Causes and Ethics

Most of the current research on Cerebral Palsy is devoted to finding causes so that better treatments can be obtained. Oftentimes, when the search for answers is elusive for so long, people look for someone to blame, even though "regardless of proper surveillance and new insights, in most cases of CP, there will be nothing or nobody to blame" (3). With more recent findings it appears that just as CP is not a disease with a single definition, there is no single cure for it. The issues surrounding cause are multi-layered and increasingly more complicated, and a "causal pathway for CP rather than a single event" (5) is currently favored.

The risk factors correlated with CP are:

• Low birthweight or premature babies
• Infection during pregnancy
• Complications in labor or delivery (such as oxygen deprivation)
• Near miscarriages

Yet, these risk factors are only part of the story. There now appears to be a genetic link to CP along with other molecular and brain based explanations.

A purely genetic reason for developing CP only occurs in about 2% of all patients, but genetic studies are valuable because "they offer a unique insight into both the causes of the disease and the development of specific neuronal pathways"(4). Once pathways are deduced, the ability to develop treatment and prevention options is greatly expanded.

Genetic predisposition to CP is a prenatal (as opposed to perinatal) condition and results in the spastic form of CP. Chromosome 2q24-25 carries an autosomal recessive gene that is involved with CP. The gene is thought to encode either a voltage-gated sodium channel that is specific to the brain or an enzyme that helps produce an inhibitory neurotransmitter (4). It is possible that some of the above risk factors may induce mutations in this CP gene, making the role of genetics more involved in CP than previously imagined.

CP is a cross-cultural problem, and another way to try and determine causes for it is to look at Epidemiological Studies.

One such study from Italy is useful in determining why the rates of CP increased in 1970 to 1980, which can further elucidate possible general causes for CP. Interestingly, during this same period of increased CP, neonatal care units were being heavily established (6).This seems to be a contradiction, but most likely just means that better care meant less newborns were dying (more were living with CP). However, this study does show that there is a correlation between the types of CP developed and perinatal or prenatal associated factors. Dyskinetic CP was the only type that decreased during the 1970-1980 period, suggesting that perinatal factors are particularly important for this kind of CP, and providing better neonatal care may reduce the risks associated with the dyskinetic CP.