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Cerebral palsy

Cerebral palsy or CP is a group of permanent disorders associated with developmental brain injuries that occur during fetal development, birth, or shortly after birth. It is characterized by a disruption of motor skills, with symptoms such as spasticity, paralysis, or seizures. Cerebral palsy is a form of static encephalopathy. The incidence is about 1.5 to 4 per 1000 live births. One form of it, spastic diplegia, is sometimes known as Little's disease in the United Kingdom. Properly speaking, the fact that CP does not get better or worse implies that it is a 'condition' (chronic nonprogressive neurological disorder) rather than a 'disease'. more...

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There is no cure, but therapy and Conductive Education has been shown to be helpful. Conversely, gait and posture can get worse over time if left untreated. While severity varies widely, cerebral palsy ranks among the most costly congenital conditions to manage.

Cerebral palsy has been described as something of an "umbrella term" in that it refers to a group of different conditions. It has been suggested that no two people with CP will have an identical case even if they have the same diagnosis.

Cerebral palsy develops while the brain is under development. 80% of all cases occur before the baby reaches 1 month old, however this disorder can occur within about the first 5 years of life. It is a nonprogressive disorder; once damage to the brain occurs, no additional damage occurs as a result of this condition. Cerebral palsy neither improves nor worsens, though symptoms may seem to increase with time, likely due to the aging process.

History

Cerebral palsy, then known as "Cerebral Paralysis", was first identified by a British surgeon named William Little in 1860. Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 that Sigmund Freud suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development. Modern research has shown that asphyxia is not found during birth in at least 75% of cases. Such research also shows that Freud's view was correct, even though during the late 19th century and most of the 20th century Little's view was the traditional explanation. ("Conditions", 9)

Cause

Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia, hypoxia of the brain, birth trauma or premature birth, genetic susceptibility, certain infections in the mother during and before birth, central nervous system infections, trauma, and consecutive hematomas. In most people with CP, the cause is unknown. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as drowning), and encephalitis or meningitis. Despite all of these causes, the cause of many individual cases of cerebral palsy is unknown.

Recent research has demonstrated that asphyxia is not the most important cause as it was once considered to be, though it still plays a role, probably accounting for about 10 percent of all cases. The research has shown that infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder.

Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia and other injury to the brain, which in turn increases the incidence of cerebral palsy.

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Cerebral palsy not identified by fetal heart monitoring
From AORN Journal, 6/1/04

One reason the incidence of cerebral palsy in term infants has not changed since the 1960s is that fetal heart monitoring does not identify babies diagnosed with white matter brain injury after birth, according to a March 26, 2004, news release from Johns Hopkins Medicine, Baltimore. White brain matter injury can occur if a fetus does not get enough oxygen from its mother's blood. Physicians use fetal heart monitoring as the primary method of identifying babies who later may be diagnosed with brain injury.

Researchers examined a database of infants born at Johns Hopkins between June 1999 and September 2001. They found 40 babies with white brain matter injury and matched them with 40 babies who were delivered at the same gestational age (ie, between 23 and 34 weeks) in the same manner. Researchers then examined fetal heart monitoring data to determine whether there were any differences that may have foretold of impending brain injury, and they did not find any.

Fetal Heart Monitoring Ineffective at Diagnosing Cerebral Palsy (news release, Baltimore: Johns Hopkins Medicine, March 26, 2004) http://www.hopkinsmedicine.org/Press _releases/2004/O3_26_04.html. (accessed 29 March 2004).

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