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Table of Contents > Conditions > Cerebral palsy Print

Cerebral palsy

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Related Terms
  • Adaptive equipment, anticholinergics, antigen, Apgar score, asphyxia, ataxia, ataxic cerebral palsy, athetoid cerebral palsy, athetosis, bilirubin, breech birth, bronchitis, carotenemia, chorea, choreoathetosis, computed tomography, CP, CT, cytomegalovirus, dental caries, diplegia, Down syndrome, dysarthria, dyskinetic, EEG, electroencephalogram, electromyography, EMG, encephalitis, epilepsy, fetal distress syndrome, fetus, German measles, Gilbert's syndrome, hemianopia, hemiparesis, hemiplegia, hemorrhage, herpes type B, Huntington's disease, hydrocephaly, hyperammonemia, hypercarotenemia, hypertension, hyperthyroidism, hypertonia, hypotonia, incontinence, jaundice, magnetic resonance imaging, meningitis, microcephaly, movement disorder, MRI, NCV, nerve conduction velocity, neurological disorder, occupational therapy, pediatric neurologist, pediatrician, physiatrist, physical therapy, placental, pregnancy, premature, proteinuria, psychotherapy, respiratory, Rh factor, rhesus factor, rubella, seizure, sensory integration therapy, shaken baby syndrome, spastic cerebral palsy, spastic diplegia, spastic hemiplegia, spastic quadriplegia, spasticity, speech therapy, stereognosis, tonic-clonic seizure, toxoplasmosis, ultrasound, vascular, walker, wheelchair.

Background
  • The term cerebral palsy, or CP, refers to a neurological disorder that appears in infancy or early childhood (most commonly under 37 weeks of age) and permanently affects body movement and muscle coordination but does not worsen over time.
  • In CP, faulty development or damage to motor areas in the brain impair the body's ability to control movement and posture. This results in a number of chronic neurological disorders. CP is usually associated with events that occur before or during birth, but may be acquired during the first few months or years of life as the result of head trauma or infection.
  • According to the National Institute of Neurological Disorders and Stroke (NINDS), the early signs of CP usually appear before a child reaches three years of age. The most common are ataxia (a lack of muscle coordination when performing voluntary movements), spasticity (stiff or tight muscles and exaggerated reflexes), walking with one foot or leg dragging, walking on the toes, a crouched or scissored gait, and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.
  • Even though CP affects muscle movement, it is not caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements.
  • There is no cure for CP, but treatment can improve the lives of those who have it. Treatment includes medicines, braces, and physical, occupational, and speech therapy. Cerebral palsy is neither contagious nor inherited, nor is it progressive. The symptoms of cerebral palsy (CP) differ from person to person and change as children and their nervous systems mature. Some have other medical conditions, including seizure disorders or mental impairment.
  • Approximately one million people in the United States have CP. Improvements in prenatal, pediatric, and intensive care over the past 30 years have enabled more critically premature and frail babies to survive infancy. Many of these surviving children suffer developmental disorders and neurological damage.
  • Some persons with severe CP are completely disabled and require lifelong care, while others display only slight awkwardness and need no special assistance. Complications associated with CP include learning disabilities, gastrointestinal dysfunction, tooth decay (dental caries), sensory deficits, and seizures.

Signs and symptoms
  • Spastic cerebral palsy: Spastic cerebral palsy (CP) is the most common form, affecting approximately 70% of CP patients. This form is characterized by stiff and permanently contracted muscles. Spastic CP has a jerky, unpredictable effect on movement, causing difficulty in moving from position to position. Spastic cerebral palsy consists of subcategories, including diplegia (both arms of both legs are affected), hemiplegia (either the right arm and leg or left arm and leg are affected), quadriplegia (all arms and legs are affected), monoplegia (only one arm or leg affected), and triplegia (three arms or legs affected).
  • Spastic diplegia: Spastic diplegia affects the legs more than the arms. The legs often turn in and cross at the knees. This causes a scissors gait, in which the hips are flexed, the knees nearly touch, the feet are flexed, and the ankles turn out from the leg, causing toe-walking. Learning disabilities and seizures are less common than in spastic hemiplegia.
  • Spastic hemiplegia: Individuals with spastic hemiplegia (hemiparesis) also may experience hemiparetic tremors or uncontrollable shaking of the limbs on one side of the body. Severe hemiparetic tremors can seriously impair movement. The arm is generally affected more than the leg. Learning disabilities, vision problems, seizures, and dysfunction of the muscles of the mouth and tongue are classic symptoms.
  • Spastic quadriplegia: Spastic quadriplegia involves all four limbs. There is dysfunction of the muscles of the mouth and tongue, seizures, medical complications, and increased risk for cognitive difficulties.
  • Ataxic cerebral palsy: Ataxic cerebral palsy is much less common that spastic, affecting approximately 5- 10% of CP patients. The main effect of this type is on the child's sense of depth perception and balance. This is often accompanied by poor coordination and children affected by ataxic cerebral palsy can display an abnormal gait when walking, as well as difficulty with precise movement. Another characteristic of ataxic cerebral palsy is the intention tremor. These tremors are initiated by a voluntary movement, such as reaching for a light switch, and become more severe as the individual gets closer to the objective.
  • Athetoid cerebral palsy: Athetoid or dyskinetic cerebral palsy affects about 10-20% of patients. Athetoid CP is characterized by athetosis (slow, uncontrolled, writhing movements of the hands, feet, arms, or legs). Patients also may have chorea (abrupt, irregular, jerky movements), choreoathetosis (a combination of athetosis and chorea), or dystonia (slow rhythmic movements with muscle tone abnormalities and abnormal postures).
