Cerebral palsy - Nouseimahii (English spelling) Cerebral palsy

Japanese: 脳性麻痺 - のうせいまひ（英語表記）Cerebral palsy

What is the disease?

It refers to "abnormalities of movement" caused by some kind of brain disorder that occurs from the time the fetus is in the womb until immediately after birth (up to 4 weeks). Paralysis that progresses with age, temporary paralysis, or simple developmental delays are not called cerebral palsy. One term that is easily confused is "polio," which is paralysis caused by poliovirus infection ( Acute poliomyelitis ( The National Diet Library ) ) and is completely different from cerebral palsy.

What is the cause?

Genetic factors and Brain malformations ( Noise regulation ) (Nerve cells do not migrate to the appropriate location and mature...neuron migration disorder), cerebrovascular disorder ( cerebral infarction ( Noise ) cerebral hemorrhage, etc.), central nervous system infections (cytomegalovirus infection in the womb, herpes infection, etc.), Asphyxiation ( snack ) There are a wide variety of causes, including poor respiratory and circulatory health during childbirth. Current medical science does not yet know the cause in many cases.

How symptoms manifest

In most cases, abnormalities in motor development are discovered during regular infant health checkups after birth. The main symptoms are: 1) delayed motor development, 2) abnormal movements and posture, 3) rib cage ( Religion ) becomes deformed and the joints become stiff ( Contracture ( Education ) Up until about 6 months of age, symptoms include delayed neck support, extremely strong arching, and extremely poor feeding. After that, symptoms include abnormal postures when excited or nervous, stiff and difficult movements of the arms and legs, residual reflexes that should disappear, and an inability to crawl or stand up. In school-age children, secondary disorders include Spine ( During ) of Scoliosis ( Sokuwan ) You may notice your joints become stiff and movement becomes restricted.

Testing and diagnosis

We refer to the records in the maternal and child health handbook (conditions during pregnancy, progress of delivery, etc.) to fully understand the mental and motor developmental state before symptoms appeared. Physical examination and psychological developmental tests are the basis, and head CT/MRI and cerebrospinal fluid tests may be added as necessary. All of this information is combined to make a diagnosis.

Treatment methods

Current medical science cannot completely cure a disease (remove any disability at all).

Therefore, treatment is centered on receiving treatment and training to help the patient control posture, movement, eating, speech, etc., despite the disability. A doctor will evaluate the type and degree of paralysis and the level of development to determine appropriate treatment and training goals. Treatments include 1) drug therapy and 2) surgical therapy. 1) involves taking medication to relieve muscle tension, and 2) surgery is performed to correct foot deformities and relieve muscle tension.

There are two types of training: ③ physical therapy and ④ occupational therapy. ③ is mainly performed to improve mobility and relieve muscle tension, and ④ is performed to improve daily movements using the hands. ① is mainly performed in the pediatric department, ② in the orthopedic department, and ③ and ④ in the rehabilitation department.

What to do if you notice an illness

Visit a pediatric or pediatric neurology outpatient clinic to determine whether cerebral palsy is suspected. We recommend that you receive a diagnosis at a medical institution with a pediatric neurology department. Even after a diagnosis, it is important to choose a medical institution where you can receive appropriate evaluations of mental and physical development and support for daily life.

There are many active groups for patients and their families with the same disease, which can be a useful reference for obtaining specific information.

Cerebral palsy
Cerebral palsy
(Musculoskeletal system diseases (including trauma))

What is the disease?

If a baby's brain is damaged for some reason between the time it is in the womb and the time it is four weeks old, it may become impossible for it to move its body or limbs freely. This is called cerebral palsy, and can be considered an aftereffect of brain damage. Although it is motor paralysis, it can also be accompanied by intellectual disability or epilepsy. Some people have very mild paralysis that does not affect their daily life, while others have severe paralysis that makes it impossible for them to sit.

What is the cause?

There are many causes of brain damage, including:

1. When in the womb

Genetic and chromosomal abnormalities, brain malformations ( Microcephaly ( Shooting ) etc.), intrauterine infection ( rubella ( Newspaper ) , cytomegalovirus, etc.), Intrauterine trauma ( Emergency medical examination ) etc.

② At the time of birth and before and after

Asphyxiation, Periventricular leukomalacia ( Nose mark collection ) , Intracranial hemorrhage ( Unusual arrival ) , Kernicterus ( Conqueror ) etc.

③Up to 1 month old

encephalitis ( Nouen ) , Meningitis ( Zuimakuen ) , Cerebrovascular disease ( Illness ) , Head trauma ( Tobu Foreign Office ) etc.

How symptoms manifest

Motor development is delayed, including being able to hold up the head (around 3-4 months), sit up (around 7 months), and start walking (around 1 year old). In addition, abnormalities such as stiffness of the body and limbs, limited limb movement, and a tendency to arch. These symptoms appear by around the age of 2. Generally, the more severe the condition, the earlier the symptoms appear.

As we grow, the muscles in our limbs shorten, our joints become stiff, Femur ( The basics )・Lower leg bone ( Hard bone ) The distortion of the spine becomes more pronounced, and the functions that have been gained tend to decline during school-age children.

Testing and diagnosis

A comprehensive diagnosis is made based on the results of ultrasound, MRI, and CT scans of the brain, as well as symptoms such as muscle tone in the limbs and delayed motor development. In cases of very mild cerebral palsy, these tests may not reveal any abnormalities, in which case the diagnosis is made based on symptoms.

