Spastic diplegia is the most commonly diagnosed form of cerebral palsy. Another name for the pathology is Little's disease. The disease is characterized by spastic tetraparesis, which is most pronounced in the lower extremities. In addition, patients have disorders in the work of the cranial nerves, speech disorders. In isolated cases, mild mental retardation is diagnosed. The prognosis for spastic diplegia of cerebral palsy directly depends on the severity of the disease and on how responsibly the patient follows medical recommendations.
Pathogenesis
ICP is a disease of both monopathogenetic and polyetiological nature. The launch of the development of the pathological process occurs when the child's brain is exposed to various kinds of adverse factors. The first signs of cerebral palsy may appear during fetal development, and duringdelivery, and in the first weeks of life. The disease is characterized by a non-progressive course. Clinical manifestations of the disease are due to motor, mental and speech disorders.
Forms of cerebral palsy:
- Spastic diplegia. It is characterized by damage to the lower extremities, the hands remain coordinated and quite active. In most cases, the intellect is not affected, the child is easily trained. In the International Classification of Diseases (ICD-10), spastic diplegia of cerebral palsy is assigned the code G80.1.
- Double hemiplegia. Both upper and lower extremities are affected. This form is also characterized by the presence of speech disorders, atrophy of the optic nerves, and rigidity of muscle tissue. This is the most severe form of cerebral palsy. ICD code - G80.2.
- Hemiplegia. One side of the body is affected. Children have deviations in intellectual and mental development. This form is characterized by the periodic occurrence of seizures of epilepsy. ICD code - G80.2.
- Dyskinetic look. Signs characteristic of this form: incorrect setting of the lower extremities, involuntary twitching of the legs, convulsions, speech disorders. Intelligence is practically not affected, as in the case of spastic diplegia of cerebral palsy. ICD-10 code - G80.3.
- Ataxic form. It is characterized by a reduced tone of muscle tissue, pronounced tendon reflexes, speech impairment, a complete lack of coordination of movements, and a lag in the intellectual sphere. Oligophrenia is often diagnosed. G80.4 - ICD-10 code.
Spastic diplegia cerebral palsy is a pathology in which a personcan be socially adapted. The patient easily perceives information and contacts with other people. However, in severe cases, he cannot serve himself in everyday life.
Etiology
Spastic diplegia cerebral palsy can occur under the influence of many provoking factors. The main causes of the development of the disease:
- Prematurity. It is a consequence of the premature start of the delivery process. This occurs with fetoplacental insufficiency, placental abruption, Rhesus conflict between mother and fetus. The causes of premature birth can also be diseases that a pregnant woman suffers from. These include: diabetes mellitus, kidney dysfunction, heart disease. Preeclampsia is also a provoking factor.
- Birth trauma. The complicated process of the birth of a child is the most common cause of the development of spastic diplegia of cerebral palsy. Injuries can be caused by rapid labor, narrow passageways, breech presentation.
- Asphyxia in a newborn baby. In some cases, after birth, babies cannot breathe on their own. Causes of asphyxia: inhalation of amniotic fluid, anomalies in the development of the child in the prenatal period, infectious diseases, immunological incompatibility between mother and baby, pneumopathy.
- Genetic predisposition. In most cases, children with spastic diplegia of cerebral palsy are born to people suffering from an illness.
- Hypoxia or fetal ischemia during fetal development. Atlack of oxygen and circulatory disorders, the child's brain is damaged. Most often, the consequence is the development of severe forms of cerebral palsy.
- Infectious lesions of the musculoskeletal system.
- Physical impact on the fetus. A risk factor is the conduct of X-ray or radionuclide studies during the gestational period.
In addition, the lifestyle of a pregnant woman is of no small importance. The risk of developing pathology increases significantly if the expectant mother is fond of smoking, drinking alcohol and drugs, and also if her daily activities are associated with constant contact with harmful compounds.
Clinical manifestations
A typical symptom of spastic diplegia of cerebral palsy is tetraparesis, with damage mainly to the lower extremities. Muscular hypertonicity is a necessary condition during the period of intrauterine development of the fetus. Soon after the birth of the baby, its intensity begins to wane. As a rule, completely muscle hypertonicity disappears by a maximum of six months. In the presence of spastic diplegia, it does not weaken.
The state of hypertonicity is most noticeable in the flexor muscles of the feet. As a result, a specific position of the legs is formed. In a sick child, the knees are joined, the hips are turned inward, and the shins are pressed together or crossed.
Other clinical manifestations:
- Lagging behind peers in physical development. Theirsick children begin to take their first steps only at the age of 3-4.
- Specific gait on toes with unbent legs. At the same time, the lower limbs rub against each other in the region of the shins.
- In the muscles of the hands, the tone is usually normal. Sometimes it is slightly increased.
- Oculomotor disorders.
- Impaired vision.
- Squint.
- Hearing loss.
- Smoothness of folds in the nasolabial area.
- Incorrect position of the tongue, it is deviated from the midline.
- Pseudobulbar palsy.
- Speech development delay is detected in 75% of patients.
- Touch functions retained.
- Involuntary movements of the upper limbs.
- Every 5th patient has mental retardation.
