Many individuals who have cerebral
palsy have no associated medical disorders. However, disorders that
involve the brain and impair its motor function can also cause
seizures and impair an individual's intellectual development,
attentiveness to the outside world, activity and behavior, and vision
and hearing. Medical disorders associated with cerebral palsy include:
Mental impairment. About one-third of children who have
cerebral palsy are mildly intellectually impaired, one-third are
moderately or severely impaired, and the remaining third are
intellectually normal. Mental impairment is even more common among
children with spastic quadriplegia.
Seizures or epilepsy. As many as half of all children with
cerebral palsy have seizures. During a seizure, the normal, orderly
pattern of electrical activity in the brain is disrupted by
uncontrolled bursts of electricity. When seizures recur without a
direct trigger, such as fever, the condition is called epilepsy. In
the person who has cerebral palsy and epilepsy, this disruption may be
spread throughout the brain and cause varied symptoms all over the
body -- as in tonic-clonic seizures -- or may be confined to just one
part of the brain and cause more specific symptoms -- as in partial
seizures. Tonic-clonic seizures generally cause patients to cry out
and are followed by loss of consciousness, twitching of both legs and
arms, convulsive body movements, and loss of bladder control.
Partial seizures are classified as simple or complex. In simple
partial seizures, the individual has localized symptoms, such as
muscle twitches, chewing movements, and numbness or tingling. In
complex partial seizures, the individual may hallucinate, stagger,
perform automatic and purposeless movements, or experience impaired
consciousness or confusion.
Growth problems. A syndrome
called failure to thrive is common in children with moderate-to-severe
cerebral palsy, especially those with spastic quadriparesis. Failure
to thrive is a general term physicians use to describe children who
seem to lag behind in growth and development despite having enough
food. In babies, this lag usually takes the form of too little weight
gain; in young children, it can appear as abnormal shortness; in
teenagers, it may appear as a combination of shortness and lack of
sexual development. Failure to thrive probably has several causes,
including, in particular, poor nutrition and damage to the brain
centers controlling growth and development.
In addition, the muscles and limbs
affected by cerebral palsy tend to be smaller than normal. This is
especially noticeable in some patients with spastic hemiplegia,
because limbs on the affected side of the body may not grow as quickly
or as large as those on the more normal side. This condition usually
affects the hand and foot most severely. Since the involved foot in
hemiplegia is often smaller than the unaffected foot even among
patients who walk, this size difference is probably not due to lack of
use. Scientists believe the problem is more likely to result from
disruption of the complex process responsible for normal body growth.
Impaired vision or hearing. A large number of children with
cerebral palsy have strabismus, a condition in which the eyes are not
aligned because of differences in the left and right eye muscles. In
an adult, this condition causes double vision. In children, however,
the brain often adapts to the condition by ignoring signals from one
of the misaligned eyes. Untreated, this can lead to very poor vision
in one eye and can interfere with certain visual skills, such as
judging distance.
In some cases, physicians may recommend surgery to correct strabismus.
Children with hemiparesis may have hemianopia, which is defective
vision or blindness that impairs the normal field of vision of one
eye. For example, when hemianopia affects the right eye, a child
looking straight ahead might have perfect vision except on the far
right. In homonymous hemianopia, the impairment affects the same part
of the visual field of both eyes. Impaired hearing is also more
frequent among those with cerebral palsy than in the general
population.
Abnormal sensation and perception. Some children with cerebral
palsy have impaired ability to feel simple sensations like touch and
pain. They may also have stereognosia, or difficulty perceiving and
identifying objects using the sense of touch. A child with
stereognosia, for example, would have trouble identifying a hard ball,
sponge, or other object placed in his hand without looking at the
object.
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