What constitutes cerebral palsy in the twenty‐first century?

Abstract

AIM Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed.METHOD Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003), the Western Australian CP Register (1975Register ( -2008, and the Surveillance of CP in Europe (SCPE; 1976-1998). An expert panel used a consensus building technique, which utilized the SCPE 'decision tree' and the original 'What constitutes cerebral palsy?' paper as frameworks.RESULTS CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety-seven syndromes/disorders were reviewed and advice on their inclusion/ exclusion is provided. INTERPRETATIONWhat constitutes CP will continue to evolve as diagnostics improve.Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.Advances and changes in diagnostic modalities and medical technology since our 1998 publication 'What constitutes cerebral palsy?' 1 have led to requests to revise the paper. Since 1998 we have seen an increase in the number of CP surveillance programmes internationally and their desire for collaboration led to the first World CP Register Day in 2009.2 Inclusion/exclusion criteria in CP surveillance were key points discussed. It was acknowledged by participants that whilst each group must meet the specific needs of their own individual surveillance programme, it is advantageous to have consensus across programmes regarding core inclusion/exclusion criteria. Consensus in criteria provides opportunities to pool data across registers, increase power for research, monitor trends over time between and across regions, and to evaluate new population level interventions such as magnesium sulphate 3 and cooling. 4 Similarly, homogeneity of inclusion/exclusion criteria is advantageous for researchers using registers as a sampling frame for multicentre trials. This article seeks to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and to illuminate areas where consensus about criteria could not be reached between surveillance programmes, and (2) provide an updated list of the consensus concerning the inclusion or exclusion of CP when a syndrome or disorder is diagnosed. the original 1998 paper 1 or identified in potential registrants of the New South Wales ...

Early Diagnosis and Early Intervention in Cerebral Palsy

“…In infants developing CP, the early unspecific neurological dysfunction gradually develops into the specific syndrome of CP. This development may take 1–5 years, but in most children the diagnosis can be established by the age of 18–24 months (4). Third, the marked developmental changes of the brain have important implications for the prediction of developmental disorders at early age.…”

“…The motor impairment may be accompanied by a seizure disorder and by impairment of sensation, cognition, communication, and/or behavior.” The definition includes the notion that CP originates during early development, i.e., prenatally or relatively early postnatally. Even though the upper age limit of the postnatal time window is debated (4), CP mostly originates from an event occurring before the age of 6 months corrected age (CA).…”

A Diagnostic Approach for Cerebral Palsy in the Genomic Era

“…While it is well established that the manifestations of CP are often relatively stable, the motor manifestations may change as a child develops from the neonatal period through childhood and into adulthood. (Smithers-Sheedy et al 2013) For example, infants with perinatal asphyxia may initially present with hypotonia and years later evolve into dyskinetic forms of CP. It is this fact that may make the identification of “masqueraders” difficult.…”

Motor Severity in Children With Cerebral Palsy Studied in a High-Resource and Low-Resource Country

“…4,7 Over the past decade, there have been a number of efforts to standardize the diagnosis of CP and motor type classification among western high-resource countries. [8][9][10] The prevalence of CP from various high-resource countries has been estimated at 2.0/1000 live births, and this has remained relatively stable throughout recent decades despite advances in medical practices. 11 Spasticity is typically cited as the predominant motor type, occurring in 77% to 93% of CP cases identified by a recent review, dyskinesia in 2% to 15%, and ataxia in 2% to 8%.…”