Cerebral Palsy and Spasticity
What is spastic cerebral palsy?
Cerebral palsy (CP) is a neurological disorder that affects movement, muscle tone or posture and is caused by damage to the motor control centers of the developing brain. It can occur during pregnancy, during childbirth or after birth up to about the age of 3 years. CP affects approximately one in 500 live births, and spastic cerebral palsy is the most common type.
Spasticity is an abnormal imbalance between excitatory and inhibitory neurotransmitters which send signals to muscles. This imbalance results in increased muscle rigidity and tone, especially in the legs of a child with spastic diplegia, or on one entire side of the body in a child with spastic hemiplegia.
Spastic diplegia involves muscle stiffness predominantly in the legs and less severely in the arms and face, although the hands may be clumsy. Toes point up when the bottom of the foot is stimulated. Tightness in certain leg muscles can make the legs move like scissors. Children with spastic diplegia may require a walker or leg braces. Intellect and language skills are usually normal.
Spastic hemiplegia affects the arm, hand and leg on one side of the body. Children with spastic hemiplegia generally walk later in development and on their tiptoes because of tight heel tendons. The arm and leg of the affected side are frequently shorter and thinner.
The natural history of spastic diplegia or spastic hemiplegia without treatment is progressively poor quality of life because these children cannot walk. They are at risk for pressure ulcers from prolonged sitting and often suffer from emotional and psychiatric problems because of their inability to move.
The cause of spastic cerebral palsy is unknown, but spastic diplegia has been associated with prematurity, low birth weight and periventricular leukomalacia, a disease that is caused by a lack of oxygen or blood flow to the periventricular area (white matter) of the brain.
Watch Dr. Manish Shah’s online presentation on Spastic Cerebral Palsy to learn more about symptoms, diagnosis and the latest treatment options available for this condition at Children's Memorial Hermann Hospital.
How is spastic cerebral palsy diagnosed?
Children with spastic cerebral palsy often walk on their tiptoes and have trouble relaxing the muscles of their legs to have a normal gait. A pediatrician or neurologist can evaluate your child for increased rigidity and tone of the lower extremities. Your physician may order an MRI of the brain which may show periventricular leukomalacia.
How is spastic cerebral palsy treated?
Even though CP cannot be cured, treatment often improves a child’s capabilities. Many children go on to enjoy near-normal adult lives if their condition is properly managed. Physical therapy, occupational therapy, therapeutic recreation and speech and language therapy provide significant benefits. The earlier treatment begins, the better the chance a child has of overcoming developmental disabilities or learning new ways to accomplish challenging tasks.
For cases of severe spasticity, selective dorsal rhizotomy (SDR) is a surgical procedure recommended when more conservative treatments – physical therapy, oral medications and drug infusion – have failed to reduce spasticity. A neurosurgeon locates and selectively severs overactivated nerves at the base of the spinal column. The procedure is most commonly used to relax muscles and decrease chronic rigidity in one or both of the lower or upper limbs.
Benefits of SDR include immediate reduction of spasticity in patients ages 2 to 40 with spastic diplegia or spastic hemiplegia and reduced risk of spinal deformities in later years. Potential side effects include sensory loss, numbness or uncomfortable sensations in limb areas once supplied by the severed nerve. A large surgical case series (approximately 2,700 cases) showed a minimal risk of a cerebrospinal fluid leak or need for surgical fusion.
At the Texas Comprehensive Spasticity Center, our affiliated physicians collaborate to provide personalized care for each patient, choosing the best treatment for each individual. The comprehensive team consists of a pediatric neurologist who specializes in movement disorders, three pediatric neurosurgeons, pediatric orthopedists and a pediatric physical medicine and rehabilitation specialist, plus physical and occupational therapists, a clinical trial program manager and physician assistants and medical assistants who coordinate care. This multidisciplinary approach ensures the most comprehensive specialized treatment for each patient, beginning with evaluation – observation, videos and medical tests – and continuing through treatment and therapy. To learn more about the Texas Comprehensive Spasticity Center, click here ».
Aubree was diagnosed as a baby with spastic triplegic cerebral palsy. In her case, both her legs and her left arm had spasticity – a condition that made her affected limbs rigid and stiff. Because of the spasticity, Aubree has had physical therapy since she was a baby to help manage it. She has needed assistance to help with her mobility and has used a pediatric walker since she was 4. “Walking on my own has always been my goal,” Aubree says. “Now, because I don’t have the spasticity, I have a much greater chance of that happening.”
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Born seven weeks early, Darius suffered an intraventricular hemorrhage in the first few days of life – a common occurrence with premature birth. The hemorrhage left him with a single significant deficit: spasticity in the lower limbs.
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For additional information on spastic cerebral palsy, visit the Centers for Disease Control and Prevention page here or the National Institute of Neurological Disorders and Stroke page here »
This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at McGovern Medical School at UTHealth and is presented to inform you about spastic cerebral palsy. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about treatment. If you have any questions about the information above or your child's care, please contact a doctor affiliated with Children’s Memorial Hermann Hospital.