Noor Chowdhary
Riya Kumar
Maihan Sediqi
Amisha Reddy
Sarone Kelete
Sam Wang
Edited By Michelle To
Introduction
Cerebral palsy, abbreviated as CP, is a collection of disorders that impair movement, balance, and posture (CDC, 2021). CP’s symptoms show up after 2-3 years of a child's life. For babies, the first symptoms of CP can just be delays in reaching certain growth milestones, such as not being able to walk by a particular age. These lead to kids having less limb control and impaired movement, such as having muscle spasms, fidgets, jerks, or tremors (NHS, 2021).
As a result, movement impairments can impede a child’s regular behavioral development (Mayo Clinic, 2021). A child’s sloppy or stiff movement in one limb can lead them to need to walk on their tip toes, or make it hard for them to feed themselves, which leads to drooling. Moreover, muscle impairment can lead to difficulty speaking, insomnia, or gastro-oesophageal reflux disease (GORD). GORD is when acid from the stomach leaks up into the esophagus (a tube connecting your mouth to your stomach). Other symptoms include having an abnormally shaped spine, hips that dislocate easily, hearing loss, or eye problems, such as reduced vision, squinting often, or inability to control where one's eye moves.
In the end, muscle impairments lead to making it difficult for patients to look and behave “normally,” making it difficult for a child to socialize properly and lead a productive life.
Causes
Causes of CP include difficulties during essential stages of pregnancy, such as the mother’s health and the baby’s brain development. Infections (e.g. bacterial meningitis, viral encephalitis, and jaundice) and lack of blood flow (e.g. injuries, strokes, and blood clots) are environmental factors that can impair a fetus’ brain (NIH, 2013). If the mother is exposed to certain toxins or viruses (e.g. cytomegalovirus, rubella, herpes, syphilis, toxoplasmosis, or the Zika virus), these external factors could also result in CP.
Genetics, such as mutations in the genes FBXO31 and RHOB, also contribute to the development of CP. The RHOB gene is known to control dendritic spine outgrowth, and FBXO31 plays a critical role in axonal and dendrite outgrowth and neuronal migration during development. Dendritic spines and axons are parts of the neuron that receive signals from other neurons, and they help signal other neurons and muscle cells. As a result, mutations in nerve cells’ abilities to communicate with muscle cells can lead to lack of motor control.
Diagnoses
Tests for CP can begin as early as genetic tests at the neonatal stage (first 4 weeks of pregnancy). In the first 5 minutes after birth, doctors use the Apgar test to score (from 0 to 2) on a baby’s skin, muscle tone, heart rate, reflexes, and breathing (NYU Langone Health). A low score indicates likely brain oxygen deprivation and neurological disorders which can lead to CP.
If CP is suspected, doctors use scans (MRIs, cranial ultrasounds, and CT scans) and laboratory tests (blood, urine, and skin) to detect lesions, injuries, or other abnormalities that cause CP. Once fairly certain, doctors will use genetic testing to confirm CP, and subsequent tests like electroencephalograms (EEGs) are used to identify whether epilepsy may be an issue in tandem with CP.
Medical Treatments
Treatment methods for CP consist primarily of two major categories: medication and therapy. These treatments target muscles affected by CP, usually loosening the muscle for stiffness and stiffening it for spasms. For medication, there are either injections or oral medicine. To loosen up the muscle, injections such as onabotulinum toxin A, or "Botox," can help a patient for up to 3 months per visit. Oral medicine (e.g. baclofen, tizanidine (Zanaflex), and dantrolene (Dantrium)) are less expensive to treat spasms but need to be taken daily.
Therapy is another alternative method to treating CP, which helps patients gain better motor control and strength through exercise. This includes regular physical therapy, speech or language therapy, and recreational therapy. A final alternative treatment for CP to both medication and therapy is surgery, which can lengthen or shorten specific muscles and tendons or even cut nerve fibers to prevent spastic muscle contractions.
Current Research
Prediction research includes advancing imaging techniques and genetic research. If a baby has a stroke while in the womb (perinatal stroke), scientists have been experimenting with systemic hypothermia, which essentially tries to “freeze” dying neurons to help restore oxygen flow to the baby’s brain.
For treating CP, CIT (constraint-induced therapy) is a therapy used for both CP and stroke patients, particularly with patients that can control only one side of their body. CIT trains a patient to use the defective side instead to be able to use both sides of their body. One way a person may obtain CP is because of a genetic defect.
Current research is still in its developmental phase, and few are actually clinical trials. Evan Snyder successfully injected stem cells in mice's brains to combat effects of perinatal strokes, but researchers are uncertain if the same results could be replicated with humans. Moreover, research has yet to find a successful method to initiate healing of damaged cells, which could cure CP (Cerebral Palsy Organization).
Research in the nervous system thus points to better prediction methods (e.g. imaging techniques and genetic tests) as well as treatments that stimulate neuron growth.
Work Cited
Cerebral Palsy (CP). (2021). CDC. Retrieved October 9, 2021, from https://www.cdc.gov/ncbddd/cp/causes.html
Cerebral Palsy. (2021). Mayo Clinic. Retrieved October 9, 2021, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
Cerebral Palsy. (2021). Mayo Foundation for Medical Education and Research. Retrieved October 9, 2021, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005.
Cerebral Palsy: Hope through research. National Institute of Neurological Disorders and Stroke. (2013). National Institutes of Health. Retrieved October 9, 2021, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research.
Cerebral Palsy Symptoms. (2020). NSH Health Care. Retrieved October 9, 2021, from https://www.nhs.uk/conditions/cerebral-palsy/symptoms/
Diagnosing cerebral palsy in Children. (n.d.).NYU Langone Health. Retrieved October 9, 2021, from https://nyulangone.org/conditions/cerebral-palsy-in-children/diagnosis
Research: Cerebral Palsy. (n.d.). Cerebral Palsy Organization. Retrieved October 9, 2021, from https://www.cerebralpalsy.org/about-cerebral-palsy/research.
