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Dystonia in children with acquired brain injury
M Pentony1, M Featherstone2, Y Sheikh3
1Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Ireland.
Insights
Dystonia affects 3.2% of children after acquired brain injury (ABI) in pediatric intensive care units (PICU), with higher rates in hypoxia/anoxia and traumatic brain injury (TBI) cases. This condition often emerges early and persists long-term.
Area of Science:
- Neurology
- Pediatric Intensive Care
- Acquired Brain Injury
Background:
- Acquired brain injury (ABI) can lead to secondary neurological complications in children.
- Dystonia is a movement disorder characterized by involuntary muscle contractions.
- The incidence and trajectory of dystonia post-ABI in pediatric intensive care unit (PICU) settings are not well-established.
Purpose of the Study:
- To determine the incidence of dystonia in children following ABI admitted to a PICU.
- To analyze the clinical course and outcomes of dystonia over a six-month period post-ABI.
Main Methods:
- Retrospective analysis of electronic PICU database at Children's Health Ireland at Temple Street.
- Inclusion criteria focused on pediatric patients with ABI.
- Review of clinical data, including dystonia development, treatments, and outcomes.
Main Results:
- An incidence of 3.2% for dystonia was observed in 379 children with ABI.
- Higher incidence rates were noted in hypoxia/anoxia (8.3%) and traumatic brain injury (TBI) (6.2%) cohorts.
- Dystonia typically developed within the first month and persisted in most patients at six months, often requiring ongoing medical management.
Conclusions:
- The incidence of dystonia post-ABI in the PICU setting is estimated at 3.2%, with significant variations based on ABI etiology.
- Early onset and persistent nature of dystonia highlight the need for vigilant monitoring and management.
- This study is the first to examine dystonia's trajectory and outcomes post-PICU ABI, underscoring the need for prospective research.
Aim:
To quantify the proportion of children who develop dystonia after acquired brain injury (ABI) admitted to a tertiary paediatric intensive care unit (PICU) and analyse the trajectory of dystonia over a 6 month period.
Methods:
Children's Health Ireland at Temple Street PICU electronic database was searched for key terms related to ABI from January 1, 2016 to March 14, 2021. Individuals meeting inclusion criteria were analysed, and clinical data pertinent to ABI, dystonia, treatment and outcomes were reviewed.
Results:
Six-hundred and forty-three PICU episodes (580 patients) met search criteria for ABI, with 379 included in the final analysis. Twelve patients developed dystonia following ABI, giving an incidence of 3.2%. The incidence was higher in the hypoxia/anoxia and TBI cohort at 8.3% and 6.2%, respectively. All patients developed dystonia within the first month following ABI (50% by a week). Patients who developed dystonia compared to non-dystonia cohort had a median lower GCS on admission (4.5 versus 7.0, p value 0.032), longer median length of PICU stay (14.0 versus 3.0 days, p value < 0.001) and were older (median age 9.08 versus 4.68 years, p value 0.06). Dystonia persisted in the majority at 6 months (10/11), requiring on-going medical therapies.
Conclusion:
In our retrospective study, the estimated incidence of dystonia following ABI admitted to the PICU was 3.2%, highest in the hypoxia/anoxia (8.3%) and TBI (6.2%) cohorts. Dystonia emerged early and persisted at 6 months in the majority. This is the first review of dystonia, clinical trajectory and outcomes conducted post-PICU admission for ABI. Future prospective studies are required to determine the true prevalence and burden of disease in the PICU setting.
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