Cerebral Palsy: Causes, Symptoms, Classification and Treatment Options

In short: Cerebral palsy is a group of disorders affecting movement, posture and muscle balance, caused by damage to the brain while it is developing. About 80% of cases are due to factors before birth, while complications of delivery cause fewer than 10%, contrary to common belief; prematurity is an important factor. There is no cure, but physiotherapy, occupational and speech therapy and early intervention improve results.

Definition of Cerebral Palsy

Cerebral Palsy (CP) is a group of disorders affecting movement, posture, or coordination. It is caused by injury or damage to the motor control centers of the developing brain, and it can occur during pregnancy, childbirth, or after birth up to approximately age three.

The degree of impact varies widely — depending on the extent of the damage and the areas affected, some individuals are significantly disabled while others experience only minor difficulties.

Around 2,000 babies from all social backgrounds and ethnic groups are diagnosed each year.

Cerebral Palsy may also be associated with abnormal brain development in some individuals, which can lead to related challenges such as intellectual disabilities, vision problems, seizures, and other complications.

Causes of Cerebral Palsy

Cerebral Palsy was first identified in 1860 by William Little, an English surgeon, who linked the disorder mainly to the possibility of asphyxia during birth.

In 1897, neurologist Sigmund Freud challenged this view, proposing instead that birth difficulties were often symptoms of other underlying effects on fetal development, rather than the root cause.

Research conducted in the 1980s by the National Institute of Neurological Disorders (NINDS) found that only a small proportion of CP cases are caused by lack of oxygen during birth.

While many people assume CP mainly results from difficulties during labor and delivery, in fact less than 10% of cases are linked to birth asphyxia. As noted above, CP arises from injury or disruption to the developing brain’s motor control centers, and this can happen during pregnancy, birth, or in early childhood up to about age three.

Antenatal (before birth) factors are found in around 80% of affected children, including genetic conditions, brain malformations, and maternal infections such as rubella or toxoplasmosis.

Premature delivery is one of the most significant risk factors — roughly 40–50% of children who develop CP were born prematurely.

Premature babies are more vulnerable because their organs are not yet fully developed, which increases the risk of hypoxic brain injury.

The good news is that some cases can be prevented. If a mother is expected to give birth very early (especially before 30 weeks), she is offered magnesium sulphate through a drip shortly before delivery, which protects the baby’s brain and lowers the risk of cerebral palsy by about one third. Babies who suffer lack of oxygen around birth can be treated with cooling (therapeutic hypothermia) within the first 6 hours of life, which reduces the risk of lasting brain damage. Low birth weight (under 2.5 kg, and especially under 1.5 kg) is also a recognized risk factor, and premature infants often fall into this category.

Babies from multiple births (twins, triplets, etc.) are more likely to be born early or with lower birth weight compared to single births.

Maternal infections — even mild or hard-to-detect ones — may triple the risk of a child developing CP. Infections trigger the release of cytokines as part of the body’s inflammatory response, and these chemicals can be toxic to the developing brain.

In summary, the causes of CP can be grouped as follows:

• Antenatal or prepartum causes of cerebral palsy:
• Random mutations in genes controlling brain development.
• Maternal infections (toxoplasmosis, chicken pox, German measles, etc.)
• Infant’s infections.
• Fetal stroke (compromise in blood supply).
• Exposure to radiation
• Multiple gestations
• Breech birth
• Intrapartum (during labor) causes of cerebral palsy:
• Premature delivery
• Birth trauma or asphyxia
• After birth causes of cerebral palsy
• Hyperbilirubinemia (jaundice).
• Meningitis.
• Lead poisoning.
• Shaken baby syndrome
• Choking on foreign objects such as toys, food, drowning or poisoning. Unfortunately, in many cases doctors can’t give parents a clear, single reason why the brain was injured or did not develop as expected — there may be multiple or complex causes involved.

Signs and Symptoms of Cerebral Palsy

The signs and symptoms of CP vary from child to child and often begin to appear soon after birth.

They may affect a single limb, one side of the body, or the entire body.

All types of CP involve some degree of irregular muscle tone, abnormal reflexes, and difficulties with motor development and coordination.

