- Definition: cerebral palsy (CP) can be defined as a disorder of aberrant (unusual) control of movement and posture, appearing early in life secondary to a CNS lesion or dysfunction that is not the result of a recognized progressive or degenerative brain disease. The brain abnormality may occur before, during or after the delivery process.

- The usual presenting problem is that the child is not reaching motor (muscle control) milestones at the appropriate age.

- A history of the child combined with a neurologic exam leads to the diagnosis.

- Periodic examinations may be necessary to assure the diagnosis of CP when the history is not reliable.

- The diagnosis is usually made before 2 years of age.

- The term CP is descriptive and includes a number of etiologies (causes) and clinical presentations.

- Each year about 10,000 babies born in the USA develop CP.

- Swedish data indicate that 36% of infants with CP were born at less than 28 weeks gestational age, 25% at 28 32 weeks, 2.5% at 33 38 weeks, and 37% at term (40 weeks).

- A Scandinavian study reported that 33% of the CP population was hemiplegic (one sided paralysis), 44% diplegic (both lower limbs involved) and 6% quadriplegic (four limbs involved).

- 70% of persons with CP have other disabilities, mental retardation being the most common.

- Of congenital disorders, CP has the highest life term costs per new case, averaging $503,000 in 1992 dollars.

Diagnostic Aids:

- Laboratory tests are not necessary to confirm the diagnosis of CP; however:

- The yield of finding an abnormal CT scan in a child with CP is about 77%.

- The yield of finding an abnormal MRI scan in a child with CP is about 89%.

- Neuroimaging is recommended in the evaluation of a child with CP if the etiology (cause) has not been established. MRI is preferred to CT.

- Metabolic and genetic studies should not be routinely obtained.

- If the clinical history or findings on neuroimaging do not determine a structural abnormality or if there are additional and atypical features in the history or clinical examination, metabolic and genetic testing should be considered.

- Because the occurrence of an unexplained cerebral infarction (area of cell death
due to inadequate blood supply) seen with neuroimaging is high in children with
hemiplegic CP, diagnostic testing for a blood coagulation disorder should be
considered.

- Children with CP often have associated conditions such as mental retardation or epilepsy.

- About 45% of children with CP have epilepsy.

- An EEG should not be obtained in order to determine the cause of CP.

- However, an EEG should be obtained when a child with CP has an indication of having epilepsy.

- Also, because of the high occurrence of other associated conditions, children with CP should routinely be screened for mental retardation, visual and hearing impairments, and speech and language disorders.

This excellent and authoritative report provides the baseline at this time for the diagnostic evaluation of the child suspected of having cerebral palsy. The Committee also makes thoughtful recommendations about fruitful areas of future studies. We are grateful for the inclusiveness of its report.