Epidemiology

• Most common motor disability in children

Etiology

Pathophysiology

Spastic cerebral palsy may be caused by white matter necrosis (seen in this patient as periventricular leukomalacia), which leads to a loss of descending inhibitory control from the upper motor neurons. This results in muscle overactivity, leading to increased tone and hyperreflexia.

Clinical features

• All types
  • Intellectual disability (50%)
  • Seizure disorder (35%–50%)
  • Upper motor neuron signs (e.g., spasticity, hyperreflexia, clonus)
  • Behavioral difficulties
  • Developmental delay, particularly motor function (e.g., rolling over from back to belly, sitting independently, crawling).
  • Attention deficit hyperactivity disorder
  • Spastic type
    • ↑ Muscle tone in one or more limbs
    • ↑ Deep tendon reflexes
    • Persistence of primitive reflexes (e.g., positive Babinski sign)

Diagnostics

Treatment

• Pharmacological management
  • Antispasmodics (e.g., botulinum toxin, baclofen, dantrolene, benzodiazepines)
  • Anticonvulsants
  • Anticholinergics for rigidity and sialorrhea