Cerebral Palsy: A Unique Illustrated Experience.

Abstract Background: Cerebral palsy is a heterogeneous condition associated with a non-progressive lesion causing permanent disorder of movement with limited mobility and is generally associated with gross motor developmental delay. In moderate to severe cases of cerebral palsy, motor developmental milestones such as walking may never be achieved. Impaired cognition and delayed speech are also commonly seen. The aim of this paper is describing our illustrated experience with cerebral palsy with emphasis on treatment with multi-factorial therapies. Patients and methods: Seventeen patients with cerebral palsy are described in this paper including two female patients whose early treatment courses were included in previous publications and 15 new cases (11 males and 4 females) observed during seven months period (May-November, 2019). Their ages ranged from 10 months to 9 years. Ten patients had significant spasticity limiting their movements. All patients had developmental delay including delayed speech. Nine patients were unable to sit without support, including a patient with significant dystonia and a patient who could stand and walk with support but was unable to sit without support. Only two patients were able to walk alone, but slowly and with difficulty. Two patients had history of birth asphyxia and one patient had a genetic condition with 2 of his brothers being affected. The patients were treated based on our published experiences with individualized treatment plans providing a combination of various interventions including nutritional support, muscle relaxants, oral pyritinol, intramuscular piracetam, citicoline (oral and injectable), intramuscular cerebrolysin and intramuscular nandrolone decanoate. The aims of these therapies include overcoming spasticity, repairing the brain and improving its function and ultimately improving mobility and advancing development. Results: All patients experienced improvement in motor development without the occurrence of any side effect. However, it was not possible to document the details of treatments and follow-up for all patients, but it was possible to provide an illustrated demonstration of improvement in seven patients. Conclusion: Cerebral palsy is a heterogeneous condition and the emergence of a single therapeutic agent that offers a comprehensive effect to improve its manifestations is very unlikely is the near future. Therefore, the use of evidence-based multi-factorial therapies is advisable. Adequate muscle relaxation is vital to prevent the complications of contractures which appear to cause a progressive disability.