Cerebral palsy encompasses a spectrum of conditions that impact both movement and posture. This condition stems from damage that typically occurs to the developing brain, often occurring before birth. Signs and symptoms of cerebral palsy typically manifest during infancy or the early years of childhood and can range from mild to severe. Children with cerebral palsy may exhibit heightened reflexes, and their arms, legs, and trunk may display either a floppy or stiff quality. Additionally, they may experience irregular postures, involuntary movements that they cannot control, an unsteady gait, or a combination of these manifestations.
Cerebral palsy can also lead to difficulties in swallowing and may result in an imbalance of the eye muscles, causing a lack of coordination in focusing on the same object. Individuals affected by this condition might also encounter limitations in joint mobility due to muscle stiffness.
In this article, we will discuss how cerebral palsy affects sleep and has an impact on gastrointestinal issues as well. Additionally, we will also find out the connection between cerebral palsy and epilepsy.
How Cerebral Palsy Causes Sleep Disturbances:
Dr Kranthi Mohan, who is a Consultant Neurologist, at Gleneagles Hospitals Kengeri, Bengaluru said, "About 23%–46% of children with cerebral palsy experience sleep problems. Many of the sensory-motor and cognitive features of cerebral palsy (such as immobility, pain, and seizures) act as predisposing factors for sleep problems in this population."
He then mentioned the following:
- Epilepsy, is a co-occurring condition in approximately 41% of children with cerebral palsy and is associated with disturbed sleep.
- Some children with cerebral palsy are also vulnerable to respiratory problems such as upper airway obstruction, which in turn can lead to repeated arousal from sleep. Glossoptosis (abnormal downward or back placement of the tongue) and recurrent aspiration pneumonia related to gastro-esophageal reflux.
- Pain is known to interfere with sleep and there is evidence that the relationship may be bi-directional such that sleep deprivation increases the severity of pain experience and increased pain interferes with sleep.
- Factors such as skin breakdown and pressure ulcers spasticity, abnormal muscle tone, involuntary movements, and abnormal postures in children with cerebral palsy, can decrease their ability to change body position during nighttime and increases their experience of pain.
- Environmental noise is one of the risk factors that influences sleep/wake behavior and sleep quality. Calming before bedtime to reduce environmental noise reduces sleep disturbances.
Dr. Chaitanya Ravikumar, who is the HOD of Department of Medicine at Athreya Hospital also listed down some reasons why patients with cerebral palsy have sleep disturbances.
- Muscle stiffness and spasticity, typical in cerebral palsy, can make finding a comfortable sleeping position difficult, leading to trouble falling asleep and frequent awakenings during the night.
- Orthopedic issues often coincide with cerebral palsy, causing pain and discomfort that can intensify at night, further disrupting sleep..
Dr Chaitanya concluded that it's important to recognize and address these sleep challenges in individuals with cerebral palsy to enhance their overall well-being and quality of life.
Ways To Address Sleep Problems:
Dr Kranthi Mohan said, "Non-pharmacological sleep interventions (NPSI) are important in addressing sleep problems and are recommended as adjunctive or alternatives to long-term use of sleep medication."
- Activity to develop a sleep routine with a regular bedtime and calming sleep behaviors, environmental modification in the home (such as light, temperature, bedding and sound), and interventions designed to improve parental sleep knowledge.
- Sleep hygiene, such as maintaining a dark, quiet environment and limiting screens 60 minutes before bedtime, is typically the first-line treatment to help sleep issues.
- Ensure your child gets adequate physical activity every day, even if their movements are restricted because of cerebral palsy. Any kind of activity you can add to the child’s day will help. It could even include therapy that helps treat cerebral palsy, such as physical therapy, aqua therapy, targeted stretching, going for a walk, or using the wheelchair more throughout the day.
- Children with cerebral palsy are especially at risk of having poor nutrition because many have difficulty eating and swallowing. Improved nutrition and diet can help to improve quality of sleep.
- Melatonin may be effective in helping children fall asleep, but it may not improve the quality or duration of sleep. Other medications, such as sedatives and hypnotics.
How Cerebral Palsy Leads To Gastrointestinal Issues
Dr. Jaideep Bansal, who is the Director and HOD of Neurology at Fortis Hospital Shalimar Bagh said, "Cerebral palsy (CP) is a non progresses neurological disorder since birth due to lack of oxygen to brain causing varying degree of damage of brain cells. CP patients may have number of issues regarding gastrointestinal tract. GI upset may be because of eating disorder, mood & behaviour disorder or irregular eating habits. The most common digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation. These disorders adversely affect the general health of CP patients."
