大腦麻痺是一種永久性的運動障礙，主要影響活動能力及姿勢，這是因為胎兒或新生嬰兒的腦部在發育時受到損害。有些嬰兒出生時腦部結構異常；有些嬰兒可能經歷難產導致缺氧；有些嬰兒可能在初生時出現嚴重的腦部出血、中風或腦部感染。有些時候，原因亦可能未明。但是，以上的情況都可導致永久性的大腦功能障礙，其形式和嚴重程度亦各有不同。
大腦麻痺嬰兒的患病率約為千分之二。在懷孕週數較少和出生體重較輕的嬰兒中更為常見。在懷孕28週或之前出生的嬰兒中，每1,000名活產嬰兒有111.8名患上此疾病；而在懷孕36週後出生的嬰兒中，患病率則降至每1,000 名有1.35。[1] 這是因為早產嬰兒患上腦室內出血（IVH）的機會率比較高[2]，腦部亦容易在受損後出現異常的囊腫。[3]
患有大腦麻痺的嬰兒在兩歲之前就會出現臨床症狀和病徵。[4] 他們的運動發展通常會較為延緩，例如頭部控制不佳、遲遲未懂翻身、穩坐或步行。他們也可能會出現無力和四肢僵硬的情況。在作出診斷前，醫生會為患者進行詳細的評估。除了運動障礙，他們還可能出現學習困難、智力障礙、聽覺及視覺障礙、進食問題和癲癇症等相關疾病。[5]
大多數患有大腦麻痺的兒童都能活到成年。為了使他們得到全面的發展，治療也十分著重增強他們日常的活動和自理能力，並盡量減少由疾病引起的痛性和不適。不同的大腦麻痺患者會有不同程度的障礙。因此，醫療專業團隊會協力為每個患病的兒童和家庭制定個人化的治療方案。除了醫生和護士外，言語治療師、物理治療師、職業治療師、營養師、臨床心理學家、醫務社工等在照顧兒童和整個家庭上亦扮演著重要的角色。
-撰寫自劉凱盈醫生
威爾斯親王醫院兒科
駐院醫生
大腦麻痺(CP)
Cerebral palsy
Cerebral palsy is a disorder that affects one’s movement and posture. It is caused by an insult to the developing brain, which happens during the fetal and/or neonatal period. Some babies were born with structural brain abnormalities; some may have experienced a difficult birth where hypoxia occurred; some may have severe bleeding, stroke, or infection of the brain in the perinatal period. In some cases, the cause may not be identified. All these could lead to life-long dysfunction of the brain with different presentation and severity.
The prevalence of cerebral palsy is around 2 per 1,000 live births. It is more common in babies born with a decreasing gestational age and birth weight. In babies who were born before 28 weeks of gestation, the prevalence could be up to 111.8 per 1,000 live births compared to about 1.35 per 1,000 live birth in those who were born after 36 weeks of gestation.[1] This can be explained by a higher rates of intraventricular haemorrhage (IVH) in preterm babies[2] and the formation of abnormal cysts in the brain after an injury.[3]
Babies with cerebral palsy develop clinical signs and symptoms before the age of two.[4] They are often found to be delayed in motor development e.g., poor head control, slow to roll, sit or walk. They may also have stiffness and weakness of the limbs. A detailed assessment is needed before the diagnosis could be made. Apart from motor impairment, they may have associated conditions like learning difficulties, intellectual disabilities, hearing and visual impairment, feeding problems, and epilepsy.[5]
The majority of children with cerebral palsy survives to adulthood.[6] To maximize their development in different aspects, therapies are designed to enhance their functional abilities and independence, also to minimize any distress caused by the disorder. Children with cerebral palsy present with different degrees of impairment, thus an individualized care plan is made for each child and family by a team of healthcare professionals. Apart from doctors and nurses, speech therapists, physiotherapists, occupational therapists, dieticians, psychologists, social workers etc. all play an important part in taking care of the child and the family as a whole.
Written by Dr. Sharon Lau
Resident, Department of Paediatrics
Prince of Wales Hospital
Reference:
[1] Oskoui M, Coutinho F, Dykeman J, et al. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013; 55:509.
[2] Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Paediatrics 2010; 126:443
[3] Sarkar S, Shankaran S, Barks J, et al. Outcome of Preterm Infants with Transient Cystic Periventricular Leukomalacia on Serial Cranial Imaging Up to Term Equivalent Age. J Pediatr 2018; 195:59.
[4] Novak I, Morgan C, Adde L, et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 2017; 171:897.
[5] Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130:e1285.