1
|
Aravamuthan BR, Fehlings DL, Novak I, Gross P, Alyasiry N, Tilton AH, Shevell MI, Fahey MC, Kruer MC. Uncertainties Regarding Cerebral Palsy Diagnosis: Opportunities to Clarify the Consensus Definition. Neurol Clin Pract 2024; 14:e200353. [PMID: 39193394 PMCID: PMC11347036 DOI: 10.1212/cpj.0000000000200353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/10/2024] [Indexed: 08/29/2024]
Abstract
Background and Objectives We have established that physicians, including neurologists, variably diagnose cerebral palsy (CP) when using the most recent CP definition from 2006. We also know that child neurologists and neurodevelopmentalists view themselves to be optimally suited to diagnose CP based on their training backgrounds. Therefore, to reduce variability in CP diagnosis, our objective was to elucidate uncertainties child neurologists and neurodevelopmentalists may have regarding practical application of the 2006 definition. Methods We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists built into a discussion seminar at the 2022 Child Neurology Society (CNS) Annual Meeting, the largest professional meeting of these specialists in North America. Seminar attendees were provided the 2006 definition and asked whether they had any uncertainties about the practical application of the definition across 4 hypothetical clinical vignettes. A group of national and international CP leaders then processed these data through iterative discussions to develop recommendations for clarifying the 2006 definition. Results The seminar was attended by 50% of all conference attendees claiming CME (202/401). Of the 164 closing survey respondents, 145 (88%) expressed uncertainty regarding the clinical application of the 2006 definition. These uncertainties focused on 1) age, both regarding the minimum and maximum ages of brain disturbance or motor symptom onset (67/164, 41%), and 2) interpretation of the term "nonprogressive" (48/164, 29%). Almost all respondents (157/164, 96%) felt that we should revise the 2006 consensus definition of CP. Discussion To address the most common CP diagnostic uncertainties we identified, we collectively propose 4 points of clarification to the 2006 definition: 1) motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible; 3) the clinical motor disability phenotype should be nonprogressive through 5 years old; and 4) a CP diagnosis should be re-evaluated if motor disability is progressive or absent by 5 years old. We anticipate that clarifying the 2006 definition of CP in this manner could address the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.
Collapse
Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Darcy L Fehlings
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Iona Novak
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Paul Gross
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Noor Alyasiry
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Ann H Tilton
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael I Shevell
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael C Fahey
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael C Kruer
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| |
Collapse
|
2
|
Malone LA, Andrejow N, Naber EC, Sun LR, Felling RJ, Kalb LG, Suskauer SJ. An Initial Psychometric Evaluation of a Novel Upper Extremity Pediatric Stroke Hemiplegic Motor Impairment Scale. Pediatr Neurol 2024; 156:26-32. [PMID: 38701621 DOI: 10.1016/j.pediatrneurol.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 03/31/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Our team designed an innovative, observation-based motor impairment measure-the Pediatric Stroke Hemiplegic Motor Impairment Scale (Pedi HEMIs). Here we present the results of a survey describing common practices in the pediatric stroke community and the initial psychometric properties of the upper extremity subscale of the Pedi HEMIs (Pedi HEMIs-UE). METHODS This is a cross-sectional study whereby participants completed a battery of assessments including the novel Pedi HEMIs-UE. Internal consistency was measured via Cronbach alpha (α). Intraclass correlation (ICC) was used to assess inter-rater reliability (IRR). Concurrent validity was investigated using Pearson or polychoric correlations and simple linear regressions. RESULTS The study sample consisted of 18 children aged 1.08 to 15 years. Two participants completed two sets of evaluations, totaling 20 data sets. Cronbach α, a measure of internal consistency, was on average 0.91 (range: 0.89 to 0.92). IRR was excellent with the six raters in almost perfect agreement (ICC = 0.91; 95% confidence interval [CI]: 0.83 to 0.96). Pearson correlation coefficient between the Pedi HEMIs-UE and logit Assisting Hand Assessment (AHA)/mini-AHA was -0.938 (95% CI: -0.979 to -0.827, P < 0.001), indicating excellent concurrent validity. CONCLUSIONS We found excellent feasibility, reliability, and validity of the Pedi HEMIs-UE in a convenience sample of youth with hemiparesis after stroke.
