Child cerebral palsy, contrary to common and popular opinion, is not a separate disease. This is a whole complex of neurological and mental disorders that are congenital in nature. They arise during the intrauterine development of the fetus as a result of any negative impact on it. The whole thing is to defeat the cerebral structure of the child even at the stage of pregnancy.

Palsy is not progressive, but difficult illness. Usually neurological violations that exist at birth remain with a person for life, which makes it difficult to social adaptation, the possibility of everyday self-service and development.

Child cerebral palsy can consist of several different types of disorders nervous system - It depends on what brain tissues and plots are amazed. There are scalance of gait, disruption of coordination of movements, delays in the mental, social, creative, intellectual development of the child, which are visible immediately with the naked eye. Because of the failures in the central nervous system, the baby in the first year of life occurs irreversible changes with muscles - their tone is lost, the muscle mass can be quickly atrophy, subjected to non-standard wear.

Feel the impact of cerebral palsy and vegetative functions. The child is violated, logical thinking, memory, he lags behind the peers in studies, in intellectual development. Child cerebral paralysis can cause other pathologies in the human body, the most common of which is epilepsy. Epileptic seizures, cramps, fainting, tremor, - all this with sufficient frequency accompanies cerebral palsy.

If a person is ill, it is very important to have the presence and constant presence of close relatives, it needs help related to everyday everyday existence. Alas, but people who suffer from cerebral palsy usually have to have direct contacts with hospitals and clinics, namely, a regular clinical examination and listen to the advice of a doctor for receiving certain medicines and occupations by other types of therapy to alleviate the symptoms.

A constant impassive nature of the disease is associated with the morphological lesions of certain sections of the brain, which do not apply and do not hurt the neighboring tissue. This is not a tumor, which grows in size, damaging vessels and brain cells.

Child cerebral paralysis is not a rare disease, and, despite the achievements of the latest technologies, the number of children suffering from illness does not reach the minimum in the percentage. According to statistical data, boys are subject to PPCs more often than girls, but despite this, science does not exceed the influence of the gender of the kid on the occurrence of pathology.

The international classification of diseases to cerebral paralysis was assigned the number of MKB-10 - G80. According to the document, the PPC is divided into seven types, each of which depends on the structural-morphological pathology on one or another portion of the brain. The main and practically the only criterion of the form of cerebrals is the localization of the anomalies that occurred during the intrauterine development.

Types of illness:

1. spastic diploggy;
2. double
3. children's hemiplegia;
4. ataxcic cerebral paralysis;
5. mixed form of cerebral palsy;
6. discinetic CPU;
7. uncomfortable cerebral palsy.

According to statistics, spastic diploggy is more common. It is expressed in a strong influence of the ailment on the muscles and to coordinate movements. Violations in the nervous system affect the lower, and on the upper limbs. They lose tone, strength. Muscles of the whole body suffer and can atrophy.

For this form, involuntary and unhealthy movements of the limbs are typical. Especially bright violations are traced in their feet - the gait is spoiled due to the lack of synchronization of movements, the feet are deformed due to abnormal functionality. The patient's legs are constantly tense - they can crossed out, get up on chicks or, on the contrary, on the heels, to disperse in different directions.

Violation of movements is developing in parallel with slow motion mental and mental disabilities. The pathologies of vegetative functions do not show themselves brightly. The main feature of this form is unhealthy foot movements, hands and muscles of the face, because of which embarrassment of eyes, mimic disorders, impairment and attention occur.

People suffering from this form of cerebral palsy, speech defects are observed, as well as a violation of the handwriting. We can sometimes suffer too much, however, it is almost always lubricated, hurried, not stand out with clarity.

Despite all these items, some people who suffer this form are excellent and without any problems poured into society, find the desired profession and live as ordinary healthy individuals.

Double hemiplegia - serious and dangerous type of children cerebral paralysischaracterized by pronounced mental retardation, which sometimes turns into oligophrenia. The movement of the limbs at double hemiplegia is also violated, and the hands are especially affected. The patient cannot physically get up, it is difficult for him to even be in a sitting position.

The muscles of the body are always tense, motor disorders are regular, so people are deformed by the joints, the diseases of the spine appear, there are constantly loudspeat in the bones. Of the vegetative violations it is worth noting the impairment of sight and hearing, speech defects. All symptoms are manifested from birth. With double hemiplegia, doctors talk about a disappointing forecast - most often the patient remains disabled, requiring care and supervision. In this case, it is important when it helps to live and deal with the symptoms of native people.

Children's hemiplegia is manifested by one-sided car, they cover the left, or the right side of the body. At the same time, all four limbs suffer, but two of them are most pronounced. In this form, mental retardation is noticeable against the background of healthy peers. Children's hemiplegia is typical of periodically arising convulsions and attacks.

Ataxcic cerebral paralysis has many similarities with a separate disease - ataxia, characterized by disorderly involuntary movements of the limbs. Their development simultaneously with children's cerebral paralysis occurs when the cerebellum and neighboring brain fabrics are damaged. Ataxic disorders are the main component of this form, while the gait, the accuracy of movements significantly suffers significantly, is the tremor limbs. Mental disorders may be completely absent, or they achieve such an extent that they will turn into a fundamentally different pathology. It depends directly from the individual characteristics of the body and on the possibilities of immunity.

Discinetic cerebral paralysis is manifested by numerous hyperkinesis - involuntary movements of some muscle groups. At cereals, unhealthy mimic, grimaces, eye ripping, loud cries or moans are observed. It should be remembered that all these actions are not special, their occurrence of the patient does not control.

Life with hyperkinosis leads to impairment of muscles, to change the shape of the joints. However, with this type of centers, intelligence, thinking, logic does not suffer.

