Experts say that in children, if cerebral palsy is not dealt with soon enough, the condition can have permanent effects. Dr Jean Paul Rukabyarwema, a paediatrician in developmental behavioural paediatrics (DBP) at Muhima Hospital, says cases of cerebral palsy are not rare, and people should know how it can be prevented and managed, in case it ensues. He says this is a condition marked by impaired muscle coordination or other disabilities, caused by damage of the brain. He explains that this is the consequence of an injury that occurred to the growing brain of the baby. “The injury by definition is a non-progressive injury but its consequences appear while the child is growing. It manifests with the disorder of movement depending on the primary injury of the brain which was affected,” he says. He, however, notes that these manifestations change with time because there are a number of things children are expected to do at a given age in terms of growth and social interaction, among others. At that given age, he says, if the child suffered brain injury, there will be impaired function. CAUSES He says to note the exact cause of cerebral palsy due to a certain factor is hard, but there are risk factors that can bring about the condition. This condition is not only caused by birth trauma, but also prenatal contact which the brain has been exposed to inside the mother’s womb, and many other factors. Raymond Awazi, a paediatrician at Heritage Clinic in Kicukiro, says other factors, like perinatal (immediately before and after birth) risks can lead to cerebral palsy. For prenatal risks, he says if the mother has any infection, or is exposed to teratogenic products that impair the genetics of the baby, it will affect the brain. Maternal infection is also another cause, as well as multiple birth cases, which are prone to cerebral palsy compared to single birth. In postnatal cases, he says this happens if the baby suffered jaundice, meningitis or hypoglycaemia, as it can affect the brain of the baby, thus causing the condition. PREVENTION Francis Kazungu, a general practitioner in Kigali, says although cerebral palsy can be prevented, when it occurs, it’s hard to treat, and a child has to live with it permanently. Therefore, he advises to try as hard as possible to prevent it. He notes that prenatal risk factors can be controlled through antenatal visits. “Pregnant women should keep this in mind throughout the pregnancy period because most infections like UTIs and congenital infections that occur during pregnancy can be controlled, screened, identified and treated, thus preventing anything that could interfere with the growing brain of the baby,” he says. A teratogen is an agent that can disturb the development of the embryo or foetus, Kazungu warns. He adds that pregnant women should also avoid exposure to radiation and imaging. “Placenta complications, hypertension and maternal conditions that can interfere with the baby’s brain can be detected by a gynaecologist early enough to prevent cerebral palsy,” he adds. Most of the cases of cerebral palsy arise from premature birth, he says, so if causes of premature birth are prevented, the outcome can be changed. Preventing perinatal factors can keep the baby safe. For instance, Kazungu says, if the baby suffers infections, early detection and treatment will prevent the condition from occurring. Another condition to be rectified under perinatal factors, he says, is jaundice; this should also be treated well to prevent complications. IDENTIFYING THE PROBLEM Christian Bahati, a paediatrician in Kigali, says that to identify the condition, observe developmental milestones. He says development milestones for babies before six months are almost similar. For those with brain injuries, one will start noticing the problem around the age of six months. This should be done by detecting and assessing the developmental milestones to see the persistence of basic reflexes. “Abnormal movements can only be detected thorough evaluation of milestones based on the age of the child, depending on the area of the brain which was affected and the extent of the injury sustained,” he says. FEATURES Rukabyarwema says that depending on the area of the brain that was damaged, a child will display mental retardation. He adds that there will be visual impairment, disorder of the eyes, especially difficulty in coordinating the eyes, hearing problems, epilepsy or seizure disorders. Many children with cerebral palsy have seizures as consequences. Awazi says speech and language disorders, both receptive and expressive, is impaired in children with cerebral palsy. He explains that this is so because such children can’t coordinate their oral muscles to be able to generate sounds. Another feature, he says, is the disorder of coordination of swallowing and chewing and that in most cases, these children always suffer malnutrition and stunted growth because of poor feeding. Awazi adds that behavioural and psychological problems such as anxiety, depression, disorder of attention, among others, can occur. They also suffer from physical disabilities such as affected limbs. HOW CAN AFFECTED CHILDREN BE HELPED? Rukabyarwema says that worldwide, the prevalence of cerebral palsy is two to 2.5 per a thousand, and this is in developed countries. In Rwanda, the figures are not yet known but he says most of them are associated with birth asphyxia. When it comes to this kind of disorder, he says the only thing that can be of help is early detection, and that is still an issue in Rwanda. “Because cerebral palsy is the ‘disease of development’, early detection and intervention should be a priority, this is because through intervention, you are reducing the factors that are likely to affect the brain,” he says. Helpful treatment of the condition involves physiotherapy, occupational therapy, language therapy and developmental assessment, as well as follow-ups. Awazi says these children also need surgery because depending on the level of impairment, they can also suffer bone dislocation and joints. “Treating complications is key because most of the features these children display are fits, like seizures,” he adds. Families should provide help to such children. They should be well-educated on what to do and if possible, provided with materials that can help. Experts share their views Proper medical care is needed to prevent infectious diseases that can affect a child’s growth or lead to other complications. In case of any suspicious behaviour from a child, seeking help early is best. Yvan Ntwari, General practitioner ************************ While pregnant, improving nutrition and sticking to the right diet is important. Also, looking out for signs, like discharge, that indicate infection is important, especially in the first trimester. Erick Musengimana, Nutritionist ************************ Taking prenatal vitamins helps prevent many birth defects, not just cerebral palsy. In case one reacts badly to them, consult a gynaecologist so they can prescribe another dosage in form of syrup. Iba Mayale, Gynaecologist ************************ Regarding pregnancy, to minimise complications, women should be vaccinated against rubella which may cause infection that can lead to brain damage in babies. Raymond Awazi, Paediatrician editorial@newtimes.co.rw
