Cerebral palsy, referred to as cerebral palsy, is a non-progressive brain injury caused by various causes from before birth to 1 month after birth, mainly manifesting as central motor deficits and postural abnormalities. At present, the etiology of the disease is unclear, and it has a large impact on the motor function of patients and a high disability rate, which seriously affects the quality of life of patients.
Epidemiology.
According to a survey in China, the prevalence of cerebral palsy among children aged 0-6 years is 1.2‰ to 2.7‰, with a male to female ratio of 1.13 to 1.57:1, and there are 6 million cerebral palsy patients in China.
Causes of morbidity.
Cerebral palsy is a syndrome, the cause of which is not fully understood. Currently, it is believed that any factors that can cause non-progressive brain defects or injuries followed by central movement disorders from before birth to one month after birth can be considered as risk factors. Specifically, they are divided into prenatal, perinatal and neonatal factors.
1, prenatal factors maternal exposure to radiation, industrial pollution, intrauterine infection, taking certain drugs, certain comorbidities, abnormal pregnancy history; placental abruption, placental dysfunction, umbilical cord bypass and intrauterine distress; fetal brain malformation; genetic factors.
2, intrapartum factors such as neonatal asphyxia and birth injuries.
3, Neonatal period such as prematurity, low birth weight infants, neonatal encephalopathy caused by hypoxia-ischemia and high unconjugated bilirubinemia, viral meningoencephalitis, septic meningitis, etc.
Clinical manifestations.
1. Backward motor development and reduced active movement: patients have backward gross and fine motor development. In the neonatal period, the movements are reduced and the sucking and feeding response is poor.
2, abnormal muscle tone: limbs and trunk muscle tone folding knife-like, gear-like increase or hypotonia.
3.Posture abnormalities: The child has a variety of abnormal postures in prone, supine, sitting and upright positions, such as “scissor” gait and “X-leg”, etc.
4. Abnormal reflexes: delayed disappearance of primitive reflexes, weakened or delayed appearance of protective reflexes.
Other manifestations are often combined with epilepsy, mental retardation, speech disorders, perceptual disorders, hydrocephalus, etc. The more limbs are involved, the worse the prognosis. The prognosis is better for spastic diplegia and hemiplegia, and worse for tetraplegia and tetraplegia.
Treatment.
There is no cure for cerebral palsy. Currently, functional training, drugs and surgery are mainly used to relieve symptoms, and treatment should be carried out early. The combination of home training and physician guidance is advocated, and comprehensive interventions for motor disorders and combined language, intelligence, epilepsy and behavioral abnormalities are carried out.
1.Functional training
Common methods include somatic training, skill training, language training, hydrotherapy, functional electrical stimulation, biofeedback therapy and the use of orthopedic devices.
2.Drug therapy
The efficacy of medications for cerebral palsy is far from ideal, but doctors can still alleviate the motor dysfunction of patients through different medications and routes of administration.
Commonly used oral medications include Antan and baclofen tablets. When oral baclofen tablets are given, some patients, although they may work, sometimes require high doses, bringing weakness, drowsiness, nausea and other side effects, and most do not achieve the desired effect, then intrathecal baclofen pump therapy can be tried.
Botulinum toxin type A (botulinumtoxin type A) can inhibit the release of presynaptic acetylcholine, thus blocking neuromuscular transmission, and is often used to relieve local muscle spasms in the upper and lower extremities, head, face and neck. The obvious effect appears 72 hours after injection and lasts for 6 weeks to 6 months. Combined with rehabilitation treatment and orthopedic appliances, the treatment effect can be prolonged without obvious side effects.
3.Surgical treatment
For patients with severe spastic cerebral palsy, neurosurgical or orthopedic surgery can be performed to relieve excessive muscle tone and spasticity and improve abnormal posture in order to obtain maximum functional recovery.
(1) Selective posterior spinal nerve rhizotomy (SPR) surgery can be performed on the lumbar and cervical segments of the spinal cord to relieve spasticity of a wide range of muscle groups in the lower and upper extremities, respectively. The posterior root bundles of the spinal nerve are electrically stimulated and the abnormal posterior root bundles associated with spasticity are identified by observing the muscle response.
(2) Selective peripheral neurotomy (SPN) can be used when the spasticity is limited, conservative treatment is ineffective, and there is no fixed contracture deformity. The procedure is less invasive, flexible in terms of site, and has positive results. For example, myocutaneous nerve SPN surgery can treat elbow spasticity, ulnar nerve and median nerve SPN surgery can treat wrist and finger spasticity, and tibial nerve SPN surgery can treat ankle spasticity.
(3) Stereotactic neurosurgery has better effect on tremor and dystonia type. Image stereotactic technique and microelectrode guided neurophysiological technique are used to anatomically localize and functionally localize the inner nuclei of the brain, respectively, and then specific nuclei are destroyed by heating with radiofrequency electrodes, with accurate localization and positive efficacy.
(4) Intrathecal baclofen pumpIntrathecal baclofen pump is a continuous intrathecal baclofen perfusion system (CIBI). It uses a program-controlled pump and catheter surgically buried in the human body, through the program-controlled pump and catheter to inject baclofen injection directly and continuously into the cerebrospinal fluid according to the designed dose, which has a significant effect on the muscle spasm caused by CP, and also improves involuntary movements. It has the following characteristics: tiny dose, less side effects; using program-controlled device to adjust the drug; adjustable dose to meet individual needs.
(5) Orthopedic surgery neurological surgery cannot completely replace the traditional orthopedic surgery, especially when the limb has obvious fixed contracture deformity, orthopedic surgery will become a necessary supplement to the aforementioned surgery.
In conclusion, there is no cure for cerebral palsy, and comprehensive treatment is still the main focus. In order to improve the function permanently, regular and lasting functional training should not be neglected after all the above surgical treatments.