The mixed form of cerebral paralysis is diagnosed if a person has several groups of symptoms characteristic of different types of other centers. It is most unpredictable, although at a certain frequency and repetition of the same manifestations close people can already know what to expect from the patient.

Symptoms of cerebral pelvis depended strictly from the shape of the cerebral paralysis, and in other words, from the brain damage zone. Each site is responsible for a certain set of functions of the body, the loss of which is irreversible.

The reasons

Modern medicine cannot accurately answer the question that is a concrete and root cause in the emergence of such pathology as children's cerebral paralysis. Nevertheless, based on numerous studies, you can identify those factors that provoke the offensive of this disease. It is known that all of them are closely related to the intrauterine development of the fetus, any deviations can affect the brain that has not yet born baby.

1. intrauterine infection;
2. nonconformity of the future mother and fetus in the Rh Factor;
3. toxoplasmosis;
4. jaundice;
5. generic injuries;
6. premature labor leading to the presence of a child;
7. epilepsy and dementia;
8. significant endocrine disorders;
9. harmful habits - alcohol, smoking;
10. incication of narcotic and chemicals.

All these items indicate the possibility of hypoxia of the child's brain, its improper development from the very beginning, cases of suffocation in the womb. This is the notorious risk factor for the future kid.

Diagnostics

The child usually examines the children's neurologist, checking it on the presence of certain types of reactions, on the ability of thinking and intelligence. It also leads a clinical inspection of the whole body of the baby, motor activity and synchronization of the limbs. It is important to presence when examining parents who will help the doctor in matters of complaints and symptoms.

Be sure to diagnose children's cerebral paralysis, such new methods are used as electroencephalography and electronography, which recognize pathological changes in the state of biotoks in the brain. Procedures, like MRI or CT, make it possible to identify the possible birth of other anomalies.

Treatment of cerebrals

Press is impossible to cure and restore the work of damaged nerve cells. The patient needs to be regularly observed by a physician, who can individually advise a certain type of therapy, which will facilitate the symptoms:

1. courses from a psychologist and speech therapist;
2. massage;
3. physical exercises;
4. reception of medicines - Baclofen, Sirdalud;
5. orthopedic treatment, sometimes with the help of surgical intervention.

RCRZ (Republican Center for Health Development MD RK)
Version: Archive - Clinical protocols MOR RK - 2010 (Order No. 239)

Another type of cerebral paralysis (G80.8)

general information

Short description

Child cerebral palsy (cerebral palsy) - A group of syndromes, which are a consequence of damage to the brain arising in the perinatal period.

A characteristic feature of the cerebral palsy is a variety of motor disorders that are manifested by paralysis, disincordination of movements are often combined with various speech disorders, psyche, sometimes epileptic seizures.

PPP - polyethological disease of the brain, which may occur during the period of its intrauterine formation, during the period of childbirth and newborn, as well as in the postnatal period. PPC is the most common cause of child disability (30-70%), among which in the first place - diseases of the nervous system. In most cases, the physical condition of the patients is improved, but restrictions of activities are preserved: reducing the possibility of movement, speech disorders and others.

According to the literature, the frequency of cerebral palsy in the population is 2 per 1000 newborns; According to L. O. Badalyan (1987) - from 3 to 6 cases per 1000 born. The main causes of cerebral pals are related to the proceedings of pregnancy and the generic act (perinatal period): chronic diseases mother infectious diseases, taking medication during pregnancy, premature delivery, prolonged generic activity, hemolytic disease Newborn, crucial cord and others.

Protocol "Cerebral palsy"

Code of ICD-10:

G 80.0 Spastic Cerebral Paralysis

Congenital spasta (cerebral)

G 80.1 Spastic diplegegia

G 80.2 Children's hemiplegia

Classification

Classification

G 80 Child cerebral palsy.

Included: Little's disease.

Excluded: Hereditary spastic paraplegia.

G 80.0 Spastic cerebral paralysis.

Congenital spastic paralysis (cerebral)

G 80.1 Spastic diplege.

G 80.2 Children's hemiplegia.

G 80.3 Discinetic cerebral paralysis.

G 80.8 Another kind of children's cerebral paralysis.

Mixed cerebral paralysis syndromes.

G 80.9 Child cerebral paralysis is unspecified.

Classification of cerebral paralysis (K. A. Semenova et al. 1974)

1. Double spastic hemiplegia.

2. Spastic diploggy.

3. Hemiparesis.

4. Hyperkinetic shape with subforms: double athettos, athettosal ballism, choreatetomethosa, ferretic hyperkines.

5. ATONICAL-ASTATICAL Form.

By severity lesions: easy middle severity, severe form.

Period:

Early recovery;

Late recovery;

Residual period.

Diagnostics

Diagnostic criteria

Complaints On the delay in psychoreche and motor development, motor disorders, involuntary movements in the limbs, seizures of convulsion.

In history - perinatal pathology (presence, asphyxia in childbirth, generic injuries, protracted conjugation jaundice, intrauterine infections, etc.), suffered neuroinfection, onMK, CHMT in early childhood.

Physical examinations: Motor disorders - paresis, paralympics, contractures and refractory in joints, hypercines, delay in psycho-speech development, intellectual failure, epileptic attacks, pseudobulbar violations (violation of swallowing, chewing), pathology from the bodies of vision (squint, atrophy spectator nerves, nistagm).

For spastic shape, cerebral palsy is characteristic:

Increase muscle tone in the central type;

High tendon reflexes with advanced reflexogenic zones, stop clocks and patella;

Pathological reflexes: Babinsky, Rossolimo, Mendel-Bekhtereva, Oppenheim, Gordon, Schaeffer. Among them are most constantly detected by Reflex Babinsky.

For the hyperkinetic form of cerebral palsy is characteristic:hyperkinesisa - ferret, atteetoid, choreathetoid, double athettos, torsion dystonia.

