From the Guidelines
Trauma to an immature brain can be considered traumatic brain injury (TBI) if there is a clear traumatic event causing acute brain injury with subsequent neurological deficits, whereas cerebral palsy (CP) is diagnosed when brain damage occurs during the developmental period and results in permanent motor impairments. The distinction between TBI and CP is crucial, as it affects treatment approaches and outcomes. TBI management focuses on preventing secondary injury and rehabilitation, while CP management centers on optimizing function with the permanent condition 1.
Key Considerations
- TBI refers to brain damage resulting from an external physical force after birth, such as a fall, car accident, or sports injury 1.
- CP refers to a group of permanent movement disorders caused by abnormal brain development or damage occurring before, during, or shortly after birth (typically within the first 2-3 years of life) 1.
- The timing and cause of the injury are essential in distinguishing between TBI and CP 1.
- Severe head trauma in very young children (under 2-3 years) may be classified as causing CP rather than TBI if it occurs during the critical developmental period and results in permanent motor disorders characteristic of CP 1.
Diagnostic Approaches
- A combination of standardized tools, such as magnetic resonance imaging, the Prechtl Qualitative Assessment of General Movements, and the Hammersmith Infant Neurological Examination, can be used to predict the risk of CP in infants 1.
- Clinical signs and symptoms of CP emerge and evolve before age 2 years, and a medical history, neuroimaging, and standardized neurological and motor assessments can indicate congruent abnormal findings indicative of CP 1.
Treatment Implications
- TBI management focuses on preventing secondary injury and rehabilitation, while CP management centers on optimizing function with the permanent condition 1.
- Early diagnosis and intervention are critical in optimizing infant motor and cognitive plasticity, preventing secondary complications, and enhancing caregiver well-being 1.
From the Research
Traumatic Brain Injury vs Cerebral Palsy
- Trauma to an immature brain can be considered a traumatic brain injury (TBI) if it results from a non-degenerative, acquired brain insult, such as a blow or penetrating trauma to the head, disrupting normal brain function 2.
- The distinction between TBI and cerebral palsy is crucial, as TBI can occur during the early stages of development, and deficits may not immediately become apparent but unfold and evolve over time 2.
- Cerebral palsy, on the other hand, is a group of permanent disorders that appear in early childhood, characterized by developmental delays, impaired muscle tone, and coordination 3.
Diagnostic Considerations
- Pediatric TBI can have direct, immediately observable neurologic, cognitive, and behavioral consequences, as well as disrupt subsequent brain development, leading to long-term outcomes that are a combination of preinjury development and abilities, consequences of brain injury, and delayed impaired development of skills that were immature at the time of injury 3.
- Abusive head trauma (AHT) is a form of severe TBI that occurs in very young children, usually associated with delay before appropriate care is sought, and outcomes are systematically worse following AHT than following accidental TBI 3.
Treatment and Management
- Seizure prophylaxis is a critical aspect of TBI management, and levetiracetam and phenytoin are commonly used antiepileptic drugs for this purpose 4, 5, 6.
- Studies have shown that levetiracetam and phenytoin are equivocal in the prevention of post-TBI seizure prophylaxis, with no significant difference in neurobehavioral side effects between the two medications 5, 6.