• Cerebral Palsy
    • Treatment
      • Aimed at supportive measures
      • Improve posture, mobility, reduce spasticity, muscle spasms and contractures
      • Symptom relief of GORD, chest infections
      • Physio, psychological counselling, OT, speech and behavioural therapy all helpful
      • Offered alongside medication, NM denervation techniques (botulinum, RF ablation, dorsal rhizotomy) and surgery (arthodhesis, osteotomy, spinal fusion, tendon transfer/lengthening)
      • Drug therapy
        • Often on anticonvulsants, antispasticity, antacids, antisialogogues, antidepressants, laxatives and prophylactic ABx (UTI/resp)
        • Antispasticity meds
          • Most rely on a degree of spasticity
          • Over treatment can result in hypotonia and worsening of mobility, swallowing and cough
          • Baclofen (GABAb agonist) inhibits release of excitatory NT at the dorsal horn. Can be given orally or intrathecally.
          • Botulinum binds to ACh receptors on the NM end plate and lasts 3-4/12
          • Tinazidine, vigabatrin and dantrolene have been tried too
      • Perioperative management
        • Liaise with parents/carers
        • Present for dental, pain procedures, orthopaedic, neuro (VP shunts), general surgical and opthalmic procedures
        • Focus history on meds, chest, renal function
        • Pre/post-op physio and HDU are advised
        • Continue most meds perioperatively
        • Propofol is the preferred IV induction agent
        • Sux is not CI
        • NDMRs have SHORTER duration of action and are LESS potent
        • RSI and ETT may be safer but gas induction with 30 degree head up may be used if IV access is a problem
        • Post op HDU or ITU due to risks of hypothermia, hypoxia and hypovolaemia
        • May need continuous pain relief on HDU
        • Pain and anxiety can worsen muscle spasms
        • Poor nutritional state leads to more wound complications
        • Use of clonidine in caudal/epidurals seems beneficial
    • Clinical features
      • Respiratory
        • Chronic lung disease due to prematurity
        • Aspiration common
        • Abnormal LOST makes aspiration commoner
        • Respiratory muscle hypotonia
        • Weak cough
        • Decreased immunity due to malnutrition
        • Scoliosis with restrictive lung defects
        • PAH and ultimately cor pulmonale and respiratory failure
      • GI
        • Low LOS tone
        • Poor swallowing
        • Hyperactive salivary glands leads to drooling
        • Poor dental hygeine
        • May benefit from PPI or be peg fed or fundoplication
      • Neurological
        • Visual, auditory and abnormal touch and pain perception can be seen
        • 50% have epilepsy
        • Periventricular lesions can be identified on MRI in 90%
        • Communication difficulty can lead to anxiety
      • MS
        • Muscle contractures can be seen resulting in joint deformity and dislocations
        • Most have some degree of muscle spasticity with tendency to tip-toe walk
        • Ulcers common
        • Osteopenia makes fractures common
        • Venous access often difficult
      • Urological
        • Incontinence common
        • Neuropathic bladder
        • Bladder stones
    • Most occur antenatally and 20% postnatally in the first 2 yrs of life
    • Collective term used for group of conditions characterised by motor, sensory and intellectual impairment
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/10/3/72.full.pdf