Infant MRI strongly recommended for suspected cerebral palsy

Thanks largely to advances in neuro MRI, cerebral palsy—the most common motor disability in children—can now be diagnosed before babies are even 6 months old (in adjusted age, meaning going by due date rather than delivery date). The stepped-up diagnostic capabilities are key, as early detection is critical to optimizing effective intervention, the authors of a new review of the literature emphasize.

In their study report, published online July 17 in JAMA Pediatrics, Iona Novak, PhD, of the University of Sydney, Lars Adde, PhD, of the Norwegian University of Science and Technology and colleagues note that, historically, cerebral palsy was not diagnosed until children were between 1 and 2 years old.

En route to recommending MRI in most suspected cases on an ASAP basis whenever safe and feasible, the team systematically searched the literature indexed in four medical-journal databases spanning decades. They also searched by hand, including prior reviews with or without meta-analyses, criteria of diagnostic accuracy and evidence-based clinical guidelines.

Their findings included:

• Before 5 months’ adjusted age, the most predictive tools for detecting risk are MRI (86 to 89 percent sensitivity), the Prechtl Qualitative Assessment of General Movements (98 percent sensitivity) and the Hammersmith Infant Neurological Examination (HINE, 90 percent sensitivity).
• After 5 months’ adjusted age, the most predictive tools for detecting risk are MRI, the Hammersmith exam and the Developmental Assessment of Young Children (DAYC, commercially available).
• Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and MRI and the HINE exam may be helpful in assisting clinical decisions.

The researchers further found that, in developed countries, two in three individuals with cerebral palsy will walk, three in four will talk and one in two will have normal intelligence.

They conclude that cerebral palsy, or high risk thereof, can and should be diagnosed accurately and early using clinical reasoning and a combination of standardized tools.

The authors note that the congenital disorder occurs in as many as 1 in 500 live births.

“High-quality evidence indicates that, for infants with newborn-detectable risks before 5 months’ corrected age, the general-movements assessment plus neonatal MRI is more than 95 percent accurate and is thus recommended,” Novak et al. write. “For infants with infant detectable risks after 5 months’ corrected age, the HINE plus neonatal MRI is more than 90 percent accurate and is therefore recommended.”

They conditionally recommend these same methods for babies whose signs or symptoms of cerebral palsy don’t show up until later, and they recommend the HINE exam in regions where MRI is not safe or affordable.

Early detection of high risk of cerebral palsy, followed by cerebral palsy-specific early intervention, “should be the standard of care to optimize infant neuroplasticity, prevent complications, and enhance parent and caregiver well-being,” the authors write.