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Medical and Dental Implications of Cerebral Palsy. Part 1 General and Medical Characteristics: a Review

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Medical and Dental Implications of Cerebral Palsy. Part 1 General and Medical Characteristics: a Review Central Bringing Excellence in Open Access JSM Dentistry Special Issue on Oral health of children with special health care needs (SHCN) Edited by: Mawlood B. Kowash, BDS, MSc, PhD, FRCDc, FDSRCPS Associate professor in pediatric dentistry, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Review Article *Corresponding author Mawlood B. Kowash, Associate Professor in Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medical and Dental Implications of Medicine, Mohammed Bin Rashid University of Medical and Health Sciences, Dubai, UAE, Tel: 00971 505939004; Email: [email protected] Cerebral Palsy. Part 1 General and Submitted: 19 April 2017 Accepted: 05 June 2017 Medical Characteristics: A Review Published: 07 June 2017 ISSN: 2333-7133 Haifa Alhashmi, Mawlood Kowash*, and Manal Al Halabi Copyright College of Dental Medicine, Mohammed Bin Rashid University of Medical and Health Sciences, © 2017 Alhashmi et al. UAE OPEN ACCESS Abstract Keywords Cerebral palsy (CP) is a group of neuromuscular disorders that affects the development • Dyskinetic of movement and posture, causing activity limitations. CP is classified into three main groups: • Ataxic spastic, dyskinetic and ataxic. Population-based studies from around the world report estimates • Seizure of CP prevalence ranging from 1.5 to more than 4 per 1,000 live births. The commonest cause • Motor disorders of CP remains unknown in 50% of the cases; prematurity remains the common asterisk factor. • CP CP children suffer from numerous problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. This paper reviews and critically discusses the definition, epidemiology, aetiology, classifications, treatments and associated manifestation and complications of CP. INTRODUCTION disturbances of sensation, cognition, communication, perception, and/or by seizure disorders [2]. Cerebral palsy (CP) is a group of neuromuscular disorders, which affect the development of movement and posture, causing [3]. activity limitations. These limitations are attributable to non- CP1)spastic, may be classifiedcharacterized into three by mainincreased groups muscle tone; progressive disturbances, which have occurred in the developing 2) dyskinetic, characterized by hypotonic, slow writhing infant brain. Such disturbances include infection, hypoxia, movements (athetotic), abnormal postural control movements, trauma, and hyper bilirubin anaemia; biochemical and genetic factors may also be involved [1]. ataxic, characterized by involuntary movement, lack of balance The motor disorders of CP are often accompanied by andswallowing depth perception. difficulties, problems of speech and coordination; 3) Cite this article: Alhashmi H, Kowash M, Al Halabi M (2017) Medical and Dental Implications of Cerebral Palsy. Part 1 General and Medical Characteristics: A Review. JSM Dent 5(2): 1088. Alhashmi et al. (2017) Email: [email protected] Central Bringing Excellence in Open Access CP is the most common motor disability which occurs during indicate the prevalence of the CP in the UAE, or Dubai in particular childhood [4]. Population-based studies from around the world report estimates of CP prevalence ranging from 1.5 to more than of Western populations [14]. [5-9]. , experts in the field indicate that it is similar in proportion to that Aetiology In the industrialized nations, the prevalence of cerebral palsy is approximately4 per 1,000 live 2 birthsper 1000 of children live births of a[10] defined. In the age United range States, Congenital aetiology: CP patients have distinctive approximately 10,000 infants and babies are diagnosed with CP deformities which result from defects occurring in normal each year, and a further 1200-1500 are diagnosed at preschool development, and follow outlines based on failures of normal age [10]. formation [15].The earliest acknowledged deformities which lead to survival with motor defects are defects of the neural The prevalence of CP in the developing world is not well tube closure, such as Meningomyelocele (the most common established, but estimated to be 1.5-5.6 cases per 1,000 live neural tube defect occurring in the spine). On the other hand, the births [11]. neural tube defects in the brain known as encephalocele may be LITERATURE REVIEW anterior, with main mid face or nasal defects [16]. Children with Definition including quadriplegic patterns associated with hypotonia, rathersignificant than encephaloceles hypertonia. Segmental have significant defects in motor the brain impairments, known as schizencephaly refer to a cleft in the brain; such schizencephalies famous work