Reduced optimality in pre- and perinatal conditions in dyskinetic cerebral palsy--distribution and comparison to...

The optimality concept developed by Prechtl was adopted to investigate a series of 108 dyskinetic cerebral palsy (CP) cases. The results were compared to those from a control series of 229 newborns. The dyskinetic cases, as compared to the controls, had significantly more reduced optimality scores. Reduced optimality was especially pronounced in the partum and postpartum periods, but was to a highly significant degree also found in the prepartum period. Dystonics and choreoathetotics differed in their pattern of reduced optimality. Dystonics had more reduced optimality in items related to deficient intrauterine growth, intra- and extrauterine asphyxia-choreoathetotics in items related to preterm birth, postpartal hypoxia and hyperbilirubinemia. Term cases had more reduced optimality scores (median 7 vs 1) compared to term controls than preterm cases compared to preterm controls (median 9 vs 4.5). The pattern of reduced optimality in term cases corresponded primarily to that among the dystonics, and the pattern in preterm cases mainly to that of the choreoathetotics. Prepartum warning signals for further partum and postpartum reduced optimality related to the brain cell damage, were maternal disorder, blood group incompatibility and leanness at birth (weight for length less than or equal to -1.0 SD). The latter condition was found to discriminate for reduced optimality in the partum period.