CPOP netværksmøde. Neuropædiatriske opgaver - inklusion i CPOP - opfølgning med neuropæd protokol - koordinering

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1 CPOP netværksmøde europædiatriske opgaver - inklusion i CPOP - opfølgning med neuropæd protokol - koordinering Fredag d. 18. marts 2016 Charlotte Reinhardt Pedersen ordsjællands Hospital Hillerød Børne og Ungeafdelingen

2 Diagnose & Klassifikation Diagnose Hvornår Definition Hvorfor Genovervejelse af diagnose i 5. leveår Klassifikation Bevægeforstyrrelse Spastisk Dyskinetisk Ataktisk Blandet / ikke klassificerbar Type (Sværhedsgrad )

3 Cerebral Palsy Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, by epilepsy and by secondary musculoscetal problems. Medfødt eller tidlig erhvervet hjerneskade med påvirkning af motorisk funktionsniveau

4 Cerebral parese en paraplydiagnose Indgår i diagnose Fænomenologi Klinisk billede Anamnese Indgår ikke i diagnose Billeddiagnostik Laboratorietest Ætiologi mv

5 Decision tree for Cerebral Palsy Does the child have a disorder of movement or posture of central origin? EXCLUDE Was the child at least 4 years old when assessed? Is the child still living? Go back and reassess after age 4 Does the child have a disorder of motor function? EXCLUDE Does the child have a syndrome/brain anomaly or chromosome abnormality? Did the child die before the age of 2 years? EXCLUDE Is the condition progressive (loss of previously acquired skills)? EXCLUDE *Recheck - Does the child meet the criteria for the definition of CP? Does the child have generalised hypotonia? Are there signs of ataxia? EXCLUDE Look at Classification Tree Ataxic CP EXCLUDE SCPE Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine and Child eurology. 2000;42: viernes 18 de enero de 2013

6 Classification tree for sub-types of Cerebral Palsy Is there persisting increased muscle tone in one or more limbs? Are both sides of the body involved? Is the tone varying? Is there generalised hypotonia with signs of ataxia? Spastic Bilateral Spastic Unilateral Dyskinetic CP* on-classifiable Ataxic CP on-classifiable Reduced activity - tone tends to be increased Increased activity - tone tends to be decreased Dystonic CP* Choreo-Athetotic CP* SCPE Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine and Child eurology. 2000;42:

7 Classification of CP Subtypes SCPE Classi! cation of CP Subtypes based on the predominant neurological! ndings All CP subtypes have in common an abnormal pattern of movement and posture. Additional features by subtype: SPASTIC CP Bilateral Spastic (BS-CP) Unilateral Spastic (hemiplegia) Increased tone Pathological reflexes - increased reflexes, e.g. hyperreflexia - pyramidal signs, e.g. Babinski response resulting in abnormal pattern of movement and posture DSKIETIC CP ATAXIC CP Dystonic Choreo-athetotic Involuntary, uncontrolled, recurring, occasionally stereotyped movements, primitive reflexe patterns predominate, muscle tone is varying Loss of orderly muscular coordination, so that movements are performed with abnormal force, rhythm and accuracy SCPE Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine and Child eurology. 2000;42:

8 Hvilke børn har ikke cp

9 europædiatriske protokol Fødselsoplysninger Subklassifikation af CP Billeddiagnostik Talefunktion Kognitiv vurdering Diverse medicin, epilepsi, ernæring mm

10 MRI and Timing of early brain lesions Krägeloh-Mann et al, Exp eurol 2004

11 MRI and Timing of early brain lesions Cortical Malformations Periventricular Lesions Cortico-subcortical Lesions Krägeloh-Mann et al, Exp eurol 2004

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14 Take home message CPOP 0-4 år: Cerebral parese Cerebral parese lignende tilstande Mistanke om cerebral parese CPOP >5 år Cerebral parese Kognitiv protokol og kommunikation