GLOBAL BURDEN OF CEREBRAL PALSY ISSUES AND SOLUTIONS

Objective: Review current status and issues in cerebral palsy.

Methods: Review of literature, personal experience and views.

Results: Cerebral Palsy is globally one of the most common developmental disabilities. Population based studies in the 1990's estimated it at 2.4 per thousand neonatal survivors in the UK and increasing prevalence is reported despite medical techno logical advance.

In India hospital based data guestimates 2.5 million affected children. Perinatal insults, suboptimal care of the new born during birth, maternal & perinatal infections hypo bilirubinemia are common insults. The neuro motor impairment has evolving needs, multiple/varied comorbidities like mental sub normality, seizures, feeding difficulties, visual impairment, hearing handicap. The process of care is multidisciplinary, challenging for the family and cost intensive. These tenets make cerebral palsy a sizable global burden.

The issues include estimates of prevalence, development of appropriate classification that is not limited to just etiology, topography or physiology but a classification that evaluates functional abilities for optimal rehabilitation. The etiology of cerebral palsy has evolved from recognition of hypoxia at birth, to a large number of antenatal factors, genetic predisposition, secondary insults to the immature brain. (Analysis of published data from developed & developing world will be compared. AIIMS data and Indian studies, reported birth asphyxia (25.6–48.7%); neonatal infections in (15%); low birth weight in 34.6%, extremes of maternal age below 20 and beyond 30 in almost 1/3 of the patients).

The pathophysiology now identifies susceptible areas of the brain at different gestations; e.g. elective vulnerability of the periventricular white matter between 26–34 weeks of gestation; of basal ganglia between 38–40 weeks. Fetal production of cytokines have moved upstream as a common pathogenetic mechanism for neuronal, oligodendrocytic and vascular endothelium damage. Etiologically the role of maternal infections is becoming important and may have avenues for prevention. The functional ability scoring systems GMFCS, MACS and Oromotor difficulty scales await appropriate placement in management algorithums.

Research – Scientifically structured international prospective studies to score etiological risk factors and preventive interventions. The second issue is to review the classification of cerebral palsy by not only etiology and topography of the disability but by validating early markers. Functional abilities, holistic evaluation which can be utilized across countries. There is little evidence-based information supporting or refuting value of many of the therapeutic interventions on long term outcome. The reported success of medical and surgical interventions, intrathecal baclofen pumps, botulinum toxin injections, variety of surgical techniques needs standardization.

Our experience with botulinum toxin, baclofen and tizanidine will be presented.

Research into drugs that reduce tone, promote myelination and neuronal regeneration and orthotics of newer materials are warranted. Clinically stem cell transplants are worthy of scientific enquiry.

Conclusion: reduction of CP is complex the motor impairment talked about most in early life was not a major determinant in ultimate life setting and the evaluation management process needs a review.