Hypertonia in babies is a medical condition where excessive muscle tone causes muscle stiffness, leading to difficulty in limb movement. Usually, the central nervous system (CNS) regulates muscle tone by sending signals from the brain to the nerves in the muscles. If certain regions of the brain or spinal cord (the CNS) that control muscles tones are damaged, they cause hypertonia.
Some babies can have transient hypertonia that resolves in a short time, while a few may have persistent hypertonia that may stay for a lifetime. Hypertonia has less occurrence in babies than hypotonia (floppy baby syndrome).
Read on as we give you a brief overview of the causes, signs, risk factors, and treatment for hypertonia in babies.
Causes Of Hypertonia In Babies
Muscle tone is a muscle’s resistance to stretch. The muscle tone is regulated by the central nervous system (the brain, spinal cord, and nerves) through nerve signals that contract and relax the muscle. In hypertonia, the nerve pathways that control the muscle are disrupted due to damage to the central nervous system (CNS).
The following conditions and factors may lead to CNS damage (1).
- Brain tumors
- Head injuries
- Neurodevelopmental anomalies, such as cerebral palsy
- Neurodegenerative diseases
Babies who develop hypertonia after a fall or blow to the head should be taken to emergency care. Some of these conditions may also cause hypotonia (low muscle tone) or floppy baby syndrome. Consult a doctor to determine the precise underlying cause.
Signs And Symptoms Of Hypertonia
Hypertonia signs and symptoms may vary depending on the severity of the damage and the part of the brain or spinal cord affected. Some babies may have high muscle tone on both sides of the body, while a few may have it on one side.
Common signs and symptoms seen in hypertonia in babies include the following (2).
- Reduced range of motion
- Stiff or rigid muscles
- Body deformity
- Awkward muscle contractions
- Frozen or fixed joints
- Unable to walk or stand as peers
- Involuntarily crossing of the legs
According to the affected area of the brain, hypertonia can be spastic or rigid. Spasticity causes higher reflex responses and increased muscle spasms. Rigidity causes excessive stiffness of the muscles.
Diagnosis Of Hypertonia
History of symptoms and physical examination can be enough to identify the presence of hypertonia in babies. Additional tests, such as blood test, CSF analysis, and imaging tests (MRI scans), are ordered to look for brain anomalies (1).
Blood tests and CSF analysis help identify infections and determine neurotransmitter levels. Specific tumor markers and toxins can also be determined from blood tests. Neuroimaging helps visualize structural anomalies and intracranial hemorrhages that often occur after head injuries.
Treatment For Hypertonia In Babies
- Baclofen, a muscle relaxer and an antispasmodic drug, is prescribed as a first-line treatment for babies with brain anomalies.
- Benzodiazepines, such as diazepam, are also used in initial treatment for hypertonia due to brain problems.
- Vitamins are often prescribed for babies with seizures.
- Levodopa, a type of amino acid, is given to babies with CNS-related causes but with no abnormalities seen in neuroimaging tests.
- Carbamazepine and phenytoin are prescribed for peripheral nervous system-related causes of hypertonia.
- Botox (botulinum toxin) injections could be given to relax hypertonic muscles.
- Physiotherapy could be conducted, often in conjunction with other treatments, to improve muscle tone.
If hypertonia is a result of another condition, it could also be treated simultaneously.
Prognosis Of Hypertonia In Babies
The outcome may vary based on the severity of hypertonia and the underlying cause. Hypertonia with cerebral palsy may often stay without change over a lifetime. In some cases, the hypertonia may worsen as the underlying condition worsens over time (4).
Mild hypertonia may cause no effect as the baby grows older. In contrast, moderate hypertonia may increase the risk of abnormal joint contractions, which increase the risk of falls. Severe hypertonia could increase the risk of several complications, such as fractures, bedsores, infections, and severe immobility.
Frequently Asked Questions
1. Do babies outgrow hypertonia?
No, babies will not outgrow hypertonia. It is a lifelong condition that needs long-term treatment, which can help the child feel better (5).
2. Is hypertonia always with cerebral palsy?
No. Apart from cerebral palsy, hypertonia may also be related to other conditions such as multiple sclerosis or Parkinson’s disease (5).
Hypertonia in babies is characterized by excessive muscle stiffness leading to problems with movement. It can be caused by problems with the central nervous system due to tumors, injuries, blows, trauma, and some diseases. Hypertonia can be unilateral or bilateral, and the symptoms and severity may depend on the area of the brain involved. The doctor may diagnose the condition with a physical examination, blood tests, and imaging tests. Physical and occupational therapy over a prolonged period can improve the condition and help them perform activities like their peers.
Infographic: Maternal And Fetal Events Leading To Neonatal Hypertonia
Various maternal and fetal risk factors may be involved in accelerating the occurrence of hypertonia in babies. The infographic below helps you identify such risk factors so that you may take timely precautions.
- Excessive muscle tone causing stiffness of the limbs is termed hypertonia.
- Some babies can have transitory or short-lived hypertonia, whereas others may have permanent hypertonia.
- Disruption of the nerve pathways that control the muscles due to damage to the central nervous system (CNS) is its main cause.
- Prompt diagnosis is essential to determine the precise cause and initiate the treatment to manage the condition.
2. Hypertonia; Physio UK
3. Hypertonia; Intermountain Healthcare
4. Hypertonia; Child Neurology Foundation
5. Hypertonia in Babies; Cleveland Clinic