Interest of neuromotor assessment in early screening of children at high risk for cerebral palsy within a specialized network
Prof Sameh GHROUBIa, Dr Wafa ELLEUCHa, Dr Saoussan MAHERSIa, Prof Fatma KAMMOUNb, Prof Nedia HMIDAc, Prof Chahinez TRIKIb, Prof Mohamed Habib ELLEUCHa
a Service de Médecine Physique et de Réadaptation, CHU Habib Bourguiba, Sfax, Tunisie, et Unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, b Service de neuropédiatrie, CHU Hedi Chaker, Sfax, Tunisie, c Service de néonatologie, CHU Hedi Chaker, Sfax, Tunisie
Objective: to identify clinical and laboratory signs of early screening of cerebral palsy in order to propose an early management of children.
Methods: prospective study including 100 newborns with risk factors for CP (relying on gestational age, birth weight, perinatal and neonatal brain injuries). The screening was conducted during a medical consultation by a specialist and was based on clinical setting (neurological examination and neuromotor assessment) and radiological examination (cranial ultrasound, magnetic resonance imaging).
The clinical assessment was performed at the 1st, 4th, 9th, 12th, 18th, 24th month and at 5 years after selection of patients.
The different clinical factors were weak predictors of becoming during the first month of life.
At 4 months, the factors correlated with the evolution to cerebral palsy were: the decrease of lower limbs’ spontaneous movements and the lower limb fixed in extension at suspension maneuvers (p<0,001), Babinski sign (p<0,001), as well as absence of an ulnar-palmar grip (p <0.01).
At 9 months, we found more predictive signs of the evolution to CP, particularly the head holding problems (p <0.001), the absence of acquisition of sitting position (p <0.001), the absence of precision grip (p <0.001), the deficit of uprising the lower limbs, of hip abduction, of extension of the knee in the lateral inclinations and drawn-seated (p <0.001), hyperreflexia (p = 0.004) and the Babinski sign (p <0.001).
At 12, 15 and 18 months, neurological examination showed a peripheral hypertonia in 62% of children.
At 24 months, peripheral hypertonia is found only in 43% of cases.
38% of children had an adequate level of psychomotor development and a normal neurological examination hence the diagnosis of transient motor abnormalities (TMA) was retained.
For imaging, normal cranial ultrasound was significantly more associated with TMA than CP (p <0.001).
Neurological examination focusing on reflexes and muscle tone is poorly predictive in the first months of life.
Neuromotor assessment with the study of spontaneous movements may reflect functional limitations in the first months of life and have been shown to predict later CP. However, the distinction between CP and TMA remains difficult and requires a long follow-up.
Ref: FREDERICK.B. Strategies for the early diagnosis of cerebral palsy. J Pediatr 2004;145:S8-S11
Keywords : cerebral palsy, neuromotor assessment, early screening, spontaneous movement