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From the Division of Child Neurology (Dr. Ashwal), Department of Pediatrics, Loma Linda University School of Medicine, CA; Departments of Pediatrics and Neurology (Dr. Russman) and Division of Neurodevelopmental Disabilities, Department of Pediatrics (Dr. Blasco), Oregon Health and Science University and Shriners Hospital for Children, Portland; Pediatrics and Neurology (Dr. Miller), Baylor College of Medicine, Houston, TX; University of North Carolina, Chapel Hill, and Olson Huff Center for Child Development (Dr. Sandler), Mission Children’s Health Services, Asheville, NC; Departments of Neurology/Neurosurgery and Pediatrics (Dr. Shevell), Department of Human Genetics, McGill University, and Division of Pediatric Neurology, Montreal Children’s Hospital, Montreal, Quebec, Canada; and Pediatrics (Dr. Stevenson), University of Virginia School of Medicine, Charlottesville.
Address correspondence and reprint requests to the Quality Standards Subcommittee of the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.
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.
Received May 27, 2003. Accepted in final form December 24, 2003.
Approved by the Quality Standards Subcommittee in March 2003. Approved by the AAN Practice Committee on August 9, 2003. Approved by the AAN Board of Directors on October 18, 2003.
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