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What is cerebral palsy?
Cerebral Palsy (CP) is caused by birth injuries that affect the central nervous system, also called static encephalopathy. Less than 1% of children are born with this type of injury. Almost half the children affected by cerebral palsy develop hypertonia (excessive muscle tension) or spasticity (excessive muscle tension with increased tendon reflexes). This is usually caused by damage to the white matter of the brain. Other affected children can have mixed cerebral palsy, experiencing multiple symptoms with a spastic component. Cerebral palsy can result in irreversible damage and dysfunction of the nervous system.
Selective Dorsal Rhizotomy: Frequently Asked Questions | Dr. Shenandoah "Dody" Robinson
Johns Hopkins pediatric neurosurgeon Shenandoah “Dody” Robinson answers frequently asked questions about selective dorsal rhizotomy for patients with spasticity conditions, such as cerebral palsy. Dr. Robinson discusses the best candidates for this procedure, the best time to consider surgery and long-term results.
Causes of cerebral palsy
Many cases of CP have unknown causes. The disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. It occurs in approximately three out of every 1,000 live births.
There are several types of injuries that can impair the nervous system, including:
- Head injuries
- Central nervous system infections
- Episodes that obstruct the oxygen flow to the brain, such as near-drowning experiences
- Cerebrovascular accidents, like stroke
- Heavy metal ingestion
Symptoms of cerebral palsy
The following are the most common symptoms of CP. However, each child may experience symptoms differently. The child may have muscle weakness, poor motor control, or have shaking, also called spasticity, of the arms or legs. Muscle stiffness in the form of stiff legs or clenched fists may also be seen. Cerebral palsy is classified according to the kind of motor function the child may have, including the following:
There are three ways that spasticity, or excessive tightening of muscles, can present itself in children suffering from cerebral palsy:
- Spastic diplegia, where the lower limbs are more involved than the upper. This typically affects premature children, born before 32 weeks gestation.
- Spastic quadriplegia, where all four limbs are involved equally. This typically affects children born closer to term.
- Spastic hemiplegia, where only one side of the body is involved. This typically affects children who have a history of ventricular bleeding that reaches their brain tissue, causing injury.
Children with CP may have additional problems, including the following:
- Vision, hearing, or speech problems
- Learning disabilities and behavior problems
- Mental retardation
- Respiratory problems
- Bowel and bladder problems
- Bone abnormalities, including scoliosis (a lateral, or sideways, curvature and rotation of the back bones, giving the appearance that the person is leaning to one side)
Babies with cerebral palsy are often slow to reach developmental milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may resemble other conditions. Always consult your child's physician for a diagnosis.
Treatment for cerebral palsy
Baclofen (Liorisol®) — Baclofen is a muscle relaxant. It can be absorbed into the bloodstream when taken orally, or it can be inserted directly into the cerebrospinal fluid (CSF). This method was recently approved by the FDA, and is particularly effective because it delivers the drug directly to the target site in the spinal cord.
To deliver baclofen to the CSF, an access device must be implanted underneath the skin and fat of the abdominal wall, requiring a two inch incision above the waistline. After the device is implanted, a needle is used to place a small, flexible tube into the lower back’s spinal fluid column near the targeted muscles. A child is usually required to stay in the hospital for a few days to recover from the procedure and allow physicians to monitor their progress. The device itself is a small titanium disk, about one inch thick and three inches wide. It contains a refillable reservoir for the drug and a computer chip that regulates the dose. An alarm sounds when the device needs to be refilled, the battery is low or the pump is not delivering the drug. The pump should be refilled and medication adjusted every two to three months.
Therapeutic electrical stimulation (TES) — TES is a type of electrical stimulation used at night while patients are sleeping. It increased blood flow to weakened muscles to allow the body to deliver more growth factors and nutrients to repair damaged tissue. This process usually takes between three and six months. Children usually undergo physical therapy in conjunction with the treatment to increase muscle strength.
Selective Dorsal Rhizotomy (SDR) — Selective dorsal rhizotomy involves cutting some of the sensory nerve fibers that come from the muscles and enter the spinal cord. A five to six inch incision is made along the center of the lower back just above the waist in order to expose the nerves and locate the abnormal portions of nerve fiber that need to be cut. This allows better balance in the spinal cord and reduces spasms, but does require a commitment to physical therapy following treatment.
To request a consultation or make an appointment, please contact Johns Hopkins Pediatric Neurosurgery at 410-955-7337.
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