11. Conclusions

future develop cerebral palsy, especially those with spastic quadriplegia, an early

Before pregnancy we have to make sure that the woman is protected against certain diseases such as rubella with vaccination and certain preventable infections or cytomegalovirus (CMV). CMV in particular, is transmitted through close personto-person contact with infected secretions such as in urine and saliva. The infection is transmitted from the mother to the fetus during pregnancy and can sometimes cause stillbirth, premature birth, and neurological conditions such as cerebral palsy. Children with cerebral palsy infected with CMV are more likely to have spastic quadriplegia, severe functional mobility limitations and a range of associated impairments including epilepsy, deafness, vision impairment, and moderate-tosevere intellectual disabilities, than children born with cerebral palsy but without CMV. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. Formulated consensus recommendations on the diagnosis, prevention, and treatment of maternal and congenital CMV infection are found in the publica-

Our primary aim, therefore, is to provide a healthy pregnancy by advising and treating appropriately treatable conditions and introduce current preventable strategies and interventions that hold promise for reducing the prevalence of cerebral palsy. Such interventions include strategies to decrease the risk of premature birth (e.g., 17α-progesterone), limit the number of multiple gestations related to assisted reproductive technology, treat mothers who are expected to deliver prior to 30 weeks gestation with magnesium sulfate for fetal neuroprotection that can prevent cerebral palsy, give antenatal steroids for mothers expected to deliver prematurely, caffeine for extremely low-birth-weight neonates, and induce hypothermia for a subgroup of neonates diagnosed with intrapartum hypoxic-ischemic encephalopathy [46]. Hypothermia, either selectively applied to the head or total body, appears to decrease the risk of cerebral palsy [47]. Interventions which either prolong gestation or decrease the risk of preterm delivery will also decrease the risk

Although 50% of very preterm children has neurodevelopmental impairments, an early prediction of infants who will experience problems later in life still remains an early diagnostic challenge. White matter abnormalities (WMA) at term have been associated with CP in very preterm children and can be used as a biomarker for early multidisciplinary approach. Very preterm children with any WMA at term require follow-up throughout childhood [48]. Abnormal general movements in very preterm infants born <30 weeks gestation, particularly at 3 months post term, are predictive of worse neurodevelopment at ages 2 and 4 years and need multidisciplinary approach. The accuracy for predicting moderate to severe cognitive impairment was good at 83% and 77% for 2 and 4 years, respectively [49].

Recent research on neuroplasticity supports intensive, repetitive, task-specific intervention for CP that should commence early while the brain is most plastic. Early postnatal recognition is important for a prompt referral to diagnostic-specific early intervention setting to optimize infant's motor and cognitive plasticity, pre-

Beside traditional conventional therapies, physical therapy, occupational therapy, and speech-language therapy, a number of other approaches have been used such as the use of Botox, selective dorsal rhizotomy, functional vision assessment and intervention programs, developmental optometry, biofeedback, hippotherapy, hyperbaric oxygen therapy, deep brain stimulation for dyskinetic forms of cerebral palsy, stem cell applications, and even yoga. It is very difficult to decide which method is "gold standard" type of therapy for CP because it is impossible to conduct

vent secondary complications, and enhance caregiver's well-being [50].

reliable biomarker.

Neurodevelopment and Neurodevelopmental Disorder

tion of Rawlinson et al. [45].

of cerebral palsy.

64

In general children with CP have epileptic seizures in about one-third that occur as a rule within the first 2 years of life. The most common seizure type is focal generalized seizures followed by focal, infantile spasms, and myoclonic seizures that are seen in one-fourth of cases. Seizures are most often seen in spastic hemiplegia and spastic quadriplegia. Children with CP and mental retardation have an early onset of seizures and more severe epilepsy. The response to antiseizure treatment in children with CP is generally difficult, and one-third to half of the cases is receiving polytherapy and/or alternative therapies.
