The term "spastic diplegia" refers to the most frequently 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, in patients revealed violations 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
Cerebral palsy is a disease of both monopathogenetic and polyetiological nature. The development of the pathological process starts when various unfavorable factors are exposed to the child’s brain. The first signs of cerebral palsy can occur during fetal development, and during delivery, and in the first weeks of life. A non-progressive course is characteristic of the disease. The clinical manifestations of the disease are caused by motor, mental and speech disorders.
Forms of cerebral palsy:
- Spastic diplegia. It is characterized by lesions of 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 the upper and lower limbs are affected. This form is also characterized by the presence of speech disorders, atrophy of the optic nerves, rigidity of muscle tissue. This is the most severe form of cerebral palsy. The code in the ICD is G80.2.
- Hemiplegia. One side of the body is affected. In children, deviations in intellectual and mental development are revealed. This form is characterized by the periodic occurrence of epilepsy attacks. The code in the ICD is G80.2.
- Dyskinetic appearance. Signs characteristic of this form are: incorrect setting of the lower extremities, involuntary twitching of the legs, cramps, speech impairment. Intelligence is practically not affected, as is the case with spastic diplegia of cerebral palsy. The ICD-10 code is G80.3.
- Ataxic form. It is characterized by a decreased tone of muscle tissue, pronounced tendon reflexes, impaired speech, a complete lack of coordination of movements, lag in the intellectual sphere. Oligophrenia is often diagnosed. G80.4 - code according to ICD-10.
Spastic diplegia of cerebral palsy is a pathology in which a person can 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 of 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 onset of the delivery process. This occurs with placental insufficiency, placental abruption, Rh conflict of the mother and fetus. The causes of preterm birth can also be the diseases from which the pregnant woman suffers. These include: diabetes, kidney dysfunction, heart disease. A provoking factor is also gestosis.
- Birth injury. 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 delivery, narrow passageways, and pelvic presentation of the fetus.
- Asphyxia in a newborn baby. In some cases, after birth, babies cannot breathe on their own. The causes of asphyxia: getting into the respiratory tract of amniotic fluid, abnormalities in the development of the child in the prenatal period, infectious diseases, immunological incompatibility of the mother and baby, pneumopathy.
- Genetic predisposition. In people suffering from an ailment, in most cases children are born with spastic diplegia of cerebral palsy.
- Hypoxia or ischemia of the fetus during fetal development. With a lack of oxygen and impaired circulation, a brain lesion occurs in the child. Most often, the consequence is the development of severe forms of cerebral palsy.
- Infectious lesions of the musculoskeletal system.
- Physical effects on the fetus. A risk factor is 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 tobacco smoking, the use of alcohol-containing drinks and drugs, as well as 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, while a lesion is observed mainly in the lower extremities. Muscle hypertonicity is a necessary condition during fetal development. Shortly after the birth of a baby into the light, its intensity begins to weaken. As a rule, completely muscle hypertonicity disappears by a maximum of six months. In the presence of spastic diplegia, it does not wane.
The state of hypertonicity is most noticeable in the area of the flexor muscles of the feet. As a result, a specific position of the legs is formed. In a sick child, the knees are connected, the hips are turned inward, and the legs are pressed together or crossed.
Other clinical manifestations:
- Backlog from peers in physical development. Sick children begin to take their first steps only at 3-4 years old.
- A specific gait on toes with spread legs. In this case, the lower extremities rub against each other in the region of the legs.
- In the muscles of the hands, the tone is usually normal. Sometimes it is slightly increased.
- Oculomotor disorders.
- Visual impairment.
- Strabismus.
- Hearing loss.
- The smoothness of the folds in the nasolabial area.
- Incorrect positioning of the tongue, it is deviated from the midline.
- Pseudobulbar palsy.
- In 75% of patients, delayed speech development is detected.
- Touch functions saved.
- Involuntary movements of the upper limbs.
- Every 5th patient has oligophrenia.
The diagnosis of "spastic diplegia of cerebral palsy" in children under 12 months of age is made in the presence of the following symptoms:
- A child cannot independently raise his head and hold it in this position.
- The kid is not able to roll over without assistance.
- The newborn is not at all interested in toys or any other bright objects.
- A child cannot sit on its own.
- The kid does not make any attempts to move from one place to another. He has no desire to crawl.
- The child cannot stand on its feet.
- The kid does not use the affected limb.
