title: Retrospective study of the investigations of children presenting with lower limbs spasticity in a single institution.
abstract: OBJECTIVE
  This retrospective study was undertaken to identify how children with spasticity entirely or mainly affecting lower limbs are investigated in a single institution, to address the diagnostic yield of these investigations, and to establish an improved diagnostic algorithm.
  
  
  METHODS
  Clinical documents regarding children referred to our institution for the diagnostic investigation of spastic diplegia and receiving their first clinical appointment between the July 1, 2010, and the December 31, 2010, were identified in our electronic database. Clinical correspondence, case-notes, magnetic resonance imaging reports, and other investigation results were reviewed.
  
  
  RESULTS
  For the 26 patients (16 males) identified, there was much variability in the investigations offered. In the 53.84% of them, a specific diagnosis was found, including one case of hereditary spastic paraplegia 3A and one of neuroblastoma.
  
  
  CONCLUSIONS
  Diagnostic rate could be optimized by a more standardized approach to investigations and by rational genetic testing. A comprehensive diagnostic algorithm is proposed for implementation of etiological diagnosis.
authors.affiliation: Department of Neurology, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Spagnoli
authors.affiliation: Department of Neurology, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Carlos
authors.initials: C
authors.lastname: de Sousa
mesh_terms: D002547:Cerebral Palsy / Q000175:diagnosis* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D009128:Muscle Spasticity; D012189:Retrospective Studies