by neuronal loss and gliosis with myelination increases, which is a typical change of kernicterus, which can be seen in the hypoxic ischemic brain damage as well.
Clinical Feature
Symptoms of CP patients in infancy commonly shows abnormal posture and movement retardation, such as neonatal hypoxic ischemic encephalopathy, and low muscle tone in the early periods of infancy, then it develops into hypermyotonia. The equilibrium disorder may be found after the baby can sit or even stand. Secondary changes, such as joint contracture and deformity of the spine, are progressive developments; epilepsy, mental retardation, behavioral disorders and sensory disturbances can be found, as well. These symptoms can be the main physical disability of CP children.
Cerebral Palsy (CP) is divided into spastic; athetoid, ataxia, hypotonia and mixed type to describe different types of movement disorders, following are several clinical
syndromes:
Spastic Hemiplegia
The most common type, involving one side of the body, upper limbs are shown to be worse than lower limbs, far-end worse than near-end, face is usually normal. Children often show obvious symptoms after 3 months, such as less limbs move, persistent fist, grasp reflex disappears, forearm pronation posture, circle gait and so on. Part of the patient's first symptoms can be low muscle tone, and then it turns to spasticity. Mental retardation and epilepsy are common in this type. Epileptic seizures show partial or secondarily generalized seizures. Strabismus is very common.
Spastic Quadriplegia
Spastic quadriplegia is usually found in children who suffer from severe asphyxia. Their limbs muscle tension is increased, often showing signs of opisthotonos, and with supranuclear bulbar paralysis, causing swallowing and articulation disorder. About half of the patients show signs of epilepsy and mental retardation.
Dyskinetic CP
Dyskinetic CP is found in about 10% of CP patients, main causes are hypoxic brain injury and neonatal nuclear jaundice. Patients commonly show hypotonia in early infancy, and then have extrapyramidal symptoms, such as athetosis. Salivation, dysphagia and the language barrier can be found as well. Deep tendon reflex in the lower limbs is shown to be normal or increased. Patients may have persistent primitive reflex, intelligence is mostly in the normal or critical state. About 1/4 of the patients have epilepsy. Cases caused by nuclear icterus show athetosis, sensory deafness, enamel hypoplasia, etc.
Ataxia CP
This type of CP is present in about 10% of CP patients; symptoms are usually hypotonia, balance disorder and motor retardation in infancy, Dysmetria, intention tremor in childhood, pyramid sign is not common, and many patients show signs of mental retardation, but nothing serious.
The evaluation of motor functions and daily life ability are helpful to judge the severity of cerebral palsy, and as a basis to evaluate the effect of the rehabilitation treatment. The common motor function assessment scale is following two types.
Treatment
Our treatment aims to improve the patient's physical function and life quality, to minimize secondary joint deformity and soft tissue contractures as far as possible, to try to postpone or avoid surgery. The traditional treatment methods include:
Physical therapy: To improve motor function and enhance the ability of self-care by increasing joints range of motion, adjusting the muscle tension, motion control, coordination ability, strength and endurance, etc.
Occupational therapy: Including fine hand functional training, activities of daily living training, brace and auxiliary means making and simple transformation of living environment, etc.
Speech Therapy: After being assessed by physicians and speech therapists, the patients will get treatment based on the type of speech disorder. such as: jaw, lips, tongue, soft palate movement control training, as well as understanding and presentation skills training.
Drug therapy: Commonly used drugs include cranial nerve nutrition medicine, muscle relaxant, etc.
Surgery: When the patient suffers from severe muscle contracture and joint deformities, the patient could consider orthopedic surgery.
WSCMC research found that traditional treatments could improve motor functions in a certain extent, but in reality they are not aimed at treating the cause of the disease.
No matter what caused cerebral palsy, there is a decrease in the number of brain nerve cells with normal function. The traditional treatments are not able to increase the number of nerve cells in the brain, neither to have the nerve damage repaired.
Through years of research and therapeutic practice, WSCMC discovered that neural stem cell implantation treatment not only can effectively increase the number of brain nerve cells, but also is able to start the re-development of the neurological process. The treatments are combined with the necessary drugs and rehabilitation, so that 80% transplanted neural cells are able to show function, so as to make the patients obtain much more improvements in neurological function.
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