Spastic Cerebral Palsy
Spastic cerebral palsy, the most common form of the disease, occurs when the brain damage occurs in the outer layer of the brain, the cerebral cortex. It is estimated that this form of CP affects between 70 to 80 percent of patients. Spastic CP affects patients in different ways, depending on the areas of the body it affects. It can affect one side of the body or just the legs.
The term spastic is generally used within the context of spasticity, a medical condition which is characterized by hypertonia, a high degree of muscle tightness. Therefore, spastic CP describes the increased tension, in a muscle. Generally, muscles work in tandem. When one group contracts the other group relaxes which allows free movement. When there are disruptions in the brain-to-nerve-to-muscle communication, the normal rise and fall of muscle tension is altered. When muscles are afflicted by spastic cerebral palsy, they become active together which effectively blocks coordinated movement. Thus the muscles in a person suffering from spastic cerebral palsy patients are constantly tense.
Although there are nine principle subcategories of cerebral palsy, professionals in the field normally classify cases of Spastic C.P. as one of four forms of the disorder: Diplegia- which primarily affects the legs, Hemiplegia – where one side of the body is affected, Quadriplegia – where all four limbs are affected, and Athetoid Dyskinetia – is characterized by involuntary and uncontrollable muscle tone fluctuations.
There are varying degrees of spastic cerebral palsy. Some patients have mild cases that affect very few movements. Others with more severe cases can have their entire bodies affected. While generally spastic CP is not considered a progressive disorder, because brain damage does not get progressively worse, spasticity in muscles can get progressively worse. As muscles become increasingly stiff, the range of movement in the joints becomes more and more limited. In addition to changes in the physiology of the muscles, anxiety and extended effort can also increase the debilitating effects of spastic CP, which can also result in overall fatigue.
Spastic cerebral palsy can disrupt normal growth in children. It also affects the child’s muscles and the joints of the hands and legs, resulting in abnormal movements. It can inhibit the synthesis of protein in muscle cells, muscle growth, and normal body movement. It causes the development of muscle and joint deformities and limits muscle stretching. Children born with spastic CP rarely display deformities of the extremities at birth but they do develop them over time.
Treatments for the disease are a function of the severity of the symptoms. Oral medicines like Valium and Baclofen, do not appear to reduce spasticity. Baclofen administered via infusion, (inserting a pump into the abdomen distributes the drug to the muscles), has proven to be slightly more effective. As soon as the Baclofen treatment is interrupted, the spasticity reoccurs. Like any drug, the use of Baclofen involves risks, such as overdose and meningitis. And being a relatively new treatment, not enough data has been collected to accurately determine the drug’s long-term affects.
A new treatment protocol involves injecting Botox into the patient’s muscles. Botox weakens the group of muscles which in turn reduced spasticity. Injected in this way the Botox is normally effective up to four months with minimal side effects. Surgery which involves lengthening tendons and muscle release, offers another form of treatment. This can improve range of motion. Surgery doesn’t eliminate or even reduce spasticity, but does reduce its consequences.
The methods of treatment depend on the development of the patient and severity of the condition. For parents without medical knowledge, deciding on treatment can be very difficult, confusing and frustrating. Parents in that situation should consult with a team comprising a neurosurgeon and orthopedic surgeon, a neurologist, pediatrician and a physical therapist.