Cerebral palsy – Diagnosis and treatment – Mayo Clinic

Diagnosis

If your family doctor or pediatrician suspects your child has cerebral palsy, he or she will evaluate your child's signs and symptoms, review your child's medical history, and conduct a physical evaluation. Your doctor may refer you to a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist).

Your doctor will also order a series of tests to make a diagnosis and rule out other possible causes.

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests may include the following:

Magnetic resonance imaging (MRI). An MRI uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of your child's brain. An MRI can often identify any lesions or abnormalities in your child's brain.

This test is painless, but it's noisy and can take up to an hour to complete. Your child will likely receive a mild sedative beforehand. An MRI is usually the preferred imaging test.

If your child has had seizures, your doctor may order an electroencephalogram (EEG) to determine if he or she has epilepsy, which often occurs in people with cerebral palsy. In an EEG test, a series of electrodes are affixed to your child's scalp.

The EEG records the electrical activity of your child's brain. If he or she has epilepsy, it's common for there to be changes in normal brain wave patterns.

Laboratory tests may also screen for genetic or metabolic problems.

If your child is diagnosed with cerebral palsy, you'll likely be referred to specialists for assessments of other conditions often associated with the disorder. These tests may identify:

Children and adults with cerebral palsy require long-term care with a medical care team. This team may include:

Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

It's important to talk about drug treatment risks with your doctor and discuss whether medical treatment is appropriate for your child's needs. Medication selection depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:

Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend onabotulinumtoxinA (Botox) injections directly into the muscle, nerve or both. Botox injections may help to improve drooling. Your child will need injections about every three months.

Side effects may include pain, mild flu-like symptoms, bruising or severe weakness. Other more-serious side effects include difficulty breathing and swallowing.

Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen).

Diazepam carries some dependency risk, so it's not recommended for long-term use. Its side effects include drowsiness, weakness and drooling.

Dantrolene side effects include sleepiness, weakness, nausea and diarrhea.

Baclofen side effects include sleepiness, confusion and nausea. Note that baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.

Your child also may be prescribed medications to reduce drooling. Medications such as trihexyphenidyl, scopolamine or glycopyrrolate (Robinul, Robinul Forte) may be helpful, as can Botox injection into the salivary glands.

A variety of nondrug therapies can help a person with cerebral palsy enhance functional abilities:

Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child.

For the first 1 to 2 years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

Braces or splints may be recommended for your child. Some of these supports help with function, such as improved walking. Others may stretch stiff muscles to help prevent rigid muscles (contractures).

Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, the school and the community.

Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.

Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language.

Speech-language pathologists can also teach your child to use communication devices, such as a computer and voice synthesizer, if communication is difficult.

Another communication device may be a board covered with pictures of items and activities your child may see in daily life. Sentences can be constructed by pointing to the pictures.

Speech therapists may also address difficulties with muscles used in eating and swallowing.

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

Orthopedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms, hips or legs in their correct positions.

Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. The procedures may also make it easier to use a walker, braces or crutches.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Some children and adolescents with cerebral palsy use some form of complementary or alternative medicine.

For example, hyperbaric oxygen therapy is widely promoted for cerebral palsy treatment despite limited evidence of efficacy. This and other unproven therapies for cerebral palsy should be viewed with skepticism. Controlled clinical trials involving therapies such as hyperbaric oxygen therapy, resistance exercise training using special clothing, assisted motion completion for children and certain forms of electrical stimulation have been inconclusive or showed no benefit to date, and the therapies are not accepted mainstream clinical practice.

Stem cell therapy is being explored as a treatment approach for cerebral palsy, but research is still assessing whether such approaches are safe and effective. Studies in the U.S. and elsewhere are examining the safety and tolerability of umbilical cord blood stem cell infusion in children with cerebral palsy.

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

Find support. A circle of support can make a big difference in helping you cope with cerebral palsy and its effects. As a parent, you may feel grief and guilt over your child's disability.

Your doctor can help you locate support groups, organizations and counseling services in your community. Your child may also benefit from family support programs, school programs and counseling.

If your child has cerebral palsy, how you learn about your child's condition may depend on the severity of the disabilities, when problems first appeared, and whether there were any risk factors during pregnancy or delivery.

Your doctor may ask you several questions during appointments, including:

If your family doctor or pediatrician believes that your child exhibits signs of cerebral palsy, you may want to discuss the following questions:

It's important to take your child to all regularly scheduled well-baby visits and annual appointments during childhood. These visits are an opportunity for your child's doctor to monitor your child's development in key areas, including:

Aug. 25, 2016

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Cerebral palsy - Diagnosis and treatment - Mayo Clinic