Spastic Cerebral Palsy

What is spastic cerebral palsy?

Spastic cerebral palsy is a condition that causes increased muscle tone (spasticity) and stiffness. It can sometimes be painful if severe. It also causes muscle spasms, or sudden movements, that your child can’t control.

Symptoms look a bit different for each person. For example, it may be difficult for your child to walk by rolling their step (heel to toe). It may be more comfortable for them to walk on their tiptoes. Quick or sudden movements, like reaching out to catch a ball, might trigger pain with this condition.

Spastic cerebral palsy is the most common type of cerebral palsy. Cerebral palsy is a group of neurological conditions (affecting your brain and nerves) that cause difficulty with movement and coordination.

What are the types of spastic cerebral palsy?

There are three types of spastic cerebral palsy:

• Spastic diplegia/diparesis. Symptoms affect your child’s legs. It makes walking difficult due to tight hip and leg muscles. Your child’s legs may pull inward and may even cross at their knees (this motion is called “scissoring” of the legs).
• Spastic hemiplegia/hemiparesis. Symptoms affect one side of your child’s body, either the right side or the left side. It may involve the arm, leg or both limbs on one side.
• Spastic quadriplegia/quadriparesis. Symptoms affect both arms, both legs and your child’s face. It represents a more severe form of cerebral palsy. Your child may also have symptoms of cognitive delay (difficulty with learning), seizures or other symptoms.

What are the symptoms of spastic cerebral palsy?

The symptoms of spastic cerebral palsy may include:

• Tight muscles
• Stiff muscles
• Muscle pain
• Involuntary muscle movements or spasms

These symptoms can make movements of the affected muscles jerky, preventing smooth motions in your child’s arms and legs. Symptoms can range from mild to severe.

What are the signs of spastic cerebral palsy?

The first signs of spastic cerebral palsy may include:

• Increased tone, or tightness, of your child’s limbs (on examination by their pediatrician)
• Difficulty fully extending joints
• Delays in meeting developmental milestones (like crawling, walking or grabbing)
• Difficulty with coordination
• Problems walking or an abnormal gait or stride (like your child’s knees crossing when walking)
• Walking on tiptoes only

What causes spastic cerebral palsy?

Spastic cerebral palsy occurs due to an injury that disrupts the brain pathways that control muscles and movement. It may happen due to a lack of oxygen to the brain, a brain injury or, less commonly, due to a genetic abnormality (change in DNA).

Lack of oxygen to the brain or brain injury can occur during pregnancy, birth or shortly after birth if the following occur:

• Lack of blood flow to the brain (ischemic stroke)
• Bleeding in the brain (hemorrhagic stroke)
• Injury to the brain due to infection
• Injury to the brain due to trauma (traumatic brain injury)

A person may be more likely to develop spastic cerebral palsy if they experienced the following:

• Born too early (preterm)
• A low birth weight
• Jaundice that’s severe and doesn’t get treated
• An infection during pregnancy that affects the fetus or placenta
• Multiples in the uterus (twins, triplets)
• Complications of pregnancy (like placental abruption or uterine rupture)
• Chemical exposure to a toxin that can damage the brain (like persistent exposure to high levels of mercury in seafood)

What are the complications of spastic cerebral palsy?

Spastic cerebral palsy can affect more than your child’s muscles. Complications may include:

• Difficulty with speech and communication
• Problems with cognitive development (intellectual disability)
• Seizures
• Vision loss
• Hearing loss

How is spastic cerebral palsy diagnosed?

A healthcare provider usually diagnoses spastic cerebral palsy during infancy or childhood. A physical exam in your child’s provider’s office is the first step in diagnosis.

Your child’s provider will examine their muscle tone, movement, motor skills and coordination. They’ll also ask you about your child’s development to see if they’re on track for their age (like crawling or walking).

What tests diagnose spastic cerebral palsy?

Findings on physical examination may suggest spastic cerebral palsy. Your child’s provider may recommend imaging tests to look for areas of damage in your child’s brain. Other tests help your child’s provider rule out conditions with similar symptoms, like:

• Magnetic resonance imaging (MRI) test
• Computed tomography (CT) scan
• Blood tests
• Genetic testing

How is spastic cerebral palsy treated?

Treatment for spastic cerebral palsy focuses on improving your child’s ability to move. Treatment could include:

• Daily stretching at home to prevent tightness from worsening over time
• Physical, occupational and/or speech therapy
• Using braces, casts or splints to keep their arms or legs in one position to stretch the muscles
• Using assistive devices such as a walker or wheelchair
• Medications to relieve muscle stiffness and spasms (baclofen, diazepam, clonazepam, dantrolene and tizanidine)
• Botulinum toxin injections (Botox®) to help their muscles relax
• Intrathecal baclofen therapy to deliver medication directly to their spinal cord
• Selective dorsal rhizotomy (surgery to reduce spasticity)

What’s the life expectancy for spastic cerebral palsy?

In most cases, spastic cerebral palsy doesn’t directly affect your child’s life expectancy. Severe symptoms and untreated cases may cause complications that might affect their lifespan. While there’s no cure, the prognosis is usually good with treatment.

Is spastic cerebral palsy progressive?

Spastic cerebral palsy isn’t a progressive disease. Early in life, the affected muscles should be the same muscles affected later in life. It shouldn’t affect any new muscles. However, without treatment, the tightness of the affected muscles may become more severe over time.

Treatment is important to reduce muscle tightness, which can affect function (such as walking, changing clothes and gripping items) and may be painful. Your child will likely need support from their care team to help them manage the condition for their entire life.

When should I see a healthcare provider?

Visit a healthcare provider if you notice signs of spastic cerebral palsy in your child. Look out for signs and symptoms that affect their movement and development.

What questions should I ask my healthcare provider?

• Can you help me understand my child’s diagnosis?
• What type of treatment do you recommend?
• What are the goals of treatment?
• Are there side effects of the treatment?
• How often is physical or occupational therapy needed?
• Will surgery improve my child’s symptoms?