TY - JOUR
T1 - Role of child neurologists and neurodevelopmentalists in the diagnosis of cerebral palsy
T2 - A survey study
AU - Aravamuthan, Bhooma R.
AU - Shevell, Michael
AU - Kim, Young Min
AU - Wilson, Jenny L.
AU - O'Malley, Jennifer A.
AU - Pearson, Toni S.
AU - Kruer, Michael C.
AU - Fahey, Michael
AU - Waugh, Jeff L.
AU - Russman, Barry
AU - Shapiro, Bruce
AU - Tilton, Ann
N1 - Funding Information:
Dr. Aravamuthan receives research funding from the National Institute of Neurological Disorders and Stroke. Dr. Shevell is on the editorial boards of Pediatric Neurology and Journal of Child Neurology and receives research support from the Kids Brain Health Network and the Harvey Guyda Chair Fund of the Montreal Children's Hospital Foundation. Dr. Wilson, Dr. Kim, and Dr. O'Malley have no relevant disclosures or financial support. Dr. Pearson receives research funding from the National Institute of Neurological Disorders and Stroke. Dr. Kruer is on the editorial board of the Journal of Child Neurology and has received consulting fees from PTC Pharmaceuticals and research support from the National Institute of Neurological Disorders and Stroke and from Medtronic. Dr. Waugh receives research support from the American Academy of Neurology and the Collaborative Center for X-linked Dystonia Parkinsonism. Dr. Russman is on the Scientific Advisory Board for Sarepta: DMC. Dr. Shapiro has no relevant disclosures or financial support. Dr Tilton serves on the board of directors of the American Academy of Neurology, on the editorial boards of the Journal of Child Neurology and Neurology, and as a consultant for Ipsen Biopharmaceuticals, Inc. Dr Tilton has received personal compensation for speaking engagements and research/grant support from Ipsen Biopharmaceuticals, Inc, and receives patent royalties through her institution for botulinum toxin in the prevention and treatment of acne. Go to Neurology.org/N for full disclosures.
Funding Information:
Funding supporting this work is from the National Institute of Neurological Disorders and Stroke (5K12NS098482-02 and 1R01NS106298).
Publisher Copyright:
Copyright © 2020 American Academy of Neurology.
PY - 2020/11/24
Y1 - 2020/11/24
N2 - Objective To contextualize the role of child neurologists and neurodevelopmentalists (CNs/NDDs) in cerebral palsy (CP) care, we review the changing landscape of CP diagnosis and survey stakeholder CNs/NDDs regarding their roles in CP care.MethodsThe optimal roles of the multiple specialties involved in CP care are currently unclear, particularly regarding CP diagnosis. We developed recommendations regarding the role of CNs/NDDs noting (1) increasing complexity of CP diagnosis given a growing number of genetic etiologies and treatable motor disorders that can be misdiagnosed as CP and (2) the views of a group of physician stakeholders (CNs/NDDs from the Child Neurology Society Cerebral Palsy Special Interest Group).ResultsCNs/NDDs felt that they were optimally suited to diagnose CP. Many (76%) felt that CNs/NDDs should always be involved in CP diagnosis. However, 42% said that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP at all. CNs/NDDs identified areas of their expertise critical for CP diagnosis including knowledge of the neurologic examination across development and early identification of features atypical for CP. This contrasts with their views on CP management, where CNs/NDDs felt that they could contribute to the medical team, but were necessary primarily when neurologic coexisting conditions were present.DiscussionGiven its increasing complexity, we recommend early referral for CP diagnosis to a CN/NDD or specialist with comparable expertise. This contrasts with current consensus guidelines, which either do not address or do not recommend specific specialist referral for CP diagnosis.
AB - Objective To contextualize the role of child neurologists and neurodevelopmentalists (CNs/NDDs) in cerebral palsy (CP) care, we review the changing landscape of CP diagnosis and survey stakeholder CNs/NDDs regarding their roles in CP care.MethodsThe optimal roles of the multiple specialties involved in CP care are currently unclear, particularly regarding CP diagnosis. We developed recommendations regarding the role of CNs/NDDs noting (1) increasing complexity of CP diagnosis given a growing number of genetic etiologies and treatable motor disorders that can be misdiagnosed as CP and (2) the views of a group of physician stakeholders (CNs/NDDs from the Child Neurology Society Cerebral Palsy Special Interest Group).ResultsCNs/NDDs felt that they were optimally suited to diagnose CP. Many (76%) felt that CNs/NDDs should always be involved in CP diagnosis. However, 42% said that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP at all. CNs/NDDs identified areas of their expertise critical for CP diagnosis including knowledge of the neurologic examination across development and early identification of features atypical for CP. This contrasts with their views on CP management, where CNs/NDDs felt that they could contribute to the medical team, but were necessary primarily when neurologic coexisting conditions were present.DiscussionGiven its increasing complexity, we recommend early referral for CP diagnosis to a CN/NDD or specialist with comparable expertise. This contrasts with current consensus guidelines, which either do not address or do not recommend specific specialist referral for CP diagnosis.
UR - http://www.scopus.com/inward/record.url?scp=85096815821&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000011036
DO - 10.1212/WNL.0000000000011036
M3 - Review article
C2 - 33046609
AN - SCOPUS:85096815821
SN - 0028-3878
VL - 95
SP - 962
EP - 972
JO - Neurology
JF - Neurology
IS - 21
ER -