Cerebral palsy syndrome

Introduction to cerebral palsy syndrome A term used to describe a series of motor disorders characterized by impaired voluntary motion is due to prenatal dysplasia or perinatal or postpartum central nervous system damage that occurs before the age of five. Cerebral palsy (CP) is not a diagnostic term, but is used to identify children with non-progressive paralysis, ataxia, or unconscious movements. About 0.1% to 0.2% of children have CP syndrome; more than 1% of premature newborns or those with small gestational age are affected. basic knowledge The proportion of illness: the probability of illness in infants and young children is 0.0023% Susceptible people: no special people Mode of infection: non-infectious Complications: epilepsy, speech and language disorders in children, learning disabilities in children, disturbance of consciousness, mental retardation

Causes of cerebral palsy syndrome

The cause is often difficult to determine, but premature delivery, intrauterine abnormalities, neonatal jaundice, birth injury, perinatal asphyxia play an important role, nearly 15% of cases may be caused by birth injury and perinatal asphyxia, especially in premature infants Paraplegia, perinatal asphyxia, limb tonic spasm, perinatal asphyxia or jaundice after hand and foot or low muscle tone, early childhood central nervous system trauma or severe systemic diseases (eg meningitis, sepsis, dehydration) ) may also cause CP syndrome.

Cerebral palsy syndrome prevention

Prevention of cerebral palsy is a cross-sectoral, multi-disciplinary project, from eugenics and superior education, maternal and child health care, perinatal care, obstetrics clinical and nursing to neonatal care, nursing, multiple links and joint implementation, cerebral palsy The prevention of concurrent disorders and secondary disorders is more multi-disciplinary, multi-disciplinary participation, and active rehabilitation can be completed. According to the principle of prevention first in modern medicine, the concept of three-level prevention, cerebral palsy Prevention should be divided into the following aspects.

Primary prevention

Primary prevention is the most important stage of prevention of cerebral palsy. The main purpose is to prevent the occurrence of cerebral palsy, that is, to prevent the occurrence of various high-risk factors leading to cerebral palsy, especially to pay attention to the health care of pregnant women during the perinatal period.

(1) Do a good job of delivery during pregnancy. From the time of mother's pregnancy to the time of childbirth, the fetus depends on maternal survival. The health and nutritional status of pregnant women are closely related to the growth and development of the fetus. The adverse factors affecting maternal health can directly harm the fetus. The first 3-4 months of pregnancy is a critical period for the differentiation of various organs of the fetus, especially the formation and differentiation of nerve organs. During this period, if the mother suffers from viral infection, poisoning, X-ray, trauma, smoking or alcohol abuse. Etc., can affect the development of the fetal central nervous system, resulting in cerebral palsy or other deformities. In addition, certain conditions during childbirth, such as dystocia, fetal asphyxia, etc. may also cause cerebral palsy, therefore, do a good job of pregnancy care, to ensure that pregnant women Good health, prevent disease, reasonable nutrition, control the number of pregnancies, do not smoke, do not drink alcohol, do prenatal checkups for pregnant women, eliminate dystocia factors, and ensure that delivery is an important and effective measure to prevent cerebral palsy.

(2) to do neonatal care first in hospital delivery, in order to carry out fetal monitoring, resuscitation or surgical delivery, if necessary, in order to avoid fetal brain damage during the production process, the baby born within one month of leaving the mother to live in the natural environment, Its various aspects of growth and development are very fast, but the ability to adapt to the environment is relatively poor, extremely susceptible to infection and lead to cerebral palsy, if you can do a good job in the health care of newborns, use a set of scientific newborn screening measures, that is Grasping the health care work in the three stages of prenatal, intrapartum and postpartum can prevent a considerable number of children with cerebral palsy, deformed children and children with mental retardation. In short, as long as the conditions permit, the babies born must Go to a nearby health center for regular physical examinations.

(3) Necessary immunization The necessary planned immunization for pregnant women, such as the injection of rubella vaccine, can prevent the infection of pregnant women with rubella virus, thereby preventing the resulting cerebral palsy.

