Neurological Complications

Seizure Activity

Children with cerebral palsy are at increased risk of having seizures (51). The primary care provider is frequently asked to evaluate a child who is having increased seizure activity.

New-onset seizures in a child with a disability should be evaluated thoroughly. For example, a new seizure in a child with spina bifida and shunted hydro­cephalus may represent a shunt malfunction with sub­sequent worsening hydrocephalus.

Spasticity

The majority of children with cerebral palsy have spas­ticity as a component of their upper motor neuron dis­order. Primary care providers are frequently asked to evaluate a child with increasing tone. The acute onset of increased tone may represent an intercurrent illness, such as an otitis media or a urinary tract infection, causing pain in a child, which is manifested as spas­ticity. The sole presenting signs of an acute fracture of an extremity in a child who is nonverbal may be increased tone. A careful assessment of all extremities is necessary when the diagnosis is unclear. Treatment of the increased spasticity should focus on treatment of the underlying illness. Use of antispasticity agents such as diazepam and baclofen may be a necessary adjunct when tone is markedly increased. Acute with­drawal from a malfunctioning intrathecal baclofen pump (see chapter on cerebral palsy) may present with increased tone, diaphoresis, tachycardia, hyperten­sion, and irritability. The irritability may be related to the pruritis that is an idiosyncratic reaction not associ­ated with a rash. Primary care providers who care for children who have intrathecal baclofen pumps should be familiar with these common presenting symptoms and management of the withdrawal from baclofen. Immediate administration of oral baclofen or intrave­nous (IV) diazepam will help decrease the symptoms, but referral to a center that can evaluate and treat the malfunction is needed to resolve the problem (52).