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In Reply: The letter by Dr Caspi and colleagues raises 3 critical points in understanding the complexity of the CP syndromes.

First, regarding practice recommendations, Ashwal et al¹ explicitly stated "In order to establish that a brain abnormality exists in children with CP that may, in turn, suggest an etiology and prognosis, neuroimaging is recommended with MRI preferred to CT (Level A)," as well as "Large prospective cohorts of children with CP should be studied to identify features based on CP subtypes that can improve specific evaluation strategies and enhance etiologic yield." Bax et al² carried out this most important task.

Second, regarding timing of MRI scans at 18 months of age, the most rapid changes in myelination occur within the first 8 postnatal months.³ With respect to central white matter, 50% of infants attain mature myelin in the precentral gyrus at 30 weeks, occipital poles at 47 weeks, posterior . . . [Full Text of this Article]

Michael E. Msall, MD
mmsall@peds.bsd.uchicago.edu
University of Chicago Comer Children's Hospital
Chicago, Ill

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