The term diplegia should be abandoned

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