  • Mixed cerebral palsy: Mixed cerebral palsy is a condition where two or more types of CP exist. This occurs in 10% of CP cases.
  • Speech: Just as patients have problems with muscle control in their arms and legs, they also have difficulties controlling their tongue, mouth, lips, jaw, and breath flow. As a result, they might have problems with speech. The most common speech problem is called dysarthria. This condition causes speech to be slow and slurred and, in some cases, hypernasal (too much air flow through the nose) or hyponasal (not enough air flow through the nose).
  • Drooling: There are a number of treatments available to combat the problem of drooling, including surgery, anticholinergics (drugs that reduce saliva flow), and biofeedback (helps allow patients to know when they are drooling).
  • Eating: Cerebral palsy can affect the muscle groups involved in the face and jaw, which can lead to difficulty eating. In severe cases, this can result in malnutrition and poor growth and development.
  • Incontinence: Incontinence is more commonly known as poor bladder control. This can take a number of forms, including enuresis or bed wetting, urination during physical activity, or a slow leak from the bladder.

Diagnosis
  • Typically, doctors diagnose cerebral palsy (CP) in infants by testing their motor skills and thoroughly analyzing their medical history. A medical history, diagnostic tests, and regular check-ups may be required to confirm the diagnosis of CP or to eliminate the possibility of other disorders.
  • Unnaturally soft, relaxed, or floppy muscle tone is called hypotonia. Stiff or rigid muscle tone is called hypertonia. Some infants with CP have hypotonia in the first two or three months of life and then develop hypertonia. They also might develop an unusual posture or favor one side of the body.
  • A newborn held on its back and tilted so its legs are above its head will automatically respond with the Moro reflex, extending its arms in a gesture that resembles an embrace. This reflex usually disappears after about six months. Infants with cerebral palsy often retain it for an abnormally long period.
  • Signs of hand preference are also observed. When an object is held in front and to the side, infants usually do not display a tendency to use either the right or left hand. This is normal during the first 12 months of life. Infants with spastic hemiplegia, however, often develop hand preference early, indicating one side of their body is stronger than the other.
  • The doctor will look for other conditions that can be linked to CP, such as seizures, mental impairment, and vision or hearing problems.
  • Intelligence tests often are given to a child with CP to evaluate mental impairment, but the results can be misleading and there is a risk of underestimating intelligence. For instance, a child with movement, sensation, or speech problems associated with CP would have difficulty performing well on such tests.
  • Rule out other conditions: If motor skills decline over time, there may be genetic disease, muscle or metabolic disorder, or tumor in the nervous system, either coexistent or instead of CP. The doctor must rule out other disorders that cause movement problems (such as Huntington's disease), identify any coexisting disorder, and determine if the condition is changing.
  • Lab tests: A chromosome analysis may be performed to identify a genetic anomaly (such as in Down syndrome or Huntington's disease) when abnormalities in features or organ systems are present. Thyroid function tests may reveal low levels of thyroid hormone, which can produce several congenital defects and severe mental retardation. Hyperammonemia, or a high level of ammonia in the blood, may lead to central nervous system toxicity (including movement disorders). A deficiency in any of the enzymes involved in breaking down amino acids can cause hyperammonemia. This may be due to a liver disorder or a defect in metabolism.
  • Visual tests: Imaging tests are helpful in diagnosing hydrocephalus (condition in which abnormal accumulation of cerebrospinal fluid causes pressure in the brain), structural abnormalities, and tumors. An electroencephalogram (EEG) traces electrical activity in the brain and can reveal patterns that suggest a seizure disorder. Computed tomography (CT scan) can show congenital (birth) malformations and hemorrhage (excessive bleeding) in infants. Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create pictures of the internal structures of the brain. This study is performed on older children. It defines abnormalities of white matter and motor cortex more clearly than other methods. Ultrasound uses the echoes of sound waves projected into the body to form a picture called a sonogram. It is often used in infants before the bones of the skull harden and close to detect cysts and abnormal structures in the brain.
  • Electromyography (EMG) and nerve conduction velocity (NCV) studies may be performed when a nerve or muscle disorder is suspected. These tests, which can be used in combination, are often referred to as EMG/NCV studies. NCV is administered before EMG and measures the speed at which nerves transmit electrical signals which can help diagnose CP. During NCV, electrodes are placed on the skin over a nerve that supplies a specific muscle or muscle group. A mild, brief electrical stimulus is delivered through the electrode and the response of the muscle is detected, amplified, and displayed. The strength of the signal is also measured. Neurological conditions can cause the NCV to slow down or to be slower on one side of the body. EMG measures nerve impulses within the muscles. Tiny electrodes are placed in the muscles in the arms and legs and the electronic responses are observed using an oscilloscope (an instrument that displays movement of an electric current). As muscles contract, they emit a weak electrical signal that can be detected, amplified, and tracked using the oscilloscope, providing information about how well the muscles are working.

Complications
  • Some individuals with cerebral palsy (CP) have other conditions, such as impaired intellectual development, seizures, failure to grow and thrive, and vision and sense of touch problems.
  • Roughly one-third of patients with CP also have mild intellectual impairment or a decrease in intelligence. Another one-third are moderately or severely impaired and the remainder are intellectually normal. Mental impairment is most common in children with spastic quadriplegia.
