The cerebral palsy (CP) syndromes are characterized by abnormalities of motor activity and posture. In affected patients, a voluntary movement that should be complex, coordinated, and varied is instead uncoordinated, stereotypic, and limited.
Classification of CP syndromes is based upon the type of motor abnormalities (spastic, dyskinetic, or ataxic) and their distribution. There may be substantial overlap among the clinical features.
Spastic CP is an upper motor neuron syndrome, which includes spastic hypertonia, hyperreflexia, extensor plantar responses, and clonus. Affected patients also have slow effortful voluntary movements, impaired fine-motor function, difficulty in isolating individual movements, and fatiguability.
Dyskinetic CP typically affects term infants and usually results from severe, acute perinatal asphyxia. The neonatal presentation includes encephalopathy characterized by lethargy, decreased spontaneous movement, hypotonia, and suppressed primitive reflexes. Affected individuals later develop involuntary movements of athetosis, chorea, and dystonia.
Ataxic CP is characterized by ataxic movements and speech, usually associated with widespread disorders of motor function. It has multiple causes, including early prenatal events and genetic defects. The diagnosis of ataxic CP is made by exclusion, and other causes of weakness, spasticity, dystonia, or choreoathetosis should be ruled out, including progressive neurodegenerative disorders.
CP often is accompanied by other disorders of cerebral function, including intellectual disability or specific learning disabilities, behavioral and emotional disorders, seizures and impaired vision and speech. Secondary consequences of CP may include:
- poor growth and nutrition,
- orthopedic problems (eg, joint subluxations and dislocations and hip dysplasia),
- osteopenia, and
- urinary disorders.
Cerebral palsy syndromes
Dyskinetic
Ataxia
|