Infantile Cerebral Palsy - Specialists and Information

In the 19th century, the English orthopedist and pediatrician William John Little first described infantile cerebral palsy. For this reason, medical professionals also refer to it as “Little’s disease.” Infantile cerebral palsy (ICP) refers to impaired motor function that affects the transmission of signals from the brain to the musculoskeletal system and back. The disorder results from brain damage sustained at an early stage of life.

In addition to motor impairment, other possible symptoms include:

• Epileptic seizures
• Reduced intellectual ability
• Sensory and perceptual disturbances
• Specific learning disabilities
• Hearing, vision, or speech problems

Internationally, there are 1.5 to 2.5 children with infantile cerebral palsy per 1,000 live births. Premature infants are particularly affected, as the risk increases with lower birth weight.

Infantile cerebral palsy typically leads to motor skill problems and increased muscle tone (spasticity) @ Maria Sbytova /AdobeStock

ICP can develop before birth (prenatally), during birth (perinatally), or after birth (postnatally).

There are various causes:

• Oxygen deprivation during pregnancy
• Thrombosis or embolism (in utero or during infancy)
• Premature placental abruption
• Infectious diseases in the mother during pregnancy
• Birth trauma
• In utero exposure to alcohol, drugs, medications, or carbon monoxide
• Insufficient blood supply due to placental insufficiency
• Genetic disorder
• Blood group incompatibility
• Infectious diseases in infancy
• Traumatic brain injury

However, experts can identify a clear cause of brain damage in only about half of the cases. This is often due to oxygen deprivation during the birthing process.

If a newborn scores four or fewer points on the Apgar test, there is an increased risk of infantile cerebral palsy. The Apgar test is a scoring system used to assess the condition of a newborn.

The symptoms that occur vary depending on which region of the brain is affected. 

Movement disorders are the most common. Affected children cannot control their muscles adequately. In infants, these movement disorders are usually not noticeable at first. 

A slight stiffness when the baby is lifted may be an early sign. In most cases, doctors do not recognize the condition until the babies have difficulty rolling over, crawling, or walking. 

Doctors summarize the symptoms. They can affect the entire body (tetraparesis), one side of the body (hemiparesis), or a specific body part (diparesis):

• Spastic syndromes (severe muscle spasms, involuntary movements, and symptoms of paralysis up to and including immobility due to increased muscle tone)
• Dyskinetic syndromes (involuntary and uncontrolled movements resulting from alternating muscle contraction and relaxation)
• Congenital ataxia syndromes (impaired gross motor skills, inability to perform purposeful movements)
• Hypotonia syndromes (reduced muscle tone, which can lead to epileptic seizures, tendon and muscle shortening, and deformities of bones and joints)

Children with infantile cerebral palsy are particularly prone to a shortened Achilles tendon, which results in what is known as clubfoot. 

Typical features of the condition include hips and arms that are turned inward and flexed, as well as spinal curvature. In addition, affected children may exhibit behavioral problems and reduced intellectual ability. Thirty to 50 percent of children develop symptomatic epilepsy.

By MC2 Jilleanne Buda - https://www.dvidshub.net/image/126489, Public Domain, Link

If infantile cerebral palsy (ICP) is suspected, the treating physician first rules out other conditions. The physician takes a detailed medical history regarding the pregnancy, birth, and the child’s development to date.

This is followed by a physical examination and close observation of the child. The doctor pays particular attention to the child’s posture and movement patterns. Further tests, such as a cranial ultrasound or magnetic resonance imaging (MRI), can confirm the suspicion.

There is no cure for infantile cerebral palsy. However, targeted therapies can help reduce the symptoms. 

Treatment is provided on a multidisciplinary basis and involves the following specialists in addition to the patient and their family:

• Pediatrician
• Pediatric neurologist
• Neuroorthopedists
• Orthopedic technicians
• Physical therapists 
• Occupational therapists

The following therapies are typically used:

• Vojta or Bobath physical therapy to relax the muscles and improve muscle movement
• Occupational therapy
• Speech therapy, if needed
• Possibly medication to reduce muscle tone
• Orthopedic walking aids
• Possible psychological counseling

For several years now, children who suffered from oxygen deprivation during the birthing process have been placed immediately in a cooling bed. Lowering the body temperature to around 32 degrees is intended to prevent further brain cell death (therapeutic hypothermia). Cold therapy has shown remarkable success.

Patients with infantile cerebral palsy should undergo physical therapy for the rest of their lives @ Ivan /AdobeStock

If conservative treatment methods do not yield satisfactory results or if the condition worsens, surgical intervention is necessary.

For example, doctors lengthen shortened tendons. This reduces muscle tension and increases joint mobility.

It is also possible to implant a medication pump near the spinal cord (baclofen pump). This allows the medication to act directly on the central nervous system and more effectively reduce spasticity. 

For patients who are able to walk, a surgical procedure on the back—known as selective dorsal rhizotomy—may also be an option. In this procedure, doctors selectively sever the nerve fibers that cause spastic muscle spasms in the legs.

If the child’s cognitive abilities are not impaired, there is nothing to prevent them from attending a mainstream school. Nevertheless, it is usually a lengthy process for parents. 

This is because many teachers are not trained to work with children with physical disabilities. An integration assistant can support the child in their daily school life. 

If attending a mainstream school is not an option, the child’s motor and cognitive development is of particular importance. Starting therapy as early as possible (even in infancy) has a positive impact on the child’s development in every case.