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Spastic Cerebral Palsy

Cerebral palsy is an umbrella term used to classify conditions that impair motor coordination caused by brain damage. Cerebral palsy is caused by brain damage occurring before, during, or after birth. Any brain damage inflicted up until approximately the age of three can result in cerebral palsy. The part of the brain that is damaged is the determining factor on how the condition affects the patient.

A type of cerebral palsy, called spastic cerebral palsy, occurs when the brain damage occurs in the cerebral cortex, the outer layer of the brain. Spastic cerebral palsy is the most common form of cerebral palsy, affecting 70 to 80 percent of patients. Spastic cerebral palsy has varying forms depending on the areas of the body it affects, whether its one side of the body or just the legs.

Spastic cerebral palsy refers to the increased tone, or tension, in a muscle. Normal muscles work in pairs. When one group contracts the other group relaxes, allowing free movement in the desired direction. Due to complications in brain-to-nerve-to-muscle communication, the normal ebb and flow of muscle tension is disrupted. Muscles affected by spastic cerebral palsy become active together and block effective movement. This causes the muscles in spastic cerebral palsy patients to be constantly tense, or spastic. Spastic cerebral palsy patients may have mild cases that affect only a few movements, or severe cases that can affect the whole body. Although spastic cerebral palsy is not thought to be a progressive disorder, as brain damage does not get worse over time, spasticity in muscles can increase over time. This increased muscle tone and stiffness in spastic cerebral palsy can limit the range of movement in the joints. The effects of spastic cerebral palsy may increase with anxiety or exerted effort, leading to excessive fatigue.

Spastic cerebral palsy negatively affects the patient’s muscles and joints of the extremities, causing abnormal movements, and can disrupt normal growth in children. Spastic cerebral palsy can inhibit several things such as normal motions in body movement, longitudinal muscle growth, and protein synthesis in muscle cells. Spastic cerebral palsy also limits stretching of muscles in daily activities and causes the development of muscle and joint deformities. Children born with spastic cerebral palsy do not have deformities of the extremities at birth but develop them over time due to joint contractures.

Treatments for spastic cerebral palsy vary depending on the severity of the symptoms in the individual. Oral medications, such as Valium and baclofen, have been tried but the general consensus is that they do not reduce spasticity. Baclofen infusion, however, a relatively new procedure, has been slightly more effective in spastic cerebral palsy. Using a pump inserted in the abdomen, baclofen is distributed to muscles, reducing spasticity. However, when baclofen treatment is stopped, spasticity returns. Risks associated with baclofen include overdose, meningitis, and other complications, and since it is a relatively new treatment, long-term affects are currently not known.

Botox injections placed in the muscles of spastic cerebral palsy patients are also a relatively new treatment. When injected into affected muscles, botox weakens the group of muscles, reducing spasticity. Botox injections usually last 3 to 4 months and side effects appear to be minimal.

Orthopedic operations are also used for the treatment of spastic cerebral palsy. Orthopedic surgery usually involves lengthening tendons and muscle release to improve range of motion. Surgery will not reduce spasticity directly, but does reduce the consequences of it.

The treatment for spastic cerebral palsy greatly depends on the severity of the condition and prior development of the patient. Deciding on treatment for children with cerebral palsy can be difficult for parents without medical knowledge. Consulting with a treatment team including a physical therapist, pediatrician, physiatrist, neurologist and neurosurgeon, and an orthopedic surgeon will aid in the decision making process.

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