At the age of 2-3 months, "dystonic attacks" appear, characterized by a sudden increase in muscle tone during movements, with positive and negative emotions, loud sounds, bright light; accompanied by a sharp cry, severe vegetative reactions - sweating, redness of the skin and tachycardia.

Tendon reflexes in most patients of ordinary livelihood or somewhat revived, pathological reflexes are not detected.

Hyperkineses in the muscles of the language appear at the age of 2-3 months of life, earlier than hyperkinesis in the muscles of the body - they appear in 4-6 months and become more pronounced with age. Hypercines are minimal alone, disappear in a dream, enhanced with arbitrary movements, provoked by emotions, are more pronounced in the position on the back and standing. Speech disorders are hyperkinetic character - dysarthria. Mental development is disturbed less than with other forms of cerebral palsy.

For the atony-astatic form of cerebral palsy is characteristic:

1. Muscular tone is sharply reduced. Against the background of the general muscular hypotension, the tone in the upper limbs is higher than in lower limbs, and movements in the upper part of the body are more active than in the bottom.

2. Tender reflexes are high, pathological reflexes are absent.

3. Recurring in the knee joints, placulous feet.

4. In the mental sphere, 87-90% of patients have a pronounced reduction in intelligence, the violation of speech is cerebellum.

Laboratory research:

1. Common blood test.

2. Common urine analysis.

3. Cal on the eggs worm.

4. IFA on toxoplasmosis, cytomegalovirus - according to indications.

5. Definition of TSH - by testimony.

Tools:

1. Computed tomography (CT) of the brain: there is a different atrophic process - expanding the side ventricles, subarachnoid spaces, cortical atrophy, porencephalic cysts and other organic pathology.

2. Electricencephalography (EEG) - the overall disorganization of rhythm, low-voltage EEG, peaks, plaster, generalized paroxysmal activity is revealed.

3. EMG - by testimony.

4. MRI brain - according to the testimony.

5. Neurosonography - in order to exclude internal hydrocephalus.

6. Okulist - the study of the eye dna reveals the expansion of the veins, the narrowing of the arteries. In some cases, congenital atrophy of the optic nerve, squint, is found.

Indications for expert advice:

1. The speech therapist is to identify speech disorders and their correction.

2. Psychologist - to clarify mental disorders and their correction.

3. orthopedic - identification of contractures, solving the issue of operational treatment.

4. Prosthetist - to provide orthopedic assistance.

5. Okulist - inspection of the eye bottom, detection and correction of the eye pathology.

6. Neurosurgeon - in order to eliminate neurosurgical pathology.

7. Physician physician is the appointment of individual classes, stacking.

8. Physiotherapist - to appoint physiotherapeutic procedures.

Minimum survey at hospital:

1. Common blood test.

2. Common urine analysis.

3. Cal on the eggs worm.

Main diagnostic measures:

1. Common blood test.

2. Common urine analysis.

3. speech therapist.

4. Psychologist.

5. Okulist.

6. Orthopedist.

7. Prosthetist.

9. Physician physician.

10. Physiotherapist.

11. Computer tomography brain.

List of additional diagnostic events:

1. Neurosonography.

2. Neurosurgeon.

3. MRI brain.

4. IFA on toxoplasmosis.

5. IFA on cytomegalovirus.

6. Infectnessist.

8. Cardiologist.

9. Ultrasound of the abdominal organs.

10. Genetic.

11. Endocrinologist.

Differential diagnosis

Treatment abroad

Treat treatment in Korea, Israel, Germany, USA

Get advice on medical examination

Treatment

Tactics of treatment

It is extremely important to suspect or make a diagnosis in the first year of life, since the child's brain has a huge potential to compensate for the damage. The brain of the child is extremely plastic, so you need to try to stimulate his restoration possibilities. IN comprehensive treatment PDCs include drugs, leaf, orthopedic assistance, different kinds Massage, reflexotherapy, physiotherapeutic procedures, classes with a speech therapist and a psychologist. Restorative therapy is most effective in patients in the early recovery period, the earlier to start a warning or decrease in the development of pathological phenomena, the greater the effect of therapeutic measures.

The basic principles of treating cerebral palsy in the restorative period:

1. Using medication tools, reducing the excitation zone and the reduction of muscle tone. Fight against the delay of tonic reflexes and pathological tone of muscles.

2. To achieve the formation vertical position The child, his movements and manual manipulations, the upbringing of standing skill, movement initially with an extraneous help, and then independently or with the help of crutches, sticks, orthopedic shoes, toys, devices.

3. Improving overall mobility and coordination of movements.

4. Promoting the normalization of mobility in the joints and performance of the muscles, eliminating the contractures of the joints.

5. Training and careport and equilibrium training.

6. Stimulation of cognitive and psycho-speech development, mental development and upbringing the right speech.

7. Training in vital, applied, labor skills, upbringing self-service skills.

Purpose of treatment:

Improving motor and psycho-speech activity;

Prevention of pathological poses and contractures;

Acquisition of self-service skills;

Social adaptation, the appearance of motivation;

Saving seizures seizures.

Non-drug treatment:

1. Common massage.

2. LFC - individual and group classes.

3. Physiotherapy - ozocenite applications, SMT, magnetotherapy.

4. Conductive pedagogy.

5. Classes with a speech therapist, psychologist.

6. Igloreflexotherapy.

7. Adeli costume.

8. Ippotherapy.

Medicia treatment

Recently, the preparations of nootropic series are widely used - neuroprotectors, in order to improve metabolic processes in the brain. Most of nootropic drugs, in connection with their psychostimulating action, are appointed in the first half of the day. The duration of treatment courses by nootrops is from one to two or three months.

