Thanks largely to advances in neuro MRI, cerebral palsy—the most common motor disability in children—can now be diagnosed before babies are even 6 months old (in adjusted age, meaning going by due date rather than delivery date). The stepped-up diagnostic capabilities are key, as early detection is critical to optimizing effective intervention, the authors of a new review of the literature emphasize.
In their study report, published online July 17 in JAMA Pediatrics, Iona Novak, PhD, of the University of Sydney, Lars Adde, PhD, of the Norwegian University of Science and Technology and colleagues note that, historically, cerebral palsy was not diagnosed until children were between 1 and 2 years old.
En route to recommending MRI in most suspected cases whenever safe and feasible, the team systematically searched the literature indexed in four medical-journal databases spanning decades. They also searched by hand, including prior reviews with or without meta-analyses, criteria of diagnostic accuracy and evidence-based clinical guidelines.
Their findings included:
● Before 5 months’ adjusted age, the most predictive tools for detecting risk are MRI (86 to 89 percent sensitivity), the Prechtl Qualitative Assessment of General Movements (98 percent sensitivity) and the Hammersmith Infant Neurological Examination (HINE, 90 percent sensitivity).
● After 5 months’ adjusted age, the most predictive tools for detecting risk are MRI, the Hammersmith exam and the Developmental Assessment of Young Children (DAYC, commercially available).
● Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and MRI and the HINE exam may be helpful in assisting clinical decisions.