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Cerebral Palsy Causes and Risk Factors – Part 1

[This post is part of our Knowledge Translation Tuesday series. Guest author Lily Collison, author of Spastic Diplegia — Bilateral Cerebral Palsy, continues the series on her journey with her son and cerebral palsy (CP). Author note: The is the view out over the Atlantic on Sunday as we climbed Knocknarea–the hill I pointed out in last week’s post.]

In coming to terms with our child’s CP diagnosis, we almost always ask the question why? This week I will write about cerebral palsy causes and risk factors. As we will see below, very often no specific cause is identified. This was the case with our son.

The term cause is self-explanatory. The term risk factor can be defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury. Causes thus have a stronger relationship with CP than risk factors. Significant deprivation of oxygen to the infant’s brain, for example, is a cause of CP. Preterm birth is a risk factor but not a cause of CP—in other words, not every preterm baby is found to have CP. There are many possible causes of brain injury, including events before and during pregnancy, during birth, or in early infant life. Much is known about the causes and risk factors for CP, but much remains unknown as well. Depending on what you read, you may come across different lists of causes and risk factors for CP.

Causes of CP
Developing fetuses and infants (up to age two to three) can develop CP if they experience brain injury or disruptions in brain development caused by1:

  • Bleeding in the brain before, during, or after birth.
  • Infections of the brain, including meningitis or encephalitis.
  • Shock—a state in which organs and tissues do not receive adequate blood flow.
  • Traumatic brain injuries, such as from a serious car accident.
  • Seizures at birth or in the first month following birth.
  • Certain genetic conditions.

Risk factors for CP
Risk factors for CP include1:

  • Preterm birth and low birth weight. A typical pregnancy lasts 40 weeks. Babies born before 37 weeks have a greater risk of having CP. The risk increases the earlier a baby is born and the lower the baby’s birth weight. Twins and other multiple-birth siblings are at particular risk because they tend to be born earlier and at lower birth weights.
  • Serious illness, stroke, or infection in the mother. CP is more common in children whose mothers:
    – Experience certain viral and bacterial infections and/or high fevers during pregnancy.
    – Have coagulation (clotting) disorders or experience blood clots during pregnancy.
    – Receive excessive exposure to harmful substances during pregnancy.
    – Have thyroid problems, seizure disorders, or other serious health concerns.
  • Serious illness, stroke, or infection in the baby. Infants who experience serious illnesses, strokes, or seizures around the time of birth are at greater risk of having CP. Such illnesses might include:
    – Severe jaundice. (Kernicterus is a rare kind of preventable brain damage that can happen in newborns with jaundice.)
    – Seizures during the first 48 hours after birth.
    – Infections of the brain, such as meningitis or encephalitis.
    – Strokes caused by broken or clogged blood vessels or abnormal blood cells.
  • Pregnancy and birth complications. For example, not enough nutrition through the placenta or a lack of oxygen during labor and birth. Incompatible blood types between mother and baby.
  • Genetic issues.

I will continue with part 2 next week.

1 Gillette Children’s Specialty Healthcare (2019) What Is Cerebral Palsy? [online].

How CPRN built its Cerebral Palsy Registry

CPRN Registry Described in the Archives of Rehabilitation Research & Clinical Translation

The Cerebral Palsy Research Network (CPRN) announced that its third publication entitled “Cerebral Palsy Research Network Clinical Registry: Methodology and Baseline Report” was published in Archives of Rehabilitation Research and Clinical Translation this past week.  The publication is “open access” meaning that anyone from the cerebral palsy (CP) community can read the article free of charge.  The article, authored by the founding members of the CPRN Executive Committee, describes the creation of the CPRN Registry from a process perspective – who was involved, what were the objectives and how and why were the data elements chosen for inclusion in the registry.

In addition to defining the process, the article also provides a baseline registry report for the first few years of data collection.  This preliminary report provides a descriptive analysis of the first 1858 patients – demographics, movement disorder, gross motor capabilities, and other clinical characteristics — included in the registry from eight sites.  Since this articled was drafted, the registry has grown to more than four thousand patients from 10 sites.  The registry is expected to continue to grow in step functions as more sites come online with their clinical practice supporting the registry.

The article also discusses how the CPRN registry uniquely leverages hospital electronic medical records (EMR) systems to include large volumes of data without burdening clinicians.  The CPRN registry database has been built into Epic – one of the leading EMR systems.  Development is underway for Cerner – another leading EMR system. The discussion section of the article also compares the focus of the CPRN Registry to the Common Data Elements for CP as defined by the National Institute of Neurological Disorders and Stroke in conjunction with the American Academy for Cerebral Palsy and Developmental Medicine.

CPRN’s other publications can be found on our publications page.

Defining Cerebral Palsy

[This post is the continuation of our Knowledge Translation Tuesday. Guest author Lily Collison, author of Spastic Diplegia — Bilateral Cerebral Palsy, continues the series on her journey with her son and cerebral palsy (CP).]

For a multitude of reasons, I believe it is very important for parents of young children and adolescents and adults with CP to fully understand the condition. I was that mom who didn’t understand my son’s diagnosis and therefore didn’t know how best to help him. My adult son now needs to have a good understanding to best help himself. When I was invited to write for CPRN to expand its knowledge translation objective, Paul (Gross) asked me to first write about SDR in adulthood because my son, Tommy had just undergone this procedure. Once I’d finished that series of posts, I debated whether it was best to work back to childhood or start from childhood. I was also conscious of recent data which showed that people who themselves have CP–adolescents/adults with CP are the biggest single group (58%) in MyCP. In the end, I decided to go back to the start and follow a logical sequence of subjects from childhood to adulthood. Issues in adulthood to some extent build on issues in childhood. It’s like the Wordsworth quotation “The Child is father of the Man.

Let’s start with the actual definition of CP. Over the years there has been much discussion of the definition of CP, and different definitions have been adopted and later discarded. The most recently adopted definition, published in 2007, is as follows:1

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems.

(Here is a link to a table explaining each term in that definition.)

CP is a lifelong condition and there is currently no cure, nor is one imminent, but good management and treatment can help alleviate some or many of the effects of the brain injury. When the brain injury occurs is important. The consequences of a brain injury to a fetus developing in the womb are generally different from those of a brain injury sustained at birth, which in turn are different from those of a brain injury acquired during infancy. It is generally accepted that only brain injuries occurring before the age of two or three fit the definition of CP. A brain injury occurring after that age is called an acquired brain injury. This cutoff is due to the differences in brain maturity when the injury occurs. In my son’s case I’m not certain when his brain injury occurred–he was born after an uneventful pregnancy and delivery–most likely it occurred during pregnancy.

Returning to the definition of CP, although this definition is very useful, I’m not sure it sufficiently alerts us to the secondary conditions that may arise in adulthood. As O’Brien, Bass, and Rosenbloom (2009) explained, the definition was developed to be used in childhood—it was not intended to infer that progressive problems might not appear in adult life.2

(The photo is one I took yesterday evening at Rosses Point, Sligo, Ireland, where I live. Yeats had close connections with Sligo. The hill in the left background is Knocknarea at 1,073 ft. Tommy was very proud when he first climbed it as a child.)

1Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M (2007) A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol 49 Suppl 2: 8–14.

2O’Brien G, Bass A, Rosenbloom L (2009) Cerebral palsy and aging. In: O’Brien G, Rosenbloom L, editors, Developmental Disability and Aging. London: Mac Keith Press, pp 39–52.