Cerebral Palsy and Spasticity

What is cerebral palsy?

Cerebral palsy (CP) is a movement and posture disorder caused by brain damage that occurs before, during, or after birth. The damage makes patients unable to control the amount of flexibility their muscles should have. The condition cannot be reversed and produces a lifelong disability predominantly characterized by muscles being too tense, or spastic. About 1 in 500 children have the neurological disorder. UTHealth Houston Neurosciences doctors have the expertise to help your family manage cerebral palsy symptoms as your child grows and develops.

What is spastic cerebral palsy?

Spastic cerebral palsy is the most common type of cerebral palsy, a neurological disorder that affects movement, muscle tone or posture and occurs in approximately one in 500 live births. Caused by damage to the motor control centers of the developing brain, cerebral palsy can occur during pregnancy or childbirth or at any time up to about the age of 3 years. Spasticity, an abnormal imbalance between excitatory and inhibitory neurotransmitters that send signals to muscles, results in increased muscle rigidity and tone. It generally impairs movement either in the legs (spastic diplegia) or one entire side of the body (spastic hemiplegia) but may also affect three limbs
(spastic triplegia) or all four limbs (spastic quadriplegia).

Causes of cerebral palsy

The brain injury that can trigger cerebral palsy can occur anytime from conception until about the third year of life. In many cases, the exact cause is unknown. Top risk factors include premature birth, low birth weight, brain trauma, or substance abuse by the mother during pregnancy. Certain viruses and infections during pregnancy, such as chicken pox, rubella, toxoplasmosis, and urinary tract infections, also are linked to the disorder. In these cases, the mother’s body may produce proteins that harm the child’s developing brain. A traumatic birth during which airflow is restricted can also put a baby at higher risk of developing cerebral palsy.

Signs of cerebral palsy

Babies with cerebral palsy are often late to reach their milestones, such as lifting their head and rolling over. Signs of spasticity aren’t always immediately apparent but develop over time. Doctors watch for a pattern of symptoms that emerges, and most diagnoses come between the ages of 1 and 3. Children with cerebral palsy typically have weakness in one or more limb, stand and walk on tiptoe, and have difficulty performing fine motor skills. They may have difficulty with balance and may drag one leg. A child may also have poor head control and rigidity throughout their muscles.

Additional issues may include scoliosis, osteopenia, seizures, and vision, speech, and hearing difficulties. Children with CP may have behavioral and intellectual problems. They might also struggle to gain weight.

Although the child’s hands may be clumsy, spastic diplegia predominantly involves muscle stiffness in both of the legs. Toes point up when the bottom of the foot is stimulated, and tightness in certain leg muscles can make the legs move like scissors.

Spastic hemiplegia affects the arm, hand and leg on one side of the body. The arm and leg of the affected side are frequently shorter and thinner. Children with spastic hemiplegia generally walk later in development and on their tiptoes because of tight heel tendons.

Spastic quadriplegia affects all four extremities with spasticity in the arms and legs. Due to the immobility and spasticity over time, children with spastic quadriplegia often require additional adaptive equipment to improve their function.

Diagnosis

The routine screenings conducted at well visits with your pediatrician may flag developmental delays. To further evaluate these delays, the doctor will examine your child’s reflexes, posture, motor skills, and muscle tone. Because many children with cerebral palsy also have intellectual disability or other delays, a pediatric neurologist should evaluate the child thoroughly. Feeding studies and a gait analysis might also be used.

A cranial ultrasound can be conducted to get a quick image of the brain, and an MRI or CT scan can provide a more detailed image. An EEG may also be used to check electrical activity in the brain. Metabolic and genetic tests may also be conducted to learn as much as possible about your child’s condition. The results will help your team at UTHealth Houston Neurosciences provide the most comprehensive treatment plan.

Treatment

Medications and injections may be effective to treat pain, lessen muscle tightness, and manage complications related to spasticity. Orthopedic surgery may be an option to improve range of motion. In some cases, surgeons may use selective dorsal rhizotomy to cut the nerves serving the spastic muscles. These types of surgeries can create other long-term issues, and your medical team at UTHealth Houston Neurosciences will discuss the pros and cons with you. Your child might benefit from speech, occupational, or physical therapy. Braces and splints may also be used.

Oral Baclofen

Oral medication requires continuous monitoring and is the least invasive treatment. This treatment option may be used to relax stiff or contracted muscles and is most appropriate for children who only need a mild reduction in muscle tone or those who have widespread spasticity.

Injectables

Administered by local injection, a neurolytic injectable relaxes contracted muscles by keeping nerve cells from overactivating them. Muscle relaxation occurs within days and peaks after a month. Because the effects of this injection last three to four months, repeated injections are required.

Intrathecal Baclofen (ITB)

An implanted programmable pump infuses baclofen directly into the patient’s spinal fluid via a catheter inserted into the spinal canal. The pump requires periodic replacement and can be removed. This treatment requires refilling the pump and frequent monitoring to ensure the appropriate dosage is dispensed; failure of the pump poses a risk of life-threatening withdrawal. ITB is usually used with patients who are spastic quadriplegics (where both arms and legs are affected) with poor trunk control, and who have severe tone that is not adequately managed with more conservative measures. It is also used for patients who have had multiple orthopedic surgeries and are and are not a candidate for other treatments.

Selective Dorsal Rhizotomy (SDR)

SDR is most effective for patients who have good trunk control, are strong underneath their spasticity, have not had multiple orthopedic procedures and are between 2 to 40 years of age. SDR can provide an immediate, permanent reduction in spasticity and the potential to walk independently within one to two years with intensive postoperative physical and occupational therapy. A young patient with a strong commitment to succeed can achieve independent walking.

This surgical procedure requires a one-level laminectomy, where the spinal canal is unroofed at one level in the mid-lower back. Next, the dorsal sensory nerve roots are exposed. They are divided into rootlets and tested one by one with around 75 percent of the most spastic rootlets cut. Overall, surgery takes about two and a half hours with five total days in the hospital, followed by six to 12 months of required intensive physical rehabilitation. Some patients may need a postoperative muscle stretching with serial casting or even a muscle/tendon release (a procedure performed by an orthopedic surgeon that lengthens the muscle or tendon so the leg or foot can straighten out properly). The postoperative mobility results can be excellent in the right patients.

Inpatient Rehabilitation

After surgery, most patients go through intensive inpatient rehabilitation to help them gain function and mobility. We work closely with TIRR Memorial Hermann’s pediatric rehabilitation program, featuring highly specialized pediatric physicians and clinicians who are trained in managing each child’s unique medical and therapeutic needs during their recovery journey. The pediatric unit features kid-friendly gym space and equipment, an outdoor sports court and other resources specifically designed to accommodate the needs of our patients.

Contact Us

At UTHealth Houston Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about us, please click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.