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February 7, 2007

MRI Findings and Cerebral Palsy—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(5):465-467. doi:10.1001/jama.297.5.466-b

In Reply: In response to Dr Jelsema, our conclusion that the centers involved in the study did not achieve full ascertainment of all the cases in their catchment area was based on detailed discussion with the clinicians in each center. As an example, in London, finding 2-year-olds with disabilities is hard. The United Kingdom has child development centers to which such children would routinely be referred, and clinicians and physiotherapists in these centers were good sources for finding cases. However, they often told us the names of children who were no longer attending these centers and therefore could not be traced. Because some parents with young children in London move frequently, we suspect that we also may have missed some children who had recently moved in. Even with the UK Health Service, it is not possible to obtain records from any centralized computer. There were different problems in each center, but in our view Lisbon had the best organized service and achieved the highest ascertainment. We therefore felt that we did not have the data to suggest that the rate of CP had decreased.