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Published on: November 3, 2016
Clinical Phenotype, Predictors and Early Biomarkers of Dyskinetic Cerebral Palsy Prognosis
Victoria D'Amours1, Nafisa Husein2, Mary Dunbar3
1Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
Insights
Gestational age (GA) is a better predictor than MRI for dyskinetic cerebral palsy (DCP) outcomes. This severe CP subtype predominantly affects term-born infants with significant impairments and comorbidities.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Dyskinetic cerebral palsy (DCP) is a severe subtype of cerebral palsy (CP) characterized by significant functional impairment and multiple comorbidities.
- Current understanding of DCP's clinical presentation and early predictive markers for impairment is limited.
- Identifying reliable early markers is crucial for timely intervention and improved prognosis in children with DCP.
Purpose of the Study:
- To describe the clinical presentation of DCP in a cohort of children.
- To evaluate the predictive value of gestational age (GA) and magnetic resonance imaging (MRI) findings as early markers for DCP prognosis.
- To investigate the association between GA, MRI findings, and DCP-associated risk factors and comorbidities.
Main Methods:
- Retrospective data analysis of 170 children with DCP from the Canadian Cerebral Palsy Registry.
- Classification of participants based on gestational age (preterm vs. full-term) and MRI findings (normal/nonspecific/injury types vs. grey matter injury).
- Pearson Chi-square analyses to examine associations between GA, MRI findings, and clinical characteristics.
Main Results:
- The majority of children with DCP were born at term (69%) and presented with severe motor impairments (GMFCS/MACS Levels IV-V) and multiple comorbidities (46%).
- Gestational age (GA) showed significant associations with neonatal encephalopathy, hyperbilirubinemia, perinatal adversity, higher MACS level, epilepsy, and deafness.
- MRI findings were associated with neonatal encephalopathy and perinatal adversity but did not correlate with motor/speech impairments or comorbidities.
Conclusions:
- Dyskinetic cerebral palsy (DCP) is a severe form of CP that predominantly affects infants born at term.
- Gestational age (GA) emerges as a more robust predictor of long-term prognosis in DCP compared to MRI findings.
- These findings highlight the importance of GA in understanding and predicting outcomes in DCP, guiding future research and clinical management.
Background:
Dyskinetic cerebral palsy (DCP) is a severe subtype of cerebral palsy in which children often present substantial functional impairment and multiple comorbidities. Our knowledge of the clinical picture of DCP is limited and our understanding of which markers best predict later impairment is scarce. This study aims to describe the presentation of DCP and examine the value of gestational age (GA) and magnetic resonance imaging (MRI) findings as early markers of eventual DCP prognosis.
Methods:
Data from 170 children with DCP were extracted from the Canadian Cerebral Palsy Registry. Participants were classified as preterm or full-term and were divided into two groups based on MRI results: (1) normal/nonspecific, white matter injury, watershed injury, focal insult, malformation and (2) deep grey matter injury, and near total grey matter injury. Pearson Chi-square analyses were carried out to examine how DCP-associated risk factors and comorbidities vary with GA and MRI findings.
Results:
Most children with DCP are born at term (69%), experience severe motor impairments (70% with Gross Motor Function Classification System and 73% with Manual Ability Classification System Levels IV-V), and present more than one comorbidity (46%). GA is associated with neonatal encephalopathy, hyperbilirubinemia, perinatal adversity, higher Manual Ability Classification System level, epilepsy and deafness (P < 0.01, P = 0.04, P < 0.01, P < 0.01, respectively). MRI findings are associated with neonatal encephalopathy, and perinatal adversity (P = 0.003), but not motor and speech impairment or any of the DCP-associated comorbidities.
Conclusions:
DCP is a severe form of CP affecting predominantly term-born infants. Relative to MRI findings, GA is a stronger predictor of eventual DCP prognosis.
