Investigators from many arenas of medicine and
health are using their expertise to help improve the treatments and prevention
of cerebral palsy.
The ultimate hope for overcoming cerebral palsy
lies with prevention. Between early pregnancy and the first months
of life, one cell divides to form first a handful of cells, and
then hundreds, millions, and, eventually, billions of cells. Some
of these cells specialize to become brain cells.
These brain cells specialize into different types and migrate to
their appropriate site in the brain. They send out branches to
form crucial connections with other brain cells. Ultimately, the
most complex entity known to us is created: a human brain with
its billions of interconnected neurons.
Mounting evidence is pointing investigators toward
this intricate process in the womb for clues about cerebral palsy.
For example, a group of researchers has recently observed that
more than one-third of children who have cerebral palsy also have
missing enamel on certain teeth. This tooth defect can be traced
to problems in the early months of fetal development, suggesting
that a disruption at this period in development might be linked
both to this tooth defect and to cerebral palsy.
As a result of this and other research, many scientists now believe
that a significant number of children develop cerebral palsy because
of mishaps early in brain development. They are examining how brain
cells specialize, how they know where to migrate, how they form
the right connections -- and they are looking for preventable factors
that can disrupt this process before or after birth.
Scientists are also scrutinizing other events
-- such as bleeding in the brain, seizures, and breathing and circulation
problems -- that threaten the brain of the newborn baby. Through
this research, they hope to learn how these hazards can damage
the newborn's brain and to develop new methods for prevention.
Some newborn infants, for example, have life-threatening
problems with breathing and blood circulation. A recently introduced
treatment to help these infants is extracorporeal membrane oxygenation,
in which blood is routed from the patient to a special machine
that takes over the lungs' task of removing carbon dioxide and
adding oxygen. Although this technique can dramatically help many
such infants, some scientists have observed that a substantial
fraction of treated children later experience long-term neurological
problems, including developmental delay and cerebral palsy. Investigators
are studying infants through pregnancy, delivery, birth, and infancy,
and are tracking those who undergo this treatment.
By observing them at all stages of development,
scientists can learn whether their problems developed before birth,
result from the same breathing problems that made them candidates
for the treatment, or spring from errors in the treatment itself.
Once this is determined, they may be able to correct any existing
problems or develop new treatment methods to prevent brain damage.
Other scientists are exploring how brain insults
like hypoxic-ischemic encephalopathy (brain damage from a shortage
of oxygen or blood flow), bleeding in the brain, and seizures can
cause the abnormal release of brain chemicals and trigger brain
damage. For example, research has shown that bleeding in the brain
unleashes dangerously high amounts of a brain chemical called glutamate.
While glutamate is normally used in the brain for communication,
too much glutamate overstimulates the brain's cells and causes
a cycle of destruction.
Scientists are now looking closely at glutamate to detect how its
release harms brain tissue and spreads the damage from stroke.
By learning how such brain chemicals that normally help us function
can hurt the brain, scientists may be equipped to develop new drugs
that block their harmful effects.
In related research, some investigators are already
conducting studies to learn if certain drugs can help prevent neonatal
stroke. Several of these drugs seem promising because they appear
to reduce the excess production of potentially dangerous chemicals
in the brain and may help control brain blood flow and volume.
Earlier research has linked sudden changes in blood flow and volume
to stroke in the newborn.
Low birthweight itself is also the subject of
extensive research. In spite of improvements in health care for
some pregnant women, the incidence of low birth-weight babies born
each year in the United States remains at about 7 1/2 percent.
Some scientists currently investigating this serious health problem
are working to understand how infections, hormonal problems, and
genetic factors may increase a woman's chances of giving birth
prematurely. They are also conducting more applied research that
could yield: 1) new drugs that can safely delay labor, 2) new devices
to further improve medical care for premature infants, and 3) new
insight into how smoking and alcohol consumption can disrupt fetal
development.
While this research offers hope for preventing
cerebral palsy in the future, ongoing research to improve treatment
brightens the outlook for those who must face the challenges of
cerebral palsy today. An important thrust of such research is the
evaluation of treatments already in use so that physicians and
parents have the information they need to choose the best therapy.
A good example of this effort is an ongoing NINDS-supported study
that promises to yield new information about which patients are
most likely to benefit from selective dorsal root rhizotomy, a
recently introduced surgery that is becoming increasingly in demand
for reduction of spasticity.
Similarly, although physical therapy programs
are a popular and widespread approach to managing cerebral palsy,
little scientific evidence exists to help physicians, other health
professionals, and parents determine how well physical therapy
works or to choose the best approach among many. Current research
on cerebral palsy aims to provide this information through careful
studies that compare the abilities of children who have had physical
and other therapy with those who have not.
As part of this effort, scientists are working
to create new measures to judge the effectiveness of treatment,
as in ongoing research to precisely identify the specific brain
areas responsible for movement may yield one such approach. Using
magnetic pulses, researchers can locate brain areas that control
specific actions, such as raising an arm or lifting a leg, and
construct detailed maps. By comparing charts made before and after
therapy among children who have cerebral palsy, researchers may
gain new insights into how therapy affects the brain's organization
and new data about its effectiveness.
Investigators are also working to develop new
drugs -- and new ways of using existing drugs -- to help relieve
cerebral palsy's symptoms. In one such set of studies, early research
results suggest that doctors may improve the effectiveness of the
anti-spasticity drug called baclofen by giving the drug through
spinal injections, rather than by mouth. In addition, scientists
are also exploring the use of tiny implanted pumps that deliver
a constant supply of anti-spasticity drugs into the fluid around
the spinal cord, in the hope of improving these drugs' effectiveness
and reducing side effects, such as drowsiness.
Other experimental drug development efforts are
exploring the use of minute amounts of the familiar toxin called
botulinum. Ingested in large amounts, this toxin is responsible
for botulism poisoning, in which the body's muscles become paralyzed.
Injected in tiny amounts, however, this toxin has shown early promise
in reducing spasticity in specific muscles.
A large research effort is also directed at producing
more effective, nontoxic drugs to control seizures. Through its
Antiepileptic Drug Development Program, the NINDS screens new compounds
developed by industrial and university laboratories around the
world for toxicity and anticonvulsant activity and coordinates
clinical studies of efficacy and safety. To date, this program
has screened more than 13,000 compounds and, as a result, five
new antiepileptic drugs -- carbamazepine, clonazepam, valproate,
clorazepate, and felbamate -- have been approved for marketing.
A new project within the program is exploring how the structure
of a given antiseizure medication relates to its effectiveness.
If successful, this project may enable scientists to design better
antiseizure medications more quickly and cheaply.
As researchers continue to explore new treatments
for cerebral palsy and to expand our knowledge of brain development,
we can expect significant medical advances to prevent cerebral
palsy and many other disorders that strike in early life.
In dealing with Cerebral
Palsy, it is important to understand the available Cerebral
Palsy Treatments that go along with a Cerebral
Palsy Diagnosis after Cerebral
Palsy has been detected. Through extensive, technology based Cerebral
Palsy Research, there is hope for possible future Cerebral
Palsy Prevention.
If your child has any type of Cerebral
Palsy such as Athetoid
Cerebral Palsy, Spastic
Cerebral Palsy, or Ataxic
Cerebral Palsy, feel comfort in knowing you have made a step
in the right direction by contacting us.