2. Secondary prevention

For children who have already caused cerebral palsy, positive preventive measures should be taken to prevent various disability, early detection and early recovery, which can significantly reduce the dysfunction of children with cerebral palsy.

As soon as possible, early treatment, the baby should go to the hospital for regular check-up immediately after birth, especially if the mother is not going well during pregnancy, or have dystocia, premature birth, neonatal asphyxia, etc. should be closely observed, once the child is found to be abnormal You should go to the hospital for a comprehensive examination immediately. If you can make a correct early diagnosis of the cerebral palsy, and make reasonable treatment and comprehensive rehabilitation measures as soon as possible, it is possible that some children with cerebral palsy will basically recover normally.

So, how can we find children with cerebral palsy early? For the average parent, it is mainly based on the early manifestations of cerebral palsy in children, that is: 1 development is behind normal children, careful parents can find children with cerebral palsy All aspects of development are behind the normal age of the same age, the whole body is soft, weak or tight limbs, playing very easy to start, less moving or excessively turbulent, eating milk is weak, often licking, licking, spitting milk, crying weak or array Screaming; 2-3 months will not laugh, will not look up, continue to cry, finger grip will not open; 4-5 months will not turn over; 8 months will not sit, even Will not grasp, hold, can not put your hand to the mouth, in addition, intellectual development is also behind the normal children of the same age, 2 with abnormal movements or postures, such as: drooling, limbs involuntarily twitching and shaking; The toes are on the ground and the heels are not hanging or the two lower limbs are crossed; the movements of the limbs are uncoordinated and asymmetrical; the head is turned to one side and cannot be kept in the middle position.

In addition, according to the different postures and performances of children with cerebral palsy and normal children, they can be found early and go to the hospital as soon as possible to obtain the best rehabilitation effect.

3. Tertiary prevention

When the cerebral palsy disorder is apparent, all possible measures should be taken early to prevent it from developing into a disability, and the preservation of existing functions to provide education and vocational rehabilitation opportunities to reduce the disability can adversely affect individuals, families and society.

On the basis of prevention of primary cerebral palsy, it should also be actively prevented for various secondary disorders, because secondary disorders will further aggravate the dysfunction of children and bring new pain to children. The difficulty of rehabilitation, because the motor dysfunction and posture abnormality of children with cerebral palsy have not been corrected in time or the severity of the disease is severe, there will be a series of secondary disorders, such as contracture of the joints of the limbs, deformity, muscle atrophy, shoulders, Dislocation of the hip, lordosis, kyphosis, scoliosis, decalcification of the bone, fractures, etc., can also cause a series of physical and mental development disorders, such as decreased cardiopulmonary function, orthostatic hypotension, thrombotic veins Tube inflammation, depression, psychological barriers, etc.

The above secondary obstacles should be prevented early, early interventional rehabilitation, and active preventive measures. The specific measures are the use of various rehabilitation treatments, including education rehabilitation, vocational rehabilitation, social rehabilitation and other comprehensive rehabilitation content, due to the late start of rehabilitation in China The prevention and treatment of cerebral palsy has not yet formed a system, and due to economic conditions, many treatment centers cannot be established in the short term. Therefore, community rehabilitation and home guidance and training are suitable for China's national conditions and have a strong vitality.

Cerebral palsy syndrome complications Complications, epilepsy, speech and language disorders, children's learning ability, disturbance of consciousness, mental retardation

In addition to dyskinesia and postural disorder, cerebral palsy syndrome often occurs concurrently with brain damage: health and physical disabilities, mental retardation, emotional and behavioral disorders, learning disabilities, visual impairment, hearing impairment, perception and cognitive impairment, Epilepsy, language problems, teeth and gum problems.

Symptoms of cerebral palsy syndrome Common symptoms Reflex stretch irritability Unsatisfactory weight gain fatigue Inability to ascend skin numbness convulsion response slow cough

CP is rarely diagnosed in early infants and does not exhibit the characteristics of each syndrome by the age of 2, and should be closely followed for children with known high risk, including various evidence, birth injury, asphyxia, jaundice, meningitis. , or neonatal period with convulsions, low muscle tone, high muscle tone, and a history of reflex inhibition.