  • As many as one-half of all patients with cerebral palsy have seizures in which uncontrolled bursts of electricity disrupt the brain's normal pattern of electrical activity. Seizures that recur without a direct trigger, such as a fever, are classified as epilepsy. Seizures generally are tonic-clonic or partial. Tonic-clonic seizures spread throughout the brain, typically causing the patient to cry out, followed by unconsciousness, twitching legs and arms, convulsive body movements, and loss of bladder control. Partial seizures are confined to one part of the brain and may be simple or complex. Simple partial seizures cause muscle twitching, chewing movement, and numbness or tingling. Complex partial seizures can produce hallucinations, staggering, random movement, and impaired consciousness or confusion.
  • Children with moderate-to-severe cerebral palsy, especially those with spastic quadriplegia, often experience failure to grow or thrive. Infants fail to gain weight normally, young children may be abnormally short, and teenagers may be short for their age and may have slow sexual development. These phenomena may be caused by a combination of poor nutrition and damage to the brain centers that control growth.
  • Some individuals, particularly those with spastic hemiplegia, have muscles and limbs that are smaller than normal. Limbs on the side of the body affected by CP may grow slower than those on the other side. Hands and feet are most severely affected. The affected foot in cases of hemiplegia usually is the smaller of the two, even in patients who walk, suggesting the size difference is due not to disuse but to a disrupted growth process. Limbs affected by CP in most instances do not reach normal physical size.
  • Vision and hearing problems are more common in people with cerebral palsy than in the general population. Differences in the left and right eye muscles often cause the eyes to be misaligned. This condition, called strabismus, causes double vision. In children, however, the brain often adapts by ignoring signals from one eye. Because strabismus can lead to poor vision and impaired depth perception, some physicians recommend corrective surgery.
  • Patients with hemiparesis may have hemianopia, a condition marked by impaired vision or blindness in half of the visual field in one or both eyes. A related condition, called homonymous hemianopia, causes impairment in the right or left half of the visual fields in both eyes.
  • Sensations of touch or pain may be impaired. An individual with stereognosis, for example, has difficulty perceiving or identifying the form and nature of an object placed in their hand using the sense of touch alone. A decrease in feeling may contribute to the difficulty in perception.
  • Hip dislocation, scoliosis (curvature of the spine), incontinence (inability to control the urine flow), constipation, dental caries (tooth decay), bronchitis (inflammation of the bronchial tubes), skin sores, and asthma are other complications commonly experienced by people with CP.

Treatment
  • A multidisciplinary team of healthcare professionals develops an individualized treatment plan based on the specific needs of each patient. The individuals with cerebral palsy (CP), families, teachers, and caregivers should be involved in all phases of planning, decision making, and treatment.
  • Healthcare providers for children with CP usually include a pediatrician, pediatric neurologist, or pediatric physiatrist (doctor who specializes in physical medicine). A family doctor, neurologist, or physiatrist provides primary care for adults with CP.
  • Other specialists on the team may include orthopedist or orthopedic surgeon (to predict, diagnose, and treat associated muscle, tendon, and bone problems), a physical therapist (to design and supervise special exercise programs for improving movement and strength), speech and language pathologist (to diagnose and treat communication problems), occupational therapist (to help the patient learn life skills for home, school, and work), social worker (to help patients and their families obtain community assistance, education, and training programs), and a psychologist (to help address negative or destructive behaviors and guide the patient and the family through the stresses and demands presented by cerebral palsy).
  • The need for and types of therapy may also change over time. Adolescents with CP may need counseling to cope with emotional and psychological challenges. Physical therapy may be supplemented with special education, vocational training, recreation, and leisure programs. Adults may benefit from attendant care, special living accommodations, and transportation and employment assistance services, depending upon his or her intellectual and physical capabilities.
  • Physical therapy: It is important for physical therapy to begin soon after a diagnosis of CP is made. A physical therapist specializes in improving the development of the large muscles of the body, such as those in the legs, arms, and abdomen (called gross motor skills). Physical therapists help children with CP learn better ways to move and balance. They may help children with CP learn to walk, use a wheelchair, stand by themselves, or go up and down stairs safely. Physical therapists will also work on skills such as running, kicking and throwing, or learning to ride a bike. Physical therapy usually begins in the first few years of life, or soon after the diagnosis of cerebral palsy is made. These therapists use specific sets of exercises to work toward the prevention of musculoskeletal complications. An example of this is preventing the weakening or deterioration of muscles that can develop with lack of use. Also, physical therapy will help avoid contractures, in which muscles become fixed in a rigid, abnormal position. Physical therapy will help prevent musculoskeletal problems, as well as help the child perform common everyday activities.
  • Occupational therapy: An occupational therapist specializes in improving the development of the small muscles of the body, such as the hands, feet, face, fingers and toes. These therapists also teach daily living skills, such as dressing and eating, as well as make sure children are properly positioned in wheelchairs. They may teach the child better or easier ways to write, draw, cut with scissors, brush their teeth, dress, and feed themselves. Occupational therapists will also help the child find the right special equipment to make everyday life a little easier.
  • Speech and language therapist: A speech and language therapist helps develop better control of the jaw and mouth muscles, which can improve speech and language skills and eating abilities. They also help develop creative communication methods for those who can not speak. A speech and language therapist will work with the child on communication skills. This means talking, using sign language, or using a communication aid. Children who are able to talk may work with a speech therapist on making their speech clearer, or on building their language skills by learning new words, learning to speak in sentences, or improving their listening skills. Children who can not talk may learn sign language or how to use special equipment, such as a computer that actually talks for the individual.
