[A clinical study of cerebral palsy in Shiga; 1977-1986--III. Diagnosis and treatment of various types of cerebral palsy].

The age at the first clinical referral or diagnosis of cerebral palsy (CP), the age at the onset of treatment, the route of referral, and the kind of school entered were investigated in 202 cases of CP in Shiga Prefecture (69 with spastic diplegia, 62 with tetraplegia, 33 with hemiplegia, 23 with the dyskinetic type and 15 with the ataxic type) born between April 1977 and March 1987. In the hemiplegia, spastic diplegia and ataxic types, the age at the first clinical referral or diagnosis, was above 1 year in 42%, 39% and 33%, respectively. In the tetraplegia and the dyskinetic types, by contrast, such a delay occurred in only 9% and 4%, respectively. Cases of the former three types were referred from medical institutions less frequently (53% in the ataxic type, 52% in spastic diplegia and 40% in hemiplegia) than those of the latter two types (76% in tetraplegia and 61% in the dyskinetic type). About 30% of the cases were referred from health centers (38% in spastic diplegia, 33% in hemiplegia, 30% in the dyskinetic type, 20% in the ataxic type and 16% in tetraplegia). A considerable number of cases visited a clinic without reference (27% in hemiplegia, 27% in the ataxic type, 10% in spastic diplegia, 9% in the dyskinetic type, and 8% in tetraplegia). Fifty-three percent of the cases entered an elementary school (ordinary classes in 30% and special classes in 23%), 41% a special school, and 5% entered a protective institution. The early diagnosis of hemiplegia, spastic diplegia and the ataxic type of CP was difficult in some cases. Cases with suspected signs of CP should be referred to clinic early in the absence of definite diagnosis.