Dr. Shiran Shetty, who is an MD, DM, and Professor and Head Dept of Gastroenterology and Hepatology, at Kasturba Medical College & Hospital, MAHE, Manipal explained the gastrointestinal problems as a result of palsy.
- Muscle Spasticity and Impaired Mobility: Many individuals with CP experience muscle spasticity, which causes muscles to contract and tighten involuntarily. This spasticity can affect the muscles responsible for swallowing, leading to difficulties in ingesting food and liquids properly.
- Oral Motor Function Deficits: CP can affect oral motor skills, making it challenging for individuals to chew and swallow food effectively. This may result in the aspiration of food or liquids into the airway, leading to respiratory issues and potential GI problems.
- Gastroesophageal Reflux Disease (GERD): GERD is a common GI issue among individuals with CP. The muscle tone and coordination issues associated with CP can lead to a weak lower esophageal sphincter, allowing stomach acid to flow back into the esophagus. This can cause heartburn, regurgitation, and discomfort.
- Dietary Challenges: Many people with CP may have dietary restrictions or difficulties in consuming a well-balanced diet. Limited food choices, difficulty chewing and swallowing, and sensory issues related to certain textures or flavors can lead to nutritional deficiencies and GI problems.
- Constipation: Chronic constipation is a frequent issue for individuals with CP. Reduced mobility and muscle tone in the abdominal area can contribute to slow bowel motility. Additionally, side effects of medications commonly used to manage CP, such as antispasmodic drugs, can further exacerbate constipation.
- Dysphagia: Dysphagia is a condition characterized by difficulty swallowing, and it can be common in individuals with CP. This can lead to the aspiration of food or liquids into the airway, increasing the risk of pneumonia and other respiratory issues.
- Impaired Gut-Brain Connection: The gut-brain connection is essential for regulating digestion and bowel movements. Disruption in this connection due to brain damage in CP can result in irregular bowel habits, making it challenging to maintain proper GI health.
- Dehydration and Malnutrition: Difficulty with oral intake and dietary challenges can put individuals with CP at risk of dehydration and malnutrition. Poor hydration and inadequate nutrition can exacerbate GI issues and overall health.
- Oropharyngeal dysfunction: This refers to a condition where there is a disruption or impairment in the normal function of the oropharynx, which is the part of the throat located at the back of the mouth and includes the tonsils, base of the tongue, and the soft palate. The oropharynx plays a crucial role in various essential functions such as swallowing, breathing, and speaking.
Cause Of Gastrointestinal Issues:
Speaking about the cause of gastrointestinal issues due to palsy, Dr. Jaideep Bansal said that they are multifactorial.
"Poor feeding, restricted mobility, increased stiffness in the body, abnormal positioning and difficulty swallowing and excess drooling all can contribute to digestive issues for children with cerebral palsy. Apart from dependency on caregivers or mood and behaviour disorders they also have structural abnormalities not only of central nervous system but also peripheral (splanchnic nerves) nervous system," he added.
Cerebral Palsy And Epilepsy:
Cerebral Palsy is a group of motor disorders caused by brain damage during early development. It often presents with symptoms like muscle stiffness, impaired movement, and coordination difficulties. On the other hand, Epilepsy is characterized by recurrent seizures, resulting from abnormal electrical activity in the brain. While they may appear distinct, Dr. Vipul Gupta, who is the Chief - Neurointerventional Surgery & Co-Chief Stroke Unit, at Artemis Hospital, Gurugram conducted a research that unveiled common threads between them.
One key finding of was that children with Cerebral Palsy have a significantly higher risk of developing epilepsy compared to the general population. This crucial insight has the potential to transform the way both conditions are diagnosed and treated.
Furthermore, his work has highlighted shared neurological pathways and genetic factors that predispose individuals with CP to develop Epilepsy.
"Understanding these connections could lead to more targeted therapies and interventions, ultimately improving the prognosis for those affected by these conditions," he said.
Additionally, Dr. Puja Kushwah, who is a Sr.Consultant- Neurology, at Metro Hospital, Noida said, "If we talk, then around 25-40% of patients in cerebral palsy have seizures. If we talk about age group then this phase is seen more commonly in the starting 2 years of life. Now what kind of seizures are commonly seen in cerebral palsy? So the most common are focal seizures, which we also call small seizures and apart from this, large seizures or generalized seizures are also seen. Now coming to which type of seizures or epilepsy is more common in cerebral palsy, it is commonly seen in cases of spastic quadriplegic or then spastic diplegic."