Children under 12 months of age are diagnosed with spastic diplegia if they have the following symptoms:
- Child is unable to raise his head and hold it in this position on his own.
- Baby unable to roll over unaided.
- A newborn is not at all interested in toys or any other bright objects.
- Child cannot sit up by himself.
- Baby makes no attempt to move from one place to another. He has no desire to crawl.
- Child cannot stand.
- Baby does not use affected limb.
In older children, parents may notice uncontrolled muscle contractions. In addition, in babies, sluggish movements are replaced by sharp ones and vice versa.
Degrees of severity
There are several options for the development of the disease. They are described in the table below.
| Severity of pathology | Characteristic clinical manifestations |
| Easy | In the first 6 months, the he alth of the child is not in doubt. He is developing normally. With a mild degree of spastic diplegia of cerebral palsy, signs of paresis of the lower extremities appear after a while. At the same time, the child is able to move independently and not resort to the help of third parties. Both mental and mental development correspond to all norms. |
| Average | This degree is characterized by pronounced spasticity in the lower extremities. A person cannot move independently. While walking, he is forced to use crutches, canes or other available means. Minor changes occur in the cognitive realm. Social adaptation is possible. |
| Heavy | Characteristic signs are pronounced immediately after the birth of the child. The baby has tetraparesis with a primary lesion of the lower extremities. In the future, the child can not move independently. Social adaptation is also impaired. |
If you have any alarming sign, you need to see a doctor. Ignoring the symptoms leads to the fact that any load on the spinal column is distributed unevenly over it. This, in turn, is a trigger for the development of all kinds of complications.
Diagnosis
A neurologist is treating spastic diplegia of cerebral palsy. It is to him that you need to contact when the first alarming symptoms occur. Based on the history and physical examination data, the specialist issues a referral for a comprehensive examination, including:
- Examination by an ophthalmologist.
- An ENT doctor's consultation.
- Electroencephalography.
- Electroneuromyography.
- Neurosonography.
- Ultrasound or MRI of the brain. Ultrasound examination is indicated with an open fontanel. In other cases, an MRI is performed.
All received data is displayed in the patient's medical record. The doctor enters into it not only the results of the studies, but also the proposed diagnosis with the ICD-10 code.
Spastic diplegia of cerebral palsy must be differentiated from other forms of cerebral palsy, pathologies of the central nervous system, as well as from other ailments due to hereditary predisposition. The doctor may also arrange a referral for a consultation with a geneticist.
Medicated treatment
Currently, no specific etiopathogenetic therapy for the disease has been developed. Treatment of pathology involves only taking medications and undergoing a course of rehabilitation.
The classical scheme of drug therapy is presented in the table below.
| Drug group | Effect on the body | Examples of funds |
| Vascularfunds | Active ingredients contribute to a significant improvement in cerebral circulation. In addition, the process of supply of nutrients to the brain tissue is normalized. | Cinnarizine |
| Neurometabolites | Prescribed to improve the functioning of the central nervous system. | "Glycine", "Thiamin", "Pyridoxine" |
| Muscle relaxants | Active ingredients help reduce the severity of muscle spasticity. | Baclofen |
| Nootropics | Against the background of reception, cognitive functions are activated. | Piracetam |
| Botulinum toxin | This remedy is administered intramuscularly. Botulinum toxin preparations are prescribed to relieve spastic tension, which significantly reduces the risk of muscle contractures. |
The goal of medical treatment is to prevent the development of all kinds of complications.
Rehabilitation Therapy
Assigned to absolutely all patients. Carrying out rehabilitation measures is aimed at improving social adaptation. In addition, therapy involves teaching patients self-care skills.
Rehabilitation treatment includes the following items:
- exercise. Classes can be held both at home and in the doctor's office. A set of exercises is developed exclusively by a neurologist. Specialist in draftingtakes into account all the individual characteristics of the patient's he alth. Exercise therapy for spastic diplegia of cerebral palsy helps to maintain range of motion. In addition, exercise therapy is an excellent prevention of the development of complications.
- Massage. Helps improve blood circulation in the affected muscles. In addition, during the treatment, muscle relaxation occurs.
- Speech correction. Includes individual sessions with a speech therapist.
If there are signs of oligophrenia, consultations with a psychologist are additionally carried out. The specialist most often corrects violations with the help of play therapy.
Possible Complications
The course of cerebral palsy often leads to negative consequences.
The following complications are most commonly diagnosed:
- Violation of the functioning of the musculoskeletal system.
- Epilepsy.
- Severe cognitive impairment.
- Hearing and vision impairment.
To prevent the development of complications, it is necessary to strictly follow all the instructions of the attending physician.
Forecast
The outcome of the disease directly depends on the timeliness of contacting a neurologist. In the absence of treatment, it is almost impossible to raise the child to his feet. According to statistics, only 20% of patients can move independently. The rest are bedridden.
With timely detection and treatment of the disease, social adaptation is possible.
In conclusion
Spastic diplegia isthe most common form of cerebral palsy. In the medical literature, it is often referred to as "Little's disease". The disease is characterized by lesions predominantly of the lower extremities. In the ICD of spastic diplegia, cerebral palsy is assigned the code G80.1.
