The early manifestations and course of diplegia in childhood.

During a recent survey of children suffering from cerebral palsy in Edinburgh it was found that diplegia was relatively infrequently diagnosed before the age of 2 years. The average delay between the doctor seeing the child for the first time, on account of manifestations of diplegia, and the diagnosis being reached was over one year. The classical picture of diplegia presented in the textbooks is of a child affected by rigidity, spasticity and contractures of the limbs, and only when these features were present was the diagnosis made in the majority of patients. Yet the symptoms and signs of the earlier stages of diplegia are typical and should enable the diagnosis to be made in most patients long before contractures have occurred. In the present paper the early manifestations and course of diplegia will be discussed. The terminology and classification used during the survey has been described in an earlier article (Ingram, 1955). The term diplegia is used to describe a condition of more or less symmetrical paresis of cerebral origin, more severe in the lower limbs than in the upper and dating from birth or shortly after. Mental deficiency, epilepsy and strabismus are frequently associated findings. Patients suffering from diplegia associated with cerebellar ataxia are not considered in this article.