Cerebral palsy: What are its causes and how do its forms manifest?

Cerebral palsy: What are its causes and how do its forms manifest?
Photo source: Getty images

Cerebral palsy, also known by the abbreviated name CP, is a disorder of central motility control and a disease of the nervous system. The disease can be congenital or acquired. Various factors that affect the developing brain are involved in its occurrence. This is during intrauterine development, in the period during childbirth, but also in the time after childbirth.


Cerebral palsy is defined as a neurodevelopmental disease that affects a child's motor development. Motor means that a failure occurs at the level of momentum, coordination, and overall control of movement.

It is also called CP.

The damage occurs during the period of brain development. It can affect the period of time during intrauterine development or during childbirth, but also in the time after childbirth. In addition to impaired motor functions, the disease also affects other parts of the nervous system. These are, for example:

  • sensory disorders such as visual impairment
  • perceptual disorders
  • attention disorders
  • speech disorders and its delayed development
  • reduction of intellect
  • behavioral disorders
  • mental retardation
  • seizures are common

The disease is not hereditary. It also affects other areas, not just the health side. CP is associated with difficulties at the level of pedagogy and social environment. It requires a multidisciplinary solution. A general practitioner for children, a pediatric neurologist, a psychologist, a speech therapist, an orthopedist, and also rehabilitation workers meet.

Brain model
Form of DMO according to the nervous system involvement. Photo source: Getty images

The child's physical development is delayed or insufficient. The disease usually manifests itself during the first 6 months of the child's life. CP has several forms. More precisely, cerebral palsy is divided into three forms: 

  1. spastic form
  2. non-spastic form
  3. atactic form
  4. separately the group is formed by the combined form

The table shows the distribution of CP

Title Damage level Representation Description
Spastic form damage to the motor part of the nervous system 70 - 80% of those affected by CP it is characterized by constant muscle tension, it limits or prevents movement this form is further divided into :
Diparetic form limb involvement, but mainly lower limbs
Hemiparetic form paralysis affects one side of the body
Triparetic form affects three limbs, such as two lower and one upper limb
Quadruparetic form severe damage to the muscles of the head, torso and limbs
Non-spastic form basal ganglia damage 10 - 20% of cases from CP Dyskinetic form - muscle tension alternates, uncontrollable involuntary body movements occur, shaky movement
Hypotonic form -  muscle tension is generally reduced, especially on the torso and limbs. Unsteady gait, increased range of motion in the joints. It usually changes to another form in the 3rd year. If it persists it is referred to as permanent hypotonic syndrome
Atactic form brain damage 5-10% of people with CP difficulty with balance, coordination of movement, there is a route of the body in conscious activity
Combined damage damage at multiple levels the most commonly combined is the spastic and dyskinetic forms


Cerebral palsy occurs due to damage to the developing brain. CP can be innate or acquired. It is not hereditary. Brain damage can affect different time stages. For example, it can occur in the stage of intrauterine development , during childbirth or in the postpartum period .

Damage during intrauterine development

It is caused, for example, by an infection of the mother during pregnancy. Diseases such as toxoplasmosis, rubella, herpes infections, CMV, or cytomegalovirus, HIV are at risk. Another group is developmental anomalies.

Intoxication, ie poisoning during pregnancy, is also at risk. It is usually caused by alcohol, drugs such as opiates, drugs, but also lead. Maternal starvation during pregnancy or associated illness may also be essential. Such as hypertension, diabetes, epilepsy, mental disorders.

Another group of risk factors is increased mental load of the mother during pregnancy, Rh incompatibility, but also the effect of X-rays. All conditions that lead to reduced blood flow to the placenta and thus to hypoxia (reduced oxygenation) of the fetus are serious .

Complications during childbirth

Premature birth or, conversely, the long-term transmission of the fetus can also be risky. Other causes may be tick birth, pelvic birth, low birth weight, and again lack of oxygen. But also multi-fetal pregnancy.

Postpartum period

A newborn, but also a child under 6 months of age is sensitive to the external environment. And, of course, the overall period of childhood. The acquired form of CP can be caused by an infection within 6 months, such as meningitis, whooping cough. Neonatal jaundice can also be the cause. But also brain damage due to injury. The cause of the accident can be a fall, but also abuse.


The disease is manifested by typical problems of posture, movement disorders, and coordination. There are several forms of movement disorders, the most common being spastic. The spastic form manifests itself in stiff muscles. Muscle contraction causes weakness, partial paralysis, or even complete impairment of mobility.

A smaller representation is non- spastic and the smallest atactic form. In the first, there are involuntary movements, which are caused by alternating muscle tension - also referred to as dyskinetic. The hypotonic form, which is manifested by the loss of muscle tension, also falls under the non-spastic. And uncertain walking may be present. This form usually changes to another form within three years of life.

The atactic form has a cause in brain damage. This will cause gait disturbances, balance perceptions, and general movement coordination disorders. The so-called drunken walk is typical. There are also routes during a certain will activity.

In particular, the group consists of a mixed combined form. It can group several difficulties, due to brain damage in different places. The most common are spastic and dyskinetic forms.

Symptoms of cerebral palsy include impaired sensitivity, speech, and psychomotor retardation. Difficulty with concentration, fatigue, memory problems are associated.

As a rule, these symptoms can be gradually observed until the child is 3 years old. When there are problems with movement and especially delayed development of movement skills. Such as climbing, sitting, standing, turning, and walking.

