From the Guidelines
Cerebral palsy is a clinical diagnosis based on a combination of clinical and neurological signs, and early diagnosis is crucial for optimal management and outcomes, as evident from the study published in JAMA Pediatrics in 2023 1. The diagnosis of cerebral palsy typically occurs between age 12 and 24 months, but with advances in diagnosis and treatment, it can now be made before 6 months' corrected age 1. The condition is characterized by a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain 1. The following key points are essential in the diagnosis and management of cerebral palsy:
- Early diagnosis is possible using clinical reasoning and a combination of standardized tools, such as the Prechtl Qualitative Assessment of General Movements and the Hammersmith Infant Neurological Examination 1.
- The diagnostic yield of exome sequencing in cerebral palsy is around 31.1%, with higher yields in pediatric populations and studies that use exclusion criteria for patient selection 1.
- Comorbidities and functional limitations are common and disabling, including chronic pain, epilepsy, intellectual disability, musculoskeletal problems, behavioral disorders, sleep disorders, functional blindness, and hearing impairment 1.
- Early intervention is recommended to optimize infant neuroplasticity, prevent complications, and enhance parent and caregiver well-being, and should be the standard of care for individuals with cerebral palsy 1.
From the Research
Treatment Options for Cell Palsy
- The treatment of spasticity in children with cerebral palsy involves a range of options, including pharmacological and non-pharmacological approaches 2.
- Common medications used to treat spasticity include benzodiazepines, dantrolene sodium, baclofen, tizanidine, botulinum toxins, phenol, and alcohol 2.
- Botulinum toxin A is a recommended treatment for spasticity in children with cerebral palsy, with sufficient evidence to support its effectiveness 2, 3, 4.
- Intrathecal baclofen is also used to treat generalized spasticity, while chemodenervation agents such as botulinum toxins, phenol, and alcohol are used to treat localized spasticity 2, 3, 5.
Interventional Approaches
- Interventional therapy, including injection and surgical approaches, is used to treat chronic pain in cerebral palsy 3.
- Botulinum toxin A injections and intrathecal baclofen are used to control chronic pain and improve comfort and quality of life 3.
- Surgical intervention, such as selective dorsal rhizotomy, may increase range of motion and quality of life, and reduce spasticity and pain, but more research is required to support its effectiveness 3.
Physical and Occupational Therapy
- Physical and occupational therapy are important components of the treatment of spasticity in children with cerebral palsy 2, 4, 6.
- These therapies can be used in combination with other treatments, such as botulinum toxin A and intrathecal baclofen, to improve functional outcomes 4, 6.
- Strength training is also an important aspect of physical therapy, as it can help to address muscle weakness associated with spasticity 6.