Epidemiology
- Most common motor disability in children
Etiology
Pathophysiology
Spastic cerebral palsy may be caused by white matter necrosis (seen in this patient as periventricular leukomalacia), which leads to a loss of descending inhibitory control from the upper motor neurons. This results in muscle overactivity, leading to increased tone and hyperreflexia.
Clinical features
- All types
- Intellectual disability (50%)
- Seizure disorder (35%–50%)
- Upper motor neuron signs (e.g., spasticity, hyperreflexia, clonus)
- Behavioral difficulties
- Developmental delay, particularly motor function (e.g., rolling over from back to belly, sitting independently, crawling).
- Attention deficit hyperactivity disorder
- Spastic type
- ↑ Muscle tone in one or more limbs
- ↑ Deep tendon reflexes
- Persistence of primitive reflexes (e.g., positive Babinski sign)
Warning
Definite hand preference before 1 year of age suggests one-sided muscle weakness and is a red flag for hemiplegia.
Diagnostics
Treatment
- Pharmacological management
- Antispasmodics (e.g., botulinum toxin, baclofen, dantrolene, benzodiazepines)
- Anticonvulsants
- Anticholinergics for rigidity and sialorrhea