What is Cerebral
Palsy?

Cerebral Palsy (CP) is defined as a non progressive disorder of the brain that leads to an inability in performing movements due to lack of muscle coordination or excessive tightness of the muscles. The Cerebral Palsy doesn’t worsen over time (non-progressive). However, the limb or part associated with that damaged part, may experience a steady loss of function as the child grows. These regions may not develop as compared to the other parts of the body.

BASED ON CLINICAL SYMPTOMS

Spastic Cerebral Palsy. Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Spastic Cerebral Palsy

This type of cerebral palsy exhibits a rigidity in the limbs involved.

Dyskinetic, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Dyskinetic Cerebral Palsy

Dyskinetic type of Cerebral palsy involves excessive involuntary movements. Types of Dyskinetic CP

Dystonic: alternating between stiffness and flaccidity,

Choreoathetoid Cerebral Palsy: Persistent involuntary movements resulting in abnormal postures.

Ataxic, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Ataxic

An ataxic type of Cerebral palsy appears if the smaller brain (cerebellum) is involved.

Mixed Cerebral Palsy, , Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Mixed Cerebral Palsy

This type of cerebral palsy implies a more severe brain damage. It may exhibit the involvement of different parts of the brain and therefore, different symptoms, which may seem like a combination of the other types.

REGION OF THE BRAIN AFFECTED

Monoplegia, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Monoplegia

A monoplegic type of cerebral palsy affects one limb, usually an arm.

Hemiplegia, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Hemiplegia

Hemiplegic type of cerebral palsy results from a one sided brain damage. This is reflected in the opposite side of the body including arms, legs, and trunk.

Diplegia, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Diplegia

Diplegic Cerebral palsy, affects either both legs or both arms.

Quadriplegia, Cerebral Palsy Treatment, Cerebral Palsy, Types Of Cerebral Palsy
Quadriplegia

Quadriplegic cerebral palsy indicates a more severe brain damage. A quadiplegic CP manifests as an affection of all four limbs.

IN CHILDREN YOUNGER THAN 6 MONTHS

Cerebral Palsy Treatment in India

Dangling neck: Poor or no neck control when picked up

Symptoms Cerebral Palsy

Scissoring: Crossing of legs when lifted or made to stand with support

Cerebral Palsy Treatment in India

Overextension of back and neck: appearing as though pushing away when lifted.

Cerebral Palsy Treatment in India

Poor feeding: Weak sucking or thrusting of tongue

Symptoms Cerebral Palsy

Abnormal muscle tone: Rigid or Floppy

 
IN CHILDREN OLDER THAN 6 MONTHS

Symptoms Cerebral Palsy

Inability to roll

Symptoms Cerebral Palsy

Inability to stand or walk without support

Symptoms Cerebral Palsy

Difficulty in bringing or moving the upper limbs together

Cerebral Palsy Treatment in India

Lopsided crawling or dragging one side of the body

Cerebral Palsy Treatment in India

Not saying words such as ‘mama’, ‘papa’, etc.

Cerebral Palsy Treatment in India

Poor or no response to own name

Cerebral Palsy Treatment in India

No babble

 

 

Symptoms Cerebral Palsy

Ataxia: Lack of muscle coordination during voluntary movements

Cerebral Palsy Treatment in India

Spasticity: Stiff or tight muscles with exaggerated reflexes

Cerebral Palsy Treatment in India

Weakness: in one limb or more

Cerebral Palsy Treatment in India

Toe walking: Crouched or “scissoring” gait

Cerebral Palsy Treatment in India

Excessive drooling: difficulties swallowing or speaking

Cerebral Palsy Treatment in India

Tremor: Shaking or random involuntary movements

Symptoms Cerebral Palsy

Poor fine motor activity: Difficulty in writing or buttoning a shirt

 

Prolonged inactivity of limbs, may result in severe spasticity leading to permanent deformities. These may eventually need surgical correction. These symptoms may arise especially at the joints resulting in bent wrist, closed fist, flexed elbow. These may or may not straighten when forcefully tried.

 

Poor feeding could result in malnourishment, which leads to a poor immunity, and low body weight. Poor neck control leads to swallowing difficulties in children with cerebral palsy. Often, the food taken orally may enter the larynx and trachea(windpipe), instead of the pharynx and oesophagus(food pipe). This could also be a common cause of recurrent pneumonia and other respiratory infections in cerebral palsy kids. Such cases of cerebral palsy could need eventual ventilatory support.

