The potential metabolic consequences of cerebral palsy: inferences from the general population and persons with spinal cord injury

Abstract

The metabolic consequences of cerebral palsy (CP) have not been reported. The observations and suggestions presented in this article are based on our current knowledge of physiology in the general population and on information on the known metabolic consequences of disability in persons with spinal cord injury. Because of pain, fatigue, and other secondary consequences of CP, adolescents with CP who are ambulatory may become less physically active with age. This phenomenon would be expected to be associated with deconditioning and adverse changes in body composition including atrophy of muscles and an absolute or relative increase in adiposity. Insulin resistance, hyperinsulinemia, and associated adverse metabolic changes may develop. In an unfavorable metabolic milieu, the ability of the pancreas to compensate for mild elevations of circulating glucose may diminish. The combination of reduced fitness and conventional risk factors for cardiovascular disease would be expected to increase the risk for coronary heart disease (CHD); however, there has been no assessment of the risk factors for CHD in adults with CP. Once subgroups with modifiable risk factors for cardiovascular disease have been identified, risk factors for CHD should be aggressively treated, according to current standards of care.

Intramuscular fat in ambulant young adults with bilateral spastic cerebral palsy

“…This study demonstrates that these muscles also have greater levels of intramuscular fat that is independent of subcutaneous fat levels. This combination of morphological and compositional changes may have implications both for the mechanical performance of these skeletal muscles and also for the predisposition of the adult with BSCP to cardio-metabolic disease [20]. …”

“…Greater intramuscular fat content in BSCP may expose these individuals to a greater risk of developing cardio-metabolic disease [20]. There is a strong relationship between intramuscular fat content, insulin resistance and type-II diabetes [15,35,36].…”

“…In an MRI study of the lower limbs in children with quadriplegic cerebral palsy (Gross Motor Function Classification System (GMFCS) levels III-V), Johnson et al [18] found increased levels of intermuscular and subcutaneous fat [18]. To date, there have been no studies of intramuscular fat in adults or children with BSCP even though this non-invasively quantified parameter appears to be one of those most associated with cardio-metabolic disease [20]. …”

Secondary muscle pathology and metabolic dysregulation in adults with cerebral palsy

“…Along with the hallmark motor impairments, pronounced sedentary behavior and fitness deficits that occur in CP (60) have prompted a comparison model of disability related to spinal cord injury (6), a population with significant muscle atrophy, increased adiposity, insulin resistance (IR), hyperlipidemia, and elevated prevalence of type 2 diabetes (7). However, individuals with CP have the added risk of secondary muscle pathology and metabolic dysregulation from birth.…”

Pedaleo de brazos en personas con lesión medular, parálisis cerebral o ataxia cerebelosa: Parámetros fisiológicos. [Armcrank pedaling in persons with spinal cord injury, cerebral palsy or cerebellar ataxia: Physiological parameters].

“…Estas limitaciones en la actividad vienen determinadas por la movilidad reducida y la postura adquirida (Jahnsen, Villien, Egeland, Stanghelle y Holm, 2004;Thorpe, 2009;Mutch, Alberman, Hagberg, Kodama y Perat, 1992). El paso del tiempo acentúa el deterioro de su condición física y también es frecuente el dolor crónico, la fatiga o la deformación de las articulaciones, incluso la mortalidad prematura, asociada al sedentarismo (Murphy, Molnar y Lankasky, 1995;Engel, Schwartz, Jensen y Johnson, 2000;Peterson y col., 2013 b;Bauman, 2009). Sin duda, la práctica regular de AF resultará determinante para mantener o mejorar su calidad de vida (Erikssen y col., 1998;Taylor, Dodd y Larkin, 2004;Bauman, 2009;Peterson, Gordon y Hurvitz, 2013 a).…”