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Published on: February 2, 2024
Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998
K Himmelmann1, G Hagberg, L M Wiklund
1Department of Paediatrics, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, Göteborg, Sweden. kate.himmelmann@vgregion.se
Insights
Dyskinetic cerebral palsy (CP) is common in term-born infants with severe motor impairments. Adverse perinatal events and late third-trimester brain lesions are frequent in these children.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Cerebral palsy (CP) is a group of movement disorders due to early brain damage.
- Dyskinetic CP, characterized by involuntary movements, is a significant subtype.
- Understanding its epidemiology and etiology is crucial for targeted interventions.
Purpose of the Study:
- To describe the epidemiology, etiology, and clinical features of dyskinetic CP.
- To identify risk factors and clinical characteristics in a population-based cohort.
- To elucidate the relationship between perinatal events and neuroimaging findings.
Main Methods:
- Population-based follow-up study of children born between 1991-1998.
- Ascertainment between 4-8 years of age, with examination of 48 children with dyskinetic CP.
- Analysis of clinical findings, Gross Motor Function Classification System (GMFCS) levels, neuroimaging, and perinatal events.
Main Results:
- Prevalence of dyskinetic CP was 0.27 per 1000 live-births.
- Most participants (39/48) had the dystonic subtype; 28/48 were GMFCS Level V.
- Adverse perinatal events and late third-trimester brain lesions were common, particularly in term-born infants with severe motor impairment.
Conclusions:
- Dyskinetic CP is the predominant type in term-born, appropriate-for-gestational-age children with severe motor disabilities.
- Adverse perinatal events and specific brain lesions are strongly associated with this CP subtype.
- Findings highlight the importance of perinatal care in preventing severe dyskinetic CP.
Abstract:
The aim of this study was to describe the epidemiology, aetiology, and clinical findings in dyskinetic cerebral palsy (CP)in a population-based follow-up study of children born between 1991 and 1998. Age range at ascertainment was 4 to 8 years and prevalence was 0.27 per 1000 live-births. Forty-eight children were examined (27 males, 21 females; mean age 9y, range 5-13y). Thirty-nine had dystonic CP and nine a choreo-athetotic subtype. Primitive reflexes were present in 43 children and spasticity in 33. Gross Motor Function Classification System levels were: Level IV, n= 10 and Level V, n= 28. The rate of learning disability (n= 35) and epilepsy (n= 30) increased with the severity of the motor disability. Thirty-eight children had anarthria. Peri- or neonatal adverse events had been present in 34 of 42 children born at >or=34 weeks' gestation. Motor impairment was most severe in this group. Placental abruption or uterine rupture had occurred in 8 participants and 19 of the 42 near-term/term children required assisted ventilation, compared with 1% and 12% respectively in other CP types. Neuroimaging in 39 children born at >or=34 weeks revealed isolated, late third trimester lesions in 24 and a combination of early and late third trimester lesions in seven. Dyskinetic CP is the dominant type of CP found in term-born, appropriate-for-gestational-age children with severe impairments who have frequently experienced adverse perinatal events.
