The European Cerebral Palsy Study Group looked at the correlation of MRI findings and clinical outcomes. MRI scans plus detailed clinical assessments were carried out on over 400 children from the age of 2 years on and it was found that the scans could provide information about the timing and extent of their lesions (Bax et al JAMA 2006;296:1602-8).
The commonest finding was that of white matter damage of immaturity with nearly 90% of the subjects having defined structural abnormalities which would allow clear prognoses to be made. The authors strongly advocate MRI scan for all children with CP.
The possibility of obstetric mishaps being the cause of CP in their study group was small which is in keeping with all similar studies. The most frequent cause was infection which obstetrically is associated with preterm labour and placental damage. When this leads to preterm delivery, the hypoxic insult can result in white matter damage. This mechanism is also thought to account for the cortical damage of those born at term with CP, the infection being either clinical or sub-clinical at an early stage of the pregnancy. Multiple pregnancies are an at-risk group accounting at least 10%, with the same numbers attributable to cerebral malformations and genetic or metabolic disorders.
Only 20% of those born after 34 weeks gestation could be considered to have CP on the basis of an intrapartum mishap. Such mishaps are unlikely to be the result of obstetric mismanagement and the proportion amenable to intervention low. The authors agree with previous findings that asphyxiated encephalopathic infants are not necessarily the result of labour malpractice or lack of vigilance in pregnancy. They suggest the treatment of infections in pregnancy, the reduction in assisted reproduction twin pregnancies and the better, earlier diagnoses of CP are the preventative measures that will reduce the burden of CP. See also the editorial by Msall (pp 1650-2).