The types of paralysis include Spastic ( Architectural type ) (Muscles are easily tense) Involuntary ( Unusual shape ) Examples include involuntary movement of the limbs (arms and legs), and ataxic (poor balance and unsteady gait).

Treatment methods

The goal of treatment is to maximize a child's motor skills and help them maintain those skills throughout their life.

1) Training

Physical therapy will relieve muscle tension and promote motor development, while occupational therapy will improve hand function.

② Prosthetics

There are functional braces that make it easier to walk or use the hands, as well as braces that are worn at night to prevent muscle shortening and joint stiffness.

3) Treatment to relieve muscle tension

Selective Dorsal rhizotomy ( Spinal cord injury ) or Intrathecal ( It's not foolish ) Continuous baclofen infusion: Both relieve tension throughout the legs.

- Botulinum toxin injection into the muscle: Relieves tension in certain muscles.

④Orthopedic surgery

It lengthens shortened muscles, corrects twisting of the femur and lower leg bones, and corrects foot deformities. It is also effective in treating severe children's Hip dislocation ( Kokansei Dump ) or Scoliosis ( Rapid response time ) It also treats (curvature of the spine).

What to do if you notice an illness

Please visit a pediatrician who specializes in neurology or an orthopedic surgeon who specializes in children. If you are unsure, please inquire at a facility for physically disabled people, a pediatric hospital, or a children's hospital.

Koji Noritake

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　胎児がおなかのなかにいる時から出生直後（4週まで）の間に起きた、脳の何らかの障害による「運動の異常」を指します。年齢とともに進行する麻痺や一時的な麻痺、あるいは単に発達が遅れているだけのものは脳性麻痺とは呼びません。間違えやすいものに「小児麻痺」がありますが、これはポリオウイルス感染によって発生する麻痺（急性灰白髄炎(きゅうせいかいはくずいえん)）のことを指し、脳性麻痺とはまったく異なります。

原因は何か

　遺伝的要因や脳奇形(のうきけい)（神経細胞が適切な位置に移動し成熟していかない…神経細胞の遊走障害）、脳血管障害（脳梗塞(のうこうそく)、脳出血など）、中枢神経感染症（胎内でのサイトメガロウイルス感染症、ヘルペス感染症など）、分娩時の仮死(かし)（分娩時に赤ちゃんの呼吸循環状態が悪くなる状態）など大変幅広い原因があります。また現在の医学では原因がわからないことも多くあります。

症状の現れ方

　多くは、出生後の定期的な乳幼児健康診断時に、運動発達の異常で発見されます。主な症状として、①運動発達の遅れ、②異常な運動と姿勢、③胸郭(きょうかく)が変形して関節が硬くなる（拘縮(こうしゅく)）などがあります。生後6カ月ころまでは、首の座りが遅い、反り返りが極端に強い、哺乳が極端に下手であるなどの症状で始まり、それ以降になると、興奮・緊張時に異常な姿勢をとる、手足が動きにくく突っ張る、消えるべき反射が残っている、「はいはい」やつかまり立ちができないなどに続きます。学童期に入ると、二次的障害として脊柱(せきちゅう)の側弯(そくわん)、関節が固くなり動きが制限されることが認められたりします。

検査と診断

　母子手帳記録（妊娠中の様子、分娩の経過など）を参照し、症状がみられるようになるまでの精神と運動発達の状況について十分に把握します。体の診察、心理発達検査を基本として、必要に応じて頭部CT・MRI、脳脊髄液検査などが加わることがあります。これらすべての情報を総合して診断されます。

治療の方法

　現在の医学では病気を完全に治す（まったく障害がない状態にする）ことはできません。

　したがって治療は、障害があっても姿勢・運動、摂食、発語などをうまくコントロールしていけるように治療、訓練を受けることが中心になります。医師の診察で麻痺のタイプと程度および発達の程度を評価して、それに合った治療と訓練の目標を決めます。治療には、①薬物療法、②手術療法があり、①は筋肉の緊張を和らげる薬の内服、②は足の変形を治し、筋肉の緊張を和らげるための手術が行われます。

　訓練には、③理学療法、④作業療法があります。③は主に移動する機能の向上と筋肉の緊張の緩和、④は手を使った日常動作を向上させるために行われます。①は小児科、②は整形外科、③④はリハビリテーション科で主に行います。

病気に気づいたらどうする

　小児科、小児神経科の外来を受診し、本当に脳性麻痺が疑わしいかどうかを判断をしてもらいます。小児神経科のある医療機関での診断を受けることをすすめます。また診断後も、心と体の発達に関する適切な評価、日常生活のサポートを受けられる医療機関を選ぶことも大切です。

　同じ疾患をもった患者ご家族の会が多く活動されており、具体的な情報を得る参考になることがあります。

脳性麻痺
のうせいまひ
Cerebral palsy
(運動器系の病気（外傷を含む）)

どんな病気か

　子どもがおなかにいるときから生後4週までに、何らかの原因で脳が損傷を受けると、その後、体や手足が自由に動かせなくなることがあります。これが脳性麻痺で、脳障害の後遺症といえます。運動の麻痺ですが、知的障害やてんかんを伴うことがあります。麻痺が非常に軽度で生活上の障害がない人から、重度で座ることができない人までいます。