Cerebral Palsy and Breathing: More than Prophylaxis of Pneumonia

Aim: Breathing is one important parameter concerning quality of life and prognosis of patients with cerebral palsy level V. Because of often occurring dysphagia, the danger of getting pneumonia is high. For assessment of the risk of dysphagia, a fiberoptic endoscopic evaluation is necessary.¹ The severity of airway obstruction increases with age because of hypotonia of the pharyngeal muscles.¹ With increasing age is therefore besides treatment of spasticity an evaluation of the breathing situation necessary.

Methods: All patients with cerebral palsy GMFCS level IV and V or clinical signs of airway obstruction get a polygraphic sleep-apnoe screening. By suspected dysphagia, they also get a fiberoptic endoscopic evaluation.

Results: First case shows that sleep depending on breathing disorders are an underdiagnosed problem which is relevant for life quality by cerebral palsy. Consistent secretion management and therapy with CPAP or noninvasive ventilation are an important alternative to tracheotomia.

Conclusion: Treatment of cerebral palsy requires an interdisciplinary management not only in behalf of the motoric and cognitive functions, but also in behalf of the respiratory situation. Therefore, a close cooperation between neuropediatricians, intensivists, and respiratory therapists is necessary. Therapy of obstructive sleep apnea syndrome by adenotonsillectomy or CPAP increases quality of life of children with cerebral palsy.² Our experiences show that decisions for tracheotomy, CPAP therapy, or noninvasive ventilation should only be done after sufficient diagnostics and in close cooperation with the parents focusing on life of quality of the family.

Keywords: cerebral palsy, dysphagia, respiratory problems.

References

References

1 Kontorinis G, Thevasagayam MS, Bateman ND. Airway obstruction in children with cerebral palsy: need for tracheostomy? Int J Pediatr Otorhinolaryngol 2013;77(10):1647–1650

2 Hsiao KH, Nixon GM. The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy. Res Dev Disabil 2008;29(2):133–140