In older children, parents may notice uncontrolled contractions of muscle tissue. In addition, in children, sluggish movements give way to sharp movements and vice versa.
Severity
There are several options for the development of the disease. They are described in the table below.
| The severity of the pathology | Characteristic clinical manifestations |
| Easy | In the first 6 months, the baby’s health is not in doubt. It is developing normally. With a mild degree of spastic diplegia of cerebral palsy, after some time, signs of paresis of the lower extremities appear. In this case, the child is able to move independently and not resort to the help of third parties. Both mental and mental development comply with all standards. |
| Average | For this degree, pronounced spasticity in the lower extremities is characteristic. A person cannot move independently. While walking, he is forced to use crutches, canes or other improvised means. Minor changes occur in the cognitive sphere. Social adaptation is possible. |
| Heavy | Characteristic signs are pronounced immediately after the birth of the child. The baby reveals tetraparesis with a primary lesion of the lower extremities. In the future, the child cannot move independently. Social adaptation is also impaired. |
If any warning sign occurs, consult 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 the starting factor for the development of various complications.
Diagnostics
A neurologist is involved in the treatment of spastic diplegia of cerebral palsy. It is to him that one should turn when the first alarming symptoms occur. Based on the history and physical examination, the specialist draws up a referral for a comprehensive examination, including:
- Ophthalmologist examination.
- Consultation of an ENT doctor.
- Electroencephalography.
- Electroneuromyography.
- Neurosonography.
- Ultrasound or MRI of the brain. An ultrasound scan is indicated for an open fontanel. In other cases, an MRI scan is performed.
All received data is displayed on the patient’s medical record. The doctor enters into it not only the results of the studies, but also the alleged 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 caused by a hereditary predisposition. The doctor may also apply for a consultation with a geneticist.
Drug treatment
Currently, no specific etiopathogenetic therapy of the disease has been developed. Treatment of pathology involves only taking medications and undergoing a rehabilitation course.
The classic drug regimen is presented in the table below.
| Drug group | Effects on the body | Sample Tools |
| Vascular agents | Active components contribute to a significant improvement in cerebral circulation. In addition, the process of nutrient entry into brain tissue is normalized. | Cinnarizine |
| Neurometabolites | Appointed to improve the functioning of the central nervous system. | Glycine, Thiamine, Pyridoxine |
| Muscle relaxants | Active components reduce the severity of muscle spasticity. | "Baclofen" |
| Nootropic drugs | Against the background of reception, cognitive functions are activated. | Piracetam |
| Botulinum toxin | This drug is administered intramuscularly. Botulinum toxin preparations are prescribed to relieve spastic stress, which significantly reduces the risk of muscle contracture formation. | |
The objective of drug treatment is to prevent the development of various complications.
Rehabilitation therapy
It is prescribed to absolutely all patients. Rehabilitation measures are aimed at improving social adaptation. In addition, therapy involves teaching patients self-care skills.
Rehabilitation treatment includes the following items:
- Exercise therapy. Classes can be held both in the home environment and in the doctor’s office. A set of exercises is developed exclusively by a neurologist. The specialist, when compiling it, takes into account all the individual characteristics of the patient’s health. Exercise therapy with spastic diplegia of cerebral palsy helps to maintain range of motion. In addition, physical therapy is an excellent prevention of complications.
- Massage. Helps to improve blood circulation in the affected muscles. In addition, against the background of treatment, muscle relaxation occurs.
- Speech correction. Means individual lessons with a speech therapist.
If there are signs of oligophrenia, consultations with a psychologist are additionally conducted. The specialist most often corrects violations using game therapy.
Possible complications
The course of cerebral palsy often leads to negative consequences.
The following complications are most often diagnosed:
- Impaired functioning of the musculoskeletal system.
- Epilepsy.
- Pronounced cognitive impairment.
- Deterioration in hearing and vision.
In order to prevent the development of complications, it is necessary to strictly comply with all the instructions of the attending physician.
Forecast
The outcome of the disease directly depends on the timeliness of contacting a neurologist. If untreated, raising a child to his feet is almost impossible. According to statistics, only 20% of patients can move independently. The rest are bedridden.
With the timely detection and treatment of the disease, social adaptation is possible.
Finally
Spastic diplegia is the most common form of cerebral palsy. In the medical literature, it is often referred to as "Little's disease." The disease is characterized by damage mainly to the lower extremities. In the ICD of spastic diplegia of cerebral palsy, code G80.1 is assigned.