Treatment of cerebral palsy and epilepsy

Children with epilepsy who also have an intellectual disability or mental handicap (a term preferred over the older term, "mental retardation") or cerebral palsy present a wider range of problems than children who have uncomplicated epilepsy. Children with mental handicaps have below-average intellectual ability and are often impaired in their ability to understand, communicate, solve problems, and function in social settings. Children with cerebral palsy have muscle weakness, difficulty standing or walking, or postural problems. Their intelligence may range from average to below average. Intellectual disability and cerebral palsy can also be associated with vision, hearing, and speech problems and possibly some physical deformity or emotional disturbance. Management of children with epilepsy and mental handicap or cerebral palsy requires the combined effort of doctors, therapists, education specialists, and parents.
Treatment of children with cerebral palsy and epilepsy varies according to their age, the severity of their symptoms, and the type of cerebral palsy. Common steps include:
corrective lenses
orthotics, braces, or corrective surgery for affected limbs
injections of tiny doses of botulin toxin to relieve spasticity and treat movement disorders
medications to reduce spastic tension in muscles
speech therapy
physical and occupational therapy
psychological counseling to assist with adjustment issues
referrals to appropriate resources, including a neuropsychologist for development of an individualized educational plan (IEP)
Comprehensive child development clinics (centers for neuromuscular and developmental disorders) can help with many parts of this treatment. They can identify, assess, and diagnose children's general health conditions; identify emotional and learning problems; refer children with particular problems to specialists; provide instruction and counseling for parents; serve as a source of referrals to other programs; and provide physical, occupational, and speech therapy.
Exercise is an essential part of the therapy for children with cerebral palsy. Babies who are developing normally are seldom still; their arms and legs are in almost continuous motion. As they roll, crawl, get into and out of sitting positions, and reach for objects and manipulate them, they are exercising without making a conscious effort. For babies with cerebral palsy, this kind of healthy, spontaneous exercise is more challenging. Some may be capable of only a few movements, so these babies are often relatively inactive. But children with cerebral palsy must have exercise. Movement through all ranges of motion can prevent contractures or joint limitations and help the child's body maintain its potential. Weight-bearing exercises can prevent bone loss. And the input from exercise is an important building block for the future development of motor and cognitive skills.
The parents of a child with epilepsy and cerebral palsy must make sure the child gets enough exercise. If the child is passive and content to lie back and watch the world go by, the parents need to encourage activity.
For young children with cerebral palsy, one of the best ways to do this is through the roughhouse play that other children instinctively make a part of their regular exercise. The touch and movement that are so much a part of this type of play are essential to the development of normal systems of touch, balance, and the sense of head and body position. A child can enjoy roughhousing if the parents keep in mind the principles of good handling and pay attention to the child's body. For example, if rapid movements such as playfully raising and lowering make the child stiff, it is better to try a slower activity involving some trunk rotation and leg separation, which should decrease the child's muscle tone (the firmness and consistency of muscles at rest and with movement) and thus reduce the child's stiffness. A good alternative might be the merry-go-round, in which the parent holds the child face-to-face with the child's legs straddling the parent's waist and twirls around. In general, children with increased muscle tone (stiff or rigid muscles) respond better to a slow pace and those with low muscle tone, who are floppy or hypotonic, generally respond well to fast movements.
Ideally, much of the child's exercise should come from the daily routine of such activities as diapering, dressing, and feeding. Two general guidelines in accomplishing this goal are:
Place objects far enough away that the child needs to reach for them or crawl to them.
Encourage the child to do all the physical activities he or she is capable of, even if it sometimes seems easier for someone else to do them.
The child's occupational and physical therapists can provide additional tips on increasing the exercise that the child gets in the daily routine.
Some parents of children with epilepsy and cerebral palsy also enroll the child in formal physical fitness programs. Gym classes, movement experiences, Special Olympics, and other programs for young children are blossoming, and many are quite receptive to children with special needs. It is not absolutely essential to find a program with a staff trained in dealing with these children, although the instructor should be helpful and cooperative. Generally, it will be up to the parent to apply the correct principles to reduce or increase muscle tone and encourage normal movement. The physical or occupational therapist can tell parents whether the child might benefit from any program being considered.

As the child grows older, it becomes increasingly important for the exercise routine to include outdoor activities. Walks with the child in a stroller or in a carrier on the parent's back provide fresh air and opportunities for learning about the world outside the house. For some children, just lying or sitting on the grass while parents do yard work can be a special event. Outdoor smells, sights, and sounds all stimulate the child's developing sensory system. With proper precautions, the child may also enjoy riding on the back of the parent's bicycle. Parents may have to be creative in thinking of outdoor play activities that are within the child's abilities, but because playing outdoors is the most enjoyable form of exercise for many children, the more activities parents can come up with, the better. For example, horseback riding can provide both good physical therapy and fun for children with cerebral palsy. As with many other aspects of raising a child with cerebral palsy, much trial and error is involved in finding enjoyable exercises that are right for the child.