Cerebral Palsy and Spasticity

Cerebral Palsy

Signs and Symptoms
Diagnosis
Treatment

Signs and Symptoms

Cerebral palsy is caused by the abnormal development of areas of the brain that control movement and posture or damage to those areas caused by head injury or disease, such as rubella, bacterial meningitis or viral encephalitis. Only 10 percent to 20 percent of cerebral palsy is acquired after birth. There are four general types of cerebral palsy:

• Spastic Cerebral Palsy -- This type causes muscles to be stiff and permanently contracted. Your child's legs may turn in at the knees. Walking is difficult. Your child also may have uncontrollable shaking or tremors on one side of the body. This form of cerebral palsy affects about 70 percent to 80 percent of patients.

• Athetoid, or Dyskinetic, Cerebral Palsy -- Characterized by uncontrolled, slow, writhing of the hands, feet, arms, legs or facial muscles. Children may frown or drool. Movements may get worse during periods of stress and go away while the child sleeps. Speaking also may be difficult. This form strikes about 10 percent to 20 percent of patients.

• Ataxic Cerebral Palsy -- This form affects depth perception, balance and coordination. Children may walk with their feet far apart and may have difficulty doing precise tasks such as picking up an object or slipping a button into a buttonhole. This form affects about 5 percent to 10 percent of patients.

• Mixed Forms -- Sometimes mixed forms of cerebral palsy occur when children have symptoms of more than one of the three forms listed above.

Infants who are at higher risk for developing cerebral palsy are those with the following conditions:

• Breech Birth -- This occurs when during birth, a baby begins to descend the birth canal feet first instead of head first.

• Complications During Labor -- Signs during labor and delivery that a baby may have brain damage or development problems may signal a greater susceptibility to cerebral palsy later on.

• Physical Birth Defects -- Babies born with problems such as hernia, a poorly formed spine, a very small jaw bone or microephaly (a very small head) are at a higher risk for cerebral palsy.

• Low Apgar Score -- The Apgar score, a way for doctors to evaluate a newborn's condition, is often lower for babies who will show signs of cerebral palsy. The Apgar score looks at signs such as the baby's heart rate, reflexes, muscle tone, breathing and skin color, both right after birth and several minutes later.

• Multiple Births -- Babies who are born as part of twins, triplets or other multiple births have an increased risk of cerebral palsy.

• Low Birth Weight or Premature Birth -- Babies weighing less than 5 pounds, 7.5 ounces at birth or who are born less than 37 weeks into pregnancy are at greater risk for cerebral palsy.

• Seizures -- Newborns who have seizures are at greater risk for having cerebral palsy.

Infants also have a higher risk for developing cerebral palsy if their mothers have the following conditions:

• Vaginal Bleeding or Severe Proteinuria -- Mothers with vaginal bleeding after the sixth month of pregnancy and severe proteinuria, which results in excess proteins in urine, have babies with a higher risk of having cerebral palsy.

• Mental Retardation, Seizures or Hyperthyroidism -- Mothers who have any of these conditions are slightly more likely to have a child with cerebral palsy.

Even if your child has one or more of these risk factors, it doesn't mean that your child will develop cerebral palsy. Many children don't develop the disease.

Symptoms

Signs and symptoms of cerebral palsy vary from child to child. They may change over time, and may be affected by other medical conditions. Symptoms may include:

• Difficulty with fine motor tasks, such as writing, buttoning shirts and using scissors.

• Hypotonia or decreased muscle tone. Your baby may seem overly relaxed, flaccid or "floppy."

• Impaired motor development or developmental delay. Your baby may be slow to roll over, smile, sit, crawl or walk.

• Trouble maintaining balance or walking.

• Hypertonia or increased muscle tone. Your baby may seem rigid or stiff.

• Involuntary movements, such as uncontrollable writhing motion of the hands, or drooling.

• Unusual posture or a tendency to favor one side of the body.

• Earlier than usual development of hand preference, or the tendency to use either the right or left hand more often.

• Retention of Moro reflex after age 6 months. The Moro reflex occurs when a baby is held on its back and tilted with the legs above the head. The baby usually extends its arms in what looks like an embrace.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007