Spasticity, dyskinesia and ataxia in cerebral palsy: Are we sure we can differentiate them?

Eggink, Hendriekje; Kremer, Daan; Brouwer, O.F.; Contarino, Maria Fiorella; Egmond, Martje E van; Elema, Agnes; Folmer, Katinka; Hoorn, Jessika F. van; Pol, Laura A. van de; Roelfsema, Vincent; Tijssen, Marina A. J.

doi:10.1016/j.ejpn.2017.04.1333

Cited by 42 publications

(37 citation statements)

References 10 publications

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“…No such tool exists for choreoathetosis, though the recently developed Dyskinesia Impairment Scale does provide a tool for the measurement of choreoathetosis separate from dystonia 21. The definitions of both chorea and athetosis proposed by the SCPE22 are very similar to those proposed by the Taskforce on Childhood Movement Disorders,19 but challenges with the practical recognition of these movements have been raised 23. It is of note in our study the relatively infrequent recognition of choreoathetosis compared with dystonia, with 2/9 centres documenting no CYP with these abnormal movements over a calendar month.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological management of abnormal tone and movement in cerebral palsy

et al. 2019

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BackgroundThe evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres.MethodsProspective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month.ResultsData were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management.ConclusionsCYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.

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Section: Discussionmentioning

confidence: 99%

Pharmacological management of abnormal tone and movement in cerebral palsy

et al. 2019

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“…Differentiation between dystonia and spasticity can be difficult, as they are often comorbid phenotypes. 3 Dystonia's GTP cyclohydrolase deficiency [6][7][8] x Brisk reflexes, clonus, dystonia classically begins in the feet TH deficiency 6,9 x x Infantile-onset: rigidity, parkinsonism, oculogyric crises, ptosis, spasticity, autonomic instability, alternating lethargy/ irritability Childhood-onset: similar to GTP cyclohydrolase deficiency; prone to L-DOPAinduced dyskinesias Sepiapterin reductase deficiency 6,10 x x Oculogyric crises, spasticity, autonomic instability, diurnal fluctuation…”

Section: Dystonia-predominant Movement Disordersmentioning

confidence: 99%

Treatable Movement Disorders of Infancy and Early Childhood

Aravamuthan

Pearson

2020

Semin Neurol

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Movement disorders in childhood can be difficult to diagnose early. Disease processes present variably and can mimic each other. It is particularly important to remain vigilant for the subset of these movement disorders that are treatable. These disorders can be managed with (1) treatments specific to the disease that substantially reduce symptoms; (2) treatments that can prevent progression; (3) treatments that can hasten recovery; or (4) surveillance and management of the associated, sometimes life-threatening, comorbidities. Here, we present a practical and phenomenology-oriented framework for diagnosing and managing these treatable movement disorders of infancy and early childhood.

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“…Many factors may influence these inconsistent results and patient screening is of importance. CP patients with ataxia may have a poorer outcome on improvement of functional impairment after DBS treatment [69], and a remarkable promotion of life quality can be found in studies primarily involve dyskinetic CP (e.g., dystonia or dystonia-choreoathetosis) [13, 14, 46, 56]. Some studies have reported clear benefits on speech and swallowing even in childhood CP [46, 59].…”

Section: Efficacy For Other Symptomsmentioning

confidence: 99%

Deep brain stimulation for the treatment of cerebral palsy: A review

Jiang

Wang

Zheng

2020

Brain Science Advances

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Deep brain stimulation (DBS) has been used as a safe and effective neuromodulation technique for treatment of various diseases. A large number of patients suffering from movement disorders such as dyskinesia may benefit from DBS. Cerebral palsy (CP) is a group of permanent disorders mainly involving motor impairment, and medical interventions are usually unsatisfactory or temporarily active, especially for dyskinetic CP. DBS may be another approach to the treatment of CP. In this review we discuss the targets for DBS and the mechanisms of action for the treatment of CP, and focus on presurgical assessment, efficacy for dystonia and other symptoms, safety, and risks.

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Spasticity, dyskinesia and ataxia in cerebral palsy: Are we sure we can differentiate them?

Cited by 42 publications

References 10 publications

Pharmacological management of abnormal tone and movement in cerebral palsy

Pharmacological management of abnormal tone and movement in cerebral palsy

Treatable Movement Disorders of Infancy and Early Childhood

Deep brain stimulation for the treatment of cerebral palsy: A review

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