 

Children with cerebral palsy may also face sensory symptoms such as vision and auditory issues. They may also show signs of intellectual disability or delay. Cerebral Palsy also includes excessive drooling as a result of poor oral motor function. The brain damage in cerebral palsy can cause irregularity of brain signals, causing seizures or convulsions.

 

Cerebral Palsy Treatment in India
Factors causing cerebral palsy before birth include:

  • Reduced blood or oxygen supply to the fetus

  • An injury to the unborn baby's head

  • Genetic disorders such as Down's Syndrome, Rett Syndrome

  • Transfer of infection from the mother, eg. cytomegalovirus, rubella, chickenpox or toxoplasmosis

Symptoms Cerebral Palsy
Factors causing cerebral palsy during or after birth include:

  • Asphyxia: Poor oxygen supply to the brain during a difficult birth

  • A brain infection such as meningitis

  • A forceps/ suction delivery leading to a serious head injury

  • Any other postpartum external traumatic head injury

  • Incidents of choking or nearly drowning, causing lack of oxygen to the brain

  • Sudden drop in blood sugar levels

  • An infantile stroke- sudden blockage of blood flow to the brain

Symptoms Cerebral Palsy
Some pregnancies or births are at high risk of such brain damage. These include:

  • Low birth weight

  • Twin or multiple pregnancy

  • A 35 years old or higher aged mother

  • An unusually low or high blood pressure in the mother

  • Bacterial and viral infections

  • Prenatal exposure to drugs and alcohol, stress, heavy metals including mercury poisoning from fish

  • Prematurity (birth before the 37th week of pregnancy): babies born at 32 weeks or earlier are at a high risk since the fetus has not grown completely

CELL THERAPY

We have effectively treated over 1286 patients of Cerebral Palsy

Cell Therapy


Until recent times, it was assumed that brain damage at the time of birth can have permanent repercussions. However, it has been proven through studies on nervous tissue regeneration, that it is possible to repair the damaged brain tissues to an extent. bone marrow-derived cells obtained from various sources can be used for cell therapy in Cerebral palsy to repair this damage.

 

 

Our approach for Cellular Therapy in NeuroGen Brain & Spine Institute uses autologous bone marrow derived mononuclear cells for transplantation. These transplanted bone marrow-derived cells have the capability to migrate to the damaged part of the brain and settle in the affected areas to help repair it. They release certain trophic factors that heal the injury and make a distinction of several types of cell types of the nervous system like oligodendrocytes, glial cells and other cells of the nervous system.

 

 

The main mechanisms that help tissue repair and regeneration include:

  • -Prevention of cell death in neuronal population

  • -Establishment of new blood vessels

  • -Cell multiplication and integration

  • -Establishment of new neuronal maps in the brain in order to learn new functions

 

These mechanisms of cell therapy, renew the damaged tissues and restore activity in the affected area which is a marked clinical improvement. cell therapy for cerebral palsy treatment in India, plays a diversified role in overall development and improvement. Autologous BM MNCs do not present any side effects and do not face an immune rejection. They are derived from the same patient and are thus, freed from all ethical issues around the usage of bone marrow-derived cells.

 

 

THE NEUROGEN OUTCOME IN CEREBRAL PALSY

92.6% patients treated at NeuroGen BSI for cerebral palsy with cell therapy in Mumbai, have experienced positive improvements. NeuroGen follows a holistic approach of neuroregenerative rehabilitative therapy, with the highest number of patients treated with cell therapy in India,

Autologous bone marrow derived mononuclear cells are used for cerebral palsy treatment in India. During cell therapy in NeuroGen Brain & Spine Institute, these cells migrate to the damaged part of the brain and settle in the affected areas to help repair it. They release certaintrophic factors that heal the injury and make a distinction of several types of cell types of the nervous system like oligodendrocytes, glial cells and other cells of the nervous system.

We record the positive improvement of our patients after cell therapy at NeuroGen with both symptomatic and clinical scans. After the patient undergoes cerebral palsy treatment in India, we monitor the changes in their brain metabolism as via their PET-CT scans.

STATISTICS OF OVERALL IMPROVEMENTS IN PATIENTS AFTER CELL TREATMENT FOR CEREBRAL PALSY IN MUMBAI

92.6% patients showed symptomatic improvement

 

 

Cerebral Palsy Stats

 

 

  •  Significant improvements

  •  Mild improvements

  •  Fair improvement

 

 

 

This proves cell therapy to be a safe and effective form of treatment for cerebral palsy children. Cell therapy renews the core of the brain damage and can be monitored on PET CT scan of the brain improvement. These cell therapies along with standard treatment add to the growth and improvement of children with cerebral palsy.

