Cerebral Palsy 

Cerebral Palsy is a neuromuscular disability resulting from damage to the central nervous system. This damage can occur in pregnancy or infancy, but usually takes place before, during, or shortly after birth. The primary effect of cerebral palsy is an inability to control motor function, particularly muscle control and coordination. These effects can range from mild to more severe. While cerebral palsy is not "curable," various treatments, services, and supports can help children and adults with cerebral palsy achieve their maximum potential for participation in home, school, work, and community activities. (from NY State UCPA Website)

Quite often, people with CP also have other medical conditions that can cause disability. However, it is very important to emphasize that many people with CP have no other medical condition at all. Some of the most common conditions accompanying CP are seizure disorders (also called epilepsy), school and learning difficulties, and speech difficulties. Each of these conditions may require different kinds of services, and so here we provide links to websites that address these conditions.

The prevalence of cerebral palsy (prevalence is the count of all cerebral palsy cases in a population) is not so different around the world. In most places, there are approximately 1.5 - 2 cases of cerebral palsy per 1000 live births. The prevalence has not changed in more than 4 decades, despite significant advances in the medical care of newborns. The percentage of boys with CP is a little higher than girls with CP. 

For more information about CP, “Cerebral palsy: what parents and doctors want to know”   by Peter Rosenbaum, professor of Paediatrics 

New Definition and Classification of Cerebral Palsy

In July 2004, experts on cerebral palsy and brain injury from North America, Europe and Australia gathered together in Bethesda, Maryland for a workshop on CP.

Dr Nigel Paneth, who created the CPON network at MSU, was a member of the five-person executive committee that organized this workshop. Doctors and researchers hoped to create an updated definition that fit better with new understanding of CP from recent research, including development of the Gross Motor Function Classification Scale, and from pictures of brain injury using magnetic resonance imaging (MRI).

Workshop participants also discussed the best way to classify cerebral palsy into different types. Types of CP are usually grouped according to which limbs are affected; how tone, balance and coordination are affected; and sometimes the presence of other conditions associated with CP. But since everyone with CP experiences it differently, and we don't have a good understanding of causes of CP, it isn't surprising that there's no agreement yet on one system to classify types of CP! One classification system for all doctors and researchers to use around the world will someday make it much easier to compare studies of people with CP, and learn more accurately about causes and treatments.

Dr Paneth was one of the authors of the proposed new definition of CP, and senior author of the section on classification, both published in the August issue of Developmental Medicine and Child Neurology. A summary of the article can be found here.

We hope this article helps those working with CP or affected by CP to think about the best ways to describe different types of CP.

* This workshop was sponsored by the Castang Foundation, UCP Research and Educational Foundation, and the National Institute of Neurological Disorders and Stroke.

Causes of CP 

Studies that try to find out what causes CP usually start by looking for risk factors. Risk factors are things that happened before CP started, and that might be causes of CP because they occurred more often to people with CP than to people without CP. For example, it has been thought for a long time that difficult births might be a cause of CP, as they are seen more often in the histories of people with CP than in people without (though lots of people with CP have had completely normal births, and lots of people without CP have had difficult births).

There is a big difference between finding a risk factor and being sure that it is a cause of CP. For example, there are now studies that suggest that difficult births in CP are really due to earlier problems in pregnancy, and that these problems led both to the difficult birth and to the CP. So the difficult birth, at least in some cases, may not be the real cause of CP.

In this section, we review the latest studies on risk factors for CP. It is important to keep in mind that not every risk factor is a cause. And even when we find causes for CP, we do not necessarily have a way of dealing with the cause. Parents will sometimes say, when they learn that something is a risk factor for CP, “I should have done something differently” or “I shouldn’t have eaten that food when I was pregnant” or “I should have had my baby in a different hospital” . This kind of thinking can cause a great deal of unnecessary distress to parents. At the present time, there are very few things we know of that parents could have done differently that would have prevented CP from occurring to their children.

As you read about these studies, you will see there is no complete answer to what causes CP. The studies are steps on the way to learning more about the causes of CP. 

Literature Review Summaries 

In this section you will find information regarding new learning about cerebral palsy with emphasis on causation. A brief summary of a particular area of research will be provided and in some cases linked to more in depth reviews.

Cerebral Palsy in twins
Vanishing Twin: A possible cause of Cerebral Palsy?
Does Magnesium Sulfate in Pregnancy prevent CP? by Dr. Nigel Paneth, M.D., M.S.
Obstetrician-Gynecologists and Pediatricians say most newborn brain injuries do not occur during childbirth
Brain Imaging in Cerebral Palsy by Steven J. Korzeniewski 

Treatment Overviews 

Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group.
Collet JP, Vanasse M, Marois P, Amar M, Goldberg J, Lambert J, Lassonde M, Hardy P, Fortin J, Tremblay SD, Montgomery D, Lacroix J, Robinson A, Majnemer A.

Review by David Weismantel, MD, Michigan State University family practice physician, CPON Co-Investigator.

Botulinum Toxin Improves Walking Patterns In Children With Cerebral Palsy
Randomized double-blind placebo-controlled trial of the effect of botulinum toxin on walking in cerebral palsy. Ubhi T, Bhakta BB, Ives HL, Allgar V, Roussounis SH. Arch Dis Child 2000; 83(6):481-7.

Review by David Weismantel, MD, Michigan State University family practice physician, CPON Co-Investigator. 

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