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Spastic diplegia


Spastic Diplegia is one of the most common types of cerebral palsy, appearing in nearly 70% of all cerebral palsy cases. Originally known as Little's Disease, after 19th century British surgeon, William Little, who first described it, Spastic Diplegia is characterized by an abnormal stiffness, rigidity and weakness of the muscles in the arms and legs. In time, Little's disease was categorized as one of a series of disorders, and it became known as Spastic Diplegia.

SPASTIC DIPLEGIA SIGNS AND SYMPTOMS

This limb stiffness is also known as static encephalopathy or paraplegia, and in children, the condition does not progress as they age. In a majority of cases, Spastic Diplegia is an inherited ailment, and it is determined by the age a patient starts exhibiting symptoms of the disorder, the patient's medical history, problems that may have occurred during the pregnancy or birth of the patient, and the presence of genetic factors that point towards the disorder.

Usually, patients who have inherited Spastic Diplegia will have a family history of the ailment, and their symptoms will manifest themselves only late in their childhood, or towards middle age. While cerebral palsy is the result of damage to the brain, Spastic Diplegia shows itself during childhood. It occurs when the patient's brain fails to form properly around fluid-filled spaces known as the ventricles. The malformation causes an insufficient supply of oxygen to the brain, and result in poor development of the brain's pyramidal tracts. These poorly formed areas can be detected in MRI scans, and are known as Periventricular leukomalacias.

As the disorder affects the lower extremities more than the upper ones, a person with Spastic Diplegia will exhibit the telltale stiffness more on the legs than in the arms. While sufferers of this disorder will still be able to walk, they will only be able to do so with a crouched gait.

Due to the tightness and stiffness in the muscles that characterize Spastic Diplegia, patients will have a difficult time trying to resist the contracted muscles, making walking and moving the affected limbs very difficult and frustrating.

The crouched gait walk that is typical of Spastic Diplegia sufferers is its “scissor gait” pattern that may make it seem that the patient is drunk, has multiple sclerosis, or is suffering from some sort of nerve disease. The tightness of the leg muscles cause the legs to turn inwards, and sometimes cross one over the other at the area around the knees.
Spastic Diplegia
Image: Spastic Diplegia


The disorder varies from person to person, and no two sufferers exhibit the same degree of symptoms. Some patients may manifest balance problems, or stiffness in walking, all the way to bone misalignments that are so severe that the sufferer will require either crutches or a cane to move around. In some rare cases, the use of a wheelchair is needed.

Most symptoms of Spastic Diplegia can be found below the hips. Above it, most persons possess normal muscle tone and can move their limbs along the normal range of motions. However, in more severe cases, the disorder may affect the upper limbs, as well. In people suffering from mental retardation, Spastic Diplegia is often one of the accompanying ailments.

In children who exhibit Spastic Diplegia, the growth of the leg muscles is affected by the disorder. At this stage, there will be a manifestation of orthopedic deformity, as well as muscle contractures, which cause the sufferer's muscle to lock into one position indefinitely.

SPASTIC DIPLEGIA RISK FACTOR

The risk of having a child with Spastic Diplegia increases when both parents are under the age of 20, or if the mother is over 40 years old. People of the African-American race also have a greater chance of having children with this disorder.

In some cases, a blood incompatibility between the mother and child will put the child at risk for Spastic Diplegia. Very rarely, if the child's central nervous system has been affected by micro-organisms, this increases the risk for acquiring the disorder.

SPASTIC DIPLEGIA DIAGNOSIS

Mostly of a congenital origin, Spastic Diplegia occurs just before or during childbirth. The main and most common cause of the disorder is known as Periventricular leukomalacia, which is a form of asphyxia that occurs when there is a shortage of oxygen delivered to the infant via the umbilical cord. Periventricular leukomalacia is a frequent occurrence in premature births, although other factors can also lead to the condition, such as a hematoma in the brain, hypoxia of the brain, congenital rubella syndrome infection in the mother, and other birth-related traumas. In these instances, Spastic Diplegia is caused by damage to the cerebral cortex, the brain’s outer layer.

Spastic Diplegia is a disorder that is difficult to diagnose. In infants and children, most doctors opt to wait until the infant has reached several developmental milestones before attempting to diagnose the disorder. However, it is important that a diagnosis be made as early as possible.

Usually, physicians will look for the telltale signs of Spastic Diplegia in a newborn infant manifested in the lack of alertness, trembling of the arms and legs, problems with sucking and swallowing, an abnormal-sounding cry, poor reflexes, the infant favoring only one side, weak muscle tone with a tendency to be very stiff and floppy in turns, and seizures.

Doctors will also determine the existence of the disorder from any milestone delays, such as rolling over, sitting, crawling, talking, and walking.

Older children with Spastic Diplegia have to undergo a gait analysis in order for doctors to determine if they are in need of assistive devices, like a brace, crutches or a walker.

SPASTIC DIPLEGIA TREATMENT

A patient with Spastic Diplegia will need a treatment team composed of a pediatrician, if the patient is a child, a physiatrist, an orthopedic surgeon, a neurologist, a neurosurgeon and a physical therapist. These specialists work hand in hand in coming up with a smooth process of treatment specifically aimed at a patient’s particular case.


There are a host of ways that specialists use to correct the “scissor gait” of patients diagnosed with Spastic Diplegia. After proper gait analysis, the doctor can immediately take steps to correct the gait of patients who walk on their toes or with flexed knees. Assistive devices such as leg braces, crutches, canes, walkers, or wheelchairs may be prescribed depending on the severity of the disorder. Other treatments include botox injections and hyperbaric oxygen therapy to help stiff muscle tone. If there are any spastic symptoms present, they can be relieved with a combination of drugs, braces, physical therapy, and if necessary, orthopedic surgery.

One of the new surgical treatments available is known as selected dorsal rhizotomy, or SDR. This procedure is specifically geared for younger patients aged 2 to 4 years old, although some older children and young adults may benefit from it as well. The procedure works to relieve severe spasticity in both arms and legs of patients. It also prevents further deformities from occurring through a severance of the nerve fibers found in the patient’s spinal cord. A successful SDR procedure can improve a young patient’s vision, speech, and leg functions considerably, as well as reduces any need for more orthopedic surgeries in the future.

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