 

TREATMENTS THAT FOLLOW

A treatment plan for Cerebral Palsy cannot be exactly the same for all CP children. Patients tend to show greater improvement after their cell therapy for cerebral palsy, with subsequent rehabilitation. Whether traditional, or unconventional, they have to be personalised. This personalisation can only be achieved with a thorough evaluation of the child. However, it is imperative that the following therapies be followed religiously after cell therapy for cerebral palsy, for the best possible outcome!

 

RESULTS

Success is the result of hard work and persistence

01. My child has been diagnosed with Cerebral Palsy. Can my child get better?

Yes, there are several medical aids available which may help your child live a better quality of life, however, no cure has yet been discovered for brain damage which occurs in Cerebral Palsy.

02. Will my Child’s condition deteriorate further?

Even though Cerebral Palsy is a non-progressive condition, without corrective measures and interventions, further complications may occur in a child with cerebral palsy, such as infections, permanent physical deformities, etc.which could seriously further hamper quality of life.

03. Why do the muscles become weak in Cerebral palsy or why do deformities happen?

In cerebral palsy, often, the child faces lack of nutrition due to poor oral motor skills such as chewing or swallowing, along with lack of voluntary limb movement. Hence, there is a generalised weakness of muscles. These muscles become stiff or spastic, over time due to lack of movement. The rapid growth of bones, as compared to muscle growth is also the main cause of contractures in the long term.

04. Will my child learn how to walk?

The answer to this question varies with every case. But in general, a child with mild Cerebral Palsy can learn to walk independently and a child with moderate Cerebral Palsy may need external aid. Child with severe Cerebral Palsy however is generally wheelchair bound.

05. Will my child learn how to talk?

The answer to this also varies based on the severity of the brain damage. While some children with cerebral palsy may not face any difficulties, others may be slow to grasp. A speech therapist can help with learning to speak and other forms of communication

06. Can my child be independent?

Appropriate guidance and encouragement, clubbed with physical therapy and occupational therapy can make it possible for a child with Cerebral Palsy to be independent. A child with a mild case of Cerebral Palsy can attain independence a lot more easily than a child with a severe case. As a parent, you play the most important role here.

07. Can my child develop behavioral problems?

Most children develop behavior problems as an outlet to their frustration. This development entirely depends upon the case specifically. A clinical psychologist can help with examining and encouraging a feel good factor.

08. Will my child have a normal life expectancy?

Yes, most children with cerebral palsy lead a good life expectancy. However, children with moderate to severe brain damage also suffer from comorbid symptoms such as epilepsy and run a risk of a reduced life expectancy.

09. If am planning a second child, will my second baby be affected as well?

Studies have revealed that there is a 6-9 fold increase, in case of an affected sibling during pregnancy complications or complications at birth. “6-9 fold” appears large in terms of percentage; but it translates to an incidence of 0.6-1%. With due precautions for the preventable causes, this incidence can be reduced in individual cases

10. What can I do to prevent a recurrence of Cerebral Palsy in my second child?

A regular prenatal check-up, as well as prior testing for complications under the supervision of your obstetrician is advisable to reduce or prevent some risk factors which increase the chances of Cerebral Palsy.

11. Should I go for cord blood/umbilical cord banking?

The potential for the usage of cord blood bone marrow-derived cells in the future is immense. The scenarios they can come in handy are:


a) In a case of blood related disorders occurring in siblings, the cord blood can be a possible source of bone marrow-derived cells, instead of allogeneic bone marrow.
b) We have increasingly seen cases of Cerebral Palsy and autism on the rise. For such instances too, cord blood cells are a good source of bone marrow-derived cells. But their use in neurological disorders has not yet been approved. In absence of the above, Umbilical Cord Blood Bank storage would be more like an insurance policy; we hope never to use it! If money/ Finances are not an issue, then cord blood storage can be chosen. In the absence of cord blood cells, autologous cells (bone marrow derived) are available at any age and in fact are much more easy to use source.

12. How does cell therapy work?

bone marrow-derived cells inherently repair and renew the damaged cells. cell therapy makes use of this function by directing these cells in high concentrations directly in and around the damaged tissue, where it is progressing towards its self healing and repair.

