United States Report



Is the US losing its place as a global leader in medical research?

 



Once the undisputed centre of global innovation in medicine, the US is steadily losing ground to Asia and Europe and will, if trends continue, relinquish its leadership in the coming decade. Middle East Health reports

A study published last year in the Journal of the American Medical Association looked at medical research activity from 1994 to 2014 in the US, Europe, Asia, Canada, and Australia, compiling data on funding by public and private sources, the creation of intellectual property, and the size of the medical and scientific workforce. It found that US spending on medical research grew at an average annual rate of 6% between 1994 and 2004. This pace fell sharply in the following decade, where the annual rate of growth decreased to 0.6%, falling behind the pace of inflation. With the exception of the temporary increases brought about by federal stimulus spending in 2009 and 2010, the last five years have seen a decrease in research funding when adjusted for inflation. Overall, medical R&D funding has declined in real terms by 13% since 2004.

“US medical research remains the primary global source of new discoveries, drugs, medical devices, and clinical procedures,” said University of Rochester neurologist Ray Dorsey, M.D., M.B.A., a co-author
of the study. “However, a decade of unprecedented growth in research activity has been followed by a decade of steady decline which now leaves open the possibility that other
nations could assume
global leadership given
their increasing investment in biomedical research.”

Research funding, particularly by the private sector, has also shifted to later stages of development and away from basic science. Guided primarily by the desire to realize short-term economic benefits, the share of spending by pharmaceutical, bio-technology, and medical device companies on phase 3 clinical trials – large studies in people that often represent the final step before regulatory approval – grew by 36% between 2004 and 2012. Industry spending is also now the largest component of US medical R&D, increasing from 46% in 2004 to 58% in 2012.

The move away from investing in early stage research has significant long-term implications, according to the authors. They point out that new knowledge often takes from 15 to 25 years to move from the discovery made in the lab to its clinical application in people. With the private sector moving more resources to late-stage research, this leaves the shrinking resources provided by the federal government and often very small companies as the primary sources of funding for early-stage, high-risk research.

The authors also found that the allocation of research resources does not reflect the burden of disease on society. Diseases that represent more than 80% of all US deaths receive less than half of the funding from the National Institutes of Health. The portion of total funding for cancer and HIV/AIDS research in particular are well above the levels that these diseases inflict in terms of death and disability. The amount of money spent by the pharmaceutical industry on finding treatments for rare diseases is also high, driven primarily by the lower barriers to market set forth in the Orphan Drug Act of 1983.

Medical research has become an increasingly global endeavour and investments by other countries, particularly in Asia, are eroding US leadership. In 2004, US medical R&D spending represented 57% of the global total. By 2014, the US share had fallen to 44% with Asia – led by China, Japan, South Korea, India, and Singapore – rapidly making up ground and increasing investment by 9.4% per year. If current trends continue, the US will be overtaken by China as the global leader in medical R&D in the next ten years. China has already surpassed the US in terms of the size of its science and technology workforce and global share of patents for medical technologies, and is closing the gap in published biomedical research articles.

The authors point to the low levels of research funding in the field of health services as an area in particular need of remedy. Health services – which study topics such as access to care, cost, quality of care, and efforts to promote well-being – represent only 0.3% of US research expenditures.

“The low levels of investment in health services research represent a missed opportunity to improve many aspects of health, especially the burden of chronic illness, aging populations, and the need for more effective ways to deliver care,” said Dorsey.

Reversing the trend

The trends are reversible, the authors note. However, given the political environment in Washington and the pressures by shareholders on industry for short-term returns, new sources of revenue will need to be identified. They recommend several possible options, including providing tax incentives that will allow medical and pharmaceutical companies to reinvest profits held overseas in research in the US, a commitment by insurance companies and the health care sector to invest more money in health services research, and government- backed research bonds and trusts similar to those employed in the United Kingdom, Australia, and Canada.