Cerebrolysin, ampoules 1 ml in / m, piracetam, ampoules 5 ml 20%, tablets 0.2 and 0.4, ginkgo-biloba (tanacanan), tablets 40 mg, pyritinol hydrochloride (encephol), dragee 100 mg, suspension - 5 Ml contains 80.5 mg of pyritinol (comparison compartment of the pyritinol hydrochloride).
Encephol - minimum of contraindications is allowed to use from the first year of life. Dosing of the suspension (with a content of 1 ml of 20 mg of encefabol) for children 3-5 years old Dose 200-300 mg dose (12-15 mg of body weight) are prescribed to 2 reception - in the morning (after breakfast) and day (after day sleep and afternoon) . The duration of the course is 6-12 weeks, a long-lasting technique is advisable, which increases the performance and ability to learn, the highest mental functions are improved.

Actovegin, ampoules 2 ml of 80 mg, dragee-forte 200 mg of active substance. Neurometabolic preparation containing exclusively physiological components. Children are appointed in Dragee-Forte, reception to meals by ½ -1 dragee 2-3 times a day (depending on the age and severity of the symptoms of the disease), up to 17 hours. Duration of therapy 1-2 months. Instenon, tablets (1 tablet contains 50 mg of elegant, 20 mg of hexobundine, 60 mg of fillina). Multicomponent neurometabolic preparation. The daily dose is 1.5-2 tablets, prescribed in 2 receptions (in the morning and day) after eating. To eliminate side effects, gradual dose increases is recommended for 5-8 days. The duration of treatment is 4-6 weeks.

In spastic forms of cerebral palsyin practice, myiospazolytics are widely used: Tolperison, Tizandine, Baclofen.
Tolperison (Middokalm) is a muscle relaxant central action, it has a membrane-prompt activity, due to which it suppresses the formation and conduct of the action potentials in the hypersulated brain barrel motnelones and in peripheral nerves.
The mechanism of action is associated with the inhibitory effect on the caudal part of the reticular formation, the suppression of pathologically increased spinal reflex activity and exposure to peripheral nerve endings, as well as central n-cholinolytic properties. Also also has a vasodilant action. This leads to a decrease in an abnormally high muscle tone, reduces pathologically elevated muscle tone, muscle rigidity, improves arbitrary active movements.
Middokalum suppresses the functions of the activating and brake reticulosperial paths and inhibits the mono-and polysinactic reflexes in the spinal cord.
Dosage mode: children from 3 months. up to 6 years old, middokalms are prescribed in the daily dose at the rate of 5-10 mg / kg (in 3 receptions during the day); at the age of 7-14 years - in a daily dose 2-4 mg / kg; Adults of 50 mg - 150 mg (1-3 dragee) 3 times a day.

Tizandine (Sirdalud) is a central action minepaszyolitic. The main point of the application of its action is in the spinal cord. It selectively suppresses polysinactic mechanisms responsible for increasing the muscle tone, mainly by reducing the emission of exciting aminoxils from intermediate neurons. The drug does not affect neuromuscular transmission.
Sirdalud is well tolerated and effective in spasticity of cerebral and spinal genes. It reduces resistance to passive movements, reduces spasms and clonic convulsions, and also increases the force of arbitrary cuts.

Baclofen - Miorlaxant of the central action; Gaba receptor agonist. Inhibited mono and polysinapotic reflexes, apparently, by reducing the release of exciting amino acids (glutamate and aspartate) and terminals, which occurs as a result of stimulation of the presynaptic GABA receptors. Against the background of the use of the drug, the motor and functional activity of patients increases.

Angioprotectors: Vinpocetin, Cinnarizin.

Group vitamins B: thiamine bromide, pyridoxine hydrochloride, cyancobalamid; Neuromulitivitis - special complex vitamins group in with directional neurotropic effect; Neurobex.

Vitamins: folic acid, tocopherol, retinol, ergocalciferrol.

Anticonvulsants with epileptic syndrome: Valproic acid, carbamzazazepine, diazepam, clonazepam, topamax, lamotrine.

With a combination of cerebral palsy with hydrocephalus, hypertensive-hydrocephallated syndrome shows the purpose of dehydration funds: acetosolamide, furosemide, at the same time potassium preparations: Panangin, Asparkamka, Potassium orotat.

With severe concern, neuro-reflex excitability syndrome are prescribed sedatives: new-passite, noofen, medicine with citral.

In recent years, botulinum toxin is used in spastic forms of cerebral palsy in order to reduce the spasticity of individual muscle groups. The mechanism of action of the toxin of botulism (drug dysport) is to brake the release of acetylcholine in neuromuscular synapses. The injection of the drug leads to spastic muscle relatives.
The main indication for the purpose of dysport in children with different forms of cerebrals is the equinrary deformation of the foot. The introduction of dysport is technically simple and not accompanied by significant side reactions.
The standard dose of dysport per procedure is 20-30 mg per 1 kg of body weight. Maximum allowable dose in children 1000 units. The average dose for each oscracule muscle head is 100-150 units., for chibaloid and rear tibial muscles - 200 units.
Injection technique: 500 units. Distports are divorced in 2.5 ml of physiological solution (so on 1 ml of solution contains 200 units. drug). The solution is introduced into the muscle into one or two points. The effect of the drug (relaxation of spastic muscles) begins to appear on the 5-7th day after the administration of the drug with the achievement of the maximum effect to 10-14 days.
The duration of the Miorosanta is individual and varies from 3 to 6 months. After administration. Distports should be entered into a comprehensive scheme as early as possible before the formation of the contractures of the joints.

Preventive actions:

Prevention of contractures, pathological poses;

Prevention of viral and bacterial infections.

Further maintenance: Dispensary accounting from a neuropathologist at the place of residence, regular exercises of the Flamm, training of parents massage skills, LFC, orthopedic styling, childcare with cerebrals.

