Spastic Diplegia Cerebral Palsy

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Diplegic cerebral palsy, also known as spastic diplegia, is one of three different types of spastic cerebral palsy.[1] The most common problem with the disorder is muscle stiffness. It manifests during infancy and early childhood, with the average age of diagnosis being three years old.

What Is Spastic Diplegia and Spastic Cerebral Palsy?

Spastic cerebral palsy is a movement and neurological disorder that causes muscles to be overly toned. This can lead to a variety of symptoms and disabilities.

In diplegic spastic cerebral palsy, the symptoms primarily affect the legs. Many children with spastic diplegia can walk but with difficulty or with the assistance of mobility devices.

What Are the Symptoms of Spastic Diplegia?

Spastic diplegia primarily affects the legs, causing them to be stiff and contracted.[2] This makes crawling and walking difficult, and most often, children walk on their toes or with a wide “scissor-like gait.” One leg may be more affected than the other.

Legs can also turn inwards and cross at the knees due to excessive muscle contractions. Other children may not be able to walk at all. There may also be some dysfunction in the arms, face, and hands.

Some children with spastic diplegia also have associated symptoms, such as problems with coordination and balance, seizures, joint contractures, or cognitive impairment, which can range in severity.

While the legs are primarily affected, children with spastic diplegia may also have some stiffness in the arms.

Other symptoms of diplegic cerebral palsy include:

• Toe walking
• Exaggerated reflexes
• Flexed knees
• Late motor milestones, including walking, are delayed until the ages of two to four

One important feature of spastic diplegia and other types of cerebral palsy is that they are not progressive. The disability is lifelong, but it does not get worse over time.

What Causes Spastic Diplegia?

As with other types of cerebral palsy, spastic diplegia is caused by brain damage, which generally happens before, during, or shortly after birth. It can also be caused by brain malformations or abnormalities that occur during fetal development.

Babies born prematurely and with low birth weight are at a heightened risk of developing cerebral palsy.[2]

Medical mistakes by healthcare providers can also cause the brain damage that leads to spastic diplegic cerebral palsy. For example:

• Improper use of forceps and other birth-assisting tools
• Failure to properly monitor fetal heartbeat and stress
• Failure to carry out an emergency C-section when indicated
• Failure to detect, diagnose, and treat maternal infections or medical conditions

Other reasons infants may develop spastic diplegia include:

• Rh incompatibility
• Maternal seizures
• Maternal exposure to toxic substances
• Intrauterine stroke
• Severe or untreated jaundice
• Neonatal infection, such as meningitis

How Is Spastic Diplegia Diagnosed?

Doctors diagnose spastic diplegia by reviewing symptoms, observing developmental milestones, conducting physical exams, and running specific diagnostic tests.

Diagnostic tests often include CT scans or MRIs to image the brain, blood tests to rule out other diagnoses, and tests that measure electrical activity in the brain and in muscles.

Most children are diagnosed before the age of three, and the earlier the better. The sooner treatments begin, the better the outcome is for the child.

How Is Spastic Diplegia Treated?

Most children with cerebral palsy benefit from physical therapy, which is especially true for children with spastic diplegia. Physical therapy can help loosen stiff muscles, promote physical healing and wellness, help with balance and posture issues, build stamina and strength, and much more.[3]

Healthcare providers may prescribe medications aimed at reducing spasticity. These include muscle relaxants, anticonvulsants, and other drugs that work on the muscles to reduce spasms.[4]

The child may need a walker, braces, and other mobility assistance. Surgery is sometimes indicated when there is increased pain or limb deformities.

Many parents take their children to massage and yoga therapy, which helps relax muscles via deep massage and builds strength. Consult with your child’s doctor to determine if massage therapy or yoga may be a suitable option for your child.

What Is the Prognosis for a Child with Spastic Diplegia?

There is currently no cure for spastic diplegia or any other type of cerebral palsy. With early intervention and proper treatment, the prognosis for children with spastic diplegia is favorable. The disorder itself will not worsen, although associated conditions may increase in severity over time.