Is Cerebral Palsy a Wastebasket Diagnosis?

Abstract

Many child neurologists avoid use of the term “cerebral palsy” due to the perception that this term is nonspecific and carries no clinically useful information. However, this term provides a precise and useful description of the time course and major features of a welldefined clinical syndrome, and it, therefore, provides important guidance for both treatment and prognosis. Cerebral palsy is, first and foremost, a disorder of the nervous system. Child neurologists can provide essential expertise in the diagnosis and treatment of this disorder, and the advent of new medical technology and medications requires the involvement of neurologists in the ongoing care of affected children. The statement that cerebral palsy is a “wastebasket” diagnosis has become so familiar that it is not uncommon to hear it restated by patients as well as doctors. The statement suggests that perhaps cerebral palsy is not a diagnosis requiring the care of neurologists who are accustomed to more specific and scientifically justifiable terminology. Irrespective of whether or not it is appropriate to make an analogy between a severe childhood neurological disorder and a trash receptacle, the motivation behind this statement would seem to suggest that different and perhaps more accurate labels should be used for children who, currently, believe themselves to have cerebral palsy. Before examining other possible terms, it is perhaps appropriate to point out that the term “cerebral palsy” has a precise definition that has been recently revised by a consensus group. 1 The revised definition is broad and encompasses children with many different types of injuries, including early-onset static disorders such as asphyxia or traumatic brain injury. In this respect, it is not much different from other terms commonly used by child neurologists, such as “epilepsy,” “developmental delay,” or “stroke.” So what do we mean by “wastebasket diagnosis”? Of course, this term is colloquial and has no precise definition relevant to child neurology. However, it seems reasonable to speculate that the intended image is of many different etiologies thrown together in a single syndrome without any attempt at establishing order. Furthermore, a wastebasket is not just a receptacle; it is a receptacle with a purpose. So an additional intended image might be that a diagnosis, once thrown in the wastebasket, can then somehow be discarded because it fulfills no useful therapeutic role. Another image that is perhaps unintended but that nevertheless reflects a