List of basic medicines:

1. Actovegin ampoules of 80 mg, 2 ml

2. Vinpocetin, (Cavinton), Tablets, 5 mg

3. PiRsets in ampoules of 5 ml of 20%

4. Pyridoxine hydrochloride ampoules 1 ml 5%

5. Folic Acid, Tablets 0,001

6. Cerebrolysis, ampoules 1 ml

7. Cyanocobalamin, ampoules 200 μg and 500 μg

Additional medicines:

1. Aevit, capsules

2. Asparkam, tablets

3. Acetosolamide, 250 mg tablets

4. Baclofen, Tablets 10 mg and 25 mg

5. Valproic acid, syrup

6. Valproic acid, tablets 300 mg and 500 mg

7. Gingo-Biloba, Tablets 40 mg

8. Glycine, Tablets 0.1

9. Hopantic acid, (Pantokalcin), Tablets 0.25

10. Diazepam, ampoules 2 ml 0.5%

11. DISTURAL, AMPUILS 500

12. Carbamazepine, Tablets 200 mg

13. Clonazepam, Tablets 2 mg

14. Convalex, capsules 150 mg, 300 mg, 500 mg, solution in drops

15. Lookinzhin, Tablets 25 mg and 50 mg

16. Magne B6, Tablets

17. Neuromidin, Tablets 20 mg

18. New Passitis, Tablets, 100 ml Solution

19. Noofen, Tablets 0.25

20. Panangin, Tablets

21. PiRsets, Tablets 0.2

22. Pyritinol, suspension or tablets 0.1

23. Tiamine Bromide Ampoules, 1 ml 5%

24. Tizanidine (Sirdalud), Tablets 2.4 and 6 mg

25. Tolpirison, (Middokalm) ampoules 1 ml, 100 mg

26. Tolpirison, Dragee 50 mg and 150 mg

27. Topamax, Capsules 15 mg and 25 mg, Tablets 25 mg

28. Cinnarizin, Tablets 25 mg

Treatment Efficiency Indicators:

1. Improving motor and speech activity.

2. Reducing muscle tone in spastic forms of cerebral palsy.

3. Increase the volume of active and passive movements in the parethous limbs.

4. Saving seizures of seizures with accompanying epilepsy.

5. Reducing hypercines.

6. Acquisition of self-service skills.

7. Replenishment of the active and passive stock of words.

8. Improving the emotional and mental tone of the child.

Hospitalization

Indications for hospitalization: Motor disorders, paresis, paralysis, retreat of psychomotor and speech development from their peers, seizures of convulsion, hypercines, contractures, refractories in the joints

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
   1. L.O. Badalyan Children's neurology.1975 Moscow Directory of the Child Psychiatrist and Neuropathologist Edited by LA Bulachova. Kiev 1997 L.Z. Kazantseva. Rett syndrome in children. Moscow 1998 Clinic and diagnosis of children's cerebral paralysis. Educational and methodical manual. Zhukabaeva S.S. 2005.

Information

List of developers:

Attached files

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3.5.3. CEREBRAL PALSY

Child cerebral palsy (cerebral palsy) (paralysis cerebralis infantilis.) — A collective term that combines a group of chronic non-progressive syndromes arising due to brain damage in intrauterine, perinatal and early neonatal periods. Palsy is characterized by persistent expressed engine, speech, behavioral disorders, mental delay, the formation of a pathological postural stereotype.

PPC is a severe disabled disease, leading to significantly pronounced restrictions of vital activity, which is the main reason for the formation of disability in the children's population. The prevalence of this pathology is 2-2.5 cases per 1000 children. The number of cases steadily increases every year. The disease is 1.3 times more common among boys, diagnosed in 90% of cases under the age of 3 years.

The final diagnosis can usually be set after a year when motor, speech and mental disorders become apparent. Criteria for diagnosis: an immanent flow, a combination of clinical picture Diseases of paralysis and paresses of various distributions, hyperkinetic syndromes, speech, coordinator, sensory disorders, cognitive and intellectual decrease.

Epidemiology: The prevalence of this pathology is 2-2.5 cases per 1000 children. The disease is 1.3 times more common among boys, diagnosed in 90% of cases under the age of 3 years.

Etiology and pathogenesis: The main reasons for the development of cerebral palsy are the antenatal causes (the age of the mother, extragenital diseases, drug therapy and professional harm, alcoholism and smoking of parents, the immunological incompatibility of the mother and the fetus, antiphospholipid syndrome at the mother), violations of the normal course of pregnancy at the various timing (toxicosis, multi-way, the threat of interruption, the pathology of the placenta, multiple pregnancy, surgical interventions, anesthesia during pregnancy, premature, premature birth, etc.), intranatal causes (long-term b / Water period, pathology of generic paths, instrumental objects, operational delivery, rapidly, etc.); Postnatal period (neonatal convulsive attacks, traumatic and infectious brain damage, toxic lesions (bilirubinic encephalopathy), hypoxia, etc.). In addition, many authors indicate for a clear connection of a cerebral palsy with low body weight. In the pathogenesis of cereals, along with the immediate damage of the motor zone of the cerebral cortex, subcortical formations and a pyramidal tract, great importance has a damage to the perivnricular region (air defense) by type perivnricular lekomolation; as well as atrophic and subatrophic processes in the cerebral cortex (more often in front and temporal departments), violation of the blood supply of brain and liquorodynamic violations [Nikitina M.N. , 1999, Mezhenina E.P., Kachev V. A., 2001].

Classification Reflects mostly features motor disorders. In our country is often used classification according to K. A. Semenova (1978),according to which it is distinguished by: spastic diplege, double hemiplegia, hyperkinetic shape, an atony-astatic form, hemiplegic form.

