[Definition and classification of cerebral palsy: a problem that has already been solved?]. / Definicion y clasificacion de la paralisis cerebral: un problema ya resuelto?

AIM: To carry out a review of the definition and classification of cerebral palsy (CP) from a historical point of view and in the light of current knowledge. DEVELOPMENT: Defining and classifying CP in the medical literature have been difficult to achieve. The different definitions and classifications have represented a limitation when it comes to interpreting the results of epidemiological studies. The definitions do not specify any age limits as regards the moment the brain injury occurred or with respect to the onset of motor disorders or how severe such disorders must be in order to be considered as CP. Within the classifications there are significant inter-observer differences in the interpretation of certain terms, particularly in the topographical and pathophysiological classifications. It has only been in recent years that the first steps have been taken towards achieving greater consistency in the definition and classification of CP. The most recent definition proposed by the Executive Committee for the Definition and Classification of CP, in April 2005, partly satisfies the clinical demands but not those of epidemiological research; nevertheless, the classification of CP proposed here would be useful for both clinical and epidemiological purposes if a number of small modifications mainly concerning the search for causations were introduced. CONCLUSIONS: The definition and classification of CP are a problem that has still not been solved. We recommend drawing up a complementary definition of CP, for epidemiological research purposes, obtained by international agreement.

Definición y clasificación de la parálisis cerebral: ¿un problema ya resuelto? / Definition and classification of cerebral palsy: a problem that has already been solved?

Objetivo. Realizar una revisión de la definición y clasificación de la parálisis cerebral (PC) desde una perspectiva histórica y a la luz de los conocimientos actuales. Desarrollo. La definición y clasificación de la PC en la bibliografía médica han sido problemáticas. La diversidad de definiciones y clasificaciones han constituido una limitación a la hora de interpretar los resultados de estudios epidemiológicos. En cuanto a las definiciones, en ellas no se especifican límites de edad de ocurrencia de la lesión cerebral, ni límites de edad con respecto al momento en que deban presentarse los trastornos motores, como tampoco la gravedad de éstos para ser considerados PC. En las clasificaciones existen variaciones significativas interobservadores en la interpretación de determinados términos, particularmente en las clasificaciones topográficas y fisiopatológicas. Sólo en años recientes se han dado los primeros pasos para el logro de mayor consistencia en la definición y clasificación de la PC. La propuesta de definición más reciente del Comité Ejecutivo para la Definición y Clasificación de PC, de abril de 2005, satisface en parte las exigencias de la clínica, pero no de las investigaciones epidemiológicas; sin embargo, la clasificación de PC propuesta resultaría útil para ambos propósitos, clínicos y epidemiológicos, si se realizaran algunas modificaciones dirigidas fundamentalmente a la búsqueda de etiologías. Conclusiones. La definición y clasificación de la PC constituyen un problema aún no resuelto. Se recomienda la realización de una definición complementaria de PC, con fines investigadores epidemiológicos, obtenida por consenso internacional

Aim. To carry out a review of the definition and classification of cerebral palsy (CP) from a historical point of view and in the light of current knowledge. Development. Defining and classifying CP in the medical literature have been difficult to achieve. The different definitions and classifications have represented a limitation when it comes to interpreting the results of epidemiological studies. The definitions do not specify any age limits as regards the moment the brain injury occurred or with respect to the onset of motor disorders or how severe such disorders must be in order to be considered as CP. Within the classifications there are significant inter-observer differences in the interpretation of certain terms, particularly in the topographical and pathophysiological classifications. It has only been in recent years that the first steps have been taken towards achieving greater consistency in the definition and classification of CP. The most recent definition proposed by the Executive Committee for the Definition and Classification of CP, in April 2005, partly satisfies the clinical demands but not those of epidemiological research; nevertheless, the classification of CP proposed here would be useful for both clinical and epidemiological purposes if a number of small modifications mainly concerning the search for causations were introduced. Conclusions. The definition and classification of CP are a problem that has still not been solved. We recommend drawing up a complementary definition of CP, for epidemiological research purposes, obtained by international agreement

Reproductive behaviour of couples at risk for sickle cell disease in Cuba: a follow-up study.

Three hundred and forty-three Cuban women at risk of having children with sickle cell anaemia or sickle cell-haemoglobin C disease were interviewed 2-8 years after the index pregnancy (that in which their risk was detected). The aim was to collect information on their attitude towards prenatal diagnosis in subsequent pregnancies. Twenty-two per cent (75/343) had dissolved their marriage and 9 per cent of these (7/75) considered that their at-risk status had influenced the separation. Sixty-three per cent of stable couples at risk (168/268) had decided to have no further children; 27 per cent of these (45/168) were afraid of having an affected child and 4 per cent (7/168) were afraid of the obstetric procedure. Nineteen per cent of the stable couples at risk (52/268) had had at least one further child or pregnancy. Of these, 44 per cent (23/52) requested prenatal diagnosis early and spontaneously, and a further 44 per cent (23/52) requested prenatal diagnosis but after re-identification by screening and recounselling. Only 12 per cent (6/52) did not request prenatal diagnosis. Attitude towards prenatal diagnosis was most positive among more educated women. The general perception of the prevention programme was good.