  • Surgery: Surgery is not always necessary for children with CP, but it is sometimes recommended to improve muscle development, correct contractures, and reduce spasticity in the legs. Before selecting any surgical procedure, the doctor will thoroughly discusses the risks involved, long-term effects, and postoperative follow-up. Second opinions are generally recommended and speaking with other parents whose children have had the same surgical procedure may be helpful.
  • Children with cerebral palsy often walk on their toes. This may indicate a tight heel cord. When other treatments for this fail, such as splints and braces, surgery may help correct it by lengthening the tendon. This surgery may help improve the child's ability to walk, improve balance, and prevent further deformity. Surgery is also available to relieve spasticity in the legs and hips of children. This surgery involves identifying sensory nerve fibers behind the spinal cord and then selectively cutting those nerve fibers thereby reducing spasticity. Research on this surgery is still being conducted. The adductors are muscle groups that bring the legs together. If a child's doctor determines that the adductors are causing deformities or problems with walking, they may suggest a surgical procedure to cut the tendon, which can release muscle contractures and improve mobility.
  • Drug therapy: Doctors may prescribe drugs to prevent or control seizures associated with CP such as carbamazepine (Tegretol®), phenytoin (Dilantin®), and valproic acid (Depakene® or Depakote®). Drug therapy can also help reduce spasticity associated with cerebral palsy and may include the use of diazepam (Valium®, a benzodiazepine), baclofen (Liorisal®, a muscle relaxant), and dantrolene (Dantrium®, a muscle relaxant). If surgery is not recommended, these drugs can help reduce spasticity for short periods. However, their long term value is still being researched. Side effects include drowsiness and fatigue (excessive tiredness). Although drug therapy may not completely correct complications associated with cerebral palsy, evidence does show that it helps manage problems such as seizures and spasticity. Anticholinergic drugs may be prescribed to control the abnormal movements associated with athetoid cerebral palsy. These drugs inhibit the effects of acetylcholine, a chemical in brain cells that triggers muscle contraction. The most commonly prescribed anticholinergic drugs are trihexyphenidyl (Artane®) and benztropine (Cogentin®). Side effects associated with anticholinergic drugs include dry mouth, constipation, agitation, and dysuria (painful urination).
  • Botulinum toxin, or BOTOX®, is injected directly into muscle. BOTOX® blocks acetylcholine and alleviates muscle spasm for three to six months. Botulinum toxin may produce muscle weakness. In some cases, physicians may try to reduce spasticity or correct a developing contracture by injecting phenol into a muscle. This weakens the muscle and gives physicians and therapists a chance to stretch and lengthen the muscle with therapy, bracing, or casts. If the contracture is treated early enough, the need for surgery may be avoided.
  • Sensory integration therapy: Another approach to help children with CP achieve their optimal level of functioning is sensory integration therapy (SIT). SIT helps to overcome problems experienced by many young children in absorbing and processing sensory information. Encouraging these abilities ultimately improves balance and steady movement. Therapies include stimulating touch sensations and pressures on different parts of the body.
  • Adaptive equipment: Special equipment is also available for children with CP. Wheelchairs, walkers, and braces may help children with CP to perform daily tasks.
  • A wheelchair is sometimes used when a child cannot walk. This will allow the child to move from one place to another. Many children with cerebral palsy can use their arms to roll the wheels of their wheelchair themselves and can move around without much difficulty at all. There are also wheelchairs available that are motorized. This type of wheelchair has a motor that moves the wheels for the child. There may be a joystick on one arm rest that the child can operate on his or her own.
  • A walker is a piece of equipment usually made out of light metal. It most often will have four legs that are adjustable in height. Some children with cerebral palsy can walk, but have poor balance and may fall. They may use a walker to help them balance and get around without the use of a wheelchair.
  • Because of the fine motor problems often associated with cerebral palsy, children may have a hard time using utensils for eating. Special handles or grips are available for children who have trouble holding onto small objects, such as a fork or spoon. Eating utensils that are specially designed for children with fine motor problems also exist. They may be curved or bent and are usually designed to fit the child's needs. Special grips and handles are also used on pencils and pens to make them easier for the child to hold and use.
  • Communication aids, including computers, books, posters, and alphabet boards, are available for children who are hard to understand or who have difficulty talking with others.
  • Psychotherapy: Behavioral therapy can complement physical therapy, employing psychological techniques that encourage the mastery of tasks that promote muscular and motor development. Praise, positive reinforcement, and small rewards can encourage a child to learn to use weak limbs, overcome speech deficits, and stop negative behaviors like hair pulling and biting. Medications for psychiatric symptoms may also be used, including antidepressants (such as fluoxetine or Prozac® and sertraline or Zoloft®) and antipsychotic medications (such as quetiapine or Seroquel®).
  • Support Groups: To meet the challenges of cerebral palsy, patients, families, and caregivers need help and support. There are many government-supported and private volunteer groups that provide information about prevention, diagnosis, and treatment, as well as clinical and support services.

