Feature article

Brain Imaging in Cerebral Palsy

Cerebral palsy, an umbrella term that covers dysfunctions related to a person’s ability to move, balance and hold themselves upright, is thought to affect between two and three children out of every 1,000 born in the United States.1 The root cause of cerebral palsy, commonly referred to as CP, is brain damage that occurs before, during or just after a baby is born. In some cases, early testing can detect CP even before the child is delivered. In many others, telling symptoms don’t develop until later, which can lead to delayed diagnosis and inception of treatment.

Brain Imaging and cerebral palsy

Brain imaging in cerebral palsy can not only effectively diagnose the disorder but also help sufferers and their family members and caretakers to understand its impact and note what development issues may arise later. Martin Bax, a British pediatrician and researcher, led a study that involved administering a brain MRI scan to several hundred children suffering from CP. He and his fellow researchers, Clare Tydeman and Olof Flodmark, designed their objective to focus on learning more about the causation and progression of CP to better understand the disease and eventually develop preventative strategies.2

Their findings were based on examinations of impacted children located throughout Europe in order to build an adequate cross-section of the population.2 Imaging results were compared to surveys completed by the children’s parents, other clinical testing and medical records. Background information revealed a large percentage of infections in mothers while pregnant, many pregnancies that ended preterm and a high incidence of multiple births. The imaging itself was normal in just 11.7 percent of the impacted children, while the others experienced various forms of white matter damage, lesions, malformations and infarcts.2

As a result, those researchers recommended that the issues found in so many of the affected pregnancies receive better attention, study and care to potentially lower the incidence of cerebral palsy. They recommended that developing better methods to deal with maternal infections, monitoring pregnancies involving multiples and investigating infantile strokes. The continued use of brain imaging through MRI studies was urged to understand root causes in each individual case and the extent of damage suffered.

The Implications of Cerebral Palsy

The impact of cerebral palsy is different on every single patient affected. Gross motor skills are often compromised, including the ability to run and jump. In children who are not diagnosed at birth, developmental delays related to the gross motor skill of crawling may be the first sign noticed by parents and health professionals. Other CP children experience issues with fine motor skills such as the ability to grasp objects using fingers or put together puzzle pieces or LEGOs. Many diagnosed with CP suffer from spastic or rigid muscles, uncontrolled muscle movement and problems with facial muscle tone, swallowing, speaking and drooling.

Severity varies widely from patient to patient. Just one portion of the body may be impacted, causing only partial disability. Alternatively, severe brain damage can result in systemic and total disability. Unfortunately, children diagnosed with cerebral palsy may also suffer from additional disorders, including vision and hearing impairment, intellectual disabilities, mental health disorders and epilepsy. Early brain imaging that locates the portion of the brain that was damaged pre- or post-birth can enable practitioners to proactively look for certain impairments and implement early interventions.3

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Expanded Brain Imaging Findings

Dr. Steven J. Korzeniewski, a professor and researcher at Michigan State University, urges the use of brain imaging in cases of suspected and confirmed cerebral palsy for another reason: because evidence from scans has shown that CP results not just from damage to the brain, as previously thought, but also because of early malformations during the brain’s development.3 This is a significant paradigm shift in how CP is regarded by scientists and practitioners. Additionally, this can provide important information to the parents of a child with CP caused by a malformation, as they may want to pursue genetic counseling before further expanding their families.

While imaging has not yet paved a different path in how cerebral palsy is medically managed or the associated prognosis, the significant benefits realized from current research and more common use of MRIs in patients will have a ripple effect in future generations of children. Changed practices during pregnancy, increased monitoring during twin and higher order pregnancies and even earlier interventions after an infant suffers a stroke may result in far lower rates of cerebral palsy. Additionally, as imaging results that point to malformations engage the practice of genetic counseling and testing, future research findings may isolate certain indicators that a baby may develop cerebral palsy.

Continued imaging will also increase the sample size that future researchers examine when compiling results from separate studies and test groups. As the sample size increases, patterns related to the causation and impact of cerebral palsy may grow stronger and more easily observed.3 Those patterns may enable future researchers to obtain the funding necessary to conduct even more in-depth research into CP, including studies designed to create changes in medical management and enhanced prognosis for patients. Today, more than three quarters of a million children and adults in the United States are living with cerebral palsy.4 With advances in innovation that may result from the continued early use of brain imaging, those individuals may experience better quality of life, while the rate of babies born with CP may decrease over time.

References:

1. MyChild at CerebralPalsy.Org. Web. 18 October 2018. <https://www.cerebralpalsy.org/about-cerebral-palsy>.

2. Bax, Martin et al. “JAMA. 2007; 297(5):465-467.

3. Korzienowski, S. “Brain Imaging in Cerebral Palsy.” Web. 18 October 2018. <http://www.epi.msu.edu/cpon/articles/brain_imaging_in_cerebral_palsy>.

4. “Prevalence of Cerebral Palsy.” MyChild at CerebralPalsy.Org. Web. 18 October 2018. <https://www.cerebralpalsy.org/about-cerebral-palsy/prevalence-and-incidence>.