What causes cerebral palsy?

What causes neurodisabilities such as cerebral palsy? This is one of the most challenging questions facing affected families and the health professionals who advise and care for people with these disparate conditions.

Traditionally, we believed that if a mother had a “difficult” delivery and a newborn adapted poorly to postnatal life and was subsequently found to have cerebral palsy, these events were causally linked. The cerebral palsy was intuitively connected to adverse preceding events, and doctors and other health professionals were easily blamed for poor care that supposedly led to the poor outcome. As perinatal medicine advanced with the aid of new technologies such as prenatal imaging,1 we have realised that impairments in brain development, structure, and function very often precede adverse perinatal or postnatal events, and may even “cause” them.

The original work by Tollånes and colleagues (doi:10.1136/bmj.g4294) takes advantage of a remarkable resource—the Medical Birth Registry of Norway, with its links to the Norwegian social insurance scheme—to explore the risk of recurrence (and perhaps heritability) of cerebral palsy in a cohort of more than two million Norwegians …