Integrative therapies
  • Note: There is currently a lack of available scientific evidence on the use of integrative therapies for the treatment or prevention of cerebral palsy. The therapies listed below have been studied for the management of neurological disorders in general, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
  • Strong scientific evidence:
  • Alpha-lipoic acid: Many studies have shown that alpha lipoic acid (ALA) is an effective treatment for neuropathy (nerve pain or damage) associated with diabetes or cancer treatment. Avoid if allergic to ALA. Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
  • Good scientific evidence:
  • 5-HTP: Cerebellar ataxia results from the failure of part of the brain to regulate body posture and limb movements. 5-HTP has been observed to have benefits in some people who have difficulty standing or walking because of cerebellar ataxia. Some research shows that 5-HTP may allow individuals with unsteady movements to stand alone without assistance, walk without aid, or improve coordination. Other research shows no benefit. Further research is needed before a conclusion can be drawn. 5-HTP may interact with other mood-altering medications, such as antidepressants and anti-anxiety drugs. Avoid 5-HTP if allergic or hypersensitive to it; signs of allergy to 5-HTP may include rash, itching or shortness of breath. Avoid with eosinophilia syndromes, Down's syndrome, and mitochondrial encephalomyopathy. Use cautiously with renal (kidney) insufficiency, HIV/AIDS- particularly HIV-1 infection, epilepsy, and/or with a history of mental disorders. Avoid if pregnant or breastfeeding.
  • Music therapy: Music therapy has been reported to improve symptoms in people with Parkinson's disease. Modest improvement in symptoms including motor coordination, speech intelligibility and vocal intensity, bradykinesia (slow movement), emotional functions, activities of daily living, and quality of life were seen. Music therapy is generally known to be safe.
  • Unclear or conflicting scientific evidence:
  • Acupressure, Shiatsu: The practice of applying finger pressure to specific acupoints (energy points) throughout the body has been used in China since 2000 B.C. Shiatsu technique involves finger pressure at acupoints and along body meridians (energy lines). It may incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal, neurological and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. In preliminary clinical study, individuals with facial spasm reported improvement when using Shiatsu acupressure. Acupressure may also benefit several measures of severity of Parkinson's disease. Further study is needed before conclusions may be made.
  • With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: Acupuncture has been reported to help relieve symptoms of some neurological disorders including Bell's palsy, cerebral palsy, nerve damage, hemiplegia (full or partial paralysis of one side of the body due to disease, trauma or stroke), Parkinson's disease (characterized by fine muscle coordination and tremors), spinal cord injury, Tourette's syndrome (characterized by "tics"), and trigeminal neuralgia. There is currently insufficient evidence available from well-designed studies supporting use of acupuncture for these indications. Additional study is needed.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures, with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Preliminary research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Well-designed human trials are necessary. No serious side effects have been reported. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Adrenoleukodystrophy (ALD) is a rare inherited metabolic disorder characterized by the loss of fatty coverings (myelin sheaths) on nerve fibers in the brain, and progressive destruction of the adrenal gland. ALD is inherited as an x-linked genetic trait that results in dementia and adrenal failure. Injections of arginine have been proposed to help manage adrenoleukodystrophy, although most study results are inconclusive.
  • Avoid if allergic to arginine, with a history of stroke, liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Ashwagandha: There is currently insufficient scientific evidence to recommend the use of ashwagandha in the management of Parkinson's disease. Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial.There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha, and most do not report the doses or standardization/preparation used.Avoid with peptic ulcer disease. Ashwagandha may have cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.
  • Ayurveda: There is evidence that the traditional herbal remedy Mucuna pruriens may improve symptoms in Parkinson's disease, and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder. One study has suggested that symptoms of Parkinson's disease may be reduced with use of an Ayurvedic formula called HP-200, which is derived from Mucuna pruriens. More studies are needed to verify what can be expected from these treatments.
  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.
  • Belladonna: The autonomic nervous system, which helps control basic body functions like sweating and blood flow, is affected in several disorders. To date, human studies have shown no benefit from belladonna in treating autonomic nervous system disorders. Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders such as myasthenia gravis, or Down's syndrome. Avoid if pregnant or breastfeeding.
  • Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Although there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease, anecdotal reports suggest a positive impact on fine muscle coordination in some individuals. More clinical research is necessary.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Choline: Data regarding efficacy of choline in the treatment of Parkinson's disease is conflicting and inconclusive. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Chromium: Chromium has been studied for its protective benefits in Parkinson's disease and is included in antioxidant multivitamins. However, there is lack of scientific evidence in humans in this area. Additional study is needed. Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. There is promising early evidence to support the use of CoQ10 in the treatment of Friedrich's ataxia and Parkinson's disease. Better-designed trials are needed using CoQ10 for neurological conditions.
  • Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with use of anticoagulants (blood thinners) or antiplatelet drugs (like aspirin and warfarin), or blood pressure, blood sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Cowhage: Traditional Ayurvedic medicine and preliminary evidence suggests that cowhage (Mucuna pruriens) contains 3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs. Cowhage treatments have yielded positive results in early studies. However, additional high quality clinical research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to cowhage, its constituents, or members of the Fabaceae family. Use cautiously with Parkinson's disease and/or when taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or dopamine reuptake inhibitors as cowhage seeds contain the dopamine precursor levodopa. Use cautiously if taking monoamine oxidase inhibitors (MAOIs) or other antidepressants. Use cautiously if taking anticoagulants (blood thinners) or with diabetes. Avoid with psychosis or schizophrenia. Avoid if pregnant or breastfeeding as cowhage may inhibit prolactin secretion.
  • Creatine: Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis and supplementation does not seem to help people with tetraplegia. Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers. There is also not enough scientific information to make a firm recommendation about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship.
  • Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix®)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • DHEA: There is conflicting scientific evidence regarding the use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn. Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Dong quai: There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking. Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae / Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use caution with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance or hormone sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
  • Feldenkrais Method®: There is not enough clinical evidence on the use of Feldenkrais for cerebral palsy. Patients who practice complementary alternative medicine methods have reported that the Feldenkrais Method®, as well as breathing therapy, massage, and relaxation techniques helped improve symptoms of dystonia. Further data are needed to form therapeutic recommendations. There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method®.
