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Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment

Lookup NU author(s): Professor Lindsay PenningtonORCiD

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This is the final published version of a review that has been published in its final definitive form by American Medical Association, 2017.

For re-use rights please refer to the publisher's terms and conditions.

Abstract

IMPORTANCE: Cerebral palsy is the most common physical disability in childhood, and occurs in 1 in 500 live births.OBSERVATIONS AND ADVANCES: Historically the diagnosis was made between 12-24 months, but now can be made early in infancy. In infants, clinical signs and symptoms emerge and evolve before 2-years of age and therefore a combination of standardized tools should be used to predict risk. Before 5-months corrected age, the most predictive tools for detecting risk of cerebral palsy are: term-age MRI (86-89%); Prechtl’s Qualitative Assessment of General Movements (98%); and the Hammersmith Infant Neurological Evaluation (90%). After 5-months corrected age, the most predictive tools for detecting risk of cerebral palsy are: MRI (86-89%) and the Hammersmith Infant Neurological Evaluation (90%). Topography and severity of cerebral palsy are most accurately predicted in infancy using the cut scores on the Hammersmith Infant Neurological Evaluation.CONCLUSIONS AND RELEVANCE: The early diagnosis of cerebral palsy begins with a medical history and then involves using a combination of neuroimaging, standardized neurological and standardized motor assessments indicating congruent abnormal findings. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications and to optimize parent well being.

Publication metadata

Author(s): Novak I, Morgan C, Adde L, Brunstrom-Hernandez J, Blackman J, Boyd RN, Cioni G, Damiano D, Darrah J, deVries L, Eliasson AC, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Harbourne R, Hadders-Algra M, Kakooza A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre NL, McIntyre S, Noritz G, Pennington L, Romeo D, Shepherd RB, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N

Publication type: Review

Publication status: Published

Journal: JAMA Pediatrics

Year: 2017

Volume: 171

Issue: 9

Pages: 897-907

Print publication date: 01/09/2017

Online publication date: 17/07/2017

Acceptance date: 19/04/2017

ISSN (print): 2168-6203

ISSN (electronic): 2168-6211

Publisher: American Medical Association

URL: https://doi.org/10.1001/jamapediatrics.2017.1689

DOI: 10.1001/jamapediatrics.2017.1689

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