“Clearly the pace of scientific discovery has outstripped the capacity of current financial and organizational models to support the opportunities afforded,” said University of Rochester neurology resident Benjamin George, M.D., M.P.H., a co-author of the study. “This analysis underscores the need for the US to find new sources to support biomedical and health services research if we wish to remain the world’s leader in medical innovation."

Medical research funding

Medical research funding in the US comes from government and the private sector.

US federal funding

The National Institutes of Health (NIH) is the agency that is responsible for management of most of the federal or government funding of biomedical research. Over the past century there were two notable periods of NIH support. From 1995 to 1996 funding increased from $8.877 billion to $9.366 billion, years which represented the start of what is considered the “doubling period” of rapid NIH support. The second notable period started in 1997 and ended in 2010, a period where the NIH moved to organize research spending for engagement with the scientific community. In 1997 Applications were added and in 2000 Awards had been added. These changes were coupled with increasing support; funding rose from $13 billion in 1997 to approximately $27 billion in 2010. In recent years, the NIH has started to publish medical research trials Success Rates per dollar spent, an initiative which illustrates that research efficiency is viewed as a significant issue both by the public and policy makers.

Privately funded medical research

Since 1980 the share of biomedical research funding from industry sources has grown from 32% to 62%, which has resulted in the development of numerous life-saving medical advances. The relationship between industry and governmentfunded research in the US has seen great movement over the years. The 1980 Bayh Dole Act was passed by the US Congress to foster a more constructive relationship between the collaboration of government and industry funded biomedical research. The Bayh Doyle Act gave private corporations the option of applying for government funded grants for biomedical research which in turn allowed the private corporations to license the technology. Both government and industry research funding increased rapidly from between the years of 1994–2003.

The funding from industry for pharmaceutical research, a large part of all industry funded research, has slowed since 1994 due to multiple perceptions, lower approval rates from the FDA, increased costs with clinical trials due to more stringent regulation and longer anticipation for return on investment. A 2004 study showed that to bring a drug to market, drug development requires an average of 12–15 years and can reach costs up to $1.7 billion.


A wealth of medical research

Although the growth rate of funding for medical research in the US is declining, there is still a tremendous volume of research being carried out in biomedical laboratories across the United States. Each day there are dozens of media releases about newly published medical research issued from medical research facilitities, the National Institutes of Health and private sector laboratories, which is testament to the continual discovery and innovation that is taking place in medical research in the United States. Following is a small sample of some of this breakthrough research that has been published recently.

Penn researchers identify cause of insulin resistance in Type 2 diabetics

Understanding the cause of insulin resistance is critical to tackling this chronic disease. A new link between high levels of certain amino acids and type 2 diabetes was found by a team led by researchers from the Perelman School of Medicine at the University of Pennsylvania, using mouse and human muscle and blood samples to evaluate the mechanisms that lead to insulin resistance.

For people with type 2 diabetes, the problem of insulin resistance means there is plenty of insulin but the body does not respond to it effectively. While most people associate this resistance with sugar levels in the blood, diabetes is also a problem with excess fat, especially too much fat inside skeletal muscle, which leads to the insulin resistance. If the level of fat in muscles can be reduced then, theoretically, insulin resistance can be prevented, surmise investigators.

“This research sought to answer a few large questions,” said senior author Zoltan Arany, MD, PhD, an associate professor of Cardiovascular Medicine. “How does fat get into skeletal muscle? And how is the elevation of certain amino acids in people with diabetes related to insulin resistance? We have appreciated for over ten years that diabetes is accompanied by elevations in the blood of branched-chain amino acids, which humans can only obtain in their diet.

However, we didn’t understand how this could cause insulin resistance and diabetes. How is elevated blood sugar related to these amino acids?”

The team found that a byproduct compound from the breakdown of these amino acids, called 3-HIB, is secreted from muscle cells and activates cells in the vascular wall to transport more fat into skeletal muscle tissue. This leads to fat accumulation in the muscle, in turn leading to insulin resistance in mice. Conversely, inhibiting the synthesis of 3-HIB in muscle cells blocked the uptake of fat in muscle.

