dystonic cerebral palsy
Introduction
Introduction to dystonia cerebral palsy Insufficient cerebral palsy is more common in young children. It is mainly manifested by a marked decrease in muscle tension. It can not stand and walk, the head and neck can not be lifted, the movement disorder is obvious, the joint activity is too large, but the tendon reflex is active, and pathological reflex can occur, often accompanied by aphasia. And smart low. Clinically, it is generally divided into sputum type dystonia type cerebral palsy, dystonia type dystonia type cerebral palsy, hand and foot type dystonia type cerebral palsy, ataxia type dystonia type cerebral palsy, mixed type dystonia type cerebral palsy class. Symptoms of dystonia-type cerebral palsy are different, resulting in a variety of dysplasia-type cerebral palsy. Therefore, family members should first understand the symptom classification of dystonia cerebral palsy before choosing a treatment method for children, so as to better distinguish patients and provide a reliable basis for future treatment. The main manifestation is that the muscle tension is significantly reduced, the standing can not walk, the head and neck can not be lifted, the movement disorder is obvious, the joint activity is too large, but the tendon reflex is active, pathological reflex can occur, often accompanied by aphasia and mental retardation. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in young children Mode of infection: non-infectious Complications: mental retardation, hearing impairment, strabismus, refractive error, speech and language disorders in children, epilepsy, hemiplegia, ataxia
Cause
Causes of dystonia cerebral palsy
1. Nuclear jaundice: an important cause of cerebral palsy. With the advancement of domestic medicine, the proportion of cerebral palsy caused by nuclear jaundice has decreased.
2, customary abortion: multiple births, premature birth, deformed children, the history of childbirth; early viral infection, early pregnancy vaginal bleeding, x-ray.
3, sports development backward: head and neck, trunk, limbs have abnormal posture, such as: often upper limb adduction, internal rotation, flexion, thumb adduction, hand clenched fist, lower limbs cross, pointed foot, scissors cloth, kyphosis, stiff Back bend, head back and so on. Often accompanied by mental retardation and language backwardness. These are certainly the causes of dystonia-type cerebral palsy.
4, smoking habits: long-term medication, diabetes history, diabetes and other endocrine disease history.
Prevention
Myasthenia cerebral palsy prevention
(1) Pre-natal prevention
1. Pre-marital health care: guidance on sexual health, fertility and genetic diseases for both men and women preparing for marriage, counseling on issues such as marriage and childbirth, and medical examinations for both men and women who may be affected by marriage and childbirth, and medical advice .
2. Do a good job of pregnancy care: regular prenatal checkups, increase nutrition, prevent the occurrence of infectious diseases.
(B), prevention of perinatal period
1. Avoid the birth of premature and low birth weight children.
2. Prevention of asphyxia and intracranial hemorrhage.
3. Prevention and treatment of hyperbilirubinemia.
(3) Prevention after birth
1. Prevent the occurrence of infectious diseases:
(1) Carry out hospital delivery.
(2) Pay attention to protecting the skin of newborns.
(3) Keep the umbilical part of the newborn dry and clean.
(4) Closely observe the growth and decline of jaundice.
(5) Pay attention to the observation before and after.
(6) Implement breastfeeding.
2. Prevent the occurrence of febrile seizures.
3. Correct treatment of lumbar puncture: lumbar puncture a small amount of brain effusion for examination, to understand the nature and condition of the disease, to provide a basis for correct diagnosis and treatment, thereby reducing the occurrence of intracranial disease sequelae. To this end, parents should work closely together to be responsible for the health of the child.
Complication
Myofasthenia cerebral palsy complications Complications, mental retardation, hearing impairment, strabismus, refractive error, pediatric speech and language disorders, epilepsy, hemiplegia, ataxia
1. Mental retardation: It is reported that about 2/3 of the children have mental retardation. About 50% of the children have mild to moderate mental retardation, and about 25% have severe mental retardation. Infants with quadriplegia and tonic cerebral palsy often have worse intelligence, and children with severe hand and foot movements have very few mental retardations.
2, visual impairment: about half of the children with visual impairment, the most common are intraocular strabismus and refractive error, such as myopia, amblyopia, etc., a few have nystagmus, occasionally blind, hemiplegic children may have ipsilateral hemianopia. Visual defects can affect eye-hand coordination.
3, hearing impairment: some children with hearing loss or even total convulsions, the most common children with hand and foot pulsation caused by hyperbilirubinemia. Most hearing loss of high-frequency audio is required to be detected by brainstem auditory evoked potentials.
4, other feelings and cognitive abnormalities: children with cerebral palsy often have sense of touch, position, physical sense, two points of discrimination. Children often lack the correct visual space and stereoscopic feeling, and their cognitive function defects are more prominent. Thus, in rehabilitation medical training, certain difficulties often arise in learning new motor skills and learning a variety of knowledge and activities.
5, language barrier: language defects in children with cerebral palsy are closely related to brain damage before and after birth and secondary brain development retardation, can also be caused by hearing impairment and other factors. According to reports, most children have varying degrees of language problems. It is characterized by slow language development, difficulty in pronunciation, unclear articulation, and inability to express correctly. Some children are completely aphasia. Children with hand, foot, and ataxia are often accompanied by language disorders. Children with quadriplegia and bilateral paralysis are often accompanied by language disorders.
