Overview of Cerebral Palsy in India |Trishla Foundation

It is found that 10% of the global population has some form of disability from different causes; in India, it is 3.8% of the population. Nearly 15-20% of physically disabled children are affected by Cerebral Palsy in India. The estimated incidence is around 3/1000 live births. Cerebral palsy is the most common motor disability in childhood. Because of the developing nature of Indian health care in semi-urban and rural areas and the lack of technology used in these areas, cerebral palsy has been a problem seen during my thirty-seven years of caring for such patients.

The topographic classification of CP is monoplegia, hemiplegic, diplegia, and quadriplegia; monoplegia and triplegia are relatively uncommon. There is a substantial overlap of the affected areas; diplegia is the commonest form at 30% – 40%), hemiplegic is 20% – 30% and quadriplegia account for 10% – 15%. In an analysis of 1000 cases of CP from India, it was found that spastic quadriplegia constituted 61% of cases followed by diplegia 22%(1). Spastic CP is the commonest and accounts for 70%-75% of all cases, dyskinetic for 10% to 15% and ataxic for less than 5% of cases.

Another classification, GMFCS, describes the functional characteristics in five levels, from I to V, level I being the mildest in the following age groups: up to 2 yrs, 2 – 4 yrs, 4 – 6 years and 6 – 12 years. For each level, separate descriptions are provided.

Early diagnosis

Cerebral palsy is a clinical diagnosis made by a history of risk factors, regular developmental screening of all high-risk babies and neurological examination. A systematic approach focusing on maternal, obstetric and prenatal histories, review of developmental milestones, and a thorough neurological examination and observation of the child in various positions such as supine, prone, sitting, standing, walking and running is mandatory. It is not possible to diagnose CP in infants less than 6 months except in very severe cases. The patterns of various forms of CP emerge gradually with the earliest clues being a delay in developmental milestones and abnormal muscle tone. In CP, the history is no progressive. Milestones once acquired do not show regression in CP. Tone may be hypertonic or hypotonic. Many cases of early hypotonic change to spasticity or dystopia by 2 – 3 yrs of age. Early signs include the presence of hand preference in the first year, prominent fisting, abnormalities of tone–either spasticity or hypotonia of various distribution, the persistence of abnormal neonatal reflexes, delay in the emergence of protective and postural reflexes, asymmetrical movements like asymmetrical crawl and hyperreflexia. Primitive reflexes should gradually extinguish by 6 months of age. Among the most clinically useful primitive reflexes are Moro, Tonic labyrinthine and Asymmetric Tonic Neck Reflex (ATNR). In many cases, a diagnosis of CP may not be possible until 12 months. Repeated examinations and observation over a period of time may be required in mild cases before a firm diagnosis can be made.

In the further evaluation of a child with CP, an EEG is obtained if there is a history of epilepsy. Neuroimaging studies are carried out if they have not been done in the neonatal period that provided the etiology of CP. MRI studies are preferred to CT scans. Genetic and metabolic tests are carried out if there is evidence of deterioration or metabolic compensation, family history of childhood neurological disorder associated with CP. Tests to rule out coagulopathy in children with stroke is necessary.

CP is a chronic condition with considerable morbidity on affected individuals. Overall prevention of CP has not been successful. Early diagnosis and comprehensive management with a multidisciplinary approach with a developmental pediatrician or neurologist, orthopedic surgeon, speech and language therapist, physico and occupational therapist are required for management of a child with CP. Complete evaluation of a child with CP must have an assessment of associated deficits like vision, speech and hearing, sensory profile, or motor evaluation, epilepsy and cognitive functioning. Orthopedic evaluation is a must as muscle imbalance and spasticity cause subluxation/dislocation of the hips, equines deformities, contractures, and scoliosis. NICE Guidelines have to be introduced in most of the Indian Cerebral palsy centers.

Treatment

Treating Cerebral Palsy is nearly as unpredictable as the condition may be, and there's no cut-out approach in light of the fact that every individual is influenced in an unexpected way. In spite of the fact that the mental damage that causes Cerebral Palsy can't be recuperated, the subsequent physical debilitation can be made do with a wide scope of medicines and treatments. Despite the fact that there is no all-inclusive convention created for all cases, an individual's type of Cerebral Palsy, the degree of disability, and seriousness level help to decide care. At Trishla Foundation get the most ideal courses for the Cerebral Palsy treatment.