“In this study we showed a new mechanism to explain how 3-HIB, by regulating the transport of fatty acids in and out of muscle, links the breakdown of branchedchain amino acids with fatty acid accumulation, showing how increased amino acid flux can cause diabetes,” Arany said.

While most of this research was conducted using mouse cells, the team also found that 3-HIB, the byproduct molecule, was elevated in people with type 2 diabetes. Because of this, Arany and colleagues say that more studies are needed to fully examine the nature of this mechanism among people with type 2 diabetes.

“The discovery of this novel pathway – the way the body breaks down these amino acids that drives more fat into the muscles – opens new avenues for future research on insulin resistance, and introduces a conceptually entirely new way to target treatment for diabetes” Arany said.

NIH investigates potential use of photon-counting CT

The Clinical Center at the National Institutes of Health (NIH) is investigating the potential use of a new generation of a computerized tomography (CT) scanner, called a photon-counting detector CT scanner, in a clinical setting. The prototype technology is expected to replicate the image quality of conventional CT scanning, but may also provide health care specialists with an enhanced look inside the body through multi-energy imaging.

Over the next five years, David Bluemke, M.D., Ph.D., chief of the Department of Radiology and Imaging Sciences, and his team will continue to develop scan protocols and image processing algorithms, which could improve screening, imaging, and treatment planning for health conditions like cancer and cardiovascular disease.

“The NIH Clinical Center has helped shape and share research advances and health care for decades. Now is an exciting time for us and for our study participants as we help test and develop this CT technology so that it may one day help patients around the world and impact the health care they receive,” said Dr Bluemke.

As the world’s largest hospital solely dedicated to research, the NIH Clinical Center sees thousands of patients every year, many of whom have rare and complicated illnesses. In collaboration with CT manufacturer, Siemens Healthcare, and researchers in the CT technology field, the Clinical Center is testing this technology to help the healthcare field optimize the scanner for clinical use across the US and around the world.

The Clinical Center is one of three sites in the world to use this technology and is the first hospital-based research setting of the device.

By advancing this technology, researchers aim to improve the diagnosis that doctors can offer by increasing the resolution and contrasts available for analysis. Areas of research investigation with the new technology include:

  • Doctors can identify materials in the body with anatomic precision. A dye, or contrast, is often given to a patient so that researchers can see a selected area in more detail. Different materials in the body can be displayed in different colours for faster diagnosis and precision.
  • The new technology may be used to help identify and characterize tumours, plaques or vessels that are smaller than half a millimetre. For many patients, finding a tumour that size may make a difference in identifying if it is benign or could be cancerous.
  • The technology may help to more accurately identify soft tissues such as proteins, tendons or collagen which are hard to differentiate with current equipment.

Doctors reconstruct new oesophagus

Writing in The Lancet, US doctors report the first case of a human patient whose severely damaged oesophagus was reconstructed using commercially available FDA approved stents and skin tissue. Seven years after the reconstruction and 4 years after the stents were removed, the patient continues to eat a normal diet and maintain his weight with no swallowing problems.

Until now, this regeneration technique has only been tested in animals. The authors, reporting on the outcome of the procedure, say that research, including animal studies and clinical trials, are now needed to investigate whether the technique can be reproduced and used in other similar cases.

Professor Kulwinder Dua from the Medical College of Wisconsin, Milwaukee, USA, and colleagues report using metal stents as a non-biological scaffold and a regenerative tissue matrix from donated human skin to rebuild a fullthickness 5cm defect in the oesophagus of a 24-year-old man. The patient was urgently admitted to hospital with a disrupted oesophagus resulting in lifethreatening infection and inability to swallow following complications from an earlier car accident which had left him partially paralysed. Despite several surgeries, the defect in the oesophagus was too large to repair.

