Spastic diplegia cerebral palsy

Alternate names

Cerebral palsy spastic diplegic

Definition

Spastic diplegia cerebral palsy is a form of cerebral palsy, a neurological condition that usually appears in infancy or early childhood, and permanently affects muscle control and coordination.

Cause

• Spastic diplegia cerebral palsy occurs when the portion of the brain that controls movement is damaged or develops abnormally.
• This usually occurs before birth, but can happen at any time while the brain is still developing (usually before age 2).
• In many cases, the exact underlying cause is unknown; however, the condition has been associated with genetic abnormalities; congenital brain malformations; maternal infections or fevers; injury before, during or shortly after birth; problems with blood flow to the brain; and severe lack of oxygen to the brain.

Risk factors

The following medical conditions or events may increase the risk for a child to be born with or develop cerebral palsy:

• Premature birth
• Low birth weight (less than 5 and a half pounds)
• Mothers with infections or high fevers during pregnancy
• Multiple births (twins, triplets and other multiples)
• Rh incompatibility (blood type incompatibility between mother and child)
• Mothers with thyroid abnormalities, intellectual disability, excess protein in the urine, or seizures
• Breech presentation
• Complicated labor and delivery
• Low Apgar score
• Newborn jaundice

Inheritance

• Scientists have found that family members of people with cerebral palsy, including spastic diplegia cerebral palsy, have an increased risk of developing the condition.
• The exact risk depends on the how closely the family members are related:
• A child with a sibling (brother, sister) or parent with cerebral palsy would have a six- to nine-fold increased risk of developing the condition (actual risk: 1 to 1.5%)
• A child with a half sibling with cerebral palsy would have up to a three-fold risk of developing the condition (actual risk: less than 1%)
• A child with a first cousin with cerebral palsy would have a 1.5-fold increased risk of developing the condition (actual risk: less than 1%)
• This and other studies suggest that there may be a genetic component in some cases of cerebral palsy.
• However, the inheritance is likely multifactorial which means the condition is caused by multiple genes interacting with each other and with environmental factors.

Signs and symptoms

• The symptoms and severity of spastic diplegia cerebral palsy vary significantly from person to person.
• It is a form of cerebral palsy, a neurological condition that usually appears in infancy or early childhood and permanently affects muscle control and coordination.
• Spastic diplegia affects the legs and arms, making them stiff and contracted (spastic).
• The legs are generally affected more than the arms.
• In fact, the upper extremities of the body are usually able to retain good range of motion and muscle tone.
• Yet, both upper and lower limbs can equally be affected in some cases, depending on severe the spastic diplegia is.
• This makes crawling and walking difficult and most often, children will walk with a wide “scissor gate.”
• Legs can also turn inwards and cross at the knees due to excessive muscle contractions.
• Other children may not be able to walk at all.
• Some children with spastic diplegia will also have some form of cognitive impairment, which can range in severity.

Other symptoms of diplegic cerebral palsy include:

• Delayed motor or movement milestones (i.e. rolling over, sitting, standing)
• Walking on toes
• Flexed knees
• Fatigue
• Strabismus (crossed eyes)
• Fatigue
• Seizures
• Coordination and balance issues

Diagnosis

A diagnosis of spastic diplegia cerebral palsy is based on the presence of characteristic signs and symptoms. However, the following tests may be recommended to rule out other conditions that cause similar features.

• Blood tests
• CT scan of the head
• MRI scan of the head
• Electroencephalogram (EEG)
• Electromyography

Treatment

• Treatment of spastic diplegia cerebral palsy varies based on the signs and symptoms present in each person and the severity of the condition.
• Affected people are often cared for by a team of healthcare providers who specialize in a variety of different medical fields (i.e. neurologists, rehabilitation physicians, social workers, physical therapists, etc).
• Orthotic devices (such as a walker, wheelchair or leg braces), physical therapy, and occupational therapy can help improve independent mobility.
• Certain medications may be prescribed to relax stiff, contracted, or overactive muscles.
• Orthopedic surgery is often recommended for severely affected people who have symptoms that make walking and moving difficult or painful.

Prognosis

• The long-term outlook (prognosis) for people with spastic diplegia cerebral palsy varies based on the signs and symptoms present in each person and the severity of the condition.
• For example, some people who are mildly affected may have no limitations on movement and be able to care for themselves independently.
• Others who are severely affected may be unable to move without assistance and require extensive care.
• Spastic diplegia cerebral palsy is a lifelong condition and long-term care from a team of medical specialists is usually required.
• Although it can be associated with a shortened lifespan, improved treatment and management options have lead to increases in survival and quality of life.

NIH genetic and rare disease info

• NIH info on Spastic diplegia cerebral palsy

Spastic diplegia cerebral palsy is a rare disease.

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