• Variation in muscle tone — either too stiff or too floppy
• Stiffness of the muscles and hyperreflexia (spasticity)
• Stiff muscles with normal reflexes (rigidity)
• Lack of muscle coordination (ataxia)
• Tremors or involuntary movements
• Slow and writhing movements (athetosis)
• Preferring to use one side of the body more than the other, such as eating with only one hand or dragging a leg while crawling
• Delays in reaching motor milestones, such as sitting up alone or crawling
• Difficulty walking, such as walking on toes, a scissors-like gait, or a wide-based gait
• Excessive drooling or difficulty swallowing, sucking, or eating
• Difficulty with drinking or eating
• Delays in speech development or speaking
• Difficulty with precise, fine motor movements

Since the underlying brain injury is not progressive, symptoms generally do not worsen with age, although they may present differently as a child grows.

Classification of Cerebral Palsy

A- Spastic Cerebral Palsy

• The most common type, occurring in around 80% of all cases
• Characterized by hypertonic (tight) muscles
• Symptoms can often be managed with consistent therapy and support
• Ongoing spasticity may cause pain and stress from muscle tightness, sometimes leading to early-onset arthritis and tendonitis
• Usually caused by damage to the upper motor neuron, corticospinal tract, or motor cortex

B- Ataxic Cerebral Palsy

• Caused by damage to the cerebellum
• Less common than the spastic type (around 10% of cases)
• Characterized by hypotonia (low muscle tone) and tremor
• Fine motor skills such as typing, writing, or using scissors may be affected
• Balance and coordination may also be affected

C- Athetoid or Dyskinetic Cerebral Palsy

• A mixed type characterized by both hypotonia and hypertonia combined with involuntary movements
• Difficulty holding the body in a steady, upright position (such as sitting or walking); everyday tasks like scratching the nose or holding a pen may require significant effort and concentration
• Brain damage in this type is usually located in the basal ganglia and thalamus (the extrapyramidal system)
• High bilirubin levels in newborns (jaundice) is an important cause of this type of CP

Treatment of Cerebral Palsy

There is currently no cure for Cerebral Palsy, but treatments and therapies can help reduce its impact and support new ways of moving and communicating. Managing CP is typically a lifelong, multidimensional process involving a care team.

Children with CP tend to do best when they receive specialized support from an early age. Because the brain continues to develop significantly in early childhood, assessing the full extent of cerebral palsy early on can be difficult — current guidelines recommend that babies at risk, such as those born very prematurely or after lack of oxygen at birth, are assessed before 6 months of age using specialised examinations and brain MRI, so that therapy can begin as early as possible.

Up to around age eight, the brain remains relatively adaptable and can reorganize or reroute many of the signal pathways affected by injury. Earlier intervention is generally associated with better outcomes.

Treatment approaches may include:

A- Medical Treatment of Cerebral Palsy

Medical treatment mainly aims to reduce muscle spasticity and manage pain.

The choice of medication depends on whether the problem affects specific muscles (isolated) or the whole body (generalized).

- Isolated spasticity: Local Botox injections directly into the affected muscle, nerve, or both — though this may occasionally cause muscle weakness as a side effect.

- Generalized spasticity: Oral medications such as diazepam, tizanidine, or baclofen, which in some cases can be delivered directly to the spinal cord via a small pump surgically implanted under the skin of the abdomen.

B- Physical Therapy for Cerebral Palsy

Targeted muscle training and exercises can help improve strength, flexibility, balance, motor development, and overall mobility.

C- Occupational Therapy for Cerebral Palsy

This therapy supports the child’s ability to participate independently in daily activities and routines at home and school.

D- Speech Therapy for Cerebral Palsy

Speech therapy helps improve the ability to speak clearly or communicate more easily, including through the use of communication devices when needed.

E- Surgical Treatment of Cerebral Palsy

Surgery may help loosen tight muscles or release fixed joints.

Insertion of a baclofen pump (baclofen being a muscle relaxant), often considered as a patient reaches young adulthood, delivers small, controlled doses of medication to help ease continuous muscle tightness.

Straightening abnormal twists in the leg bones is performed through a procedure called derotation osteotomy, in which the bone is carefully cut and reset in correct alignment.

Selective cutting of the nerve supply to the muscles most affected by spasms is a procedure known as rhizotomy.

If you have concerns about your pregnancy or would like guidance on prenatal care and monitoring, the team at Dr. Najeeb Layyous’s clinic is here to help support you and your baby’s health every step of the way.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist