Uncertainties Regarding Cerebral Palsy Diagnosis: Opportunities to Clarify the Consensus Definition
Bhooma R Aravamuthan1, Darcy L Fehlings1, Iona Novak1
1Division 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.
Child neurologists often misdiagnose cerebral palsy (CP) due to definition uncertainties. Clarifying the 2006 CP definition regarding age and progression can reduce diagnostic variability.
Area of Science:
- Neurology
- Developmental Pediatrics
- Clinical Diagnostics
Background:
- Physicians, including neurologists, exhibit variability in diagnosing cerebral palsy (CP) using the 2006 definition.
- Child neurologists and neurodevelopmentalists feel best equipped for CP diagnosis due to their training.
Purpose of the Study:
- To identify uncertainties child neurologists and neurodevelopmentalists have in applying the 2006 CP definition.
- To reduce variability in cerebral palsy diagnosis.
Main Methods:
- A cross-sectional survey was conducted among child neurologists and neurodevelopmentalists at the 2022 Child Neurology Society Annual Meeting.
- Participants reviewed the 2006 CP definition and discussed uncertainties using hypothetical clinical vignettes.
Main Results:
- 88% of survey respondents expressed uncertainty in applying the 2006 CP definition.
- Key uncertainties involved the age of onset (41%) and the interpretation of "nonprogressive" (29%).
- 96% of respondents advocated for revising the 2006 consensus definition of CP.
Conclusions:
- Proposed clarifications to the 2006 CP definition include: motor symptoms by age 2, early diagnosis, nonprogressive phenotype through age 5, and re-evaluation if progressive or absent by age 5.
- These clarifications aim to address identified uncertainties and decrease diagnostic variability in cerebral palsy.
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