What Is Spastic Diplegia?

The term “spastic diplegic cerebral palsy” can be understood by looking at each word individually:

• Spastic/spasticity: describes increased muscle tone (hypertonia) and resultant spasms (stiff, jerky movements)
• Diplegic/diplegia: describes the limbs involved, specifically the lower limbs.
• Cerebral: to do with the brain; referring to the brain damage or abnormality underlying this condition.
• Palsy: refers to muscle weakness or paralysis.

Although the signs and symptoms of spastic diplegia overlap with other forms of cerebral palsy, the following characteristics are especially common with this subtype:

• Stiff or tight leg muscles
• Exaggerated reflexes in the legs
• Walking on toes
• “Scissor gait”

As with other forms of cerebral palsy, spastic diplegia is caused by brain abnormalities or damage. In many cases, it stems from brain damage that occurs during or around the time of birth, i.e. a birth injury. Birth injuries do not necessarily have to involve blunt force trauma; rather, the term refers to many different sorts of harm to a baby around the time of birth, including issues like oxygen deprivation and infection. The following are some examples of medical issues and birth injuries that are associated with spastic diplegia (2, 3):

• Preterm delivery (premature babies often have a low birth weight and fragile/easily-injured brains)
• Twin/multiples birth
• Low Apgar score
• Birth asphyxia (oxygen deprivation), which can lead to a form of brain damage known as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy
• Maternal infections
• Rh incompatibility
• Preeclampsia
• Abnormal fetal presentation (e.g. breech)
• Newborn jaundice

Unfortunately, these issues are often related to medical malpractice (either because they are caused by negligent actions, or because medical professionals fail to respond appropriately when complications arise). If this is the case, parents can consider pursuing a birth injury lawsuit.

Spastic diplegia tends to primarily affect the lower limbs. However, more severe cases can involve impairment of the upper limbs and other complications. Although the manifestations of this condition vary widely between individuals, signs and symptoms of spastic diplegic cerebral palsy may include (2, 4):

• Muscular stiffness (hypertonia)
• Muscular weakness/atrophy
• Delayed developmental milestones
• Scissor walking
• Toe walking
• Spastic movements or gestures
• Unsteady movement and poor balance
• Seizures
• Sensory loss
• Crossed eyes (strabismus)
• Intellectual disability

While newborns who experienced a birth injury (HIE, infection, brain hemorrhage, etc.) are often classified as “high-risk” for cerebral palsy, a formal diagnosis may take months or years. This is because the signs and symptoms may not be very apparent until the child begins to miss developmental milestones. (Click here for more information on how cerebral palsy is diagnosed.)

Spastic diplegic cerebral palsy must be distinguished from other conditions that cause spasticity, including neurodegenerative disorders.

The appropriate treatments will vary based on the child’s individual signs and symptoms. Among other things, treatment for spastic diplegia may include (2, 4, 5):

• Physical therapy (PT)
• Occupational therapy (OT)
• Orthotic devices/orthoses
• Medications such as botulinum toxin (Botox) and Baclofen.
• Orthopedic surgery (such as a selective dorsal rhizotomy, or SDR)
• Recreational therapy

In addition to these treatment options, children with spastic diplegia may benefit from mobility equipment and other forms of assistive technology.

For more information on treatment and therapy options for children with cerebral palsy, please click here.