  • Ginseng: A clinical study found that patients with neurological disorders may improve when taking Asian ginseng (Panax ginseng). This supports research findings that report Panax ginseng improving cognitive function. More research is needed in this area. Avoid ginseng with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Kava: There is unclear evidence for the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam.
  • Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects. Avoid if allergic to kava or kavapyrones. Avoid with liver disease, a history of medication-induced extrapyramidal (the motor system related to the basal ganglia) effects, and chronic lung disease. Avoid if taking medications for liver disease or CNS depressants such as alcohol or tranquilizers. Avoid while driving or operating heavy machinery (may cause drowsiness). Use cautiously with depression or if taking antidepressants. Avoid if pregnant or breastfeeding.
  • L-carnitine: Although used traditionally for the support of neurological conditions, one poorly designed preliminary clinical study reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither efficacy nor toxicity towards patients with Huntington's disease. Further trials are required to determine if L-carnitine is beneficial in individuals with neurological disorders. Currently there is insufficient evidence to support the use of carnitine for peripheral neuropathy. Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Massage: Early evidence suggests a possible benefit of calf massage for children with cerebral palsy. However, more study is needed. Early scientific evidence suggests that people with Parkinson's disease might have reduced symptoms after massage. More studies are needed in this area as well. Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Melatonin: Melatonin is a naturally occurring hormone that helps regulate the sleep/wake cycles (circadian rhythm). Melatonin has been reported useful in neurological conditions including Parkinson's disease, periodic limb movement disorder, and tardive dyskinesia. The use of melatonin in these conditions, however, is not supported by rigorous scientific testing. Better-designed research is needed to determine if melatonin is beneficial in individuals with neurological disorders.
  • Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects, including alterations of pituitary-ovarian function and potential inhibition of ovulation or uterine contractions. High levels of melatonin during pregnancy may increase the risk of developmental disorders.
  • Moxibustion: Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi (energy). Early study reported treatment of trigeminal neuralgia with cupping to have a significant therapeutic effect. Additionally, limited available study suggests that acupuncture plus moxibustion, with or without conventional treatments for Bell's palsy, may have benefit. More studies are needed to verify these findings.
  • Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, allergic skin conditions, ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously in elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
  • Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in cold water fish (including salmon, herring, and tuna) and other marine life (such as krill and algae). Omega-3 fatty acids can also be found in certain plants and nuts, including purslane and walnuts. Well-designed research is necessary before a clear conclusion can be reached regarding the effects of omega-3 fatty acids for infant eye/brain development. An investigational drug for the symptomatic treatment of the neurological condition Huntington's disease (HD) is ethyl-EPA (Miraxion®), a pharmaceutical drug based on a component of omega-3 fatty acids called eicosapentaenoic acid (EPA). Miraxion® seems to help decrease the chorea (involuntary movements) that can be debilitating in individuals with HD. More research should be performed for the use of Miraxion® in other neurological disorders.
  • Omega-3 fatty acid supplements (including fish oils) may cause an increase in bleeding in sensitive individuals, including those taking blood thinning drugs such as warfarin (Coumadin®) or those with bleeding disorders. Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Use cautiously with diabetes, low blood pressure or drugs, herbs or supplements that treat these conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
  • Physical therapy: There is limited study of physical therapy for the treatment of neurological disorders such as Guillain-Barre Syndrome and Parkinson's disease. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy. Results are inconclusive and additional high-quality studies are needed.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Qi gong: There is promising early evidence suggesting that internal Qi gong may help in the treatment of Parkinson's disease. However, the evidence is somewhat unclear, and further research is needed. Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Reiki: Reiki is a system of lying on of the hands that originated as a Buddhist practice approximately 2,500 years ago. Clinical study suggests that Reiki may have an effect on autonomic nervous system disorders by affecting heart rate, blood pressure, or breathing activity. Large, well-designed studies are needed before conclusions can be drawn.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or to receive established therapies. Use cautiously with psychiatric illnesses.
  • Rolfing® Structural Integration: Rolfing® Structural Integration may improve movement slightly in cerebral palsy patients. More studies are needed to confirm these possible benefits.
  • Rolfing® Structural Integration should not be used as the sole therapeutic approach to disease, and it should not delay the time it takes to speak with a healthcare provider about a potentially severe condition. Rolfing® Structural Integration is generally believed to be safe in most people. Avoid in patients taking blood thinners and in patients with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc problems, aneurysm, fever, recent scar tissue, connective tissue disease, cancer, and in patients who have just received cortisone shots or who are on chronic cortisone therapy. Use cautiously in patients with varicose veins or phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver, or intestinal disease, diabetes, menstruation, infectious conditions, colostomies, high blood pressure, and stenoses or strictures.
  • Safflower: In clinical study, safflower (Carthamus tinctoria) decreased deterioration caused by Friedreich's ataxia. More high-quality studies with larger sample sizes are needed to establish safflower's effect on neurological conditions.
  • Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, hypotension, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
  • Taurine: Taurine may affect cellular hyperexcitability by increasing membrane conductance to potassium and chloride ions, possibly by altering intracellular (within the cell) availability of calcium. Results from limited available clinical study suggest that taurine supplementation may result in improvements in myotonic dystrophy. Well designed clinical trials are needed.
