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Controversy
The term diplegia should be abandoned
  1. A F Colver,
  2. T Sethumadhavan
  1. 1Senior Lecturer in Community Child Health, Northumbria Healthcare NHS Trust and University of Newcastle upon Tyne, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK
  2. 2Specialist Registrar in Paediatrics, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Rake Lane, North Shields, UK
  1. Correspondence to:
    Dr A F Colver, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK;
    allan.colver{at}ncl.ac.uk

https://doi.org/10.1136/adc.88.4.286

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    Use of the term has served to confuse classification and obscure interpretation of epidemiological and clinical studies

    From the writings of Freud onwards there is broad agreement on the definition of cerebral palsy (CP) but attempts to classify it, based on brain pathology, timing of postulated insult, aetiology, or clinical syndrome, taking account of one or more of neurological findings, distribution, and associated impairments, have been less successful.

    Any syndrome must be clearly defined, meaningful, reliable, and used consistently by different people. A few CP syndromes such as choreoathetosis with deafness caused by bilirubin encephalopathy and ataxia caused by hydrocephalus have stood the test of time and are reviewed by Ingram.1 However, we think that diplegia is not a description of a valid category or syndrome and use of the term has served to confuse classification and obscure interpretation of epidemiological and clinical studies. We draw on historical papers and our own new analyses of recent published epidemiological papers to argue that the term diplegia should be abandoned.

    HISTORICAL OVERVIEW OF USE OF TERM DIPLEGIA

    Table 1 summarises important classifications of the past 150 years which we shall discuss with respect to their use of the term diplegia.

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    Table 1

    Classifications of cerebral palsy

    William Little2 first described the syndrome complex of cerebral palsy in 1862. His paper proposed a link between abnormal parturition, difficult labour, premature birth, asphyxia neonatorum, and physical deformities, which he described lucidly. He did not use the term diplegia.

    In 1890, Sachs and Peterson proposed a classification which linked clinical syndrome to timing of the insult,3 and introduced diplegia and paraplegia as separate categories.

    In 1893, Freud considered cerebral palsy to be caused not just at parturition but also sooner in pregnancy because of “deeper effects that influenced the development of the foetus”.4 Freud was the first to use the …

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