Practice Parameter: Diagnostic assessment of the child with cerebral palsy [RETIRED]

Abstract

Abstract-Objective:The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter the authors reviewed available evidence on the assessment of a child suspected of having cerebral palsy (CP), a nonprogressive disorder of posture or movement due to a lesion of the developing brain. Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification. Results: CP is a common problem, occurring in about 2 to 2.5 per 1,000 live births. In order to establish that a brain abnormality exists in children with CP that may, in turn, suggest an etiology and prognosis, neuroimaging is recommended with MRI preferred to CT (Level A). Metabolic and genetic studies should not be routinely obtained in the evaluation of the child with CP (Level B). If the clinical history or findings on neuroimaging do not determine a specific structural abnormality or if there are additional and atypical features in the history or clinical examination, metabolic and genetic testing should be considered (Level C). Detection of a brain malformation in a child with CP warrants consideration of an underlying genetic or metabolic etiology. Because the incidence of cerebral infarction is high in children with hemiplegic CP, diagnostic testing for coagulation disorders should be considered (Level B). However, there is insufficient evidence at present to be precise as to what studies should be ordered. An EEG is not recommended unless there are features suggestive of epilepsy or a specific epileptic syndrome (Level A). Because children with CP may have associated deficits of mental retardation, ophthalmologic and hearing impairments, speech and language disorders, and oral-motor dysfunction, screening for these conditions should be part of the initial assessment (Level A). Conclusions: Neuroimaging results in children with CP are commonly abnormal and may help determine the etiology. Screening for associated conditions is warranted as part of the initial evaluation. NEUROLOGY 2004;62:851-863 Cerebral palsy (CP) can be defined as a disorder of aberrant control of movement and posture, appearing early in life secondary to a CNS lesion or dysfunction that is not the result of a recognized progressive or degenerative brain disease.1 The brain abnormality may occur pre-, peri-, or postnatally. The diagnosis of CP always involves a motor deficit and the usual presenting complaint for which medical evaluation is sought is that the child is not reaching motor milestones at the appropriate chronological age. In most

Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998

“…The decrease in prevalence of bilateral spastic CP may be explained by improvements in neonatal care, but there is no obvious reason for the increase in unilateral spastic CP. Neuro-imaging studies [10,11]suggest that slightly different patterns of brain abnormalities are observed in unilateral and bilateral spastic CP. Thus, it might be possible that prevention has affected the two subtypes differently.…”

“…As the number and severity of impairments increase with increasing gestational age [6,7] and birthweight, [8] the type of brain lesion among term or NBW children tends to exhibit a different pattern to that of preterm or low birthweight births. [9][10][11] Time trends for CP prevalence in NBW children vary across studies. [12,13] Most of them reported stable prevalence rates from the 1970s to the 1990s.…”

Comorbidities and clinical determinants of outcome in children with spastic quadriplegic cerebral palsy

“…4 While studies exist looking at comorbidities in children with CP, few exist looking specifically at children with the SQ subtype. This is of particular relevance given that the recent American Academy of Neurology practice guidelines 5 recommends that all children with CP undergo screening for mental retardation,* ophthalmological and hearing impairments, speech and language disorders, and oral-motor dysfunction.…”

Efectos de las terapias ecuestres en personas con parálisis cerebral

“…Los niños con mejor CI se agrupan en aquellos con mejor funcionalidad motora o más bien aquellos niños con mejor funcionalidad motora tienen mejor CI. Por otro lado, los niños con PC tetraparética tienen un grado de compromiso intelectual mayor que los niños con hemiplejia (Paneth y Stark, 1983;Murphy et al, 1998;Beckung y Hagberg, 2002;Ashwal, S. et al, 2004). Así se resume que aquellos niños con menor afectación motora presentan a su vez un mayor CI.…”