According to the ICD-10Seven groups of cerebral palsy (G80) are distinguished depending on the localization of the affected structures (hereditary spastic paragliding is excluded - G11.4):

G80.0 Spastic Cerebral Paralysis

Congenital spastic paralysis (cerebral)

G80.1 Spastic diplegegia (Little disease);

G80.2 Children's hemiplegia

G80.3 Discinetic cerebral paralysis

Atteetoid cerebral palsy

G80.4 Ataxcic Cerebral Paralysis

G80.8 Other kind of children's cerebral paralysis

Mixed cerebral paralysis syndromes

G80.9 Children's cerebral paralysis

Allocate the following stageschildren's cerebral paralysis: early stage (up to 4-5 months): general heavy condition, vegetative violations, nystagm, convulsions, intracranial hypertension, motor disorders syndrome; initial chronic residual stage (from 5-6 months to 3-4 years): proceeds against the background of residual phenomena. Resistant neurological disorders are formed - persistent muscle hypertension (during spastic forms); plucky residual stage (after 3 years). Characterized by the formation of persistent dezadapoting syndromes various degrees severity.

1. Static disorders syndrome (spastic paresis, hyperkinesis, ataxia, contracture and deformation of the joints); In the process of rehabilitation, complete compensation is movement without support, in a sufficient pace, regardless of distance; deformation of the limbs are absent; Subcompensation - movement with a distance limit, if there is an additional support; Partial compensation - a sharply limited possibility of movement, more often only within the apartment; Decompensation or lack of compensation is a complete inability to move.

2. Syndromes of violations of expressive and written speech: Dysarthria, Alalia, Dysgraphy, Dysxia, etc.

3. Disorders of sensory functions: violations of vision (squint, nistagm, amblyopia, cortical loss of field fields); hearing impairment (hearing loss of varying degrees);

4. Hypertensional-hydrocepal syndrome of various severity;

5. Paroxysmal disorder syndrome;

6. Cognitive disorder syndromes (psychoorganic syndrome, etc.);

7. Behavior disorders and personal disorders (neurosis-like, psychopathoid disorders, hyperactivity, impulsiveness);

8. Intellectual decrease (various degrees of mental backwardness);

9. Violation of the function of the pelvic organs (attenuation or lack of control).

Clinical characteristics of individual forms of centers:

Spastic double hemiplegia (tetraplegia) - One of the most severe forms of cerebral palsy, is found in 2% of cases. It is clinically characterized by a spastic tetraparez, while due to the high muscle tone, a pathological posture is formed: the hands are bent in the elbow and raying joints, are shown to the body, the legs are bent in the hip joints, bent or, on the contrary, dismissed in the knee joints, are rotated inside, hips are shown. Such children are not able to hold the vertical pose, sit, stand, walk, hold their heads, form pronounced pseudobulbar symptoms, rybism, atrophy of the visual nerves, impairment of hearing. Due to hypertensive syndrome, the contractures of the joints, bone deformities of the body and limbs arise. In half cases, this disease is accompanied by generalized and partial epileptic paroxysms. This form is prognostically unfavorable.

Spastic diplegegia (Little disease G80.1): The most common form of cerebral shape (60% of cases) is developing, as a rule, due to intraventricular hemorrhages. It is characterized by the development of uneven tetrapabin with a predominant lesion of the lower extremities, sometimes in combination with athettoid and / or choreathuteoid hyperkinosis, attaxia. Accompanied by stabism, atrophy of the visual nerves, reduced hearing, dysarthria. Intellect, as a rule, does not suffer. In children with this form of cerebral palsy, pathological motor stereotype is formed. The shock formulation of the foot on the support is noted, the depreciation function of walking is disturbed, i.e. There is no slight bending of legs in the knee joint in the phase of the median support. This increases the shock load on the joints of the lower extremities, which leads to the early development of arthrosis of the joints (dysplastic arthrosis). This form is favorable for overcoming mental and speech violations.

Children's hemiplegia (hemiplegic form G80.2) It is characterized by one-sided defeat of the limbs. Children has a violation of stative dynamic functions due to asymmetry of poses, the occurrence of paralytic scoliosis, the backlog in the growth of paralyzed limbs, anatomical shortening of the struck hands and legs. This form is accompanied by disorders of speech functions according to the type of pseudobulbar dysarthria, mental disorders are possible, the occurrence of epileptic paroxysms.

Discinetic cerebral paralysis:hyperkinetic (discnetic) form (G80.3.) Formed, as a rule, after transferred to the so-called. "Nuclear jaundice." Accompanied by disorders of statitional functions due to ferretical, atteetoid, torsion hyperkinesis, violation of speech, mental delay, decrease in hearing, violation of the functions of the autonomic nervous system. Intelligence in most cases does not suffer, this causes a favorable forecast for social adaptation and learning.

Ataxcic cerebral paralysis (ataxy form G80.4) characterized the following manifestations: Muscular hypotension, ataxia, various symptoms of cerebellasting asynology, intente tremor, dysarthria.

Thus, in patients with cerebral diseases arise in life limitations due to violations of vestibular functions (equilibrium, coordination of movements, kinsthesia (disorder of the sensation of movement, weakening of proprioceptor from muscles, tendons, joints)); perception anomalies - ignoring the affected limbs in 50% of children with hemiplegia; cognitive violations (violation of attention, memory, thinking, emotional sphere) in 65% of children; mental retardation of more than 50% of children with cerebral palsy; disorders of expressive and written speech in the form of dysarthria, alalia, dyslexia, deprigraphy, etc.); behavior disorders and personal disorders (violation of motivation, neurosis-like and psychopathoid disorders, hyperactivity, impulsiveness); delays in the pace of motor and / or psychoretical development; symptomatic epilepsy (in 50-70% of cases); violations of vision (squint, nystagm, amblyopia, cortical loss of field fields); hearing impairment (hearing loss of varying degrees); hypertensional hydrocephalic syndrome; diffuse osteoporosis; violations from cardiovascular and respiratory systems; urological disorders (bladder hypereflexia, deloading-sphincter dissigation), developing in 90% of patients; Orthopedic pathology: shortening limbs, violation of posture, scoliosis, joint contractures, etc.- are observed in 50% of children suffering from cerebrals.