The team hypothesised that if the three-dimensional shape of the oesophagus could be maintained in its natural environment for an extended period of time while stimulating regeneration using techniques previously validated in animals, oesophageal reconstruction may be possible.

They used commercially available, FDA-approved, materials to repair the defect. To maintain the shape of the oesophagus and bridge the large defect, they used an endoscope to place selfexpanding metal stents. The defect was then surgically covered with regenerative tissue matrix and sprayed with a plateletrich plasma gel produced from the patient’s own blood to deliver high concentrations of growth factors that not only stimulate growth but also attract stem cells to stimulate healing and regeneration. The sternocleidomastoid, a muscle running along the side of the neck, was placed over the matrix and the adhesive platelet-rich plasma gel.

The team planned on removing the stent 12 weeks after reconstruction, but the patient delayed the procedure for three and a half years because of fears of developing a narrowing or leakage in the oesophagus. One year after the stents were removed, endoscopic ultrasound images showed areas of fibrosis (scarring) and regeneration of all five layers of the oesophageal wall. Full recovery of functioning was also established by swallowing tests showing that oesophageal muscles were able to propel water and liquid along the oesophagus into the stomach in both upright and 45° sitting positions. But, how long the regeneration process took is unclear because the patient delayed stent removal for several years.

Researchers identify new predictive tool for assessing breast cancer risk

Harvard Stem Cell Institute (HSCI) researchers at Dana-Farber Cancer Institute (DFCI) and collaborators at Brigham and Women’s Hospital (BWH) have identified a molecular marker in normal breast tissue that can predict a woman’s risk for developing breast cancer, the leading cause of death in women with cancer worldwide.

The work, led by HSCI principal faculty member Kornelia Polyak and Rulla Tamimi of BWH, was published in the April 1 issue of Cancer Research.

The study builds on Polyak’s earlier research finding that women already identified as having a high risk of developing cancer – namely those with a mutation called BRCA1 or BRCA2 – or women who did not give birth before their 30s had a higher number of mammary gland progenitor cells.

In the latest study, Polyak, Tamimi, and their colleagues examined biopsies, some taken as many as four decades ago, from 302 participants in the Nurses’ Health Study and the Nurses’ Health Study II who had been diagnosed with benign breast disease. The researchers compared tissue from the 69 women who later developed cancer to the tissue from the 233 women who did not. They found that women were five times as likely to develop cancer if they had a higher percentage of Ki67, a molecular marker that identifies proliferating cells, in the cells that line the mammary ducts and milkproducing lobules. These cells, called the mammary epithelium, undergo drastic changes throughout a woman’s life, and the majority of breast cancers originate in these tissues.

Doctors already test breast tumours for Ki67 levels, which can inform decisions about treatment, but this is the first time scientists have been able to link Ki67 to precancerous tissue and use it as a predictive tool.

“Instead of only telling women that they don’t have cancer, we could test the biopsies and tell women if they were at high risk or low risk for developing breast cancer in the future,” said Polyak, a breast cancer researcher at Dana-Farber and co-senior author of the paper.

“Currently, we are not able to do a very good job at distinguishing women at high and low risk of breast cancer,” added cosenior author Tamimi, an associate professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School. “By identifying women at high risk of breast cancer, we can better develop individualized screening and also target risk reducing strategies.”

Screening for Ki67 levels would “be easy to apply in the current setting,” said Polyak, though the researchers first want to reproduce the results in an independent cohort of women.

Cornell researchers report blood-brain barrier breakthrough

Cornell researchers have discovered a way to penetrate the blood-brain barrier (BBB) that may soon permit delivery of drugs directly into the brain to treat disorders such as Alzheimer’s disease and chemotherapy-resistant cancers.

The BBB is a layer of endothelial cells that selectively allow entry of molecules needed for brain function, such as amino acids, oxygen, glucose and water, while keeping others out.

