dyskinetic-cerebral-palsy

Dyskinetic Cerebral Palsy is one of the four subtypes of Cerebral Palsy and occurs due to damage sustained by the cerebellum or basal ganglia. It causes involuntary contractures and gait abnormalities that can be highly painful to navigate, which is why it is vital for children to start receiving treatment as early as possible. It is natural to feel overwhelmed if you hear that your child has Dyskinetic Cerebral Palsy, which is why having a thorough understanding of what to expect is critical. Here, we provide a brief guide to the same.

Understanding Dyskinetic Cerebral Palsy

Dyskinetic Cerebral Palsy is a subtype of Cerebral Palsy, which refers to a group of neurological disorders that affect movement, muscle tone, coordination, and motor skills caused by damage or abnormalities in the developing brain. It typically occurs due to injury or infection before, during, or shortly after birth. Dyskinetic Cerebral Palsy is a subtype characterized by abrupt involuntary movements that can be fast and jerky or slow and writhing. Often, children exhibit a range of symptoms on the basis of which doctors further subdivide the diagnosis. The two main Dyskinetic Cerebral Palsy types include:

  • Athetoid Dyskinetic Cerebral Palsy: This subtype leads to sudden movements in the limbs, hands, and feet, and sometimes the face and tongue. The movements may be jerky or slow and can be repetitive at times, or may be continuous and writhing and get worse as the child tries to move. Stress may exacerbate the movements.
  • Dystonic Dyskinetic Cerebral Palsy: This leads to random and twisting involuntary movements when the child tries to move on their own, which can be painful. Here too, the movements may be either fast or slow. Dystonia may occur all over the body or just in certain limbs.

However, these terms are often used interchangeably, and the causes and treatments are the same for both. As a non-progressive disease, Dyskinetic Cerebral Palsy will not worsen with time, although the patient’s needs may evolve as they grow older. Treatment helps to manage the symptoms and improve the patient’s overall functionality.

Symptoms of Dyskinetic Cerebral Palsy

Patients with Dyskinetic Cerebral Palsy have difficulty moving their muscles the way they want them to. The symptoms will vary based on the location and extent of the brain damage. There is considerable overlap between the symptoms of the Athetoid and Dystonic subtypes, which is why we can list them together. The commonly observed Dyskinetic Cerebral Palsy symptoms include:

  • Developmental delays in crawling, sitting up, standing, walking, or reaching for objects
  • Abnormal involuntary movements, either fast or slow
  • Twisting of the torso
  • Writhing movements in the hands or limbs
  • Pain during involuntary movements
  • Uncontrollable eye movements and/or squinting
  • Involuntary facial movements like grimacing or drooling
  • Muscle spasms from hypertonia or hypotonia and fluctuations between the two
  • Difficulty holding onto objects
  • Difficulties with balance and posture
  • Problems with speaking and swallowing
  • Comorbidities like epilepsy

The initial symptoms of Dyskinetic Cerebral Palsy, including jerky movements and poor balance, may be noticeable as early as nine months of age. However, some children may have irregular movement patterns simply because of a developmental delay and not Cerebral Palsy. Parents should thus avoid panicking and rely on the child’s doctor to provide a diagnosis. 

Causes and risk factors of Dyskinetic Cerebral Palsy

Cerebral Palsy occurs due to damage to the brain before, during, or shortly after birth. Specifically, Dyskinetic Cerebral Palsy occurs due to damage sustained by either the cerebellum or the basal ganglia.

  • Basal ganglia damage: The basal ganglia are a group of nuclei located in the cerebral cortex, the part of the brain that controls voluntary movement. The basal ganglia also regulate learning and thinking. When the basal ganglia are damaged, motor function is disrupted, which leads to involuntary movements.
  • Cerebellum damage: The cerebellum regulates precision of movement, coordination, and balance, along with cognitive functions like attention and communication. When the cerebellum is damaged, it affects fine motor skills and general coordination, and may also lead to co-occurring conditions like epilepsy or autism. 

The risk factors for Dyskinetic Cerebral Palsy include:

  • Infections during pregnancy
  • Complications during birth or negligence on the part of the physician
  • Premature birth
  • Blood clots in the placenta
  • Fetal strokes
  • Genetic conditions
  • Lack of oxygen during pregnancy or at birth
  • Jaundice, meningitis, or other infections shortly after birth
  • Head trauma sustained at or after birth

Diagnosing Dyskinetic Cerebral Palsy

There is no specific diagnostic test for Dyskinetic Cerebral Palsy. If you observe symptoms in your child, it is important to get an appointment with a doctor who will observe your child’s movements and reflexes in a clinic setting. As a parent, you will need to provide a full medical history for the child, including any conditions that run in the family, along with detailed information on your child’s symptoms. 

