Spastic Cerebral Palsy

Spastic cerebral palsy (CP) refers to the increased tone, or tension, in a muscle. Spastic cerebral palsy is the most common form of cerebral palsy, affecting 70 to 80 percent of patients. Spastic CP occurs when the brains outer layer called the cerebral cortex is damaged.

Spastic cerebral palsy has varying forms depending on the areas of the body it affects. Diplegia affects two extremities either both arms or both legs. Hemiplegia affects either the right or left side of the body (right arm and right leg or left arm and left leg). Quadriplegia affects all extremities, here, both arms and both legs are affected. Monoplegia, as the name implies affects only one arm or leg. Finally, triplegia, with a prefix meaning three implies three limbs are affected.

Normally muscles work in pairs. When one group contracts the other group relaxes, allowing ease of movement in the desired direction. With spastic cerebral palsy this does not occur. Muscles of individuals with spastic cerebral palsy contract together and block natural movement causing tense or spastic muscles. Although damage to the brain does not worsen over time spasticity in muscles can increase. As spasticity and stiffness increases, the range of movement in the joints can decrease.

Spastic cerebral palsy affects the patient's muscles and joints of the extremities, causing abnormal movements. Spastic cerebral palsy can inhibit several things such as normal motions in body movement, longitudinal muscle growth, protein synthesis in muscle cells and can alter typical growth in children. Spastic cerebral palsy also limits stretching of muscles in daily activities and causes the development of muscle and joint deformities. Children with spastic cerebral palsy may develop physical abnormalities in their extremities over the course of their lives due to joint contractures.

Treatments for spastic CP differ depending on the severity of the spasticy in the individual.  Medications like Valium and Baclofen, have been shown to have little effect on spasticity. Baclofen infusion, however, a relatively new procedure, has been slightly more effective in controlling spastic cerebral palsy. Baclofen is administered by using a pump placed in the abdomen distributes the medication to effected muscles, and thus reducing spasticity. However, when Baclofen treatment is stopped, spasticity returns. There are risks associated Baclofen, however which include overdose, meningitis, and other complications, and since it is a relatively new treatment, long-term affects are currently not known.

Botox injections placed in the muscles of spastic cerebral palsy patients are also a relatively new treatment and show promise. When injected into the tight muscles, Botox relaxes the group of muscles, thus, reducing spasticity. Botox injections usually last 3 to 4 months and side effects appear to be minimal.

Additionally, operations are used to treat spastic cerebral palsy. These surgeries usually involve lengthening tendons and muscle release to improve a patients range of motion. This surgery will not reduce spasticity directly, but does reduce the consequences of it.

Hyperbaric oxygen therapy (HBOT) is a medical treatment that uses pure oxygen to speed and enhance the body's natural ability to heal. High dose oxygen therapy is American Medical Association, FDA and Medicare approved. During therapy, the patient breathes pure, 100% oxygen under increased atmospheric pressure. The concentration of oxygen normally dissolves in the bloodstream is thus raised many times above normal (up to 2000%). In addition to the blood, all body fluids including the lymph and cerebrospinal fluids are infused with oxygen. It can reach bone and tissue which are inaccessible to red blood cells, enhance white blood cell function, and promote the formation of new capillary and peripheral blood vessels. This results in increased infection control and faster healing of a wide range of conditions.

Patients undergoing oxygen therapy demonstrate reduced tissue swelling after the lapse of years. It works by constricting blood vessels and interrupting the vicious cycle where lack of oxygen leads to tissue swelling, which then leads to further oxygen deficiency.

Selective Dorsal Rhizotomy (SDR) is a surgical procedure. It involves an operation under general anesthetic, which attempts to distinguish nerve branches giving unusual responses to stimuli. The nerves tested are those leading to and from spastic muscles in the legs. Any branches which reveal abnormal responses are severed by the neurosurgeon. “Selective” - selected by testing. “Dorsal”  - the top portion of the nerves leading down from the brain, which is where they are cut. A Selective Dorsal Rhizotomy attempts to permanently relieve tension in the legs, which means that walking may also improve.

The main advantage of SDR is that the results are permanent. Children of a younger age have more success with Selective Dorsal Rhizotomy’s. The down sides are that the effects cannot be undone and extensive therapy is needed afterwards. Careful assessment is suggested before choosing any method of dealing with high muscle tone.

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