Cerebral palsy

Diagnosis

Signs and symptoms of cerebral palsy can become more apparent over time, so a diagnosis might not be made until a few months after birth.

If your family doctor or pediatrician suspects your child has cerebral palsy, he or she will evaluate your child's signs and symptoms, monitor growth and development, review your child's medical history, and conduct a physical exam. Your doctor might refer you to a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist, pediatric physical medicine and rehabilitation specialist, or child developmental specialist).

Your doctor might also order a series of tests to make a diagnosis and rule out other possible causes.

Brain scans

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests might include the following:

• MRI. An MRI scan uses radio waves and a magnetic field to produce detailed 3D or cross-sectional images of your child's brain. An MRI can often identify lesions or abnormalities in your child's brain.

  This test is painless, but it's noisy and can take up to an hour to complete. Your child will likely receive a sedative or light general anesthesia beforehand.

• Cranial ultrasound. This can be performed during infancy. A cranial ultrasound uses high-frequency sound waves to produce images of the brain. An ultrasound doesn't produce a detailed image, but it may be used because it's quick and inexpensive, and it can provide a valuable preliminary assessment of the brain.

Electroencephalogram (EEG)

If your child is suspected of having seizures, an EEG can evaluate the condition further. Seizures can develop in a child with epilepsy. In an EEG test, a series of electrodes are attached to your child's scalp.

The EEG records the electrical activity of your child's brain. It's common for there to be changes in normal brain wave patterns in epilepsy.

Laboratory tests

Tests on the blood, urine or skin might be used to screen for genetic or metabolic problems.

Additional tests

If your child is diagnosed with cerebral palsy, you'll likely be referred to specialists to test your child for other conditions often associated with the disorder. These tests can identify problems with:

• Vision
• Hearing
• Speech
• Intellect
• Development
• Movement

Treatment

Children and adults with cerebral palsy require long-term care with a medical care team. Besides a pediatrician or physiatrist and possibly a pediatric neurologist to oversee your child's medical care, the team might include a variety of therapists and mental health specialists.

Medications

Medications that can lessen muscle tightness might be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

Muscle or nerve injections

To treat tightening of a specific muscle, your doctor might recommend injections of onabotulinumtoxinA (Botox, Dysport) or another agent. Your child will need injections about every three months.

Side effects can include pain at the injection site and mild flu-like symptoms. Other more-serious side effects include difficulty breathing and swallowing.

Oral muscle relaxants

Drugs such as diazepam (Valium), dantrolene (Dantrium), baclofen (Gablofen, Lioresal) and tizanidine (Zanaflex) are often used to relax muscles.

Diazepam carries some dependency risk, so it's not recommended for long-term use. Side effects of these drugs include drowsiness, blood pressure changes and risk of liver damage that requires monitoring.

In some cases, baclofen is pumped into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.

Your child might also be prescribed medication to reduce drooling — possibly Botox injections into the salivary glands.

Therapies

A variety of therapies play an important role in treating cerebral palsy:

• Physical therapy. Muscle training and exercises can help your child's strength, flexibility, balance, motor development and mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child.

  For the first one to two years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

  Braces or splints might be recommended for your child to help with function, such as improved walking, and stretching stiff muscles.

• Occupational therapy. Occupational therapists work to help your child gain independence in daily activities and routines in the home, the school and the community. Adaptive equipment recommended for your child can include walkers, quadrupedal canes, seating systems or electric wheelchairs.

• Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language. They can also teach the use of communication devices, such as a computer and voice synthesizer, if communication is difficult.

  Speech therapists can also address difficulties with eating and swallowing.

• Recreational therapy. Some children benefit from regular or adaptive recreational or competitive sports activities, such as therapeutic horseback riding or skiing. This type of therapy can help improve your child's motor skills, speech and emotional well-being.

Surgical procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

• Orthopedic surgery. Children with severe contractures or deformities might need surgery on bones or joints to place their arms, hips or legs in their correct positions.

  Surgical procedures can also lengthen muscles and tendons that are shortened by contractures. These corrections can lessen pain and improve mobility. The procedures can also make it easier to use a walker, braces or crutches.

• Cutting nerve fibers (selective dorsal rhizotomy). In some severe cases, when other treatments haven't helped, surgeons might cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can cause numbness.

Alternative medicine

Some children and adolescents with cerebral palsy use some form of complementary or alternative medicine. These therapies aren't accepted clinical practice.

For example, hyperbaric oxygen therapy is widely promoted for cerebral palsy treatment despite limited evidence of benefit. Controlled clinical trials involving therapies such as hyperbaric oxygen therapy, resistance exercise training using special clothing, assisted motion completion for children and certain forms of electrical stimulation have been inconclusive or showed no benefit to date.

Stem cell therapy is being explored as a treatment approach for cerebral palsy, but research is still assessing whether it's safe and effective.

Coping and support

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

• Foster your child's independence. Encourage any effort at independence, no matter how small.
• Be an advocate for your child. You're an important part of your child's health care team. Don't be afraid to speak out on your child's behalf or to ask tough questions of your physicians, therapists and teachers.

• Find support. A circle of support can make a big difference in helping you and your family cope with cerebral palsy and its effects. As a parent, you might feel grief and guilt over your child's disability.

  Your doctor can help you locate support groups, organizations and counseling services in your community. Your child might also benefit from family support programs, school programs and counseling.

Preparing for your appointment

If your child has cerebral palsy, how you learn about your child's condition can depend on the severity of the disabilities, when signs and symptoms started, and whether there were risk factors during pregnancy or delivery.

Here's some information to help you get ready for your child's appointment with his or her doctor.

What you can do

Make a list of:

• Symptoms that concern you and when they began
• All medications, vitamins and other supplements your child takes, including doses
• Your child's medical history, including other conditions with which he or she has been diagnosed
• Questions to ask your doctor

Take a relative or friend with you, if possible, to help you remember the information you receive.

Questions to ask your doctor

• What tests will my child need?
• When will we know the results of the tests?
• What specialists will we need to see?
• How will you monitor my child's health and development?
• Can you suggest educational materials and local support services regarding cerebral palsy?
• Can my child be followed through a multidisciplinary program that addresses all of his or her needs on the same visit, such as a cerebral palsy clinic?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• What concerns do you have about your child's growth or development?
• How well does your child eat?
• How does your child respond to touch?
• Do you observe favoring of one side of the body?
• Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?