Child with DMO
Mobility disorder and walking aid. Photo source: Getty images

Cerebral palsy is determined by symptoms such as:

  • movement disorder
  • delayed motor development
  • increased masseter reflex
  • disorder of the sensory organs, damage to the eyes, eye muscles - strabismus, ie training
  • speech disorder, dysarthria, yawning
  • delayed speech development
  • reduction of intellect
  • behavioral disorders, neuroses and affective disorders
  • mental retardation
  • reduced ability to concentrate
  • memory and learning disorders
  • increased fatigue
  • excessive salivation, ie hypersalivation
  • swallowing disorder
  • reduced immunity and increased risk of intoxication
  • convulsive diseases such as epilepsy
  • problem with bladder control and emptying


Diagnosis of the disease is difficult after the birth of a child. Gradual psychomotor development is evaluated. Are important neurological examinations, such as the test position. Ultrasonography of the brain is helpful. Severe forms can be detected after birth. 

CP is diagnosed by the presence of signs and symptoms of the disease. Diagnosis is easier at the age of 6 to 12 months. The gradual development of symptoms can be observed up to 3 years of age. 

Diagnosis of the disease after birth is difficult and is usually only possible after a few months.

Undetectable during pregnancy. 
To determine the CP, professional examination and monitoring of the child during growth is necessary.

Accompanying eye symptoms are also decisive. Children with cerebral palsy very often have various cataracts or inflammations in the eyes. In addition, magnetic resonance imaging and  CT of the brain and spine are performed to detect changes in the central nervous system, and various genetic tests can be performed.

Regular inspections are performed on children at risk. About every 2 weeks. The occurrence of epileptic seizures leads to the diagnosis. Epilepsy accompanies CP in approximately 35-55% of cases. The manifestations can be varied, such as the presence of involuntary movements, screaming, absent gaze, or whole-body cramps.


Child with CP and prosthetic walking aid
Child with CP and prosthetic walking aid. Photo source: Getty images

The disease usually begins at an early stage of life . The child may be sleepy, apathetic. Its mobility is low. The overall motor development is slowed down , delayed. Fixation, and thus visual tracking is slowed down, grips objects as well.

Turning and sitting is the same at a later time. From the 6th month, when the baby has problems with basic movement and movement disorders. He has a slow or insufficient development of physical activities . Later, problems with posture or torsional movements are added, or the mobility of the limbs is affected according to the specific form. 

Manifestations are diverse, including the development of symptoms. There may be tremors of the limbs , but also seizures . These are symptoms of epilepsy. Later, there will be a delay in psychomotor development , or mental retardation and  problems with growth , hearing and  vision .

Difficulties with concentration , learning, memory or behavior in general may be associated . Such as inattention, restlessness or, conversely, a general slowdown.

Neurotic disorders , explosive affective behavior, moodiness .

How it is treated: Cerebral palsy

Can cerebral palsy be treated? Rehabilitation and other treatments

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Informations about CP in video

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Interesting resources

  1. "Cerebral Palsy: Hope Through Research". National Institute of Neurological Disorders and Stroke
  2. Oskoui, M; Coutinho, F; Dykeman, J; Jetté, N; Pringsheim, T (June 2013). "An update on the prevalence of cerebral palsy: a systematic review and meta-analysis". Developmental Medicine & Child Neurology55 (6): 509–19. 
  3. Haak, Peterson; Lenski, Madeleine; Hidecker, Mary Jo Cooley; Li, Min; Paneth, Nigel (October 2009). "Cerebral palsy and aging". Developmental Medicine & Child Neurology51: 16–23. 
  4. "Cerebral Palsy: Overview". National Institutes of Health
  5. "CEREBRAL PALSY, SPASTIC QUADRIPLEGIC, 1; CPSQ1". Online Mendelian Inheritance in Man
  6. Rosenbaum, P. (February 2007). "A report: the definition and classification of cerebral palsy April 2006". Developmental Medicine & Child Neurology49: 8–14.
  7. Farag, Sara M.; Mohammed, Manal O.; EL-Sobky, Tamer A.; ElKadery, Nadia A.; ElZohiery, Abeer K. (March 2020). "Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials". JBJS Reviews8 (3): e0119.
  8. Blumetti, Francesco C; Belloti, João Carlos; Tamaoki, Marcel JS; Pinto, José A (8 October 2019). "Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy". Cochrane Database of Systematic Reviews2019 (10): CD001408. 
  9. "How many people are affected?". National Institutes of Health. 
  10. Panteliadis, C; Panteliadis, P; Vassilyadi, F (April 2013). "Hallmarks in the history of cerebral palsy: from antiquity to mid-20th century". Brain & Development35 (4): 285–92. 
  11. "What is cerebral palsy?". The Cerebral Palsied Association of the Philippines Inc. 
  12. Rosenbaum, P; Paneth, N; Leviton, A; Goldstein, M; Bax, M; Damiano, D; Dan, B; Jacobsson, B (2007). "A report: The definition and classification of cerebral palsy April 2006". Developmental Medicine & Child Neurology49 (s109): 8–14.
  13. Kent R (2013). "Chapter 38: Cerebral Palsy". In Barnes MP, Good DC (eds.). Handbook of Clinical Neurology. 3. Vol. 110. Elsevier. pp. 443–459. ISBN 978-0444529015.
  14. Mathewson, Margie A.; Lieber, Richard L. (February 2015). "Pathophysiology of Muscle Contractures in Cerebral Palsy". Physical Medicine and Rehabilitation Clinics of North America26 (1): 57–67. doi:10.1016/j.pmr.2014.09.005. PMC 4258234. PMID 25479779.
  15. El-Sobky, TA; Fayyad, TA; Kotb, AM; Kaldas, B (25 September 2017). "Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review". Journal of Pediatric Orthopedics. Part B27 (3): 221–230.