Practice parameter: Diagnostic assessment of the child with cerebral palsy - Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society
Practice parameter: Diagnostic assessment of the child with cerebral palsy - Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society
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DOI：
10.1212/01.wnl.0000117981.35364.1b
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发表时间：
2004-03-23
期刊：
影响因子：
9.9
通讯作者：
Stevenson, R
中科院分区：
文献类型：
--
作者：
Ashwal, S;Russman, BS;Stevenson, R
目的：美国神经病学学会质量标准小组委员会和儿童神经病学学会实践委员会根据证据分析制定了实践参数作为患者管理策略。对于该参数，作者回顾了评估疑似脑瘫（CP）儿童的现有证据，CP是一种由于发育中大脑病变导致的非进行性姿势或运动障碍。方法：查阅相关文献，进行归纳、整理和分类。这些建议是根据证据分类的四层计划提出的。结果：CP是一种常见的问题，每1,000例活产中约有2至2.5例发生。为了确定脑瘫患儿是否存在脑异常，进而提示病因和预后，建议使用MRI而非CT进行神经影像学检查（A级）。代谢和遗传研究不应常规用于CP儿童（B级）的评估。如果临床病史或神经影像学检查结果不能确定特定的结构异常，或者如果病史或临床检查中存在其他和非典型特征，则应考虑进行代谢和基因检测（C级）。CP患儿脑畸形的检测需要考虑潜在的遗传或代谢病因。由于脑梗死的发生率在偏瘫型CP儿童中较高，因此应考虑凝血功能障碍的诊断性检测（B级）。然而，目前还没有足够的证据来确切说明应该进行哪些研究。除非有癫痫或特定癫痫综合征的特征（A级），否则不建议进行EEG。由于CP儿童可能存在相关的智力低下、眼科和听力障碍、言语和语言障碍以及口腔运动功能障碍，因此这些疾病的筛查应作为初始评估的一部分（A级）。结论：脑性瘫痪儿童的神经影像学检查结果通常异常，可能有助于确定病因。作为初步评估的一部分，有必要筛查相关疾病。
Objective: The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter the authors reviewed available evidence on the assessment of a child suspected of having cerebral palsy (CP), a nonprogressive disorder of posture or movement due to a lesion of the developing brain. Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification. Results: CP is a common problem, occurring in about 2 to 2.5 per 1,000 live births. In order to establish that a brain abnormality exists in children with CP that may, in turn, suggest an etiology and prognosis, neuroimaging is recommended with MRI preferred to CT (Level A). Metabolic and genetic studies should not be routinely obtained in the evaluation of the child with CP (Level B). 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). Detection of a brain malformation in a child with CP warrants consideration of an underlying genetic or metabolic etiology. Because the incidence of cerebral infarction is high in children with hemiplegic CP, diagnostic testing for coagulation disorders should be considered (Level B). However, there is insufficient evidence at present to be precise as to what studies should be ordered. An EEG is not recommended unless there are features suggestive of epilepsy or a specific epileptic syndrome (Level A). Because children with CP may have associated deficits of mental retardation, ophthalmologic and hearing impairments, speech and language disorders, and oral-motor dysfunction, screening for these conditions should be part of the initial assessment (Level A). Conclusions: Neuroimaging results in children with CP are commonly abnormal and may help determine the etiology. Screening for associated conditions is warranted as part of the initial evaluation.