Collapse
Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland.
| | | | | | - Lisa R Sun
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Luther G Kalb
- Kennedy Krieger Institute, Baltimore, Maryland; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland
| |
Collapse
|
3
|
Aspden JW, Murphy MA, Kashlan RD, Xiong Y, Poznansky MC, Sîrbulescu RF. Intruders or protectors - the multifaceted role of B cells in CNS disorders. Front Cell Neurosci 2024; 17:1329823. [PMID: 38269112 PMCID: PMC10806081 DOI: 10.3389/fncel.2023.1329823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
B lymphocytes are immune cells studied predominantly in the context of peripheral humoral immune responses against pathogens. Evidence has been accumulating in recent years on the diversity of immunomodulatory functions that B cells undertake, with particular relevance for pathologies of the central nervous system (CNS). This review summarizes current knowledge on B cell populations, localization, infiltration mechanisms, and function in the CNS and associated tissues. Acute and chronic neurodegenerative pathologies are examined in order to explore the complex, and sometimes conflicting, effects that B cells can have in each context, with implications for disease progression and treatment outcomes. Additional factors such as aging modulate the proportions and function of B cell subpopulations over time and are also discussed in the context of neuroinflammatory response and disease susceptibility. A better understanding of the multifactorial role of B cell populations in the CNS may ultimately lead to innovative therapeutic strategies for a variety of neurological conditions.
Collapse
Affiliation(s)
- James W. Aspden
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Matthew A. Murphy
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Rommi D. Kashlan
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Yueyue Xiong
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mark C. Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ruxandra F. Sîrbulescu
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
4
|
Colovic H, Zlatanovic D, Zivkovic V, Jankovic M, Radosavljevic N, Ducic S, Ducic J, Stojkovic J, Jovanovic K, Nikolic D. A Review of Current Perspectives on Motoric Insufficiency Rehabilitation following Pediatric Stroke. Healthcare (Basel) 2024; 12:149. [PMID: 38255037 PMCID: PMC10815565 DOI: 10.3390/healthcare12020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Pediatric stroke (PS) is an injury caused by the occlusion or rupture of a blood vessel in the central nervous system (CNS) of children, before or after birth. Hemiparesis is the most common motoric deficit associated with PS in children. Therefore, it is important to emphasize that PS is a significant challenge for rehabilitation, especially since the consequences may also appear during the child's growth and development, reducing functional capacity. The plasticity of the child's CNS is an important predecessor of recovery, but disruption of the neural network, specific to an immature brain, can have harmful and potentially devastating consequences. In this review, we summarize the complexity of the consequences associated with PS and the possibilities and role of modern rehabilitation. An analysis of the current literature reveals that Constraint-Induced Movement Therapy, forced-use therapy, repetitive transcranial magnetic stimulation, functional electrical stimulation and robot-assisted therapy have demonstrated at least partial improvements in motor domains related to hemiparesis or hemiplegia caused by PS, but they are supported with different levels of evidence. Due to the lack of randomized controlled studies, the optimal rehabilitation treatment is still debatable, and therefore, most recommendations are primarily based on expert consensuses, opinions and an insufficient level of evidence.
Collapse
Affiliation(s)
- Hristina Colovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Dragan Zlatanovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Vesna Zivkovic
- Department for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (D.Z.); (V.Z.)
- Clinic for Physical Medicine and Rehabilitation, University Clinical Center Niš, 18000 Niš, Serbia
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Natasa Radosavljevic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia;
| | - Sinisa Ducic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Pediatric Surgery, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Jovan Ducic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
| | - Jasna Stojkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Kristina Jovanovic
- Department of Pediatrics, University Children’s Hospital, 11000 Belgrade, Serbia;
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (S.D.); (J.D.); (J.S.); (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| |
Collapse
|
5
|
Janas AM, Barry M, Lee S. Epidemiology, causes, and morbidities of stroke in the young. Curr Opin Pediatr 2023; 35:641-647. [PMID: 37779483 DOI: 10.1097/mop.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW The purpose is to describe the latest research on epidemiology, causes, and morbidities of stroke in neonates and children. RECENT FINDINGS The global incidence of childhood stroke is approximately 2 per 100 000 person-years, which is significantly lower compared to neonates (20-40 per 100 000 live births) and adults (80-90 per 100 000 person-years). Placental abnormalities are a risk factor for perinatal stroke, although cause is usually multifactorial. In children, nonatherosclerotic arteriopathies and arteriovenous malformations are major causes of ischemic and hemorrhagic strokes, respectively. The perinatal period confers a high risk of stroke and can lead to long-term disability, including motor delay, cognitive or speech impairment, and epilepsy. Recent studies suggest that at least 50% of survivors of perinatal stroke have abnormal neurodevelopmental scores in long-term follow up. Childhood stroke is associated with significant morbidity, including epilepsy, motor impairments, and behavioral disability. Recent studies have also identified an association between pediatric stroke and behavioral disorders, such as attention deficit hyperactivity disorder and autism. SUMMARY Perinatal and childhood strokes are important causes of neurological morbidity. Given the low incidence of childhood stroke, prospective research studies on epidemiology, causes, and outcomes remain limited, highlighting the need for continued multisite collaborations.
