1 / 50

CEREBRAL PALSY IN CHILDREN

CEREBRAL PALSY IN CHILDREN. M. Mohammadi MD Professor of Pediatrics and Neurology Tehran University of Medical Sciences November 12 Tehran, Iran.

terah
Download Presentation

CEREBRAL PALSY IN CHILDREN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CEREBRAL PALSYIN CHILDREN M. Mohammadi MD Professor of Pediatrics and Neurology Tehran University of Medical Sciences November 12 Tehran, Iran

  2. Cerebral palsy isan umbrella term coveringa group of non-progressive,but often changing,motor impairment syndromes secondary to lesions or anomaliesof the brain arising inthe early stages of its developmentDMCN, 1992, 34: 547-55

  3. Cerebral PalsyThe dimensions of the problem • There are an estimated 15 million people with cerebral palsy around the world and of them haveepilepsyas well as 30%-70%significant cognitive impairments

  4. CP prevalence rates in Europe

  5. Overall CP Prevalence Rate 0.25%

  6. Cerebral PalsyRisk Factors Associated with • Before pregnancy • Hx of fetal wastage • Long menstrual cycles • Maternal thyroid disorder • Family hx of MR • During pregnancy • Low socioeconomic status • Rx of mother c thyroid hormone, estrogen or progesterone • Maternal seizure disorder • Polyhydramnios • Eclampsia

  7. Cerebral PalsyRisk Factors Associated with • During pregnancy • Bleeding in 3rd trimester • Twin gestation • Congenital malformation • Fetal growth retardation • Abnormal fetal presentation • During labor & delivery • Premature separation of the placenta • During the early postnatal period • Newborn encephalopathy

  8. SB rate/1000 total births CP and NND rates/1000 live births Stillbirths Neonatal deaths Cerebral palsy Cerebral palsy, neonatal death and stillbirth ratesWestern Australia, 1966 - 1992 * Excludes cerebral palsy due to postneonatal causes

  9. <1500g Rate per 1000 live births (3-year moving averages) 1500-2499g >=2500g Central year of birth Birth weight specific cerebral palsy rates(3-year moving averages) in WA, 1967-1992 * Excludes cerebral palsy due to postneonatal causes

  10. Cerebral PalsyClassification • Physiologic • Topologic

  11. Cerebral PalsyPhysiologic Classification • Spastic (70-80% of cases, pyramidal tract injury) • Dyskinetic (10-15%, hyperbilirubinemia, basal ganglia injury, less seizure & cognitive impairment) • Ataxic (<5%, cerebellar injury) • Mixed (10-15%,, more seizures & cognitive impairments)

  12. Cerebral PalsyTopologic Classification • Spastic Diplegia (25-35%) • Spastic Quadriplegia (40-45%) • Spastic Hemiplegia (25-40%) • Spastic Paraplegia (Rare) • Spastic Monoplegia (Very rare)

  13. Clinical Presentations

  14. Clinical Presentations

  15. Clinical Presentations

  16. Clinical Presentations

  17. Clinical Presentations

  18. Clinical Presentations Ankle Clonus Reflex Extension

  19. Cerebral palsyImportant Questions to be Asked • How was the pregnancy & delivery? • How was the baby at the birth time (SGA, premature …)? • Could the mom see her baby just after the labor? • How was the APGAR score? • How long was the newborn admitted at the hospital? • Was there any jaundice and if yes what was the cause?

  20. Cerebral palsyImportant Questions to be Asked • Was there any tube feeding? • Was there any need for respirator or parenteral oxygen therapy? • Was there any hx of neonatal seizures, sepsis or other important neonatal conditions? • Was there any spasticity and or hypotonia? • How were the integrated reflexes? • Was there any handedness before the age of 18 months? • Was there any hx of early head control or rolling-over?

  21. Cerebral palsyImportant Questions to be Asked • Was there any cortical fist? • How was the motor development esp. in gross motor aspects? • Is there any focal atrophy? • Is there any hx of movement disorders such as choreoathetosis or dystonia? • Was there any minor anomalies? • Is there any strabismus? • Is there any disturbance in head shape or circumference?

  22. Cortical Fist

  23. Cortical Fist

  24. Cortical Fist

  25. BRAIN LESION DETECTION • Brain imaging • Neurophysiological tests • Neurological clinical examination - spontaneous activity - reactions - developmental reflexes - rating scales

  26. NEUROIMAGING

  27. NEUROIMAGING

  28. NEUROIMAGING

  29. Fidgety Movements

  30. Preventionof cerebral palsy depends on knowledge of the causes, but actionneed not be delayed until understanding is complete. Much could be achieved now by using such knowledge as we have.Mitchel, 1971

  31. Cerebral palsy islong-life, but improves with adequate intervention

  32. Treatments of Cerebral Palsy • Repair of the Injured Brain • Replacement of injured cells • Repairing injured dendrites & axons • Alternative brain pathways • Management of disabilities • Brain & spinal cord • Drugs • Dorsal rhizotomy • Intrathecal baclofen • Bone & muscles • Botulinum toxin • Medical & Surgical procedures • Physiotherapy & occupational therapy • Alternative Medicine

  33. Pharmacotherapeutic treatment • Dantrolen • Valium • Baclofen • Intrathecal Baclofen

  34. Other therapies available for CP compared to BTA General Oral Therapy DR ITB Reversible Permanent Surgery BTA Focal

  35. Other therapies available for CP compared to BTA

  36. USE OF BOTULINUM TOXIN IN 55 CHILDREN WITH CEREBRAL PALSY Type of Cerebral Palsy in Our Patients

  37. USE OF BOTULINUM TOXIN IN 55 CHILDREN WITH CEREBRAL PALSY Walking After BTA Administration

  38. USE OF BOTULINUM TOXIN IN 55 CHILDREN WITH CEREBRAL PALSY • Changes in the range of motion of the affected joints after Botulinum Toxin A (BTA) injection

  39. Alternative Medicine • Bio-energy • Acupuncture • Herbal Medicine • Quackery Medicine • ...... www.quackwatch.com

  40. A child with cerebral palsy is first and foremost a child ! • Berta Bobath

  41. Cerebral palsy islong-life, but improves with adequate intervention

More Related