H Eggink1, D Kremer1, O F Brouwer1, M F Contarino2, M E van Egmond3, A Elema4, K Folmer5, J F van Hoorn4, L A van de Pol6, V Roelfsema1, M A J Tijssen7. 1. University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands. 2. Haga Teaching Hospital, Department of Neurology, The Hague, The Netherlands; Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands. 3. University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands; Ommelander Ziekenhuis Groningen, Department of Neurology, Delfzijl and Winschoten, The Netherlands. 4. University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, The Netherlands. 5. Department of Rehabilitation, Revalidatiecentrum de Trappenberg, The Netherlands. 6. Department of Child Neurology, VU Medical Center Amsterdam, The Netherlands. 7. University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands. Electronic address: m.a.j.de.koning-tijssen@umcg.nl.
Abstract
OBJECTIVE: Cerebral palsy (CP) can be classified as spastic, dyskinetic, ataxic or combined. Correct classification is essential for symptom-targeted treatment. This study aimed to investigate agreement among professionals on the phenotype of children with CP based on standardized videos. METHODS: In a prospective, observational pilot study, videos of fifteen CP patients (8 boys, mean age 11 ± 5 y) were rated by three pediatric neurologists, three rehabilitation physicians and three movement disorder specialists. They scored the presence and severity of spasticity, ataxia or dyskinesias/dystonia. Inter- and intraobserver agreement were calculated using Cohen's and Fleiss' kappa. RESULTS: We found a fair inter-observer (κ = 0.36) and moderate intra-observer agreement (κ = 0.51) for the predominant motor symptom. This only slightly differed within the three groups of specialists (κ = 0.33-0.55). CONCLUSION: A large variability in the phenotyping of CP children was detected, not only between but also within clinicians, calling for a discussing on the operational definitions of spasticity, dystonia and ataxia. In addition, the low agreement found in our study questions the reliability of use of videos to measure intervention outcomes, such as deep brain stimulation in dystonic CP. Future studies should include functional domains to assess the true impact of management options in this highly challenging patient population.
OBJECTIVE:Cerebral palsy (CP) can be classified as spastic, dyskinetic, ataxic or combined. Correct classification is essential for symptom-targeted treatment. This study aimed to investigate agreement among professionals on the phenotype of children with CP based on standardized videos. METHODS: In a prospective, observational pilot study, videos of fifteen CPpatients (8 boys, mean age 11 ± 5 y) were rated by three pediatric neurologists, three rehabilitation physicians and three movement disorder specialists. They scored the presence and severity of spasticity, ataxia or dyskinesias/dystonia. Inter- and intraobserver agreement were calculated using Cohen's and Fleiss' kappa. RESULTS: We found a fair inter-observer (κ = 0.36) and moderate intra-observer agreement (κ = 0.51) for the predominant motor symptom. This only slightly differed within the three groups of specialists (κ = 0.33-0.55). CONCLUSION: A large variability in the phenotyping of CPchildren was detected, not only between but also within clinicians, calling for a discussing on the operational definitions of spasticity, dystonia and ataxia. In addition, the low agreement found in our study questions the reliability of use of videos to measure intervention outcomes, such as deep brain stimulation in dystonic CP. Future studies should include functional domains to assess the true impact of management options in this highly challenging patient population.
Authors: Jake P Levy; Maryam Oskoui; Pamela Ng; John Andersen; David Buckley; Darcy Fehlings; Adam Kirton; Louise Koclas; Nicole Pigeon; Esias van Rensburg; Ellen Wood; Michael Shevell Journal: Neurol Clin Pract Date: 2020-04
Authors: Bhooma R Aravamuthan; Michael Shevell; Young-Min Kim; Jenny L Wilson; Jennifer A O'Malley; Toni S Pearson; Michael C Kruer; Michael Fahey; Jeff L Waugh; Barry Russman; Bruce Shapiro; Ann Tilton Journal: Neurology Date: 2020-10-12 Impact factor: 9.910