Guidelines of the Croatian Child Neurology Society for cerebral palsy

Cerebral palsy is the most common cause of severe neuromotor disabilities in childhood, representing a group of disorders which involve impairment of movement and posture and of motor function. It is permanent but not unchanging, caused by non-progressive interference/lesions/abnormality in developing/immature brain. Overall, the cerebral palsy prevalence is between 2 and 3 per 1000 live births. Excluded are all progressive conditions resulting in loss of acquired skills, spinal diseases, as well as hypotonia as the sole neurological finding. Surveillance of Cerebral Palsy in Europe (SCPE) is a network of cerebral palsy surveys and registers, which extends across Europe, set up to monitor trends in cerebral palsy rate, to provide a framework for collaborative research and to serve as a basis for service planning. According to SCPE proposal, definition of cerebral palsy is based on phenomenology (clinical picture and history). Classification is made on the basis of the predominant neurological findings into three basic types: spastic, dyskinetic, and ataxic cerebral palsy. These basic types of cerebral palsy are further classified into subtypes according to neurological findings: bilateral spastic, unilateral spastic (hemiplegia), dystonic, and choreoathetotic cerebral palsy. All cerebral palsy subtypes have in common an abnormal pattern of movement and posture. Functional grading of cerebral palsy comprises the following domains, which are considered to be key elements in the description of a child with cerebral palsy: motor development, cognitive development, visual function, hearing, and epilepsy. The Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) criteria describe the severity of impairment of lower limbs, whereas Bilateral Fine Motor Function (BFMF) and Manual Assessment Classification System (MACS) are related to the function of upper limbs in children with cerebral palsy. Because of the changing pattern of neurological findings, diagnosis and classification of cerebral palsy is not allowed before age of 4 years (at least 3 years, and optimally 5 years). Neuroimaging (intracranial ultrasonography and magnetic resonance of the brain) are valuable diagnostic methods in visualization of perinatal brain lesions, which are the cause of cerebral palsy. Cranial ultrasonography is a noninvasive, widely available method that can detect hypoxic-ischemic and hemorrhagic brain lesions, particularly in preterm neonates. It enables visualization of cystic periventricular leukomalacia, which is 70%-96% related to cerebral palsy and additional neurodevelopmetal impairments. Magnetic resonance has the potential to visualize and further specify or identify lesions or maldevelopments of the brain. It should ideally be performed after age of 2 years because of developing myelinization. On functional assessment of the central nervous system in children with cerebral palsy, neurophysiological procedures (EEG) and evoked potentials (VEP, SSPE, BERA) are increasingly used, particularly if epilepsy and sensory problems are accompanying neurodevelopmental disorders.

Category: Guidelines
Volume: Vol. 47, No 2, april - june 2003
Authors: V. Mejaški Bošnjak
Reference work:

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