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Sat, Aug. 24

Doctor: cerebral palsy comes in many forms

PRESCOTT – Dr. John MacKenzie, a neurologist in Prescott, likens the cause of cerebral palsy (CP) in children to strokes in adults, in that the results of both come from trauma to the brain, and do not worsen over time.

CP, according to MacKenzie, is a result of injury during prenatal or perinatal stages. It predominantly affects a patient's motor skills, and "it's non-progressive, which means that when the damage occurs, it occurs and it's done."

MacKenzie said there are four different causes of CP: developmental abnormalities, congenital infections, perinatal trauma or metabolic trauma.

Developmental abnormalities occur, Mac-Kenzie said, when the brain cells migrate, or grow, and leave larger-than-normal ventricles that fill with cerebral spinal fluid. Also, sometimes the cells will form in an abnormal shape, and one lobe will end up larger than the other.

A mother's congenital infections – MacKenzie called the list "TORCH" – can lead to problems in a fetus' brain development. TORCH stands for toxoplasmosis, rubella, cytomegalovirus and herpes – all diseases mothers can carry and pass on to their unborn children. HIV also affects a fetus' brain development.

Babies can encounter problems during labor and delivery, MacKenzie said, that cause them to have strokes or bleeding in the brain.

"That can leave damage and structural problems," he said.

Finally, metabolic trauma is trauma that affects a baby's metabolic functions, like lack of oxygen or hypoglycemia (high blood sugar).

There are also four types of CP. The different causes can lead to any of the four types.

Spastic CP, MacKenzie said, means that the patient's muscles are "real tight, and they can't control them." There are several types of spastic CP that affect different combinations of the person's limbs.

MacKenzie read from a medical book that said spastic quadriplegic CP (where the disease affects all four limbs) that includes severe mental retardation is more likely to result in an early mortality than less severe cases.

Extraparametal CP, or hyperkinetic CP, shows up as chorieform movements, where a patient moves, almost writhing, continually. Dystonic CP is similar, MacKenzie said.

Hypotonic or atonic CP, MacKenzie said, is where a person cannot move, or has a difficult time moving.

Finally, there are mixed forms of CP.

Some cases of CP, depending on their severity, affect a person's sight or intelligence, and some cause a person to have seizures.

MacKenzie said there is no cure for CP, but obstetricians try to prevent the disease by screening for infections and limiting trauma to unborn babies and to babies during birth.

MacKenzie said that CP patients can "absolutely" lead normal lives. And, "some people can function mentally pretty well," he said.

And he said that the best doctors can do is treat the symptoms through prescriptions and therapy.

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