This is the current release of the guideline.

Definitions of the strength of the recommendations (A, B, C, U) and classification of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.

Neuroimaging

1. Neuroimaging is recommended in the evaluation of a child with cerebral palsy (CP) if the etiology has not been established; for example, by perinatal imaging (Level A, class I and II evidence).
2. Magnetic resonance imaging (MRI), when available, is preferred to computed tomography (CT) scanning because of the higher yield of suggesting an etiology and timing of insult leading to CP (Level A, class I–III evidence).

Metabolic and Genetic Testing

1. Metabolic and genetic studies should not be routinely obtained in the evaluation of the child with CP (Level B, class II and III evidence).
2. If the clinical history or findings on neuroimaging do not determine a specific structural abnormality or if there are additional and atypical features in the history or clinical examination, metabolic and genetic testing should be considered (Level C, class III and IV).
3. Detection of a brain malformation in a child with CP warrants consideration of an underlying genetic or metabolic etiology (Level C, class III and IV evidence).

Coagulopathies

1. Because the incidence of unexplained cerebral infarction seen with neuroimaging is high in children with hemiplegic CP, diagnostic testing for a coagulation disorder should be considered (Level B, class II–III evidence). There is insufficient evidence to be precise as to what studies should be ordered.

Associated Conditions

Epilepsy

1. An electroencephalogram (EEG) should not be obtained for the purpose of determining the etiology of CP (Level A; class I and II evidence).
2. An EEG should be obtained when a child with CP has a history or examination features suggesting the presence of epilepsy or an epileptic syndrome (Level A; class I and II evidence).

Mental Retardation, Ophthalmologic Impairments, Speech and Language Disorders, Hearing Impairments

1. Because of the high incidence of associated conditions, children with CP should be screened for mental retardation, ophthalmologic and hearing impairments, and speech and language disorders (Level A, class I and II evidence). Nutrition, growth, and other aspects of swallowing dysfunction should be monitored. Further specific evaluations are warranted if screening suggests areas of impairment.

Definitions:

Rating of Recommendation

A = Established as useful/predictive or not useful/predictive for the given condition in the specified population.

B = Probably useful/predictive or not useful/predictive for the given condition in the specified population.

C = Possibly useful/predictive or not useful/predictive for the given condition in the specified population.

U = Data inadequate or conflicting. Given current knowledge, test, predictor is unproven.

Translation of Evidence to Recommendations

Level A rating requires at least one convincing class I study or at least two consistent, convincing class II studies.

Level B rating requires at least one convincing class II study or overwhelming class III evidence.

Level C rating requires at least two convincing class III studies.

Classification Scheme for Determining the Yield of Established Diagnostic and Screening Tests

Class I: A statistical, population-based sample of patients studied at a uniform point in time (usually early) during the course of the condition. All patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients’ clinical presentations.

Class II: A statistical, non-referral-clinic-based sample of patients studied at a uniform point in time (usually early) during the course of the condition. Most (>80%) patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentations.

Class III: A selected, referral-clinic-based sample of patients studied during the course of the condition. Some patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation by someone other than the treating physician.

Class IV: Expert opinion, case reports, or any study not meeting criteria for class I to III.

A clinical algorithm was provided for the evaluation of the child with cerebral palsy (CP).

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2004 Mar 23

American Academy of Neurology - Medical Specialty Society

American Academy of Neurology (AAN)

Quality Standards Subcommittee of the American Academy of Neurology

Practice Committee of the Child Neurology Society

AAN Quality Standards Subcommittee Members: Gary Franklin, MD, MPH (Co-Chair); Gary Gronseth, MD (Co-Chair); Charles E. Argoff, MD; Stephen Ashwal, MD (ex-officio); Christopher Bever, Jr., MD; Jody Corey-Bloom, MD, PhD; John D. England, MD; Jacqueline French, MD (ex-officio); Gary H. Friday, MD; Michael J. Glantz, MD; Deborah Hirtz, MD; Donald J. Iverson, MD; David J. Thurman, MD; Samuel Wiebe, MD; William J. Weiner, MD; Catherine Zahn, MD (ex-officio)

Practice Committee of the Child Neurology Society Members: Carmela Tardo, MD (Chair); Bruce Cohen, MD (Vice-Chair); Elias Chalhub, MD; Roy Elterman, MD; Murray Engel, MD; Bhuwan P. Garg, MD; Brian Grabert, MD; Annette Grefe, MD; Michael Goldstein, MD; David Griesemer, MD; Betty Koo, MD; Edward Kovnar, MD; Leslie Anne Morrison, MD; Colette Parker, MD; Ben Renfroe, MD; Anthony Riela, MD; Michael Shevell, MD; Shlomo Shinnar, MD; Herald Silverboard, MD; Russell Snyder, MD; Dean Timmons, MD; Greg Yim, MD; Mary Anne Whelan, MD

Not stated

This is the current release of the guideline.

This NGC summary was completed by ECRI on August 17, 2004. The information was verified by the guideline developer on September 9, 2004.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.