AKT · Neurology/Seizures, delirium & paeds

Cerebral palsy

Non-progressive motor disorder from an early brain injury (incl. HIE)

Overview

A permanent, NON-PROGRESSIVE disorder of movement and posture from an injury to the developing brain (antenatal, perinatal — including hypoxic-ischaemic encephalopathy — or early postnatal). The motor disorder is static but its clinical expression changes with growth; comorbidities (epilepsy, learning disability) are common.

Recognise

Delayed motor milestones, abnormal tone/posture, persistent primitive reflexes, early hand preference (<12 months)
Types: SPASTIC (commonest — UMN, hypertonia), dyskinetic (choreoathetoid), ataxic
Comorbidities: epilepsy, learning disability, visual/hearing impairment, feeding/communication difficulties

Red flags

Loss of previously-acquired skills = NOT cerebral palsy (which is static) → investigate a neurodegenerative/metabolic cause

Differentials & how to tell them apart

Neurodegenerative/metabolic disorderREGRESSION (loss of skills) — cerebral palsy is non-progressive

Muscular dystrophyprogressive proximal weakness, Gowers, raised CK

Hereditary spastic paraplegiaprogressive, family history

Spinal cord/structural lesionimaging, sensory level

Investigations

Clinical diagnosis; MRI brain to identify the lesion/timing; assess comorbidities (vision, hearing, epilepsy, feeding, development).

Management

Multidisciplinary supportive care; spasticity management (baclofen/botulinum toxin)

1Confirm clinically + MRI; coordinate multidisciplinary care (physio, OT, SALT, orthopaedics, paediatric neurology); manage spasticity and comorbidities.Gate: Cerebral palsy is NON-PROGRESSIVE — any loss of acquired skills (regression) points away from it to a neurodegenerative/metabolic disorder needing investigation
2Spasticity (baclofen, botulinum toxin, orthopaedic surgery), epilepsy treatment, feeding/nutrition, communication aids; long-term MDT and family support.

Spasticity: baclofen, botulinum toxin — symptomatic tone management

MDT supportive care — physio, OT, SALT, orthotics; treat epilepsy/comorbidities

Key points

Static motor disorder from an early brain injury (incl. HIE), with changing expression as the child grows. Regression rules it out. Spastic is the commonest type. (Cross-reference: child_health developmental milestones.)

Monitor & prognosis

Motor function, growth/feeding, comorbidities (epilepsy, vision, hearing), development.

Non-progressive motor disorder; function depends on severity and comorbidities.

Source: NICE NG62 (cerebral palsy under 25s)