Cornell researchers report that an FDA-approved drug called Lexiscan activates receptors – called adenosine receptors – that are expressed on these BBB cells.

“We can open the BBB for a brief window of time, long enough to deliver therapies to the brain, but not too long so as to harm the brain. We hope in the future, this will be used to treat many types of neurological disorders,” said Margaret Bynoe, associate professor in the Department of Microbiology and Immunology in Cornell’s College of Veterinary Medicine. Bynoe is senior author of the study, which appears in The Journal of Clinical Investigation.

Bynoe’s team was able to deliver chemotherapy drugs into the brains of mice, as well as large molecules, like an antibody that binds to Alzheimer’s disease plaques, according to the paper.

The lab also engineered a BBB model using human primary brain endothelial cells. They observed that Lexiscan opened the engineered BBB in a manner similar to its actions in mice.

Because Lexiscan is an FDA-approved drug, “the potential for a breakthrough in drug delivery systems for diseases such as Alzheimer’s disease, Parkinson’s disease, autism, brain tumours and chemotherapy- resistant cancers is not far off”, Bynoe said.


Liver transplantation: A pathway to cure for paediatric metabolic disorders

An 8-year-old boy from Qatar with propionic acidemia (PA) was transferred in serious condition to Children’s Hospital of Pittsburgh of UPMC in the United States for evaluation and care. A team of specialists determined that his metabolic disease was causing his heart to fail, and liver transplant was identified as a solution. His mother, a viable candidate, stepped forward as a living donor, providing a segment of her liver to be transplanted into her son. Today, the mother’s liver function is fully recovered as her son continues to recuperate. His cardiac condition is significantly improved.

This example illustrates two significant developments with regard to liver transplantation – the ability for liver transplants to be used as a treatment for metabolic disorders, such as PA, and the growing impact of living donor transplants to help resolve critical medical situations in a timely fashion.

Liver transplants have been successfully performed in humans since the 1980s and were initially developed as a therapy for liver diseases that had a high risk of near-term mortality, such as biliary atresia, tumours, or acute liver failure.

Today, however, liver transplantation is finding an expanding role as treatment for a growing number of inborn metabolic diseases. Rather than viewing liver transplants exclusively as a life-saving procedure, it can now be seen as a “life-improving” therapy, providing a new pathway to health by dramatically reducing symptoms of primary disorders and, in some cases, even providing a complete cure. Concurrent with this is the greater reliance on and positive outcomes derived from transplanted liver tissue from living donors.

The use of tissue from living donors, in particular, helps achieve success in multiple ways, including: reduced wait times; more positive outcomes, which may be related to genetic matching from healthy living related donors; and providing an alternative to use of tissue from deceased donors, which are a scarce resource.

Metabolic conditions treated by liver transplant

Metabolic diseases are generally caused by a defect in a single or multiple genes that are supposed to instruct enzymes to convert one substance into another. Here, liver transplantation can help for disorders that are liver-specific as well as for systemic disorders, where liver replacement can result in sufficient metabolic support to normalize metabolism.

Known examples where liver transplants can provide a therapeutic option include methylmalonic acidemia (MMA), Maple Syrup Urine Disease (MSUD), urea cycle disorders (UCDs), Crigler-Najjar Syndrome, selected mitochondrial disease, alpha-1 antitrypsin disease, as well as PA. Additionally, certain glycogen storage diseases (GSD) and phenylketonuria (PKU) show potential for improvement through liver transplantation.

Many of these conditions can be medically managed, but they can have serious and sometimes fatal consequences if not treated. In some cases, medical management may be done through a very carefully controlled low-protein diet that includes special supplements required for the rest of the patient’s life. Such medical therapy can mean life-limiting compromises for the patient, including vigilant blood monitoring, dietary restrictions, travel limitations, and ongoing concerns that a misstep in therapeutic adherence may have dire health consequences.