Required data when directions on ITU: Conclusion of a neurologist, epileptologist, psychiatrist, oculist (research of the eyeboard and fields), Surdian, orthopedic, pediatrician, speech therapist; EPO with an assessment of intelligence; states of mental processes and personality; Echo ehg, EEG, RG (according to indications), CT and (or) MRI brain.

Indications for the Direction on ITU: the presence of a resistant motor defect (spastic paresis, hyperkines, ataxia, contractures and deformation of the joints) from moderate to significantly pronounced degree; The combination of motor disorders of various degrees of severity with the presence: persistent moderate and pronounced disorders of expressive and written speech; persistent moderate and pronounced disorders of sensory functions; lungs (absans, simple partial, myoclonic seizures) and heavy seizures (large convulsive seizures, secondally generalized partial seizures - Jackson, astatic, outpatient automates); persistent moderate and severe cognitive disorders (psychoorganic syndrome, etc.); persistent moderate and pronounced syndromes of the "personal" register (nerity-like, psychopath-like disorders, hyperactivity, impulsiveness); intellectual insufficiency of varying degrees; Indications for the direction of ITU in the presence of mental and paroxysmal disorders, see section - "Medical and social expertise and rehabilitation of children with disabilities with mental disorders and behavior disorders "and in the section -" Epilepsy ".

Criteria for disability: Resistant moderate, severe or significantly pronounced disorders of neuromuscular, skeletal and associated with the movement (statineamic), language and speech, sensory functions, urinary function, etc., leading to the limitation of self-service, independent movement, communication, training, the ability to control their behavior defining necessity social protection Baby.

The quantitative system of assessing the severity of persistent violations of the functions of the human body in percent is presented in Table 72.

Table 72.

Quantitative system of assessing the severity of persistent violations of the functions of the human body in percent

For children's hemiplegia (hemipartic form) PRPs are observed disorders of minor functions (10-30%), temperate (40-60%), pronounced (70-80%), significantly pronounced (90-100%): Static function - from insignificant to significantly pronounced degree, violations of linguistic and Speech functions - from insignificant to a pronounced degree, disorders of mental functions - from insignificant to a pronounced degree.

Forspastic diplegegia (diplegic form)Palilation of functions are observed (40-60%), pronounced (70-80%), significantly pronounced (90-100%): a static function from moderate to significantly pronounced, violation of language and speech functions of a pronounced degree, violation of mental functions expressed degree.

For discinetic (hyperkinetic) form

For spast cerebral paralysis (double hemipilegia, spastic tetraprezen)there are violations of functions significantly pronounced (90-100%): the static function of a significantly pronounced degree, violation of the linguistic and speech functions of a pronounced degree, violation of the mental functions of a pronounced degree.

For atronically-astatic form Palsy There are violations of the functions pronounced (70-80%) and significantly pronounced (90-100%): the static function from pronounced to significantly pronounced, violation of the linguistic and speech functions of a pronounced degree, violation of mental functions of a pronounced degree.

Rubric on the ICF.: main functions - b117 intelligent functions; B126 Temperament and personal functions, B140 Fighting functions, B144 - Memory functions; B310- B 399 Voice and speech functions; B 710-789 Neometric, skeletal and associated function.

Medical rehabilitation : Reconstructive surgery According to the testimony: Achilloplasty, shortening osteotomy, transplanting of tendons, arthropeses, tenets, arthroplasty, neuroectomy, etc.; restorative therapy: Medical therapy with drugs stimulating exchange processes brain, reduced muscle tone, reducing hypercines that improve neuromuscular transmission, stimulating the metabolism in muscle tissue, which improve microcirculation, stimulating regeneration; In especially difficult cases, the use of injections of botulinum toxin (botox or dysport) into muscle-agonists in order to reduce the tone of muscles involved in the construction of a pathological motor stereotype in patients with spastic forms of cerebral palsy; symptomatic therapy of major disadaptation syndromes (anti-kvulsants, proofreaders of behavior, etc.); physiotherapy, physiotherapy, massage, needleflexotherapy; The method of dynamic proprioceptive correction is wearing a gravitational costume (therapeutic suits "Adele", "Gravistat", "Spiral", "Atlant"); spa treatment In the absence of contraindications.

Technical means of rehabilitation: with a pronounced and significantly pronounced violation of the static, sensory function, the functions of the urinary system are shown to ensure the disabled person with technical means of rehabilitation: wheelchairs for children with cerebral palsy (indoor and pleasure), walkers; Supporting canes, toilet chairs; Mattresses and pillows anti-shirt; absorbent underwear, diapers, learning and development of the ability to carry out everyday self-service, etc.; Other technical means for self-service and movement can be applied, etc., included in state guarantees (for example, various types of orthosis, appliances for dressing, undressing and capturing subjects); Technical means according to GOST R 52079-2006, not included in state guarantees.

