Neuroimaging Tests for Cerebral Palsy

The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society have released a new guideline on neuroimaging tests for cerebral palsy and related disorders. “Practice Parameter: Diagnostic Assessment of the Child with Cerebral Palsy” appears in the March 2004 issue of Neurology and is available online at http://www.neurology.org/content/62/6.toc.

According to the guideline, available evidence now supports the use of magnetic resonance imaging (MRI) rather than computerized tomography when cerebral palsy is suspected, although this is not yet routine. Metabolic and genetic studies need not be done routinely unless the cause of the brain’s abnormality is not evident on the MRI scan or by clinical history and examination.

Because the incidence of cerebral infarction is high in children with hemiplegic cerebral palsy, diagnostic testing for coagulation disorders should be considered. However, there is insufficient evidence at present to be precise as to what studies should be ordered. Electroencephalography is not recommended unless there are characteristics suggestive of epilepsy or a specific epileptic syndrome.

Evidence also suggests that children who are diagnosed with cerebral palsy should be routinely examined for other related disorders, such as mental retardation, vision and hearing impairments, speech and language disorders, and chewing and swallowing disorders.

An early diagnosis helps the child’s parent or caregiver and the child’s physician understand the cause of the disorder, as well as make informed decisions on a treatment plan. Most children with cerebral palsy are diagnosed by the time they are two years of age and their condition improves as they get older.