Collapse
Affiliation(s)
- Anna M Janas
- University of Colorado School of Medicine, Department of Pediatrics, Section of Pediatric Critical Care Medicine
| | - Megan Barry
- University of Colorado School of Medicine, Department of Pediatrics, Section of Child Neurology, Aurora, Colorado
| | - Sarah Lee
- Stanford University School of Medicine, Department of Neurology, Divisions of Child Neurology and Stroke, Palo Alto, California, USA
| |
Collapse
|
6
|
Hill NM, Malone LA, Sun LR. Stroke in the Developing Brain: Neurophysiologic Implications of Stroke Timing, Location, and Comorbid Factors. Pediatr Neurol 2023; 148:37-43. [PMID: 37651976 DOI: 10.1016/j.pediatrneurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions. METHODS In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence. RESULTS Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment. CONCLUSIONS A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
Collapse
Affiliation(s)
- Nayo M Hill
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
7
|
Aravamuthan BR, Fehlings DL, Novak I, Gross P, Alyasiri N, Tilton A, Shevell M, Fahey M, Kruer M. Uncertainties regarding cerebral palsy diagnosis: opportunities to operationalize the consensus definition. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.29.23292028. [PMID: 37461618 PMCID: PMC10350155 DOI: 10.1101/2023.06.29.23292028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background and Objectives Cerebral palsy (CP), the most common motor disability of childhood, is variably diagnosed. We hypothesized that child neurologists and neurodevelopmentalists, often on the frontlines of CP diagnosis in North America, harbor uncertainties regarding the practical application of the most recent CP consensus definition from 2006. Methods We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists at the 2022 Child Neurology Society Annual Meeting. Attendees were provided the 2006 CP consensus definition and asked whether they had any uncertainties about the practical application of the definition across four hypothetical clinical vignettes. Results Of 230 attendees, 164 responded to the closing survey questions (71%). 145/164 (88%) expressed at least one uncertainty regarding the clinical application of the 2006 definition. Overwhelmingly, these areas of uncertainty focused on: 1) Age, both with regards to the minimum age of diagnosis and the maximum age of brain disturbance or motor symptom onset, (67/164, 41%), and 2) Interpretation of the term "non-progressive" (48/164, 29%). The vast majority of respondents (157/164, 96%) answered 'Yes' to the question: Do you think we should revise the 2006 consensus definition of CP? Discussion We propose that the uncertainties we identified could be addressed by operationalizing the 2006 consensus definition to support a more uniform CP diagnosis. To address the most common CP diagnostic uncertainties we identified, we propose 3 points of clarification based on the available literature: 1) Motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible, even if activity limitation is not yet present, if motor symptoms/signs can be reasonably predicted to yield activity limitation (e.g. by using standardized examination instruments, Brain MRI, and a suggestive clinical history); and 3) The clinical motor disability phenotype should be non-progressive through 5 years old. We anticipate that operationalizing the 2006 definition of CP in this manner could clarify the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.
Collapse
Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcy L Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, AustraliaCerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Paul Gross
- The Cerebral Palsy Research Network, Salt Lake City, Utah, USA
| | - Noor Alyasiri
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ann Tilton
- Louisiana Health Science Center New Orleans, Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Michael Shevell
- Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Fahey
- Department of Paediatrics, Monash University Melbourne Australia
| | - Michael Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in, Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ USA
| |
Collapse
|