PPC is caused by a number of different factors that act in different periods of life - during pregnancy, childbirth, in early childhood. In most cases, cerebral cerebrals arises of the brain received during birth during asphyxia. Nevertheless, extensive studies in the 1980s showed that only 5-10% of cases of cerebral palsy are associated with generic injury. Others possible reasons Includes abnormalities of brain development, prenatal factors that directly or indirectly damage neurons in developing brain, premature genera, brain injuries that occur in the first few years of life.
Prenatal causes.
Brain development - very thin process, I have an impact on which many factors can. An extraneous effect can lead to a structural abnormal brain, including a conductive system. These damage may be hereditary, but most often true causes are unknown.
Mother and fetus infections increase the risk of cerebral paralysis. In this regard, they have the importance of rubella, cytomegalovirus (CMV) and toxoplasmosis. Most women have immunity to all three infections by the time to achieve a childbearing period, and the immune status of women can be determined by analyzing the Torch infection (toxoplasmosis, rubella, cytomegalovirus, herpes) before or during pregnancy.
Any substance that can affect the development of the brain of the fetus, directly or indirectly, can increase the risk of developing cerebral paralysis. In addition, any substance that increases the risk of premature birth and low birth weight, such as alcohol, tobacco or cocaine, can indirectly increase the risk of cerebrals.
Due to the fact that the fetus receives all nutrients and oxygen from the blood, which circulates through the placenta, everything that interferes with the normal function of the placenta may negatively affect the development of the fetus, including its brain, or may increase the risk of premature birth. Structural anomalies of the placenta, premature detachment of the placenta from the wall of the uterus and placental infections represent a certain risk of cerebral palsy.
Some diseases of the mother during pregnancy may be dangerous for the development of the fetus. In women with enhancement-intensive or anti-phospholipidantomants are in a group of high risk on cerebral palsy in their children. It is also an important factor that indicates the high risk of this pathology is the high level of cytokines in the blood. Cytokines are proteins associated with inflammation in infectious or autoimmune diseasesThey can be toxic for neurons of the brain of the fetus.
Perinatal causes.
Among the perinatal causes, asphyxia is of particular importance, the curse of the cord around the neck, the detachment of the placenta and its presence.
The infection of the mother is sometimes not transmitted to the fetus through the placenta, but is transmitted to the child during childbirth. Herpetic infection can lead to severe peeks of newborns, which entails neurological damage.
Postpartum reasons.
The remaining 15% of cases of cerebral palsy are associated with neurological injury after birth. Such form of cerebrals are called acquired.
The incompatibility of blood groups RH Mother and Child (if the mother has a negative rhesus factor, and the child is positive) can lead to severe anemia in a child, which entails heavy jaundice.
Serious infections that directly on the brain, such as meningitis and encephalitis, can lead to irreversible brain damage and children's cerebral paralysis. Caucasus B. early age Can lead to cerebral palsy. Idiopathic cases are diagnosed not so often.
As a result of the hard handling of the child, the cranial and brain injuries, drowning, suffocation arises of the physical injury to the child, often leading the cerebral palsy. In addition, the use of toxic substances, such as lead, mercury, other poisons, or certain chemicals can cause neurological damage. Random overdose of some medicinal preparations It can also cause similar damage to the central nervous system.

PPC is caused by a number of different factors that act in different periods of life - during pregnancy, childbirth, in early childhood. In most cases, cerebral cerebrals arises of the brain received during birth during asphyxia. Nevertheless, extensive studies in the 1980s showed that only 5-10% of cases of cerebral palsy are associated with generic injury. Other possible reasons include the abnormalities of brain development, prenatal factors that directly or indirectly damage neurons in the developing brain, premature genera, brain injuries that occur in the first few years of life.
Prenatal causes.
The brain development is a very subtle process, to have an impact on which many factors can. An extraneous effect can lead to a structural abnormal brain, including a conductive system. These damage may be hereditary, but most often true causes are unknown.
Mother and fetus infections increase the risk of cerebral paralysis. In this regard, they have the importance of rubella, cytomegalovirus (CMV) and toxoplasmosis. Most women have immunity to all three infections by the time to achieve a childbearing period, and the immune status of women can be determined by analyzing the Torch infection (toxoplasmosis, rubella, cytomegalovirus, herpes) before or during pregnancy.
Any substance that can affect the development of the brain of the fetus, directly or indirectly, can increase the risk of developing cerebral paralysis. In addition, any substance that increases the risk of premature birth and low birth weight, such as alcohol, tobacco or cocaine, can indirectly increase the risk of cerebrals.
Due to the fact that the fetus receives all nutrients and oxygen from the blood, which circulates through the placenta, everything that interferes with the normal function of the placenta may negatively affect the development of the fetus, including its brain, or may increase the risk of premature birth. Structural anomalies of the placenta, premature detachment of the placenta from the wall of the uterus and placental infections represent a certain risk of cerebral palsy.
Some diseases of the mother during pregnancy may be dangerous for the development of the fetus. In women with enhancement-intensive or anti-phospholipidantomants are in a group of high risk on cerebral palsy in their children. It is also an important factor that indicates the high risk of this pathology is the high level of cytokines in the blood. Cytokines are proteins associated with inflammation in infectious or autoimmune diseases, they can be toxic for neurons of the fetal brain.
Perinatal causes.
Among the perinatal causes, asphyxia is of particular importance, the curse of the cord around the neck, the detachment of the placenta and its presence.
The infection of the mother is sometimes not transmitted to the fetus through the placenta, but is transmitted to the child during childbirth. Herpetic infection can lead to severe peeks of newborns, which entails neurological damage.
Postpartum reasons.
The remaining 15% of cases of cerebral palsy are associated with neurological injury after birth. Such form of cerebrals are called acquired.
The incompatibility of blood groups RH Mother and Child (if the mother has a negative rhesus factor, and the child is positive) can lead to severe anemia in a child, which entails heavy jaundice.
Serious infections that directly on the brain, such as meningitis and encephalitis, can lead to irreversible brain damage and children's cerebral paralysis. Early age convulsions can lead to cerebral palsy. Idiopathic cases are diagnosed not so often.
As a result of the hard handling of the child, the cranial and brain injuries, drowning, suffocation arises of the physical injury to the child, often leading the cerebral palsy. In addition, the use of toxic substances, such as lead, mercury, other poisons, or certain chemicals can cause neurological damage. Random overdose of certain drugs can also cause similar damage to the central nervous system.