Early Diagnosis and Early Intervention in Cerebral Palsy

Hadders‐Algra, Mijna

doi:10.3389/fneur.2014.00185

Cited by 164 publications

(139 citation statements)

References 134 publications

(222 reference statements)

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“…Studies show that an enriched environment and tactile stimulation can also improve developmental outcomes. 8 Strategies in infancy center on avoidance of traumatic injury and include child restraints (seatbelts) and shaken baby prevention among others.…”

Section: Variations In Clinical Practice and Thementioning

confidence: 99%

Report of a workshop on research gaps in the treatment of cerebral palsy

et al. 2016

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Cerebral palsy (CP) is heterogeneous in etiology and manifestations, making research into relevant therapies difficult and limiting the generalizability of the results. We report here on the NIH CP symposium, where stakeholders from academic, clinical, regulatory, and advocacy backgrounds discussed the major challenges and needs for moving forward with clinical research in CP, and outlined priorities and action items. New information is constantly generated through research into pathogenesis and etiology. Clinical research and new therapeutic approaches need to keep pace, through large data registry integration and new research designs. Development of standardized data collection, increasing academic focus on CP research, and iterative approaches to treatment throughout the patients' lives, have all been identified as areas of focus. The workshop identified critical gaps and areas of focus to increase the evidence base for therapeutic approaches to determine which treatments work best for which patients in the near future. These include consolidation and optimization of databases and registries, updates to the research methodology, and better integration of resources and stakeholders. DEFINING THE PROBLEM Cerebral palsy (CP) is a group of neurologic disorders of motor control with onset early in development and persistence throughout the lifespan. CP is the most common cause of motor disability in childhood, with an incidence of 2 to 3 per 1,000 live births, occurring 20 to 30 times more frequently in premature or low-birth-weight infants.1 These disturbances of movement and posture cause activity limitations.2 Those activity limitations resulting from spinal or neuromuscular disorders are excluded from the diagnosis. Various etiologies can cause the CP clinical spectrum but all have a disruption of motor control in common. In addition to prematurity, other known etiologies include developmental defects of the brain, perinatal stroke, hypoxia, shock, and fetal or neonatal inflammation/infection. However, CP may also occur in low-risk children for whom there is no obvious etiology or risk factor. CP is often accompanied by comorbidities such as seizures, communication deficits, hearing and vision deficits, and intellectual disability. There is a wide spectrum of functional outcomes from normal educational, career, and social activities to complete disability and dependence.An upper age limit for acquired pathology in the brain leading to CP is not absolute, but the onset of symptoms and the diagnosis are generally expected to occur by the age of 2. Given the heterogeneity in terms of etiology, pathology, clinical manifestations, and progression, it is best to consider CP as a collection of conditions rather than one uniform entity for developing treatment guidelines or conducting research on potential therapies.To address pressing research challenges, the National Institute of Neurological Disorders and Stroke (NINDS) organized a workshop with the main goal of discussing research needed to determine best ...

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Section: Variations In Clinical Practice and Thementioning

confidence: 99%

Report of a workshop on research gaps in the treatment of cerebral palsy

et al. 2016

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“…Tonic responses may be one of the components of hypertonia, one of the highly prevalent signs in children with cerebral palsy (8). However, evident hypertonia is rarely present in early infancy and a reliable diagnosis of cerebral palsy can be made from 18 mo onwards (8)(9)(10).…”

mentioning

confidence: 99%

“…The secondary aim of the study was to assess whether possible differences in reflex activity in early infancy are associated with general movement quality, as general movement quality is the best clinical predictor for neuromotor development at this age (10). General movements are spontaneous movements that are characterized by variation; they are present until about 4 mo corrected age (11).…”

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confidence: 99%

Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study

et al. 2016

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Background: Following our clinical observation of tonic responses in response to the knee jerk in infants at very high risk for cerebral palsy (VHR infants), we systematically studied tonic responses, clonus, and reflex irradiation. We questioned (i) whether these responses occurred more often in VHR infants than in typically developing (TD) infants, and (ii) whether they were associated with abnormal general movement quality. Methods: Twenty-four VHR and 26 TD infants were assessed around 3 mo corrected age. Surface electromyograms of leg, trunk, neck, and arm muscles were recorded while eliciting the knee jerk. All assessments were video-recorded. results: VHR infants more often than TD infants showed tonic responses in the ipsilateral quadriceps and hamstring (MannWhitney U; P = 0.0005 and P = 0.0009), clonus (Chi-square; P = 0.0005) and phasic responses in the contralateral quadriceps and hamstring (Mann-Whitney U; P = 0.002 and P = 0.0003, respectively). Widespread reflex irradiation occurred in VHR and TD infants. Definitely abnormal general movements and stiff movements were associated with tonic responses (MannWhitney U; P = 0.0005, P = 0.007, respectively) and clonus (Mann-Whitney U; P = 0.003 and P = 0.0005) in the ipsilateral quadriceps. conclusion: Similar to clonus, tonic responses may be regarded as a marker of a loss of supraspinal control. Reflex irradiation primarily is a neurodevelopmental phenomenon of early ontogeny.

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“…[22][23][24] Y de esto la importancia de un abordaje clínico, en el cual se detecte de una forma realista y objetiva las variaciones en el desarrollo motor temprano, que compromete el desarrollo funcional del niño y poder realizar una intervención terapéu-tica. 19,25,26 Esta evaluación realista y objetiva, resulta de gran ayuda en especial en casos en el cual hay problemas para una adecuada caracterización del desarrollo motor 27 y es en estos casos donde se debe hacer un seguimiento estrecho, en ser vicios apropiados de neurodesarrollo, para evaluar su progreso, y eventualmente poder decidir si el estado clíni-co del niño corresponde a PC. 19,27 Dentro de los métodos diagnósticos además de la adecuada identificación temprana de alteración en los patrones motores, también se cual ya se han identificado algunos factores epigenéticos donde su presencia disminuye el riesgo de desarrollar la enfermedad como la presencia del receptor Toll-like-4 (TLR-4) y otros que aumentan la susceptibilidad como polimorfismos en la interleuquina-6 G-174C (rs1800795) 38,39 o en el gen promotor interleuquina 1b 40 .…”

Section: Introductionunclassified

“…44 Muchos estudios en los últimos 20 años y soportados por el grupo de la Dra. Novak en Australia [22][23][24][25][26][27][28][29][30][31][32][33] confirman que el 20-25% de casos de parálisis cerebral moderada o severa se asocian con malformación congénitas del sistema nervioso central. Toda esta profundización de la etiología de la parálisis cerebral sugiere que el desarrollo temprano de anomalías juega un papel importante y significativo en la etiología de la parálisis cerebral.…”

Section: Introductionunclassified