From the Guidelines
Cerebral palsy may start during the prenatal, perinatal, or early postnatal stages of neural development, with most cases originating before or during birth due to brain damage as the brain is developing. The exact timing of the brain injury is critical, as the developing brain is particularly susceptible to damage, and the specific neural structures affected determine the type and severity of cerebral palsy that manifests 1. According to a study published in JAMA Pediatrics in 2017, cerebral palsy is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain 1.
Some key factors that can disrupt normal brain formation during prenatal development include:
- Maternal infections
- Placental problems
- Genetic abnormalities These factors can particularly affect the motor cortex and pathways that control movement 1.
During the perinatal period, oxygen deprivation (hypoxia-ischemia), stroke, or physical trauma can damage vulnerable developing brain tissues, leading to cerebral palsy 1. In some cases, cerebral palsy can also develop in early infancy due to severe infections like meningitis, brain injuries, or severe jaundice that leads to kernicterus 1.
It is essential to note that once the brain damage occurs, it is non-progressive, though the symptoms may change over time as the child grows and develops 1. Early diagnosis and intervention are crucial to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being 1.
From the Research
Cerebral Palsy and Neural Development
- Cerebral palsy (CP) is a group of disorders of movement and posture resulting from nonprogressive disturbances of the fetal or neonatal brain 2.
- The most prevalent pathological lesion seen in CP is periventricular white matter injury (PWMI) resulting from vulnerability of the immature oligodendrocytes (pre-OLs) before 32 weeks of gestation 2.
- More than 80% of cases of CP in term infants originate in the prenatal period; in premature infants, both prenatal or postnatal causes contribute 2.
Stage of Neural Development
- CP may start during the prenatal period, with prenatal risk factors causing non-progressive motor abnormality of tone or posture 3.
- Asphyxia around the time of birth in term infants accounts for less than 15% of CP in developed countries, but the incidence is higher in underdeveloped areas 2.
- Experimental models indicate that neurons in the neonatal brain are more likely to die by delayed apoptosis extending over days to weeks than those in the adult brain 2.
Key Findings
- The diagnosis of CP is crucial, and effective management can improve the quality of life for the child and family 4.
- Pharmacological and non-pharmacological treatments, including physical therapy, occupational therapy, orthotics, rhizotomy, and orthopedic surgery, all play important roles in the management of spasticity in children with CP 5.
- Botulinum toxin is widely prescribed for the treatment of limb spasticity in children with CP, and numerous randomized, placebo-controlled studies have shown efficacy in reducing spasticity and improving motor function 6.