13. Are there ethical concerns surrounding adult cell research and therapy?

Bone marrow transplantation has effectively been used for genetic disorders of blood, such as sickle cell anemia, thalassemia, as well as cancers such as leukemia. Since our cell therapy for cerebral palsy treatment in India makes use of autologous cells, there are no major ethical concerns. Ethical concerns are mainly concerned on the use of embryonic bone marrow-derived cells (which we do not use).

14. Does the treatment have any side effects?

Cell therapy for cerebral palsy treatment in Mumbai is all-encompassing and practically safe. None of our patients have shown any neurological worsening connected to cell therapy. Some short-term, self-limiting side effects, such as headache (spinal headache) lasting 3-4 days may occur neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/ cell injection may occur. There is a slight possibility in the case of children with seizures, or previous history of seizures or an abnormal EEG. However, proper antiepileptic cover/drugs could avoid this problem.

15. How long will it take me to know that my child has benefitted from the treatment?

Most improvements are seen within 3-6 months after the cell treatment. Some patients take several months/years together to get better. While on the other hand, most patients show some immediate improvements even before their discharge.

16. Is the transplantation of the cells done once or more than once?

This decision is taken after considering the growth and improvements after the first cell therapy round. If you show significant amounts of improvement, your case is evaluated by the whole medical and rehabilitation team again. Some special imaging tests, such as PET CT Scan of the brain will be repeated and then a second cell treatment may be suggested. It can be done anytime between 3-6 months of the first therapy.

17. Can other treatments be taken at the same time?

It is better that you notify us before taking any medications. We evaluate what other prescription the patient is on, and in most cases we allow the patients to proceed on with their other treatment.

18. How much improvement will the patient have?

The question of improvement depends on many factors like the age of the patient, type of illness, duration of illness and extent of rehabilitation taken after the treatment. Therefore, improvement varies from case to case. At NeuroGen Brain and Spine Institute, we have treated over 1200 Cerebral Palsy cases. Cell therapy was found to be safe and effective in 92.6% of the patients in a study taken of 108 patients with a maximum follow up of 4 years. Our information is published on a regular basis in various medical and scientific journals. You are strongly advised to study all the guidelines before proceeding on with the bone marrow-derived cell treatment for cerebral palsy.

CASE REPORT 1

 

Baby AR, is a known case of dystonic cerebral palsy, with no positive history of cerebral palsy in the family. When she was a mere six months old, her parents noticed that she did not display the normal milestones of an infant her age. It distressed her parents and they decided to visit her pediatrician. They were advised to...

 

CASE REPORT 2

 

Master HS is a known case of diplegic Cerebral Palsy with autistic features. On examination, it was seen that he had poor social skills, stereotypical features and was slightly aggressive as compared to other children his age. He also displayed problems with his fine motor skills and balance, and was dependent for most of the...

 



FREQUENTLY ASKED QUESTIONS

01. My child has been diagnosed with Cerebral Palsy. Can my child get better?

Yes, there are several medical aids available which may help your child live a better quality of life, however, no cure has yet been discovered for brain damage which occurs in Cerebral Palsy.

02. Will my Child’s condition deteriorate further?

Even though Cerebral Palsy is a non-progressive condition, without corrective measures and interventions, further complications may occur in a child with cerebral palsy, such as infections, permanent physical deformities, etc.which could seriously further hamper quality of life.

03. Why do the muscles become weak in Cerebral palsy or why do deformities happen?

In cerebral palsy, often, the child faces lack of nutrition due to poor oral motor skills such as chewing or swallowing, along with lack of voluntary limb movement. Hence, there is a generalised weakness of muscles. These muscles become stiff or spastic, over time due to lack of movement. The rapid growth of bones, as compared to muscle growth is also the main cause of contractures in the long term.

04. Will my child learn how to walk?

The answer to this question varies with every case. But in general, a child with mild Cerebral Palsy can learn to walk independently and a child with moderate Cerebral Palsy may need external aid. Child with severe Cerebral Palsy however is generally wheelchair bound.

05. Will my child learn how to talk?

The answer to this also varies based on the severity of the brain damage. While some children with cerebral palsy may not face any difficulties, others may be slow to grasp. A speech therapist can help with learning to speak and other forms of communication

06. Can my child be independent?

Appropriate guidance and encouragement, clubbed with physical therapy and occupational therapy can make it possible for a child with Cerebral Palsy to be independent. A child with a mild case of Cerebral Palsy can attain independence a lot more easily than a child with a severe case. As a parent, you play the most important role here.