If the doctor suspects Dyskinetic Cerebral Palsy, they may then recommend you to a specialist who will closely examine your child’s movement, speech, hearing, reflexes, posture, and coordination. Some of the tests they might order include an MRI, a CT scan, an electroencephalography (EEG), and an electromyography (EMG). These serve to identify brain damage and also rule out any other conditions that may be causing the symptoms. In addition, they may recommend specialists who will assess the child’s speech, hearing, vision, and intellectual capabilities. Getting a final diagnosis might take thus some time, up to several months in some cases. It is important to be patient and not panic unduly.

Treatment for Dyskinetic Cerebral Palsy

A treatment plan tailored to your child’s symptoms and abilities will help to expand their range of functional movement. The earlier the intervention, the better your child’s chances at gaining motor control and functionality. Typically, Dyskinetic Cerebral Palsy treatment will feature the following:

  • Physical Therapy: This is perhaps the most essential component of Dyskinetic Cerebral Palsy treatment. It includes a variety of exercises to improve muscle strength, coordination, and control over gross and fine motor skills. There will typically be daily sessions with a therapist, which may even be incorporated into the school day to make sure that the child is making consistent progress.
  • Occupational Therapy: This involves teaching the child how to perform daily activities of living on their own, such as getting dressed, having a bath, or feeding themselves. The therapist will teach them useful exercises that help them improve coordination and control, and may recommend special gadgets to make it easier.
  • Speech Therapy: Children who have trouble speaking and swallowing can benefit from Speech Therapy, as the therapist will teach them articulation techniques, safe swallowing techniques, and exercises to improve strength in the mouth and jaws. This not only helps them communicate better but also ensures that they are ingesting proper nutrition.
  • Stem Cell Therapy: This revolutionary form of treatment involves using the patient’s own healthy cells to treat the ones damaged by cerebellar degeneration. The process is safe, easy, and allows patients to go home the very same day.
  • Assistive devices: Thera[ists may recommend mobility devices like leg braces, walkers, or wheelchairs to help children get around more easily.
  • Medication/surgery: There are special medicines that doctors may prescribe to ease muscle stiffness and pain. In addition, surgery can correct significant deformities in the limbs and joints, thus helping children move more comfortably.
  • Yoga: Activities like yoga or stretching, when performed with a trained therapist, can help to alleviate the pain of muscle contractions. 
  • Diet: The doctor may recommend special nutrition for your child to help their muscles grow properly.

Some parents may wish to sign their child up for alternative treatments like herbal medicine or acupuncture. However, always consult your doctor before doing so, as some of these treatments may interfere with the doctor-prescribed therapies.

FAQs

  • Is Dyskinetic Cerebral Palsy common?

Dyskinetic Cerebral Palsy is the second most common subtype of Cerebral Palsy after Spastic Cerebral Palsy. However, it accounts for only 5-6% of cases, as compared to around 75% for Spastic CP.

  • What are the four types of Cerebral Palsy?

The four main types of Cerebral Palsy are Spastic, Dyskinetic, Ataxic, and Mixed.

  • How is Athetoid Cerebral Palsy treated?

Athetoid Cerebral Palsy can be treated through a multi-pronged approach that includes Physical Therapy, Occupational Therapy, Speech Therapy, and medication.

  • How common is Athetoid Cerebral Palsy?

Athetoid Cerebral Palsy accounts for around 10% of all Cerebral Palsy cases.

  • What causes Athetoid Cerebral Palsy?

Athetoid Cerebral Palsy is caused due to a brain injury sustained before, during, or shortly after birth.

  • What is the difference between chorea and athetosis?

While chorea refers to a continuous, randomly appearing sequence of one or more involuntary movements, athetosis is a slow, continuous writhing movement.

  • What does the word Athetoid mean?

Athetoid is a word used to describe slow, writhing involuntary movements of the limbs, feet, and hands.

  • What is Choreoathetosis?

Choreoathetosis is a movement disorder that causes involuntary movements of both the chorea and the athetosis type. It is usually indicative of an underlying cause.

  • What is the meaning of Athetosis?

Athetosis is a condition in which involuntary writhing movements occur due to abnormal muscle contractions. It impairs gross and fine motor skills as well as speech.

  • How is Athetosis treated?

Athetosis can be treated by regular physical therapy to regain strength in and control over muscles. There are also certain medications that can suppress involuntary movements.

  • Is chorea a tremor?

Both chorea and tremor are types of involuntary movement. However, chorea does not have predictability and rhythmicity, which tremors do.

  • Is Athetosis progressive?

Cerebral Palsy is a non-progressive disease, which means that athetosis will not get worse as the child grows older.

  • How do you test for Athetosis?

Signs of athetosis to watch out for include slow, writhing involuntary movements that get worse when the patient attempts to correct their posture or move of their own volition.

Living with Dyskinetic Cerebral Palsy can be overwhelming, but treatment and support can go a long way to manage it. As the parent, be sure to constantly monitor your child’s progress and keep your doctor informed of any changes. With early intervention and regular treatment and check-ups, your child can enjoy a functional and pain-free life.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.