  • Taurine is an amino acid and it is reportedly unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, coagulation disorders, potential for mania, or epilepsy. Avoid consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients, then consuming alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Several case reports and a small number of controlled trials report improvements in pain symptoms in people with peripheral neuropathy or nerve damage. However, these studies have not been well designed or reported, and additional research is needed before a firm conclusion can be drawn about effectiveness. Several studies have reported benefits of TENS therapy in patients with trigeminal neuralgia (facial pain). However, these trials have been small without clear descriptions of design or results. A small clinical study also found TENS effective in decreasing symptoms associated with spinal cord injury. Therefore, additional research is needed before a firm conclusion can be drawn in the area of neurological disorders. Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Vitamin B6: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine, and for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Major sources of vitamin B6 include: cereal grains, legumes, vegetables (carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription drugs called neuroleptics, which are used in psychiatric conditions, may cause movement disorders as an unwanted side effect. Vitamin B6 has been studied for the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular disorder characterized by a feeling of "inner restlessness," a constant urge to be moving) in schizophrenic and schizoaffective disorder patients. Preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems. Vitamin B6 may also have some antioxidant effects, which theoretically may benefit patients with tardive dyskinesia. Results from a small high-quality trial suggest a benefit of vitamin B6 on symptoms of tardive dyskinesia. Further research is needed to confirm these results.
  • Avoid if sensitive or allergic to any ingredients in vitamin B6 products. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Use cautiously if pregnant or breastfeeding.
  • Vitamin E: Vitamin E has been studied in the management of tardive dyskinesia, and has been reported to significantly improve abnormal involuntary movements, although the results of existing studies are not conclusive enough to form a conclusion. The scientific evidence regarding Parkinson's disease is also inconclusive. Additional research is needed.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.
  • Yohimbe bark extract: It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction (autonomic failure). However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a conclusion can be made.
  • Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders or schizophrenia. Avoid use in children or if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Choline: Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Creatine: Overall, the evidence suggests that creatine supplementation does not offer benefit to individuals with amyotrophic lateral sclerosis (ALS). Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix®)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • Octacosanol: Preliminary study does not show any evidence of benefit with use of octacosanol in neurologic (brain) or pulmonary (lung) symptoms of amyotropic lateral sclerosis (ALS) patients. Additional study is needed in this area. Avoid if allergic or hypersensitive to octacosanol or policosanol. Use cautiously in patients taking nitrates, lipid lowering drugs/herbs (such as acipimox, statins, bile acid sequestrants/resins), cholesterol absorption inhibitors (such as ezetimibe, fish oil, plant stanols/sterols, polyphenols), nutraceuticals (such as oat bran, psyllium, and soy proteins), aspirin, or agents that lower blood pressure. Avoid if pregnant or breastfeeding.

Prevention
  • Adequate prenatal care during pregnancy, labor, delivery, and immediately after the delivery of the infant is essential. Healthcare professionals recommend that individuals see their doctor regularly, take prenatal vitamins as prescribed, stop smoking, and eat healthy foods including more fresh fruits and vegetables. Failure to perform the necessary tests and accurately interpret the results of these tests may cause injury to the developing brain. Improper use of medications, unrecognized fetal distress, untreated infections, excessive use of abortion, and the failure to perform a timely cesarean section may result in damage to the motor centers in the brain.
  • Preventing head injuries by using child safety seats in automobiles and helmets when riding bicycles and skateboards is important. Supervision of young children closely during bathing and swimming helps prevent injury.
  • Vaccination against German measles (rubella) is recommended before becoming pregnant.
  • Physical exhaustion from inadequate rest or recovery from illness or injury can lead to an overall decline in physical and mental function. Ways to maintain physical function include appropriate wheelchair seating and posture, assumption of various positions out of the wheelchair, and use of a wheelchair when fatigued and when walking is difficult. Also, regular and appropriate exercise, including stretching exercises and exercises to maintain flexibility in joints, is recommended.
  • Maintaining ideal weight is important. It may be best to avoid refined foods such as white breads, pastas, and sugar. Doughnuts, pastries, bread, candy, soft drinks, and foods with high sugar content may all contribute to weight gain that may worsen symptoms of movement disorders.
  • Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Cerebral Palsy Information. . Accessed March 8, 2009.
  2. Cerebral Palsy Source. . Accessed March 8, 2009.
  3. Kenney C, Simpson R, Hunter C, et al. Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg. 2007;106(4):621-5. .
  4. The Movement Disorder Society. . Accessed March 8, 2009.
  5. National Association of Neurological Disorders and Stroke. . Accessed March 8, 2009.
  6. National Student Speech Language Hearing Association. . Accessed March 8, 2009.
  7. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed March 8, 2009.
  8. United Cerebral Palsy. . Accessed March 8, 2009.
  9. Worldwide Education and Awareness for Movement Disorders. . Accessed March 8, 2009.

Causes
  • Acquired cerebral palsy: Approximately 10-20% of children in the United States with cerebral palsy (CP) acquire the disorder after birth. Brain damage in the first few months or years of life, brain infections, such as bacterial meningitis or viral encephalitis, or head injury account for many of the cases of acquired cerebral palsy. In such cases, the disorder may result from brain infections like bacterial meningitis (inflammation of the lining of the brain caused by a bacteria), viral encephalitis (inflammation of the brain caused by a viral infection), head trauma sustained from an accident, fall, or inflicted injuries (such as shaken baby syndrome).
  • Congenital cerebral palsy: CP that occurs at birth is often the result of specific events during pregnancy or around the time of birth. These events result in damage to the motor centers in the developing brain. Often times, however, congenital cerebral palsy may not be detected for months. However, birth complications account for only about 3-13% of congenital CP cases.