07. Can my child develop behavioral problems?

Most children develop behavior problems as an outlet to their frustration. This development entirely depends upon the case specifically. A clinical psychologist can help with examining and encouraging a feel good factor.

08. Will my child have a normal life expectancy?

Yes, most children with cerebral palsy lead a good life expectancy. However, children with moderate to severe brain damage also suffer from comorbid symptoms such as epilepsy and run a risk of a reduced life expectancy.

09. If am planning a second child, will my second baby be affected as well?

Studies have revealed that there is a 6-9 fold increase, in case of an affected sibling during pregnancy complications or complications at birth. “6-9 fold” appears large in terms of percentage; but it translates to an incidence of 0.6-1%. With due precautions for the preventable causes, this incidence can be reduced in individual cases

10. What can I do to prevent a recurrence of Cerebral Palsy in my second child?

A regular prenatal check-up, as well as prior testing for complications under the supervision of your obstetrician is advisable to reduce or prevent some risk factors which increase the chances of Cerebral Palsy.

11. Should I go for cord blood/umbilical cord banking?

The potential for the usage of cord blood bone marrow-derived cells in the future is immense. The scenarios they can come in handy are:


a) In a case of blood related disorders occurring in siblings, the cord blood can be a possible source of bone marrow-derived cells, instead of allogeneic bone marrow.
b) We have increasingly seen cases of Cerebral Palsy and autism on the rise. For such instances too, cord blood cells are a good source of bone marrow-derived cells. But their use in neurological disorders has not yet been approved. In absence of the above, Umbilical Cord Blood Bank storage would be more like an insurance policy; we hope never to use it! If money/ Finances are not an issue, then cord blood storage can be chosen. In the absence of cord blood cells, autologous cells (bone marrow derived) are available at any age and in fact are much more easy to use source.

12. How does cell therapy work?

bone marrow-derived cells inherently repair and renew the damaged cells. cell therapy makes use of this function by directing these cells in high concentrations directly in and around the damaged tissue, where it is progressing towards its self healing and repair.

13. Are there ethical concerns surrounding adult stem cell research and therapy?

Bone marrow transplantation has effectively been used for genetic disorders of blood, such as sickle cell anemia, thalassemia, as well as cancers such as leukemia. Since our cell therapy for cerebral palsy treatment in India makes use of autologous cells, there are no major ethical concerns. Ethical concerns are mainly concerned on the use of embryonic bone marrow-derived cells (which we do not use).

14. Does the treatment have any side effects?

Cell therapy for cerebral palsy treatment in Mumbai is all-encompassing and practically safe. None of our patients have shown any neurological worsening connected to cell therapy. Some short-term, self-limiting side effects, such as headache (spinal headache) lasting 3-4 days may occur neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/ cell injection may occur. There is a slight possibility in the case of children with seizures, or previous history of seizures or an abnormal EEG. However, proper antiepileptic cover/drugs could avoid this problem.

15. How long will it take me to know that my child has benefitted from the treatment?

Most improvements are seen within 3-6 months after the cell treatment. Some patients take several months/years together to get better. While on the other hand, most patients show some immediate improvements even before their discharge.

16. Is the transplantation of the bone marrow-derived cells done once or more than once?

This decision is taken after considering the growth and improvements after the first cell therapy round. If you show significant amounts of improvement, your case is evaluated by the whole medical and rehabilitation team again. Some special imaging tests, such as PET CT Scan of the brain will be repeated and then a second cell treatment may be suggested. It can be done anytime between 3-6 months of the first therapy.

17. Can other treatments be taken at the same time?

It is better that you notify us before taking any medications. We evaluate what other prescription the patient is on, and in most cases we allow the patients to proceed on with their other treatment.

18. How much improvement will the patient have?

The question of improvement depends on many factors like the age of the patient, type of illness, duration of illness and extent of rehabilitation taken after the treatment. Therefore, improvement varies from case to case. At NeuroGen Brain and Spine Institute, we have treated over 1200 Cerebral Palsy cases. Cell therapy was found to be safe and effective in 92.6% of the patients in a study taken of 108 patients with a maximum follow up of 4 years. Our information is published on a regular basis in various medical and scientific journals. You are strongly advised to study all the guidelines before proceeding on with the bone marrow-derived cell treatment for cerebral palsy.