Cerebral palsy natural history, complications and prognosis

Although the neurologic deficit is permanent and non-progressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient resulting in gait abnormalities. Cerebral palsy affects multiple systems. Common complications include contractures, hip dislocation, scoliosis, failure to thrive, dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia), increased risk of aspiration pneumonia, bronchiolitis/asthma, epilepsy, and mental retardation.

• Although the neurologic deficit is permanent and nonprogressive, if cerebral palsy is left untreated it can have a dynamic effect on growth and development of the patient.
• Growth, along with altered muscle function across joints, can lead to progressive loss of motion, contracture, and eventually joint subluxation or dislocation, resulting in degeneration that may require orthopedic intervention.^[1][2]
• Injury to the developing brain can occur at any time and can result in delayed development and may affect cognition, vision, hearing, language, cortical sensation, attention, vigilance, and behavior.

Cerebral palsy affects multiple systems. Common complications include:^[3][4][5]

• Decubitus ulcers and sores
• Contractures
• Hip dislocation
• Scoliosis
• Failure to thrive due to feeding and swallowing difficulties secondary to poor oromotor control
• Obesity
• Gastroesophageal reflux
• Constipation
• Dental caries (enamel dysgenesis, malocclusion, and gingival hyperplasia)
• Increased risk of aspiration pneumonia
• Bronchiolitis/asthma
• Epilepsy
• Hearing loss
• Visual-field abnormalities due to cortical injury
• Strabismus
• Mental retardation
• Attention-deficit/hyperactivity disorder
• Learning disabilities

• Prognosis of cerebral palsy depends on the type and severity of motor impairment.^[6]
• Average life expectancy of patients with cerebral palsy is 44% of normal.
• The strongest predictors of early mortality are immobility and impaired feeding ability.^[7]
• Retention of asymmetric and symmetric tonic neck reflex, moro reflex, neck righting reflex, and presence of lower-extremity extensor thrust response in early infancy are associated with poor prognostic factors for the development of independent walking
• Long-term monitoring depends on the degree of involvement:^[8][9]
  • Patients with a gross motor function classification system (GMFCS) level of I or II need less monitoring.
  • Patients with level III should be monitored every other year.
  • Patients with level IV or V need assessment every year during active growth.

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