What Other Diagnoses are Similar to Cerebral Palsy?

Cerebral palsy can be confused with other medical conditions. It is especially important to consider other causes that might have different treatments. Distinguishing features of these “other” diagnoses can often be identified by taking a careful medical history. Clinical clues to consider carefully include:

  • Is there is an absence of difficulties at or around the time of birth that account for the developmental motor and associated abnormalities.
  • Is the child having a decline in motor function, intellectual ability or degree of high muscle tone over time that not explained by an orthopedic issue/growth/or change in health status.  

One of the diagnoses that can appear like cerebral palsy is a progressive movement disorder called Dopa responsive dystonia (DYT5). This rare genetic disorder occurs due to impaired production of a neurochemical called DOPA. This results in a progressive increase in muscle tone and physical limitations and can resembles cerebral palsy. Patients with this condition typically do not have cognitive challenges but may have progressive and severe spasticity or dystonia. A large number of these individuals also have variation in their tone during the day. These children and adults often respond to very low dose DOPA supplement and have significant improvement in their symptoms.

Another genetic disorder that is confused with cerebral palsy early in the course of the disorder is Glutaric aciduria type 1. The distinguishing feature of this condition is progression of the movement disorder with the child developing chorea (rapid random movements). Also imaging of the brain reveals a distinctive pattern of abnormalities in the temporal area. While reversal of the symptoms is not anticipated, specific medical interventions may limit further progression of the condition.

Instability of the spinal column is also an important consideration. This possibility should be strongly considered if an individual has progressive spasticity, deterioration of motor function, sensory changes and progressive bowel and bladder abnormalities. The spinal cord can be injured directly by the increased movement of the bone vertebra. This may be as high as the cervical area or at any point along the spine. Intervention to stabilize the spine is critical to stop the progression. Reversal of the new neurological findings is frequently not possible but again the intervention may stop the deterioration.

Other slowly progressive disorders are occasionally misdiagnosed as cerebral palsy. These are predominantly rare diagnoses that have other symptoms that help separate them from individuals with cerebral palsy. For example, several have an associated loss of cognitive skills. These patients do not have a stable, predominantly motor problem but instead deteriorate across several domains (e.g. cognitive, behavioral, fine and gross motor).  Imaging (MRI preferably) may reveal changes that are consistent with the diagnosis. Examples of such diagnoses include:

  • Metachromatic Leukodystrophy
  • Pelizaeus-Merzbacher disease
  • Rett’s Syndrome should be considered when the symptoms of motor delay and spasticity are combined with autistic features and non-purposeful hand movements

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Resources:

Brain Injury Research Foundation
www.birf.info

National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov

Children’s Hemiplegia and Stroke Association
www.chasa.org