Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- early general movement abnormalities
- abnormal HINE scores
- delay in motor development
- delay in speech development
- delay in cognitive/intellectual development
- retention of primitive reflexes
- lack of age-appropriate reflexes
- spasticity/clonus
- selective voluntary motor control impairment
- toe walking/knee hyperextension
- scissoring
- crouched gait
- contractures
Otros factores de diagnóstico
- muscle weakness
- joint instability/dislocation
- dystonia
- chorea
- athetosis
- ataxia
- neonatal hypotonia
- scoliosis
Factores de riesgo
- prematurity
- low birth weight
- fetal birth asphyxia
- multiple births
- maternal illness
- fetal brain malformation
- major birth defects
- familial metabolic/genetic disorder
- neonatal complications
- meningitis
- maternal teratogen exposure
- low socioeconomic status
- nonvertex presentation
- postmaturity
- head injury
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- MRI brain
Pruebas diagnósticas que deben considerarse
- ultrasound/CT brain
- coagulation studies
- genetic testing
- metabolic screen
- x-ray of affected joint
- instrumented gait analysis
Algoritmo de tratamiento
spastic hemiplegia
spastic diplegia
spastic quadriplegia
dyskinetic
ataxic
Colaboradores
Autores
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, null
Los Angeles
CA
Divulgaciones
See individual author disclosures.
William L. Oppenheim, MD
Distinguished Professor Emeritus Pediatric Orthopedics
Margaret Jones Kanaar Chair, Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Divulgaciones
WLO is an author of several references cited in this topic.
Loretta Staudt, MS, PT
Research Physical Therapist
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Divulgaciones
LS is a clinical evaluator for several sponsored clinical trials as part of her salaried employment at UCLA. She has received travel, meals, and accommodation to attend training meetings for some of these trials but does not receive any direct reimbursements or personal benefits from the companies, which include Pfizer, Sarepta, Audentes Therapeutics, Bristol-Meyers Squibb, Biogen, Santhera, Fibrogen, Cytokinetics, Italfarmaco, and AveXis. As part of her salaried employment at UCLA, LS is working on a project funded by the Cerebral Palsy Foundation. She is an author of several references cited in this topic.
Rachel Thompson, MD
Assistant Professor-in-Residence, Department of Orthopaedic Surgery
Associate Residency Program Director, Department of Orthopaedic Surgery
Director, UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
William and Patricia Oppenheim Presidential Chair in Pediatric Orthopaedics
David Geffen School of Medicine at UCLA
Los Angeles
CA
Divulgaciones
RT declares that she has no competing interests.
Marcia Greenberg, MS, PT
Physical Therapist
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Divulgaciones
MG is a consultant for the NGO, UCP Wheels for Humanity, teaching physical therapists in developing countries. She is an author of several references cited in this topic.
Eileen Fowler, PhD, PT
Professor
Department of Orthopaedic Surgery
Director of Research and Education
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
Peter William Shapiro Chair
David Geffen School of Medicine at UCLA
Los Angeles
CA
Divulgaciones
EF receives grant funding from the Cerebral Palsy Foundation. She is a member of the Scientific Advisory Committee of the Cerebral Palsy Foundation. She is an author of several references cited in this topic.
Agradecimientos
Dr William L. Oppenheim, Loretta Staudt, Dr Rachel Thompson, Marcia Greenberg, and Dr Eileen Fowler wish to gratefully acknowledge Dr Albert Stroberg, Dr Erika Hassan, Dr Rebecca Hanson, Dr Joan Earle Hahn, Dr Tien T. Nguyen, and Dr Sarah Copeland, previous contributors to this topic.
Divulgaciones
AS, EH, RH, JEH, TTN, and SC declare that they have no competing interests.
Revisores por pares
Hank Chambers, MD
Clinical Professor
Department of Orthopaedic Surgery
University of California at San Diego
Medical Affairs Officer
Rady Children's Hospital
San Diego
CA
Divulgaciones
HC is an author of a number of references cited in this topic. HC has received research support from the National Institutes of Health greater than 6 figures USD.
Michael Sussman, MD
Orthopaedic Surgeon
Shriners Hospital for Children
Portland
OR
Divulgaciones
MS declares that he has no competing interests.
Charles Fairhurst, MBBS MSc
Consultant in Paediatric Neurodisability
Evelina Children's Hospital
Guy's & St Thomas' NHS Foundation Trust
London
UK
Divulgaciones
CF declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007 Feb;109:8-14. Resumen
Noritz G, Davidson L, Steingass K, et al. Providing a primary care medical home for children and youth with cerebral palsy. Pediatrics. 2022 Nov 21;e2022060055.Texto completo Resumen
Shepherd E, Salam RA, Middleton P, et al. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2017 Aug 8;(8):CD012077.Texto completo Resumen
Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020 Feb 21;20(2):3.Texto completo Resumen
Shepherd E, Salam RA, Middleton P, et al. Neonatal interventions for preventing cerebral palsy: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev. 2018 Jun 20;(6):CD012409.Texto completo Resumen
Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907. Resumen
American Academy of Neurology. Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy. Jan 2010 [internet publication].Texto completo
Fehlings D, Brown L, Harvey A, et al. Pharmacological and neurosurgical interventions for managing dystonia in cerebral palsy: a systematic review. Dev Med Child Neurol. 2018 Apr;60(4):356-66.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
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Más DiferencialesGuías de práctica clínica
- Providing a primary care medical home for children and youth with cerebral palsy
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Cerebral palsy: what is it?
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