With a history of paediatric liver transplants, spanning back to 1981, Children’s Hospital of Pittsburgh of UPMC has conducted more than 320 liver transplants for metabolic disease alone and more than 1,700 paediatric liver transplants in all, more than any other paediatric centre in the United States. Building on its experience with liver transplants for metabolic disorders, Children’s collaborated with the Clinic for Special Children in Strasburg, Pennsylvania, to create the first elective liver transplantation protocol for patients with MSUD in 2004, and has since conducted more than 65 transplants for MSUD patients with 100 percent graft and patient survival rates.

Conclusion

Today as the risks of liver transplant have decreased and post-operative outcomes have improved, the procedure has evolved into an attractive approach for improving life for patients with a growing number of metabolic diseases. The range of disorders suitable for this approach continues to evolve as the medical community, patients, and their families balance traditional medical management versus surgical intervention that may favourably impact their disease. And, while living-donor transplants can help overcome the ongoing demand shortfall for traditional cadaveric organs, their greater role may ultimately be in helping to provide better longterm outcomes for the patients who receive them.


Cancer care centre dedicated to excellence

Using a mix of modern technology, world renowned physicians, and the latest and greatest research, CHI St. Luke’s Health¬– Baylor St. Luke’s Medical Center (Baylor St. Luke’s) physicians treat cancer patients from more than 75 countries.

CHI St. Luke’s Health’s has a unique educational, clinical, and research alliance with Baylor College of Medicine – one of the nation’s top medical schools. Both institutions collaborate through their dedication to provide comprehensive care while creating healthier communities across the globe.

“When patients have a difficult medical illness or condition, this is where you come,” said Steven Curley, MD, Chief of Surgical Oncology at Baylor College of Medicine and Chief of Oncology at Baylor St. Luke’s. “Taking care of cancer patients is tough, but we’re willing and able to treat and perform aggressive surgeries that other facilities in the world can’t do.”

The unparalleled success and expertise of Baylor St. Luke’s physicians and Baylor College of Medicine’s Dan L. Duncan Comprehensive Cancer Center in the world renowned Texas Medical Center are backed by national recognition for cutting- edge cancer research and treatments. Baylor St. Luke’s is a recipient of the Outstanding Achievement Award for top performance in cancer, and is designated as a four-time ANCC Magnet® Designation for Nursing Excellence – the highest honour bestowed to a hospital for nursing.

Additionally, the Dan L. Duncan Comprehensive Cancer Center is designated as a Comprehensive Cancer Center by the National Cancer Institute – the highest possible designation in an elite class of 45 centres from around the country with programs that demonstrate significant clinical research and leading-edge treatments. The NCI-designation also includes a $14.5 million grant over the next five years, which enables Baylor College of Medicine to continue its cancer treatment research.

“We have the best clinical genetics program in the country, if not in the world,” Dr. Curley noted. “We perform – right here, in-house – advanced genetic testing with access to world-class researchers and clinicians who are seeking new opportunities for: medications, treatments for cancer patients, and clinical and immunotherapy trials. All of these groups have been recognized among the nation’s best in their respective fields, and they exist here.”

In addition to exceptional cancer care, patients with other conditions and illnesses besides cancer can be treated by renowned physicians at Baylor St. Luke’s.

“We have world-class physicians in noncancer areas as well,” Dr. Curley noted. “If our patients have other diseases, such as heart disease or neurological problems, we have physicians who can treat those illnesses. We provide care across a full spectrum of maladies.”

For more than 60 years, Baylor St. Luke’s has been home to the Texas Heart® Institute – one of the nation’s best programs for cardiology and heart surgery, and one of the world’s most renowned centres for cardiovascular diseases. The Texas Heart Institute’s world-wide legacy began with Denton A. Cooley, MD, who performed the nation’s first successful heart transplantation and implantation of the world’s first artificial heart in a human.

