What is cerebral palsy?
Cerebral palsy is a condition in which there may be abnormal brain development or injury to the brain as it develops. This can occur before, during, after birth or during early childhood when the brain is growing. Cerebral palsy in itself is not one specific disease and is an “umbrella term” which applies to a collection of conditions where there is primarily a disorder of voluntary movement and/or co-ordination. Children with cerebral palsy have difficulties in controlling muscles and movements as they grow and develop. The nature and extent of these difficulties may change as children grow but cerebral palsy itself is not progressive: the injury or impairment in the brain does not change.
Cerebral palsy can have mild to severe manifestations. Often Cerebral Palsy does not necessarily incapacitate the patient entirely as part of the brain which controls our thinking is different from the part which controls our movements. Hence many people with cerebral palsy can have normal intelligence inspite of motor and movement difficulties.
What causes cerebral palsy?
Cerebral Palsy is not contagious or hereditary. In some instances, there may be no obvious single reason to identify. It is generally accepted that causes of cerebral palsy can be multiple and complex which can include following causes and risk factors:
- Very premature delivery
- Infections in mother which affects the baby in womb
- Disruption of blood supply to growing brain of the unborn baby (fetus)
- Lack of oxygen to the brain (asphyxia) related to difficult labor or delivery
- Infections after birth that cause inflammation in or around the brain
- Traumatic head injury to an infant from a motor vehicle accident, fall or child abuse
What are the features of cerebral palsy?
The signs and symptoms vary from patient-to-patient. An important fact is that the child with cerebral palsy often show delay in reaching developmental especially motor milestones.
- A child over 2 months with cerebral palsy might
- Have difficulty controlling head when picked up
- A child over 6 months with cerebral palsy might
- Continue to have a hard time controlling head when picked up
- Reach with only one hand while keeping the other in a fist
- Have stiff legs that cross or "scissor" when picked up
- A child over 10 months with cerebral palsy might:
- Crawl by pushing off with one hand and leg while dragging the opposite hand and leg
- Early hand preference (Normally only comes after 2 year age)
- Not sit by himself or herself
- A child over 12 months with cerebral palsy might:
- Stiffness in arms and legs
- Not crawl
- Not be able to stand with support
- A child over 24 months with cerebral palsy might:
- Not be able to walk
- Not be able to push a toy with wheels
What is the treatment?
There is no cure as such for cerebral palsy but physical therapy is one of the most important treatments and can help the child to achieve his full potential. Medicines, surgery, and special equipments are also often required.
Is there any role of Botox therapy?
Botox injections have become very popular and in fact this is treatment of choice for selected spastic muscles. It should be done after comprehensive evaluation including posture, gait and functional analysis. The goal is to decrease the spasticity, pain and increase the range of motion at a given joint. Once you have received the therapy, you should follow a disciplined physiotherapy program to achieve the maximum benefit of Botox injections.
How does it work?
Skeletal muscles tighten in response to the release from nerve endings of the neurotransmitter acetylcholine. When BTA is injected into the muscle, the release of acetylcholine is blocked, resulting in a relaxation of overactive muscles. The injections generally take effect within a few days and last for several months.
Can Botox cure cerebral palsy?
No, this cannot cure the disease and it is not the suitable treatment for all types of cerebral palsy. It only helps in management of spasticity (tight muscles) and dystonia (fluctuating muscle tone) with good results.
Children with Toe walking usually have tight gastrocnemius muscles; can be helped by injecting these muscles. When injected into the calf or lower leg muscles, it can relax these muscles, making walking easier and more comfortable, as well as generally improving balance and reducing the frequency of falls. Children with scissoring gait have tight hamstrings and adductor muscles..
What are the side effects of Botox?
In the main, reported side-effects are mild and short-lived.
- Post-injection pain requiring simple analgesia
- Increased frequency of falls within first 2 weeks of injection
- Mild, cold or flu-like symptoms
- Temporary incontinence
- Difficulty with swallowing, especially where upper limb or neck injected
- Mood swings/irritability
- Anaphylaxis [severe allergic reaction], but this is rare.
In brief, botulinum injection (Botox) is good option in cerebral palsy, however, it should be administered by experts with good experience and needless to emphasis the importance of details evaluation before and after the therapy. One must remember that these injections are not beneficial if not combined with a good rehabilitation program.