The spastic diparesis or spastic diplegia is a type of cerebral palsy that affects the control of muscles and motor coordination. These patients suffer from an exaggerated increase in muscle tone, known as spasticity.
This neurological disorder usually appears in childhood. It is distinguished by muscular rigidity and accentuated reflexes only in the legs. It is rare that the muscles of the arms are affected. If they are, it is lighter than the legs.
Spastic diparesis appears from various causes. They can be summarized in that the motor areas of the brain are injured at a young age, or they do not develop correctly.
The reason for this is not known with certainty, although many link it to genetic alterations, hypoxia, or maternal infections during pregnancy. It can also appear from damage before, during or shortly after birth.
In terms of treatment, spastic diparesis has no cure. That is why it is focused on improving the quality of life of the person to the maximum, alleviating as much as possible the individual signs and symptoms.
Discovery
The first to describe spastic diparesis was William Little in 1860. This English surgeon observed that this disorder appeared in the first years of life, and that it was notable for muscular rigidity and distortion of the limbs.
For many years it was called "Little's disease" by its discoverer, although today it is known as diparesis or spastic diplegia. It is included within the concept of cerebral palsy as a subtype of it.
Cerebral palsy was described by William Osler in 1888. It encompasses a set of syndromes characterized by non-progressive motor problems. These are due to brain lesions or malformations produced before, during or after birth; at a very young age.
Symptoms of spastic diparesis
Spastic diparesis is characterized primarily by elevated muscle tone, exaggerated reflexes, and stiffness (called spasticity). They occur mainly in the lower part of the body (legs), and affect movement, coordination and balance.
However, the symptoms and severity of this condition appear to vary greatly from person to person. These manifestations can change throughout life. Spastic diparesis is not progressive, so it does not get worse over time.
Some of the signs and symptoms that can accompany spastic diparesis are:
- Delayed motor development. That is, it takes much longer than other children to crawl, sit, stand, or walk. It is difficult for him to reach those developmental milestones at the age he should.
- An important manifestation of this motor delay is that instead of using their legs and arms to crawl around, they only use their upper extremities. Even some affected children do not crawl or crawl in any way.
- Between 1 and 3 years of age, they may prefer to sit in a "W" shape. Although this is not recommended, and professionals advise that the child sit cross-legged.
- There are children who at 3 years old cannot stand without help.
- Walk on tiptoe or on your toes. Normally they can only walk short distances, there are cases in which walking becomes impossible.
- Scissor walking. It is a typical gait for people with spastic diparesis in which the legs are crossed at each step due to strong muscle tone. The balls of the feet face inwards and the knees are crossed.
- As a consequence, the appearance of the spastic hip is common. This can gradually increase the dislocation of the hip, leading to more and more joint problems.
- Generally the legs are more affected than the arms. Even the upper limbs can move properly and have normal muscle tone. In more severe cases, all limbs may be involved.
Other symptoms can be:
- Cognitive impairment of some kind.
- Fatigue.
- Strabismus (one eye looking inward).
- Some children may have seizures.
Causes of spastic diparesis
Spastic diparesis arises from acquired lesions in areas of the brain that control movement. Or, a bad development of these.
This usually occurs before birth, during delivery, or shortly after. That is, at times when the brain is still developing basic areas for motor control. It usually occurs before the age of 2.
The specific underlying causes of these brain disorders are often unknown. Although it has been related to different factors:
- Hereditary genetic abnormalities: it seems that if in a family there is a member with some type of cerebral palsy (including spastic diparesis) there is a greater probability of presenting it. Thus, a child with a brother with this condition will have 6 to 9 times the risk of developing the disease.
This suggests that genes may be involved in spastic diparesis, although exactly what they are is not known. It is probably due to the interaction of multiple genes combined with the influence of the environment.
- Congenital malformations of the brain.
- Infections or fever of the mother during pregnancy.
- Damages acquired in the baby before, during or after birth.
- Blood flow deficit in the brain.
- Severe lack of oxygen causing brain damage (hypoxia).
It is important to mention that around 10% of spastic diparesis cases are due to medical negligence. For example, by:
- Misuse of forceps and other tools to aid delivery.
- Lack of supervision of stress and heartbeat of the fetus.
- Not having adequately planned an emergency cesarean section.
- Not having detected, diagnosed or treated infections or other diseases of the mother.
In the event that one of these medical negligence has occurred, it is recommended to go to a lawyer for advice on the measures to be taken.
Treatment
The treatment of spastic diparesis varies according to the severity and symptoms of each case. As there is no cure today, treatment focuses on alleviating deficits as much as possible and improving the person's life.
Ideally, these patients receive care from a multidisciplinary group of healthcare professionals. Like neurologists, neuropsychologists, social workers, physical therapists, occupational therapists, etc.
In addition, orthotics or devices such as walkers, wheelchairs, crutches, etc. are useful.
There are certain medications that can also be prescribed if the disease is accompanied by seizures. Or, to relax overactive muscles or eliminate pain.
Physical therapy is essential as it helps reduce spasticity, increase strength, coordination, and balance.
On the other hand, in a study by Fajardo-López and Moscoso-Alvarado (2013) it was demonstrated that an excellent way to improve the aerobic capacity of patients with spastic diparesis was through aquatic therapy.
In cases where walking or moving is very difficult or painful, orthopedic surgery may be recommended.
References
- Diplegic Cerebral Palsy. (sf). Retrieved on March 31, 2017, from the Birth Injury Guide: hbirthinjuryguide.org.
- Fajardo-López, Nandy, & Moscoso-Alvarado, Fabiola. (2013). Aerobic capacity training through aquatic therapy in children with spastic diplegia cerebral palsy. Journal of the Faculty of Medicine, 61 (4), 365-371.
- Madrigal Muñoz, Ana. (2007). The family and the cerebral palsy. Psychosocial Intervention, 16 (1), 55-68.
- Spastic diplegia cerebral palsy. (sf). Retrieved on March 31, 2017, from the Genetic and Rare Diseases Information Center (GARD): rarediseases.info.nih.gov.
- Spastic Diplegia Cerebral Palsy. (sf). Retrieved on March 31, 2017, from Cerebral Palsy Guidance: cerebralpalsyguidance.com.