A young practitioner named Sigmund Freud, before he turned to the human unconscious as his life’s work, first hypothesized that cerebral palsy may be closely associated with natal deveopments. It was several decades before his conjectures became widely accepted. Still, depending on which source you are using, the causes of cerebral palsy has been suggested to be anywhere from 20% to 50% unknown. This is partially because though there are many associated markers or conditions associated with the disease, and evidence of those conditions or risk factors don’t guarantee that they are, indeed, the cause.
In the 1970s obstetricians suggested that if the sequence was altered by making care more ‘optimal’ (which they defined as emergency caesarean section for abnormalities on the electronic fetal monitor) then the cerebral palsy would be avoided (Quilligan and Paul 1975). The major effects of electronic monitoring on the fetal heart in labour are an increase in caesarean section rates and a reduced rate of neonatal seizures; it has had no effect on the rates of cerebral palsy (Stanley and Watson 1993, Nelson et al. 1996). This may be because few cases of cerebral palsy result from this pathway. Even those cases in which brain damage is caused by excessive intrapartum hypoxia, clinical signs sufficient to warrant emergency caesarean section may only be recognizable after the damage is done. And of course caesarean section may not be the ‘optimal’ response.? (Stanley, Blair & Alberman, p. 107)
Children that acquire cerebral palsy later in childhood from influences unconnected to natal or birth trauma are the easiest cases to clearly isolate the cause. Many factors contribute to the difficulty is discerning cause for children already born with the condition or later exhibit the symptoms from events before they were born or during the birth process. We strongly suggest the book (004) for the details of this difficult search. Literally thousands of researchers are exploring for clues to decrease the occurrence of this malady. Huge strides have been made in the developed world reducing the various ways that cerebral palsy does occur. The only reason that there has not been a stready decline in the percentage of children exhibiting the disease is that Western strides in the ability to keep alive and bring to health extremely premature infants has also increased the number of children who contract cerebral palsy, children whom 30 years ago would have never made it to their first birthday.
A profound challenge to researchers in this field is teasing out the difference between a specific cause or causes from epiphenomena, or events associated with causes but not the causes themselves. For example periventricular leukomalacia (PVL) is the strongest predictor of cerebral palsy in extremely preterm infants. Yet many of the variables associated with PVL could be assigned to either cause or epiphenomena depending on the situation. A particular insult, when it occurred and where specifically in the brain it occurred, complicated by an understanding of the extent of the resources available to combat the damage, all contribute to a determination on how specifically cerebral palsy was created in a specific case. It is important to understand how several variables can ally themselves in different constellations to contribute to an outcome. For example a very preterm infant is vulnerable to outside influences a full term baby would be unhindered by. A small number of those preterm infants might suffer a combination of assaults that would result in later diagnosis. At the same time, a genetic defect might not evidence itself with a healthy child until that child was exposed to any number of effects including infection or physical trauma.
The researchers and practitioners in this field are often nothing less than compassionate detectives following a very old trail exploring events that have unfolded in the tinest portion of a human brain.
Consider the outline below, from (Geralis, p. 14), for an introduction to the risk factors associated with cerebral palsy.
Pregnancy Risk Factors
• Maternal diabetes or hyperthyroidism
• Maternal high blood pressure
• Poor maternal nutrition
• Maternal seizures or mental retardation
• Incompetent cervix (premature dilation) leading to premature delivery
• Maternal bleeding from placenta previa (a condition in which the placenta covers a portion of the cervix leads to bleeding as the cervix dilates) or abruptio placenta (premature separation of the placenta from the uterine wall)
Delivery Risk Factors
• Premature delivery (less than 37 weeks gestation)
• Prolonged rupture of the amniotic membranes for more than 24 hours leading to fetal infection
• Severely depressed (slow) fetal heart rate during labor, indicating fetal distress
• Abnormal presentation such as breech, face, or transverse lie, which makes for a difficult delivery
Neonatal Risk Factors
• Premature birth the earlier in gestation a baby is delivered, the more likely she is to have brain damage
• Asphyxia insufficient oxygen to the brain due to breathing problems or poor blood flow in the brain.
• Meningitis infection over the surface of the brain
• Seizures caused by abnormal electrical activity of the brain
• Interventricular hemorrhage (I. V. H.) bleeding into the interior spaces of the brain or into the brain
• Periventricular encephalomalacia (P.V.L.) damage to the brain tissue located around the ventricles
(fluid spaces) due to the lack of oxygen or problems with blood flow
Some of the techniques used to prevent cerebral palsy include constant monitoring of blood pressure and gases in the neonate and the mother, intubation, handling, suction or the airways, administering sodium bicarbonate, “blood volume expansion, pressors to reduce blood supply, sedatives, unbilical artery catheter placement, heparinization of catheters, ductal ligation, super oxide dismutase.” (Stanley, Blair & Alberman, p. 161) In the developing nations iodized salt and vaccinations have had a profound effect on lowering the incidence of cerebral palsy. All through this site you will discover interventions and supplements that have resulted in the birth and growth and of humans free of cerebral palsy.
Miller, Freeman & Bachrach, Steven J. (1995) Cerebral Palsy: A Complete Guide for Caregiving. The John Hopkins University Press
Geralis, Elaine (ed.). (1998) Children with Cerebral Palsy. Woodbine House
Stanley, Fiona, Blair, Eve, Alberman, Eva. (2000) Cerebral Palsies: Epidemiology & Causal Pathways. Mac Keith Press