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Cerebral Palsy
 

Cerebral Palsy Introduction

Cerebral Palsy (CP) is a term used to describe a number of chronic conditions involving motor (physical) and brain (neurological) function. Cerebral Palsy is not a disease but a life-long condition that affects the communication between the brain and the muscles, causing a permanent state of uncoordinated movement and posturing.[1]

There is not one single cause but several triggering factors that could contribute to the manifestation of this disorder. It was in the 1860’s when the symptoms of Cerebral Palsy were first described; at that time the disorder came to be known as Little’s disease. William Little, and English surgeon, observed the stiff, spastic leg movements of children as they tried to grasp objects, and attempt to walk and crawl. He noticed that as these children grew older, their condition didn’t improve or grow worse. What was apparent in each child was the presence of mental retardation, visual disturbances and seizures. He then suggested that depletion of oxygen during birth was the cause of these behaviors. Sigmund Freud, however, disagreed and proposed there was some other, notable event that occurred prior to birth. “Difficult birth, in certain cases,” he wrote, “is merely a symptom of deeper effects that influence the development of the fetus.” [2]

Today, the cause of cerebral palsy is still somewhat elusive. Many different types of brain injury can lead to cerebral palsy, and many times an exact cause cannot be determined. Birth injuries and oxygen deprivation to the brain before, during, and immediately after birth, account for approximately 10 to 15% of all cases. [3] It has also been theorized that because the first few years of life are a more tenuous time for infants, the threat and onset of severe illness, inflammation, trauma or severe dehydration could cause brain damage, which may result in cerebral palsy. Other risk factors include; premature birth, low birth weight, blood type incompatibility between mother and child, lack of proper nutrients during fetal development via the placenta and absence of growth factors during fetal development.[4]

The diagnosis of cerebral palsy is difficult in early infancy, due to many other conditions that can have similar presentation. As the child matures, developmental milestones can be key indicators of poor coordination, weakness and mental delay. Typically, doctors diagnose cerebral palsy in infants by testing their motor skills, thoroughly analyzing their medical history, and employing some diagnostic tests such as magnetic resonance imaging (MRI) or computed tomography (CT) to discern the nature of any brain damage and help rule out other conditions.[5]

Cerebral Palsy Symptoms

Because Cerebral Palsy is an umbrella term for several chronic conditions, its manifestation depends on the classification of the disorder. Symptoms can range from mild to severe and thus cause varying degrees of handicap. In all forms of cerebral palsy there is difficulty with annunciation of words, seeing or hearing properly and behavioral problems. Cerebral Palsy may be grouped into 4 main groups, depending on symptoms displayed and other factors.

Spastic

  • Approximately 70% of children with cerebral palsy have the spastic version.
  • Stiff and weak muscles- can affect arms legs on one side of both
  • Poorly developed affected legs/arms
  • Mental retardation (sometimes severe)
  • Seizures
  • Trouble swallowing
  • Choking on secretions from mouth and stomach
  • Difficulty breathing

Choreoathetoid

  • Affects nearly 20% of children with cerebral palsy
  • Spontaneous, slow muscle movement
  • Jerky abrupt movements
  • Symptoms better with sleep
  • Symptoms worse with strong emotions
  • Rarely have seizures
  • Usually have normal intelligence

Ataxic

  • About 10% of children with cerebral palsy have the ataxic form
  • Poor coordination, shaky movements
  • Muscle weakness and trembling
  • Difficulty with rapid or fine movements
  • Difficulty walking

Mixed

  • Those with this form typically have a combination of symptoms of ataxic
  • Cerebral Palsy and Choreoathetoid Cerebral Palsy.[6]

Cerebral Palsy Statistics

  • About 764,000 children and adults in the United States manifest one or more of the symptoms of cerebral palsy.
  • Currently, approximately 8,000 babies and infants are diagnosed with the condition every year.
  • 1,200 - 1,500 preschool age children are said to have cerebral palsy each year.[7]

Cerebral Palsy Treatment

There is no cure for Cerebral Palsy and the condition’s symptomatic problems will be present throughout an individual’s life. Treatment focuses on making the quality of living as comfortable as possible. Physiotherapy, occupational therapy and braces are often used to help with walking and muscle control. Surgery could be an option for those with spastic muscle movements. Surgical options also exist for medical practitioners wishing to lengthen the tendons of stiff muscles in individuals suffering from this debilitating condition. Anticonvulsant medications are also prescribed to help those with seizures. Speech therapy is also another commonality amongst cerebral palsy sufferers, as it can help to improve both communication and swallowing issues.[8]

Supplements helpful for Cerebral Palsy

Multivitamin/minerals

Caused by varying factors, individuals suffering from Cerebral Palsy often suffer from an extremely reduced caloric intake. Some have a hard time communicating their needs for food or food preferences, and some have a hard time feeding themselves. Other persons suffer from a certain amount of oral motor dysfunction and lack the ability to provide sufficient self-maintenance. [9] Whatever the reason, the end result can be stunted growth, especially in children.[10]

Due to the poor nutritional status of many children with Cerebral Palsy, there is a lack of essential vitamins and minerals needed for optimal growth and development. One particular study involved 19 spastic quadriplegics between the ages of 3 and 20, being fed by means of a gastrostomy tube. It was noted that 16 of the participants had insufficient vitamin D intake, while 11 had a calcium intake of less than 80% of the RDAs established dosage. [11] Supplementation with a multivitamin would assist these persons in meeting their individual vitamin and mineral requirements, which are not being fulfilled due to factors greater than themselves.

