This is defined as a non-progressive neuromuscular disorder of

cerebral origin. (static encephalopathy in a growing child)

It includes a number of clinical disorders, mostly arising in
childhood.
The essential features of all these disorders is a varying degree of
upper-motor neurone type of limb paralysis (spasticity) together
with
difficulty in co-ordination (ataxia) and purposeless movements
(athetosis).

Spascticty – increase muscle

tone due to stretching
Dystonia – without changing
muscle length. It does not
lead to contracture

Pathology:
The pathology of this disorder is the degeneration of the cerebral
cortex or basal ganglion, either because of their faulty development
or because of damage caused by the various factors

CLINICAL FEATURES
Presenting complaints: The clinical features vary according to
The severity of the lesion,
The site of the neurological deficit and
The associated defects.

Severity of lesion: The lesion may be

1. Mild in 20 per cent of cases, in which case the child may
remain ambulatory without any help and may never require
consultation.
2. In the majority (almost 50 per cent of cases), the child
requires help with ambulation. The usual presentation is
a. a child less than one year old,
b. in whom the parents have noticed a lack of control on
the affected limb,
c. There is a delay in the developmental milestones such
as sitting up, standing or walking.
3. In about 30 per cent of cases, the involvement is severe, and
the child is bed-ridden.

Pattern of involvement:
A. The pyramidal tracts are involved in 65 per cent of cases,
 they present with spasticity,
 Exaggerated reflexes etc.
  One or all the limbs may be involved.

a. The commonest pattern is

a symmetrical spastic paresis of the lower limbs,
resulting in a tendency to flex and adduct the hips
(scissoring), to keep the knees flexed and the feet in
equinus.
b. Less commonly,
it may present as monoplegia, hemiplegia or
quadriplegia.
In the upper limb, there is typical flexion of the wrist and
fingers with adduction of the thumb and pronation of the
forearm.
B. In 35 per cent of cases, extra-pyramidal symptoms such as
Ataxia,
athetoid movements,
dystonia predominate.

Associated defects: These consist of

speech defect, sensory defect, epilepsy, occular defects and
mental retardation.
 severely mentally retarded – 50%
 moderate mental retardation – 25%
 borderline mental retardation – 25%

Complete cure is impossible since an essential part of the brain is

destroyed and cannot be repaired or replaced