Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
While some people believe that the term "cerebral palsy"
(CP) refers to a specific disease, it actually refers to a range of disorders
involved the control of muscles. Cerebral palsy can be caused by many different
problems. About half a million people in the US have some form of cerebral
palsy.
Cerebral palsy is usually congenital and becomes evident
early in life. However, it can be acquired later, for example, as a result of a
head injury. Researchers now believe that congenital cerebral palsy is caused by
faulty cell development in the embryo in the
early stages of pregnancy. Maternal infection with the rubella virus (German
measles) during pregnancy and severe jaundice of the newborn (as from
untreated Rh incompatibility) are some of the conditions that have been
associated with the development of cerebral palsy.
Children with cerebral palsy usually show symptoms within
the first three years of life.
Cerebral palsy (CP) is an abnormality of motor function (as opposed to mental
function) and postural tone that is acquired at an early age, even before birth.
Signs and symptoms of cerebral palsy usually show in the first year of life.
This abnormality in the motor system is the result of brain lesions that are
non-progressive. The motor system of the body provides the ability to move and
control movements. A brain lesion is any abnormality of brain structure or
function. "Non-progressive" means that the lesion does not produce ongoing
degeneration of the brain. It is also implies that the brain lesion is the
result of a one-time brain injury, that will not occur again. Whatever the brain
damage that occurred at the time of the injury is the extent of damage for the
rest of the child's life.
Cerebral palsy affects approximately one to three out of every thousand children born. However,
it is much higher in infants born with very low weight and in premature infants.
Interestingly, new treatment methods that resulted in an increased survival
rate of low-birth weight and premature infants actually resulted in an overall
increase number of children with cerebral palsy. The new technologies, however, did not
change the rate of cerebral palsy in children born full term and with normal weight.
What are causes of cerebral palsy?
The term cerebral palsy does not indicate the cause or prognosis of the child
with cerebral palsy. There are many possible causes of cerebral palsy.
In full term infants the cause of cerebral palsy is usually prenatal and not related to
events at time of delivery; in most instances it is related to events that
happened during the pregnancy while the fetus is developing inside the mother's
womb.
Premature birth is a risk factor for cerebral palsy. The premature brain is at a high
risk of bleeding, and when severe enough, it can result in cerebral palsy. Children that are
born prematurely can also develop serious respiratory distress due to immature
and poorly developed lungs. This can lead to periods of decreased oxygen delivered to
the brain that might result in cerebral palsy. A poorly understood brain process observed in some premature infants is called periventricular leukomalacia. This
is a disorder in which holes form in the white matter of the premature infant's
brain. The white matter is necessary for the normal processing of signals that
are transmitted throughout the brain, and from the brain to the rest of the body.
White matter abnormalities are observed in many cases of cerebral palsy. Nevertheless, it is
important to recognize that the vast majority of premature infants, even those
born very prematurely, do not suffer from cerebral palsy. There have been many advances in
the field of neonatology (the care and study of problems affecting newborn
infants) which have enhanced the survival of very premature infants.
Other important causes of cerebral palsy include accidents of brain development,
genetic
disorders, stroke due to abnormal blood vessels or blood clots, or infections of
the brain.
Even though it is widely believed that the most common cause of cerebral
palsy is a lack
of oxygen to the brain during delivery (birth asphyxia), it is actually a very
rare cause of cerebral palsy. When cerebral palsy is the result of birth asphyxia, the infant almost
always suffers severe neonatal encephalopathy with symptoms during the first few
days of life. These symptoms include:
In rare
instances, obstetrical accidents during particularly difficult deliveries can
cause brain damage and result in cerebral palsy. Conversely, it is very unlikely that
cerebral palsy
symptoms would develop after a few years of age as a result of obstetrical
complications.
Child abuse during infancy can cause significant brain damage which, in turn,
can lead to cerebral palsy. This abuse often takes the form of severe shaking from a
frustrated parent or caregiver, causing hemorrhage in or just outside the brain.
To further compound the problem, many children with developmental abnormalities
are at risk for being abused. Thus, a child with cerebral palsy may be made significantly
worse or even killed by a single incident of abuse.
Despite the diversity of causes of cerebral palsy, many cases remain without a defined
cause. However, the enhanced ability to see the brain structure with
magnetic resonance imaging (MRI) and
CT
scans as well as improved diagnostic capabilities for genetic disorders has made
the number of such cases much lower.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Scoliosis causes an abnormal curvature of the spine. When the cause of scoliosis is unknown the disorder is described based on the age when the scoliosis develops (infantile, juvenile, or adolescent idiopathic scoliosis). In functional scoliosis, curvature develops due to a problem somewhere else in the body. With neuromuscular scoliosis, there is a problem when the bones of the spine are formed. Treatment typically involves observation, bracing, and surgery and is dependent upon the severity of the curvature.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Toxoplasmosis (toxo) is a parasitic infection that causes flulike symptoms, swollen lymph nodes, and muscle aches and pains that may last from a few days to several weeks. Toxoplasmosis can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces. Toxoplasmosis can also be contracted by eating raw or partly cooked meat, especially pork or lamb, or touching the hands to the mouth after contact with raw or undercooked meat.
Child abuse falls into four categories: neglect, physical abuse, sexual abuse, and emotional abuse. There are certain risk factors that predispose a child to being abused and an adult to abusing a child. Risk factors for children are age, children with learning disabilities, adopted and foster children, children with congenital abnormalities, and a past history of abuse. Parental risk factors include young or single parents, those who suffered abuse themselves, adults with substance-abuse problems or psychiatric disease, and those who didn't graduate from high school.
Aphasia is a condition that is the result of damage to portions of the brain. It can be caused by stroke, head injury, brain tumor, or infection. There are two types of aphasia, fluent and non-fluent. Some patients may fully recover from aphasia over time, while others may not.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Dystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Microcephaly is a genetic condition where the circumference of the head is smaller than normal due to underdeveloped brain. Microcephaly is caused by genetic abnormalities, or from abuse of alcohol, drugs, infection (for example, German measles or chickenpox), exposure to toxins, or PKU while the mother is pregnant. Symptoms of microcephaly depend upon the severity of the accompanying syndrome. There is not treatment for microcephaly.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Encopresis is a type of elimination disorder in which bowel movements are passed into places other than the toilet. Children with encopresis may have symptoms that include abdominal pain, watery stools, scratching the anal area or loss of appetite. Causes of encopresis may include a low-fiber diet, lack of exercise, fear of using unfamiliar bathrooms, or changes in bathroom routines. Treatment focuses on encouraging good bowel habits and preventing constipation.
Febrile seizures, or convulsions caused by fever in small children or infants can be frightening, however, in general are harmless. Febrile seizures is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Jaundice in infants occur when the baby's liver may not be developed enough to efficiently rid the body of bilirubin. Symptoms of jaundice include yellowish colored eyes, and yellowing of the skin. Some babies are more at risk to develop jaundice. Kernicterus is a type of brain damage that occurs when a baby has jaundice and is not treated. Treatment of infant jaundice is generally with phototherapy so that kernicterus should not develop.
Aphasia is a disorder that results from damage to portions of the brain that are
responsible for language. For most people, these are areas on the left side
(hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result
of a stroke or head injury, but it may also develop slowly, as in the case of a
brain tumor, an infection, or dementia. The disorder impairs the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.
Who has aphasia?
Anyone can acquire aphasia, including children, but most people who have aphasia are middle-aged or older. Men and women are equally affected. According to the National Aphasia Association, approximately 80,000 individuals acquire aphasia each year from strokes. About one million people in the United States currently have aphasi...