Early-onset HSP: why it is mistaken for cerebral palsy

A plain-language summary of a published scientific study. It is educational and does not replace medical advice.

The study: Wilson JL et al., Movement Disorders Clinical Practice, published online 20 September 2026[1]. A narrative literature review, supplemented by expert consensus.

What the researchers studied

The authors reviewed studies published up to February 2026 on the forms of hereditary spastic paraplegia (HSP) that usually begin in childhood or adolescence[1]. The aim: to describe what these forms look like, how they can be diagnosed sooner, and which treatments exist or are being studied.

What they found

• Early-onset HSP is under-recognised. It often resembles cerebral palsy or other genetic, metabolic or acquired conditions, which delays diagnosis[1].
• Besides leg stiffness and weakness, some forms can include dystonia (involuntary muscle contractions), parkinsonism or developmental problems[1].
• SPG4 (the SPAST gene) and SPG11 are among the most common causes[1].
• Some subtypes have characteristic MRI signs that can guide the doctor[1].
• Care needs a team from several specialties to manage spasticity, movement problems and other neurological issues[1].

What it means for families

If a child's stiffness gets worse over time or does not fit cerebral palsy, it is worth asking the doctor about genetic testing. The authors see recognising typical signs, early genetic testing and an individual care plan as essential[1].

What the study does not tell us yet

The authors write that therapies that could change the course of the disease are emerging, such as gene replacement and antisense oligonucleotides, but for selected subtypes[1]. They are still being researched, not available treatments. For SPG4, on 6 November 2026 there was no registered clinical trial on ClinicalTrials.gov of a treatment that changes the course of the disease[2].