  • Infections during pregnancy: Viruses such as rubella (German measles) or herpes group B can infect the developing fetus in a pregnant woman and cause damage to the developing nervous system. Brain injury in the developing fetus may also be caused by other infections such as cytomegalovirus (herpesvirus type 5) and toxoplasmosis (a protozoal infection). Infections of the placental may also be associated with cerebral palsy.
  • Jaundice: If left untreated, severe jaundice can damage the brain. Jaundice is a condition produced when excess amounts of bilirubin circulating in the blood stream dissolve in the subcutaneous fat (the layer of fat just beneath the skin), causing a yellowish appearance of the skin and the whites of the eyes. With the exception of physiologic jaundice in the newborn (normal newborn jaundice in the first week of life), all other jaundice indicates overload or damage to the liver or inability to move bilirubin from the liver through the biliary tract to the gut. Jaundice in an infant, child, or an adult should always be evaluated by a doctor.
  • Newborn jaundice is common and, unless it is associated with an abnormal condition, it will clear without treatment. Gilbert's syndrome is another hereditary condition in which mild jaundice develops during times of stress. This condition, once recognized, requires no further treatment or evaluation. There are also other more rare hereditary causes of elevated bilirubin levels. All other jaundice is the result of an underlying disease, condition, or toxicity.
  • A yellow-to-orange color may be imparted to the skin by excessive intake of beta carotene, the orange pigment seen in carrots. Individuals who consume large quantities of carrots or carrot juice or take beta-carotene supplements may develop a distinctly yellow-orange cast to their skin. This condition is called hypercarotenemia or just carotenemia. Hypercarotenemia is easily distinguished from jaundice in that the sclera, or the white of the eyes, remains white, while people with true jaundice have a yellow sclera.
  • Rh incompatibility: When the mother's body produces immune cells called antibodies that destroy the fetus's blood cells, this may lead to a form of jaundice in the newborn.
  • Severe lack of oxygen: Hypoxic-ischemic encephalopathy is the name of a condition that occurs when the brain is deprived of oxygen for a prolonged period of time during labor and child delivery. Brain damage may occur. Birth complications, including asphyxia (lack of oxygen to the brain), account for approximately six percent of congenital cerebral palsy cases. Birth asphyxia is associated with spastic quadriplegia, the most commonly occurring form of CP.
  • Brain hemorrhage: Brain hemorrhage or bleeding may occur in the fetus during pregnancy or in newborns around the time of birth. Bleeding can damage fetal brain tissue and cause neurological problems, including congenital CP. These hemorrhages are a type of stroke that may be caused by broken, abnormal, or clogged blood vessels in or leading to the brain or by respiratory distress, a common breathing disorder in premature infants.

Risk factors
  • Parental age: If the mother is over 40 years old, or younger than 20 years old, the risks for having a child with cerebral palsy (CP) increase. Also, if the father is younger than 20 years old, the incidence increases for having a child with CP.
  • Parental ethnicity: Individuals with African-American descent have a higher rate of having children born with CP.
  • Pregnancy and birth complications: Infants at the highest risk for developing cerebral palsy are usually premature (born younger than 37 weeks), have a low birth weight (less than 5.7 pounds), do not cry within five minutes of delivery, are sustained on a ventilator for more than four weeks, or have a brain hemorrhage.
  • Complications during pregnancy, such as vaginal bleeding after the sixth month of pregnancy, proteinuria (protein in the urine), hyperthyroidism (high levels of thyroid hormone), hypertension (high blood pressure), exposure to viruses (such as herpes group B), Rh incompatibility, mental retardation, and seizures, can be risk factors for developing cerebral palsy (CP). Rh stands for rhesus factors found in the blood. All individuals either have, or do not have, the rhesus factor (or Rh antigen) on the surface of their red blood cells. There may be a prenatal danger to the fetus when a pregnant woman is Rh-negative and the biological father is Rh-positive. Tests are given to determine the Rh compatibility of the fetus and the mother before birth. Rh immunoglobulin (RhIg or Rhogam®) is a blood product given by injection to help the Rh negative mother by suppressing her ability to react to the Rh positive red cells. Reactions to the medication are generally minor, including soreness at the injection sight and sometimes a slight fever.
  • Studies have found that exposure to herpes group B viruses were found more often in babies who were later diagnosed with CP. In fact, the risk of cerebral palsy was nearly doubled with exposure to herpes group B viruses.
  • Breech birth is when the fetus is born with the feet or buttocks first. Manipulating the baby to prepare it for birth can result in complications such as CP. Fetal distress may occur in labor and delivery, including vascular (blood flow) or respiratory (breathing) problems, and may indicate brain damage or abnormal brain development.
  • Multiple births, such as having twins and triplets, may increase the incidence of CP. CP may be a result of prematurity (common in multiple births) or intrauterine growth retardation due to more fetuses in the womb.
  • Birth defects, such as malformation of spinal bones, hernia in groin area, abnormally small jawbone, seizures in the newborn, or microcephaly (small head), can result in developing CP.
  • Low Apgar score: The Apgar score is a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth. Infant heart rate, breathing, muscle tone, reflexes, and skin color are each scored as 0 (low), 1 (intermediate), or 2 (normal) after delivery. A total score of seven to ten at five minutes is considered normal; four to six, intermediate; and zero to three, low. Scores that remain low 10-20 minutes after delivery indicate increased risk for CP.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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