Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment.
Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment.
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DOI：
10.1001/jamapediatrics.2017.1689
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发表时间：
2017-09-01
期刊：
影响因子：
26.1
通讯作者：
Badawi, Nadia
中科院分区：
文献类型：
--
作者：
Novak, Iona;Morgan, Cathy;Adde, Lars;Blackman, James;Boyd, Roslyn N.;Brunstrom-Hernandez, Janice;Cioni, Giovanni;Damiano, Diane;Darrah, Johanna;Eliasson, Ann-Christin;de Vries, Linda S.;Einspieler, Christa;Fahey, Michael;Fehlings, Darcy;Ferriero, Donna M.;Fetters, Linda;Fiori, Simona;Forssberg, Hans;Gordon, Andrew M.;Greaves, Susan;Guzzetta, Andrea;Hadders-Algra, Mijna;Harbourne, Regina;Kakooza-Mwesige, Angelina;Karlsson, Petra;Krumlinde-Sundholm, Lena;Latal, Beatrice;Loughran-Fowlds, Alison;Maitre, Nathalie;McIntyre, Sarah;Noritz, Garey;Pennington, Lindsay;Romeo, Domenico M.;Shepherd, Roberta;Spittle, Alicia J.;Thornton, Marelle;Valentine, Jane;Walker, Karen;White, Robert;Badawi, Nadia
脑瘫是儿童时期最常见的身体残疾，每500名活产婴儿中就有1名发生脑瘫。历史上，诊断是在12至24个月之间进行的，但现在可以在6个月的校正年龄之前进行。系统地回顾早期准确诊断脑瘫的最佳证据，并总结有关脑瘫特异性早期干预的最佳证据，这些干预应遵循早期诊断，以优化神经可塑性和功能。本研究系统检索了MEDLINE（1956-2016）、EMBASE（1980-2016）、CINAHL（1983-2016）和科克伦图书馆（1988-2016）中有关脑瘫早期诊断的文献，并采用手工检索。检索词包括脑瘫、诊断、检测、预测、鉴定、预测有效性、准确性、灵敏度和特异性。该研究包括系统评价，有或没有荟萃分析，诊断准确性标准和循证临床指南。根据PRISMA声明报告了调查结果，并根据指导方针、研究和评价（AGREE）II工具的评估报告了建议。6篇系统性综述和2篇循证临床指南符合纳入标准。所有纳入的文章均具有较高的诊断准确性研究（QUADAS）方法学质量评估评级。在婴儿中，脑瘫的临床体征和症状在2岁之前出现和发展;因此，应结合临床病史使用标准化工具来预测风险。在5个月校正年龄之前，最具预测性的风险检测工具是足月年龄磁共振成像（86%-89%灵敏度），Prechtl一般运动定性评估（98%灵敏度）和Hammersmith婴儿神经系统检查（90%灵敏度）。在校正年龄5个月后，检测风险的最具预测性的工具是磁共振成像（86%-89%的灵敏度）（在安全可行的情况下），哈默史密斯婴儿神经系统检查（90%的灵敏度）和幼儿发育评估（83%的C指数）。脑性瘫痪的地形图和严重程度在婴儿期更难确定，磁共振成像和Hammersmith婴儿神经系统检查可能有助于辅助临床决策。在高收入国家，三分之二的脑瘫患者会走路，四分之三会说话，二分之一的人智力正常。早期诊断从病史开始，包括使用神经影像学、标准化神经学和标准化运动评估，这些评估表明脑性瘫痪的一致异常结果。临床医生应了解及时转诊至诊断特异性早期干预的重要性，以优化婴儿运动和认知可塑性，预防继发性并发症，并提高护理人员的福祉。
Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age. To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956–2016), EMBASE (1980–2016), CINAHL (1983–2016), and the Cochrane Library (1988–2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%−89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%−89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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