Gamma-aminobutyric acid (GABA)

An amino acid produced in the brain, gamma-aminobutyric acid (GABA) is an amino acid/neurotransmitter that fosters communication between nerve cells. Large amounts of research implicate its role in the provocation of seizure activity when in short supply. GABA is an inhibitory neurotransmitter, and when not present in adequate amounts, the lack of inhibition can lead to over excitation that results in convulsive episodes. [12 To this end, many standard epilepsy drugs, such as benzodiazepines and phenobarbital, aim to boost GABA levels in the brain. Rather than achieving increased levels of GABA when using powerful drugs with many side effects, one can directly augment GABA levels via supplementation with the amino acid itself. The addition of supplemental GABA into diet may have a positive effect on reducing seizure activity often seen in those with Cerebral Palsy. In addition, supplementation with GABA can help reduce spasticity and rigidity common to those with Cerebral Palsy by limiting over excitation.

Creatine Monohydrate

Creatine monohydrate is commonly used to improve athletic performance by increasing muscle mass and function. Found primarily in skeletal muscle, it is thought that creatine enhances the body’s ability to regenerate energy (ATP), and decrease the recovery time from intense exercise. In those with muscular dystrophies, short-term supplementation seems to improve muscle strength and improve the many activities of daily living. [13] Due to the muscle rigidity, and weakness and atrophy seen in those with Cerebral Palsy, creatine could be helpful in maintaining muscle mass and strength.

Magnesium

Many of the most commonly encountered symptoms in persons with Cerebral Palsy include sleep disturbances, muscle rigidity, muscle spasms and anxiety. Supplementing with magnesium may help to alleviate all these symptoms. Magnesium is found in a high abundance throughout the body, and more particularly, in cells. It is a mineral that plays a major role in enzymatic reactions including those responsible for cellular energy production. [14] Magnesium is involved in over 300 enzymatic reactions in the body, and is also essential for the proper function of nerves and muscles and transmission of these impulses across the neuromuscular junction. [15] One study involving a person with paraplegia suffering from painful muscle spasms was given intravenous magnesium and subsequently experienced immediate pain relief. [16] Another study showed the benefit of magnesium in reducing pain postoperatively. In 24 patients undergoing surgery, preoperative magnesium supplementation greatly reduced the need for postoperative pain-relievers, including morphine. [17]

Docosahexanoic acid (DHA) and Eicosapentaenoic acid (EPA)

DHA and EPA are long chain polyunsaturated fatty acids derived from fish and other marine animals as well as microalgae. DHA and EPA are both omega-3 fatty acids, and compete with arachidonic acid in the cyclooxygenase and lipoxygenase pathways.[18]

DHA is used as a supplement for preterm infants and is now a standard ingredient in many infant formulas. DHA is vital during the first four months of life to enhance mental development. DHA is also used for enhancing vision, treating depression, and reducing aggressive behavior in people under stressful situations. In combination with eicosapentaenoic acid (EPA), DHA is employed to optimize proper brain function. Both fatty acids play a major role in brain function and are thought to contribute to proper structural arrangement, neurologic development, and synaptic membrane cohesiveness. [19] In addition, research shows that DHA exerts a helpful effect on visual acuity, learning ability, and memory. [20] Because of these functions, supplementation with EPA and DHA may help to optimize neurologic function in people with Cerebral Palsy.

References

1 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

2 ibid

3 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

4 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

5 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

6 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

7 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

8 Online Document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

9 Lancet Leading Article: Growth and nutrition in children with cerebral palsy. Lancet 335: 1253-1254,1990.

10 Krick J, Van Duyn MAS: The relationship between oral-motor development and growth: a pilot study in a pediatric population with cerebral palsy. J Am Diet Assoc 84: 555-559 1984.

11 Fried MD, Pencharz BP: Energy and nutrient intake in children with spastic quadraplegia. J Pediatr 119: 947-949, 1991.

12 Treiman , David M, GABAergic Mechanisms in Epilepsy, Epilepsia Volume 42 Issue s3 Page 8.

13 Walter MC, Lochmuller H, Reilich P, et al. Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study. Neurology 2000;54:1848-50.

14 Covington TR, et al. Handbook of Nonprescription Drugs. Washington, DC: Am Pharmaceutical Assn, 1996.

15 ibid

16 Clinton CW, Braude BM, James MF, Painful muscle spasm reversed by magnesium sulphate. A case report. S Afr Med J. 1985 Aug 31;68(5):332-3.

17 Kara H, Sahin N, Ulusan V, Aydogdu T Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol. 2002 Jan;19(1):52-6.

18 Calder PC. N-3 polyunsaturated fatty acids, inflammation and immunity: pouring oil on troubled waters or another fishy tale? Nutr Res 2001;21:309-41.

19 Moriguchi T, Greiner RS, Salem N Jr. Behavioral deficits associated with dietary induction of decreased brain docosahexaenoic acid concentration. J of Neurochem 2000;75:2563-73.

20 Gamoh S, Hashimoto M, Sugioka K, et al. Chronic administration of docosahexaenoic acid improves reference memory-related learning ability in young rats. Neuroscience 1999;93:237-41.