The early manifestations and course of diplegia in childhood

Abstract

During a recent survey of children suffering from cerebral palsy it was found that the average delay in a diagnosis of diplegia being made following the first visit to a doctor was over one year. This delay appeared to be due to ignorance of the early manifestations to be expected in diplegia before the late stage of rigidity or spasticity with contractures. The early manifestations of diplegia are described as they were encountered during the survey. It is suggested that the majority of patients pass through a stage during which they show hypotonia and a stage during which they show sudden generalized dystonic attacks on changes of position before rigidity or spasticity is evident. The stage of dystonia seems to be of shorter duration and the dystonic attacks less marked in patients with paraplegic involvement than in those with triplegia or tetraplegia. It is suggested that the diagnosis would be reached earlier in patients with diplegia if a neurological examination, including attempts to produce dystonia, was made in every suspected case.