The majority of parents of children who develop cerebral palsy leave the hospital with an initial diagnosis of some form of brain injury, although the extent of the damage is not known. Other parents might be sent home with a vague concern about low Apgar scores and little else. Symptoms such as lack of suck and lethargy may send these parents; frustrated and worried, back to a pediatrician repeatedly. Over time, failure to meet developmental milestones leads to a diagnosis of cerebral palsy.
Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary between people. Often problems include: poor coordination, stiff muscles, weak muscles, trouble swallowing or speaking, and tremors among others. There may also be problems with sensation, vision, and hearing. Often babies with CP do not roll over, sit, crawl, or walk as early as other children their age. Difficulty with the ability to think or reason and seizures each occurs in about one third of cases. While the symptoms may get more noticeable over the first few years of life, the underlying problems do not worsen over time.
Most children with cerebral palsy are diagnosed by the age of three. A diagnosis of a movement disorder within cerebral palsy can follow the same path of frustration. Due to a number of factors, movement disorders are often times misdiagnosed.
Seizures; for example, occur in 30-50% of children with cerebral palsy. In some instances, severe movement disorders may mimic the same exaggerated muscular involvement as a seizure with similar posturing, spasticity and uncontrollable movements. An infant or a non-verbal child do not have the ability to communicate what they are experiencing or feeling during these episodes - something that makes it very hard for a health care provider to diagnose the condition.
The same spastic or uncontrollable movements may also be triggered by things such as acid reflux, ear aches, or certain medications, all of which will need to be treated and ruled out. Even an attempt by a person with cerebral palsy to control a movement may trigger the types of spasms seen in a movement disorder.
Because of these reasons, a non-verbal child with a movement disorder may go for years without a diagnosis. It is not uncommon for doctors with no experience with the needs of this population or movement disorders to misdiagnose a movement disorder as a seizure one. In severe movement disorders such as dystonia, it usually takes a neurologist or developmental pediatrician who specializes in children with cerebral palsy to achieve a diagnosis. An EEG or extended EEG with video would be helpful in reaching a movement disorder diagnosis. It might confirm or rule out seizure activity.
A Parent's To Do List for Children with Cerebral Palsy
Some different actions on the part of parents of children with cerebral palsy can help to achieve a diagnosis from a pediatrician. These actions include the following:
Some movement disorders, if left untreated, may seriously compromise a child's quality of life and have a negative impact on the child's development. Make note of as many details of the behavior as you can, such as what limbs were involved and the severity of the movements. Ask yourself if the movements were mild, extreme, or violent. Were your child's movements jerky, or did they resemble tremors? Did your child appear to experience pain with the movements? Write down anything and everything that will give as much information as possible to your child's doctor. Try to paint a picture for the doctor using words and be as descriptive as you can.
Symptoms and Signs of Movement Disorders
To gain some insight into what it is to experience a movement disorder, consider something everyone has experienced at some point, while in the twilight stages of sleep as we are falling asleep - our body twitches. Another analogy would involve spasms or muscle cramps. A number of movement disorders involve excessive muscle tone, also referred to as, 'hypertonia,' or, 'spasticity,' which may lead to spasms. Imagine your entire body or some extremity experiencing similar episodes of muscle spasms, spasticity, or involuntary movement for an extended period of time and there is nothing you can do to stop it. Symptoms and signs of movement disorders can include:
It is a common misconception and stereotype that prompts people who have no knowledge of cerebral palsy or movement disorders to associate movement disorders with learning disabilities or cognitive impairment. Depending upon the severity and nature of the cerebral injury, not all of those with movement disorders are developmentally delayed.
Forms of Movement Disorders
Movement disorders often times involve either excessive or reduced levels of muscle tone and may include a number of involuntary gross motor movements. These movements may be described by the following:
Hyperkinetic: 'Hyperkinetic,' means excessive tone and is also known as hypertonia or spasticity.
Bradykinetic: Bradykinetic indicates reduced activity or tone and is often referred to as hypotonia.
Dyskinesia: Dyskinesia involves a number of abnormal involuntary movements classified as Chorea, Tremors, Myoclonus, Ballism, Dystonias and Tics.
Clonus: Clonus is a common movement disorder associated with cerebral palsy; it involves a series of involuntary muscular contractions and relaxation of skeletal muscles.
Myoclonus: There are a number of forms of myoclonus, which is characterized by rapid muscular jerking movements and may be triggered by attempts at coordinated movement.
Dystonia: Dystonia is one condition involving movement disorders that might be associated with cerebral palsy. Dystonia is a movement disorder that causes sustained muscle contractions and may result in abnormal involuntary muscle movements in the form of repetitive, twisting or posturing movements.
Chorea: Chorea is a state of spontaneous, excessive movements that are irregularly timed, non-repetitive, randomly distributed and abrupt in character. Chorea may vary in severity from restlessness with mild intermittent exaggeration of expression and gesture, to a continuous flow of violent and disabling movements.
Medications and Treatment of Movement Disorders
Bensodiazepines are a class of medications that act upon a person's central nervous system to reduce communication between certain neurons, lowering the level of activity in the person's brain. Benzodiazepines are muscle relaxants such as baclofen, diazepam and dantrolene. They are often times the first line of treatment in managing movement disorders.
Developed in the 1980's to treat spinal cord injury and other neurological conditions involving motor neurons, spinal cord stimulation is a procedure involving the implantation of an electrode that selectively stimulates nerves at the base of the person's spinal cord to inhibit and decrease nerve activity. The effectiveness of spinal cord stimulation for the treatment of cerebral palsy has not been proven in clinical studies. It is considered only when other conservative or surgical treatments have been unsuccessful at relaxing the person's muscles, or relieving their pain.
Selective Dorsal Rhizotomy or, 'SDR,' is a surgical procedure recommended only for people with severe spasticity when all of the more conservative treatments have proven to be ineffective. In this procedure, surgeons locate and selectively sever over-activated nerves at the base of the person's spinal cord.
Intrahecal Baclofen was approved by the FDA in 1996 for treatment of cerebral palsy. The therapy is becoming the common choice of treatment in movement disorders that do not respond well to other types of treatments. This type of therapy uses an implanted pump device to deliver baclofen, a muscle relaxant, into the intrathecal space of the person's spinal cord. This type of therapy is most appropriate for children who experience chronic, severe hypertonia and uncontrolled movement disorders throughout their bodies.
Aggressive research is being conducted around the word involving the treatment and prevention of movement disorders. A lot of progress has been made and children who experience muscle spasms and dystonic posturing due to severe cerebral injury and subsequent neuromuscular involvement; for example, are benefiting.
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