of 1862, though he did not apply that term at the vary greatly in their effects, from causing minimal disability time.Sir William John Little Osler, was in histhe book first “Theto define cerebral cerebral palsy palsyof children” in his to causing very severe quadriplegic pattern involvement, and usually present with spasticity and mental retardation [17]. children, grouping them according to their expected aetiology, in(1889), order definedto interpret the clinicalthe physiopathological features, which mechanismspresented 151 of theCP Primary proliferation defects of the brain result in cerebral lesion (damage location). Sigmund Freud, in his “Die infantile Cerebrallahmung” (1897) inspected the causes of these of microencephaly, most of which relate to toxins or infection [15]microencephaly.. Megaloencephaly Regardless, is caused there by arecellular numerous hyper-proliferation, other causes and intrauterine development disorders, in contrast to Little [12]. commonly in syndromes such as sebaceous nerves syndrome, motor disorders, emphasizing the significance of pre-term birth where as macrocephaly is most often due to hydrocephalus. The American Academy for Cerebral Palsy (AACP) was Throughout development neurons transfer toward the founded in 1947 and is considered a multidisciplinary periphery of the brain, a defect in this migration pattern leads professional association, aimed at sponsoring research in the to lissencephaly, which means “smooth brain”; in other words, a child with decreased cerebral gyri. This defect usually leads to severe spastic quadriplegic pattern involvement. There is a field of infant disability. but Mutchoften etchanging, al., (1992) secondary defined CP to as brain “an umbrella lesions termor anomalies covering in a young child may preclude synaptic remodelling through broad-spectrum understanding that significant seizure activity appearinga number ofin syndromesthe early stages with ofmotor brain deficiency, development non-progressive, ”[12]. excitotoxic injury, which may lead to CP. Neonatal aetiology: Neonatal and prenatal causes of CP are et al., (2007) as follows: “Cerebral palsy (CP) describes a group of disordersAnother definitionof the development was then introduced of movement in by and Rosenbaun posture, to numerous patterns [15]. The general trend is that premature chiefly linked to prematurity and birthing problems, which lead causing activity limitation that are attributed to non-progressive infants with more severe bleeds in the brain (in ventricles and the periventricular white matter areas) have a worse prognoses for disturbances that occurred in the developing foetus or infant brain. survival and are at a higher risk of developing CP; nonetheless, The motor disorders of cerebral palsy are often accompanied by there are no restrictions which may accurately predict the risk disturbances of sensation, cognition, communication, perception, of developing CP, much less predict the severity of CP in an and/or behaviour, and/or by a seizure disorder” [12]. individual child. In full-term infants, Hypoxic events occurring Prevalence surrounding delivery usually lead to disability; these events have been called hypoxic-ischemic encephalopathies (HIE) [16]. Cerebral palsy (CP) is the most common motor disability occurring during childhood [4]. Population-based studies from Sub cortical cyst formations develop in severe cases of HIE around the world report prevalence estimates of CP ranging from and are called multi cysticencephalomalacia. When this cystic pattern forms, the prognosis for good function is poor, with most age range [5-9]. In the industrialized world, the prevalence of children developing severe quadriplegic pattern involvement, cerebral1.5 to more palsy than is about4 per 21,000 per 1000live births live births or children [10]. In of the a defined United with severe mental retardation. Further, some of these children States, approximately 10,000 infants and babies are diagnosed develop cysts in the thalamus and basal ganglia, which may lead with CP each year, and a further 1200-1500 are diagnosed at to dystonia [16]. preschool age [10]. The prevalence of CP in the developing world In the preterm or full-term infant, neonatal stroke usually is not well established, however, it is estimated to be 1.5-5.6 affects the middle cerebral artery and presents as a wedge- cases per 1000 live births [11]. In Saudi Arabia, a prevalence shaped defect in one hemisphere. If such awedge-shaped defect is ratio of 5.3 in every 1000 individuals was reported among the Saudi population [13]. While there are no available studies which especially with a cyst, usually presents as hemiplegic pattern small, the child may not be affected; similarly, a significant defect, JSM Dent 5(2): 1088 (2017) 2/6 Alhashmi et al. (2017) Email: [email protected]
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