Cerebral Palsy Diagnosis and Management

Introduction to Cerebral Palsy

• The absence of spasticity and normal tone cannot rule out cerebral palsy, as motor types and topography of cerebral palsy may emerge and change during the first 2 years of life 1
• The American Academy of Pediatrics recommends that early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy 2

Diagnostic Approach

• When cerebral palsy is suspected but cannot be made with certainty, use the interim clinical diagnosis of "high risk of cerebral palsy" until a diagnosis is confirmed 3
• To assign the interim diagnosis of high risk of cerebral palsy, the infant must have motor dysfunction (essential criterion) and at least one of two additional criteria (abnormal neuroimaging or clinical history indicating risk for cerebral palsy) 3

Motor Assessment and Classification

• In infants younger than 2 years, motor severity is difficult to accurately predict because almost half of all infants younger than 2 years have their Gross Motor Function Classification System (GMFCS) reclassified 1
• The presence or absence of hypertonia changes and evolves, and there is rapid brain growth and use-dependent reorganization in response to caregiving and therapy 1

Standardized Assessment Tools

• For early detection before 5 months' corrected age, the most predictive tools are the Prechtl Qualitative Assessment of General Movements (98% sensitivity) and the Hammersmith Infant Neurological Examination (90% sensitivity) 2
• After 5 months' corrected age, the most predictive tools are magnetic resonance imaging (86%-89% sensitivity) and the Hammersmith Infant Neurological Examination (90% sensitivity) 2

Clinical Implications and Monitoring

• When an infant is perceived to be at risk of cerebral palsy, they should be referred for cerebral palsy-specific early intervention with regular medical, neurological, and developmental monitoring 3
• Prognosis of motor severity predictions should be made cautiously in infants younger than 2 years and always involve the use of standardized tools 5

Important Considerations

• In high-income countries, population data indicate that 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence 1, 2
• Eighty-six percent of parents of a child with cerebral palsy suspect it before the clinical diagnosis is made, and seeking to avoid false-positive results by delaying diagnosis is harmful to parent and caregiver well-being 1