Cerebral Palsy Prognosis Based on the Physical and Neurologic Examination

Abstract

Cerebral palsy (CP) is a static disorder of movement and posture due to injury, genetic, and/or developmental abnormality of the maturing fetal, neonatal, or early infant central nervous system. The early neurodevelopmental exam, although helpful, cannot reliably prognosticate the severity and type of CP. The diagnosis needs to be secure. With the advent of neuroimaging, metabolic studies, and explosion of genomic studies, the physician must be more vigilant to not confuse this slowly changing and presumably static condition for masqueraders of CP, particularly progressive, degenerative, treatable, or specific genetic disorders. The neurologist and pediatrician have an important role to help families understand the uncertainty and complexity of a diagnosis of CP, which should never be a final diagnosis without a modifier of what risk factors or specific causative etiology may exist. CP is a starting point, not an end in itself. Discussion with the family of the potential for motor dysfunction and neurologic injury should be addressed as early as possible, even before a clear diagnosis of CP is established. Developmental therapies should be initiated early. The physician should clearly emphasize that predicting severity is often impossible from the infant examination. Hopeful, positive, and guarded expectations should be provided. Additionally, serial follow-up for monitoring the progression of symptoms and preparing the family for the comorbidities that may accompany the CP motor disability is important. It is essential for the neurologist, pediatrician, and developmental team to be vigilant for uncovering the myriad of CP masquerading conditions. They should also provide ongoing support and therapeutic guidance while respecting the integrity of the family facing the challenges of CP.