Early Signs of Cerebral Palsy Poorly Studied, Can Delay Help

Early Signs of Cerebral Palsy Poorly Studied, Can Delay Help

A clear hand preference in the first year or two of life, and delayed motor milestones are commonly cited as early signs of cerebral palsy (CP), a review study reported.

But care providers need more to act on suspicions of CP promptly, getting a young child into rehabilitation and treatments that could preserve skills, and such research is lacking, its authors said.

The study, “Early Clinical Features of Cerebral Palsy in Children Without Perinatal Risk Factors: A Scoping Review,” was published in Pediatric Neurology.

Cerebral palsy is caused by damage to the brain early in life, typically at or before birth. However, symptoms usually become evident later, as divergences from normal development are noted. While some risk factors may alert health professionals to watch for signs of CP in a child, many children with CP don’t have any of these factors.

As such, it is necessary to understand what clinical features in very early childhood are possibly indicative of CP, so that primary care providers can refer infants with them to experts for a proper diagnosis.

Researchers analyzed 41 published scientific papers in an attempt to answer the question: “In children of all ages, what clinical signs have been identified as attributes for the early detection of cerebral palsy?” These papers included 14 studies on groups of people with CP; the remaining 27 papers were reviews or expert commentaries.

From these papers, the researchers identified common early indicators of CP, which they grouped into three broad categories.

The first category concerned factors that could be identified from a patient’s clinical history. The most common of these was the development of a hand preference earlier than usual. Often, this was considered before 1 year of age, though cutoffs ranged from 6 months to 2 years old across papers.

Symptoms of irritability, such as being overly jumpy or startling easily, and of lethargy, including irregular sleep patterns, were also clinical features indicative of CP.

The second category focused on failing to achieve milestones of motor development. The researchers noted that, “[p]arental concern for developmental delay in and of itself constitutes an early feature.”

Being unable to roll over, sit up, and crawl at appropriate ages were all included, though there was again some variability in exact cutoff ages for each of these milestones. Being unable to walk was also a common feature, though the researchers noted that this “cannot truly constitute an early sign.”

The third category included abnormalities on neurological examinations. With appropriate training on the part of the healthcare provider, many of these types of examinations — such as the Hammersmith Infant Neurological Examination — can be performed in an office setting.

Specific abnormalities typical of CP included abnormally high or low muscle tone, and delays in so-called postural responses such as the parachute reflex — infants extending their arms, as if to protect against a fall, when they’re quickly lowered toward a surface, or rotated from an upright to face-forward position.

Abnormalities in primitive reflexes (those exhibited by infants but not adults, such as the palmomental reflex, when lower lip muscles move after stroking the palm) were also common. This included both the absence of these reflexes early on (when they should be present), and their persistence over time (at points when they should no longer be present).

“This study lays the groundwork for the development of knowledge translation tools to enhance early identification for children suspected of having CP that are easy to apply in the context of the primary care setting,” the researchers wrote.

They added, however, that, “[o]verall, the literature on the early observable clinical signs that should prompt referral for investigation of possible CP in the specific context of well-baby care surveillance was sparse and inconsistent.”

As such, further studies are needed to identify clinical features that should raise suspicion of CP among primary care providers. This is critical because earlier diagnosis may facilitate earlier treatments, which can lead to better outcomes in the long run.