Cerebral Palsy Management and Treatment

Cerebral palsy is mainly caused by brain malfunction or brain dysfunction or brain abnormalities which occur before or during or immediately after birth whiles the infants brain is under development.

So let’s look forward how a brain injury hampers or affects the child’s motor functioning and intellectual abilities which is highly dependent on the nature of brain injury, where the damage occurs and many more.

Now a question arises in our mind then;

What are a brain injury, birth injury and brain malfunction?

During the development of the brain or during the birth or after birth the brain injury or brain malformation that occurs points to the main cause of the cerebral palsy. Due to brain damage during brain development, as a result child’s muscle control, muscle co-ordination, muscle tone and reflex posture is affected and hampered. It also hampers child’s motor skills, gross motor skills and oral motor functioning.

Cerebral Palsy is unique to the individual. So the reasons behind the causes the cerebral palsy is:

• · Prenatal disturbance of brain cell migration: Several factors in genetic and environmental factors prevent the brain cells migration to appropriate location for brain development.
•     Prenatal poor myelination of developing the nerve cell fibres: Poor myelin impedes the brain function that forms a protective covering over the nerve fibre that aids in transmission.
•    Perinatal Brain cell death: Events in the birthing processes that ruptures the blood vessels or starve oxygen to the brain.
•    Inappropriate connections between brain cells:  Trauma, asphyxia or any other infections that damage connections developed in the brain.

Cerebral palsy Primary terminology causes:

Brain Development: It shortly occurs after the occurrence of conception, a rapid cell division or cell proliferation takes place from a small group of cells. The tissue strip rolls into the neutral tube, where one end develops in the brain and the other in the spinal cord. The cells form cluster and group and reaches different regions of the brain.  The brain is considered to be fully developed three to five years after birth.

Brain Defects: Irregularities in brain structure typically cause impairment. Defects occur due to several injuries, malformation or any kind of damage. Degree of impairment is very often linked to the severity of damage. Sometimes compensation may occur to bypass the damage areas by the brain. So for this cause early and initial treatment is very necessary.

Brain malformations: It is mainly caused due to abnormal development of the brain. Defects can occur at any time during foetal development specially the first twenty weeks which is mostly vulnerable. Any kind of malformation that occurs during the neural tube can have very serious and permanent consequences. Brain malformation results in several underdeveloped areas, abnormal growth or improper brain division into hemispheres and lobes.

Brain Lesions: Those are defects that occur generally from an injury or disease. It causes several problems during foetal development can include bleeding in brain, infections, asphyxia and many others.  Lesions typically result from an accident or event that causes brain tissue damage and death. 

Cerebral palsy Management and Treatment:

• The main goals of treatment of Cerebral palsy include:
• Enhance or optimize the mobility.
• Try to manage the primary conditions.
•  Control pain
•   Prevent and try to manage the complications, associative conditions and co mitigating factors.
•  Increase social and peer interactions.
•  Provide self-care.
• Increase ability to communicate.
•  Maximize learning potentials.
• Try to offer quality life.

Comprehensive Treatment Plan: The primary condition is referred as the child’s impairment according to the comprehensive treatment plan. It may involve certain challenges like improper muscle tone, unconditional reflexes, posture difficulties, balance problem and other motor nerve functionalities. These conditions can, in turn, create secondary conditions that also require treatment.  But in some cases it’s found that cerebral palsy is complicated, that is it is not caused by brain injury or brain malformation. But it also requires a simultaneous separate treatment. For example, child’s Cerebral Palsy may create certain problems with facial coordination and control which may be considered as primary condition. While the secondary conditions are considered due to the lack in facial muscle control, the child may find it difficult to chew, swallow, or communicate

Numerous medications have been suggested to reduce the difficulties associated with cerebral Palsy. These drugs mainly aim towards spasticity, dystonia, myoclonus, chorea, and athetosis. For example, a drug named baclofen administered either orally or intrathecally is often used for treating.

1.       Botulinum toxin with or without casting: Abobotulinum toxin A (Dysport) is the first botulin toxin to gain FDA approval for the treatment of lower limb spasticity in children aged 2-17 years. Approval was based on a randomized, multicentre, double-blind, placebo-controlled, international Phase III study in 235 paediatric patients aged 2 to 17 years with lower limb spasticity due to cerebral palsy causing dynamic foot deformity. Patients treated with abobotulinum toxin a showed statistically significant improvement in efficacy assessments.

2.       Phenol Intramuscular Neurolysis: Phenol intramuscular neurolysis has been considered another formulation for the medication purpose. For the treatment of large muscles the following neurolysis is performed but phenol therapy is difficult to administer. It is difficult because it is administered along with a nerve stimulator and the method of treatment is really painful.

3.       Anti-parkinsonian, anticonvulsant, anti-dopaminergic, and antidepressant agents: Although anti-parkinsonian drugs (e.g., anticholinergic and dopaminergic drugs) and anti-spasticity agents (e.g., baclofen) have primarily been used in the management of dystonia, anticonvulsants, anti-dopaminergic drugs, and antidepressants have also been tried. The benzodiazepines such as diazepam, valproic acid, and barbiturates listed among the anticonvulsant drugs have been useful in the management of myoclonus or palsy. Therefore drugs like benzodiazepines, neuroleptics, and anti-parkinsonian drugs (e.g., levodopa) have been tried. Benzodiazepines and baclofen are commonly used to manage spastic.

Through MRI’s and CT scan report the initial and primary treatment should be done. Together this will help the doctors to treat the brain damage and diagnose the cerebral palsy. Treatment therapy and care plans are then made to help a child reach the future potential and safe treatment.