Before the manifestation of specific motor syndrome, the child showed motor developmental stagnation and sustained infancy reflexes, high reflexivity, and changes in muscle tone. CT or MRI may be helpful when the diagnosis or cause is uncertain.

(1) Basic performance

Cerebral palsy is characterized by non-progressive motor development abnormalities after birth, and generally has the following four manifestations.

1. Exercise retardation and active limb movements reduce the inability of children to complete the developmental process of normal children of the same age, including vertical neck, sitting, standing, walking and other large movements, as well as the fine movements of the fingers.

2. Abnormal muscle tone varies with different clinical types, sputum type shows increased muscle tone; low muscle type shows squat limbs soft, but can still induce sputum reflex; while hand and foot pulsation type shows variable dystonia .

3. Postural abnormalities are affected by abnormal muscle tension and original reflexes. Children may have various abnormal postures, which may affect their normal motor function. In the physical examination, the children are placed in the prone position and supine position. When standing upright and pulling up into a sitting position on the back, you can find abnormal postures and abnormal postures of the limbs.

4. Reflex abnormalities A variety of primitive reflexes disappeared, and sputum cerebral palsy was active in children with sputum, which can lead to sputum and positive Babinski sign.

(B) four major clinical types of CP syndrome

type, hand and foot Xu type, ataxia type, and mixed type.

1. Sickle syndrome occurs in about 70% of cases, sputum is caused by the involvement of upper motor neurons, can be mild or severely affecting motor function, the syndrome can produce hemiplegia, paraplegia, quadriplegia, bilateral sputum.

Affected limbs are usually stunted and exhibit deep reflexes and high muscle tone, weakness, tendency to contracture, characteristic scissor gait and toe walking, and in mildly affected children, only some activities may be impaired ( Such as running), accompanied by quadriplegia, it is common to have damage to the mouth, tongue, and ankle movement associated with the cortical medulla, resulting in poor articulation.

2. Hand and foot movement or dyskinesia syndrome occurs in about 20% of cases, which is the result of involvement of the basal ganglia. Slow, writhing, unconscious movements may affect the limbs (hand and foot) or the proximal part of the limb and the trunk ( Dystonia type); sudden, rapid, and large-scale movements (dancing disease type) can occur, the movement increases with emotional stress, disappears during sleep, and there is serious difficulty in articulation.

3. Ataxia syndrome occurs in about 10% of cases due to involvement of the cerebellum or its conduction pathway, weakness, poor coordination, instability caused by intentional tremor, squat gait, and difficulty in rapid and fine motor.

4. Hybrid type is common - most commonly seen, sputum type and hand and foot Xu move type; less common, ataxia type and hand and foot Xu move type.

Laboratory tests can help to rule out some progressive biochemical disorders involving the motor system (such as Tay-Sach disease, metachromatic leukodystrophy and mucopolysaccharidosis), other progressive abnormalities (such as infant axonal nutrition) Disorders cannot be ruled out by laboratory tests and must be ruled out by clinical and pathological examinations. Children with significant mental retardation and symmetrical motor abnormalities should be examined for amino acid and other metabolic abnormalities.

Related diseases: seizures occur in approximately 25% of patients, most commonly in sputum type patients, and strabismus and other visual impairments can also occur. Children with circadian rhythm often show neurological deafness and upward Patients with gaze palsy, spastic hemiplegia or paraplegia often have normal intelligence; spastic quadriplegia and mixed type are often associated with disability mental retardation, and attention time is short and hyperactivity is common.

Examination of cerebral palsy syndrome

Cerebral palsy syndrome needs to do the following checks

1. Electroencephalogram (EEG).

2. EEG topographic map (BEAM).

3. Magnetoencephalography.

4. Evoked potentials.

5, EMG.

6. Brain impedance blood flow map (REG).

Diagnosis and differentiation of cerebral palsy syndrome

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.

Differential diagnosis

Cerebral palsy syndrome often needs to be differentiated from the following diseases:

1, autism congenital ligament relaxation.

2, three-body syndrome.

3, metachromatic white matter malnutrition.

4. GM1 gangliosideosis.

5. Infant progressive spinal muscular atrophy.

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