6. Seizures: The incidence of hypotonic cerebral palsy with epilepsy is very different in the literature. At least 25% of children have seizures at different ages, with quadriplegia, hemiplegia, single limb paralysis and associated Those with low intelligence are more common, and children with both hands and feet and ataxia are rare.
7, oral, dental dysfunction: some children with cerebral palsy sucking weakness, swallowing, chewing difficulty, poor lip closure, often drooling, some suffering from caries or tooth dysplasia, these symptoms are most common in children with hand and foot.
8. Emotional and behavioral disorders: Most children with cerebral palsy have emotional or behavioral abnormalities, which are associated with impaired brain function. A large number of clinical data indicate that when the limbic system of the brain (especially the hippocampus) is damaged, it can cause emotional abnormalities in the child. The children showed good crying, self-willedness, stubbornness, loneliness, temperament, fragile emotions, easy to be excited, and some have a sense of clarity, joy, and emotional instability. These symptoms are more common in children with hand and foot movements. In addition, most children with cerebral palsy show excessive activity, distraction, and scattered behavior. Occasionally, the child has a "forced" behavior of slamming his head, jaw, and other injuries.
Symptom
Symptoms of dystonia cerebral palsy Common symptoms Intelligent hypoesthesia of the eyeball vertical movement disorder Soft neck can not raise the head and fear standing, hi rely on muscle tension reduction
The main manifestation is that the muscle tension is significantly reduced, the standing can not walk, the head and neck can not be lifted, the movement disorder is obvious, the joint activity is too large, but the tendon reflex is active, pathological reflex can occur, often accompanied by aphasia and mental retardation.
Examine
Examination of dystonia cerebral palsy
1, physical examination
The original reflex examination: the hand grasping reflex, the tension and the stray reflex are still present in the four heads, and the breath reflex and the neck reflex are still not lost after 6 months of birth.
Vojta posture is abnormally reflected. Vojta posture reflex examination is often used to diagnose cerebral palsy early in brain injury. Cerebral palsy should be examined in 2-3 abnormal postures in 7 posture reflexes. Combined with primary reflection, vertical reflection, balanced reflex and muscle tone examination, comprehensive evaluation of early dyskinesia in infants.
Muscle tone test: The muscle tension of a child can be expressed as too high, reduced or successfully shaken.
2, physical inspection
Such as EEG, brain topography, nerve evoked potentials, brain ultrasound and cranial ct, nuclear magnetic resonance. The above can improve the predictability of dyskinesia in children with brain damage, and improve the accuracy of early diagnosis of children with cerebral palsy.
Diagnosis
Diagnosis and differentiation of dystonia cerebral palsy
1. High-risk medical history
Mainly for the high risk factors of cerebral palsy, whether there is a history of nervous system in the family, whether the parents are married to close relatives; whether the child is currently accompanied by high blood pressure, diabetes, anemia and other diseases, whether it has been exposed to radioactive substances, whether there is Intrauterine infection; whether the baby is born with suffocation, birth injury, convulsions, whether it is caused, twin or multiple births, whether he has had hyperbilirubinemia or serious infectious diseases.
2, early performance often have the following points:
Feeding difficulties, suction and swallowing movements are not coordinated.
Irritable, easy to be shocked, easy to provoke.
Poor response to the surrounding environment.
There are gaze and strabismus.
The head is unstable, the limbs are less active, and the trunk and limbs are soft.
Zhang mouth sticks out his tongue, his body is hard and strong, his movements are uncoordinated and asymmetrical.
Delayed exercise development, at least 3 months behind normal children.
Diagnostic criteria
1 There are high risk factors.
2 developmental neurological abnormalities. That is, poor motor development, abnormal muscle tone, abnormal muscle strength, abnormal posture, and abnormal development of reflex.
3 clinical manifestations of cerebral palsy in infancy.
4 There may be abnormalities in auxiliary examinations such as imaging and electrophysiology.
Key points of cerebral palsy
1 Dyskinesia is caused by brain damage or developmental defects.
2 encephalopathy is non-progressive.
3 symptoms appear in infancy.
4 can be combined with mental retardation, epilepsy, sensory disturbances, communication disorders, behavioral abnormalities and other abnormalities, may have secondary bone and muscle system damage.
5 Excluding central dyskinesia caused by progressive disease and normal children with sexual dysmotility.
Friendly reminder: If you find that the child has abnormal conditions, it is recommended to go to the local hospital for further examination and diagnosis under the guidance of the doctor, and find out the child's condition, early intervention, early treatment and early recovery.
Differential diagnosis
Some genetic metabolic or degenerative diseases may progress slowly, such as metachromatic leukodystrophy, familial spastic paraplegia, etc. These diseases are difficult to identify early in the brain and may be misdiagnosed. Uric acidosis type 1 is easily mistaken for dyskinesia cerebral palsy, while arginase deficiency is easily mistaken for bilateral sputum cerebral palsy. For infants with low muscle tone, they must be differentiated from the lower motor neuron, and the latter tend to reduce or disappear. Infants with low muscle tone must also pay special attention to the exclusion of genetic metabolic diseases. Spastic sputum sometimes needs to be differentiated from dopa-reactive dystonia.