Baylor St. Luke’s is also named as one of the nation’s top 100 hospitals for neurosurgery and spinal care. Baylor St. Luke’s recently unveiled the design for its $1.1 billion medical campus, Baylor St. Luke’s McNair Campus, which will become home to the collaboration between Baylor College of Medicine and Catholic Health Initiatives, and the Texas Heart Institute. All clinical services currently provided at the Texas Medical Center location of Baylor St. Luke’s will be moved to the new campus. The Campus will feature a 650-bed hospital built across two bed towers, a medical office building and ambulatory care complex, and new facilities for basic science and translational research. Expected completion of hospital construction is early 2019.

“Physicians and scientists will work together on one integrated campus that creates a state-of-the-art infrastructure for advanced patient care, basic and translational science, and education,” said Wayne Keathley, President, Baylor St. Luke’s. “This establishes a unique and best-inclass environment unlike any other institution in the Texas Medical Center.”

For more information, contact CHI St Luke’s Health International Services at: international@stlukeshealth.org or call +1 832 355 3350 or visit StLukesInternational.org Texas Medical Center, Houston, Texas - USA

 


Cerebral palsy - the most common physical disability in children

Cerebral palsy (CP) is the name for a series of neurological disorders caused by abnormalities in parts of the brain that control muscle movement. It is the most common form of physical disability in childhood, being present in two of every 1,000 children. Symptoms can range from mild to severe both in physical and mental capacities. In mild cases a single limb may be affected. In more severe cases, all four limbs and almost all functional aspects of the child are affected. CP is usually caused by brain damage that occurs before or during a child’s birth, or during the first 3 to 5 years of a child’s life. The brain damage that leads to cerebral palsy can also lead to other health issues, including vision, hearing and speech problems and learning disabilities.

Cerebral palsy affects muscle control and coordination, so even simple movements – or standing still – are difficult. Other vital functions that also involve motor skills, such as breathing, bladder and bowel control, eating, and learning, also may be affected when a child has CP. Cerebral palsy does not get worse over time.

The causes of most cases of CP are unknown, but many are the result of problems during pregnancy. This can be due to infections, maternal health problems, a genetic disorder, or something that interfered with normal brain development. Problems during labour and delivery can cause CP, but this is the exception.

Premature babies – particularly those who weigh less than 3.3 pounds (1,510 grams) – have a higher risk of CP than babies that are carried full-term, as are other low-birth-weight babies and multiple births (twins, triplets, etc.). Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant, or being in a car accident while not properly restrained.

Associated medical problems

Children with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected. The brain damage that causes CP can also affect other brain functions, and can lead to further medical issues. Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration, gastroesophageal reflux, speech problems, drooling, tooth decay, sleep disorders, osteoporosis and behaviour problems.

Seizures, speech and communication problems, and mental retardation are more common among kids with the most severe forms of CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs.

Collaborative approach

Currently there’s no cure for cerebral palsy, but a variety of resources and therapies can provide help and improve the quality of life for kids with CP. Children with neuromuscular disabilities require the collaborative approach of a multidisciplinary team. Because cerebral palsy symptoms can vary from child to child, children with cerebral palsy need specialized care tailored to their own individual needs.

As soon as CP is diagnosed, patients should begin therapy for movement, learning, speech, hearing, and social and emotional development. Paediatric cerebral palsy treatment also may include medication, surgery or braces to help improve muscle function. Different kinds of therapy can help them achieve maximum potential in growth and development.

Orthopaedic surgery can help address deformities of hips, knees, feet and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump implanted under the skin.

A variety of medical specialists might be needed to treat the different medical onditions. If several medical specialists are needed, it’s important to have a primary care doctor or a CP specialist help you coordinate the care.


Nemours – Children’s Health System

Nemours is committed to improving the health of children. As a nonprofit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centred care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfils the promise of a healthier tomorrow for all children – even those who may
never enter our doors.

www.nemours.org

 

 Date of upload: 11th May 2016

 

                                  
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