From the Guidelines
Cerebral palsy can occur as early as the first trimester of pregnancy, and in some cases, it can be diagnosed before 6 months' corrected age. This condition results from damage to or abnormal development of the parts of the brain that control movement, balance, and posture, which can be caused by various factors such as maternal infections, fetal stroke, oxygen deprivation during birth, brain hemorrhages, severe jaundice, or head injuries in early infancy 1. The damage can occur during fetal development, childbirth, or within the first few years of life, generally before age three when brain development is most rapid.
Key Factors in Cerebral Palsy Development
- Maternal infections
- Fetal stroke
- Oxygen deprivation during birth
- Brain hemorrhages
- Severe jaundice
- Head injuries in early infancy
According to recent studies, early diagnosis of cerebral palsy is now possible, and it can be accurately predicted before age 6 months' corrected age using a combination of standardized tools such as neonatal magnetic resonance imaging (MRI), the Prechtl Qualitative Assessment of General Movements (GMs), and the Hammersmith Infant Neurological Examination (HINE) 1. The use of these tools, coupled with clinical reasoning, can provide an accurate diagnosis of cerebral palsy or high risk of cerebral palsy, allowing for early intervention and optimization of infant neuroplasticity.
Diagnostic Tools for Cerebral Palsy
- Neonatal magnetic resonance imaging (MRI)
- Prechtl Qualitative Assessment of General Movements (GMs)
- Hammersmith Infant Neurological Examination (HINE)
- Developmental Assessment of Young Children
Early signs of cerebral palsy may include delayed motor milestones, abnormal muscle tone, or unusual postures, and while the condition is non-progressive, meaning the brain damage doesn't worsen over time, symptoms may change as the child grows 1. It is essential to recognize the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
From the Research
Cerebral Palsy Onset
- Cerebral palsy (CP) can occur due to disturbances in the fetal or infant brain, with most lesions underlying CP occurring in the second half of gestation 2.
- The initial injury to the brain in most cases of CP occurs during early fetal brain development, with prematurity and low birthweight being important risk factors for CP 3.
- CP can be diagnosed early based on a combination of clinical history, standardized neuromotor assessment, and findings on magnetic resonance imaging (MRI), although it is more reliably recognized by 2 years of age 3.
Timing of Cerebral Palsy Diagnosis
- Early diagnosis of CP is possible, but the best early diagnostics and intervention methods may differ for various subgroups of children with CP 2.
- The predictive value of neuromotor and neurological exams, neuroimaging techniques, and neurophysiological assessments can be used to predict CP, with the best prediction achieved when complementary techniques are used in longitudinal series 2.
- In infants admitted to neonatal intensive care, the best prediction of CP is achieved with the combination of neuroimaging and the assessment of general movements, while in other infants, best prediction is based on carefully documented milestones and neurological assessment 2.
Factors Influencing Cerebral Palsy Onset
- Multiple factors have been associated with an increased risk for CP, including maternal infections, multiple gestation, and intracerebral hemorrhage and periventricular leukomalacia in preterm infants 3.
- The movement disorders associated with CP can result in secondary problems, including hip pain or dislocation, balance problems, hand dysfunction, and equinus deformity 4.
- The diagnosis and management of CP require a multidisciplinary team approach, with treatments including intramuscular onabotulinumtoxinA, systemic and intrathecal muscle relaxants, selective dorsal rhizotomy, and physical and occupational therapies 4, 5, 6.