Dyskinetic Athetoid Cerebral Palsy

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Dyskinetic cerebral palsy, also known as athetoid cerebral palsy or ADCP, is a form of the disorder marked by involuntary movement.[1] Though not as common as spastic cerebral palsy, it’s not as rare as ataxic or mixed CP.

What Causes Dyskinetic Cerebral Palsy?

Dyskinetic/Athetoid cerebral palsy is caused by damage to the brain’s basal ganglia. The basal ganglia are responsible for submitting messages to the body to help coordinate and control movements.

Damage to the basal ganglia compromises voluntary movements, resulting in involuntary and abnormal movements.[2]

Characteristics and Symptoms of Dyskinetic Cerebral Palsy

There are three defining characteristics of dyskinetic cerebral palsy: dystonia, athetosis, and chorea. Each of these characteristics come with their own symptoms.

Dystonia

Dystonia involves involuntary muscle contractions marked by writhing, slow and repetitive movements that become worse when the child begins to move

Other symptoms include:

• Abnormal and awkward posture
• Movements that alternate from slow and painful to fast and rapid
• Involuntary movements that increase when the child is stressed or tired

Dystonia can affect all parts of the body, but in some cases, it occurs in only one area of the body. For example, while one child may have involuntary, awkward movements in the entire body (generalized dystonia), another child may have these same symptoms only in the legs (focal dystonia).

Many people with dystonia use sensory tricks to suppress involuntary movements. For example, resting against the wall or placing their hand behind the head can help some people with dystonia control their movements.

Other sensory tricks include pressing fingers against the eyes or nose, using a tight headband on the forehead, and placing the hand under the chin.

Athetosis

Athetosis is another characteristic of dyskinetic cerebral palsy, marked by slow twitching and wriggling movements. The symptoms can surface while resting and generally become worse when the child moves.

Other common symptoms of athetosis include:

• Involuntary slow, continuous writhing movements which worsen with attempts to move[3]
• Fluctuating muscle tone (from stiff to floppy)
• Grimacing and drooling from lack of facial muscle control
• Difficulties with eating and drinking
• Problems grasping and holding small objects because of changes in muscle tone
• Involuntary movements may be continuous unless the child is totally relaxed
• Involuntary movements typically disappear when the child is asleep

Chorea

Chorea is a characteristic of dyskinetic cerebral palsy marked by brief irregular and involuntary movements. The name comes from the Greek word, chorea, meaning “dance,” since the involuntary movements are often repetitive. This can affect multiple parts of the body.[4]

Chorea can result in difficulties with chewing, drinking, swallowing, and speech.[5]

Treatment Options for Dyskinetic/Athetoid Cerebral Palsy

Treatment plans vary by individual but typically involve physical therapy along with other strategies.

Physical Therapy

Physical therapy is generally one of the first types of treatment advised for people with dyskinetic forms of cerebral palsy. Physical therapy should begin as soon as possible.

Once a child reaches school age, it may be incorporated into the daily schedule at school, along with weekly treatment sessions at a designated physical therapy center, doctor’s office, or at home with a licensed physical therapist.[6]

Speech Therapy

Since children with dyskinetic/athetoid cerebral palsy often have problems with communication, speech therapy usually accompanies physical therapy.

Speech therapy, also known as speech and language therapy, helps children learn to communicate more effectively. It also assists with breathing and chewing problems by helping patients to learn techniques through frequent practice.

Medications

Doctors may also prescribe medications to children with athetoid/dyskinetic cerebral palsy. Since involuntary muscle movements are some of the primary symptoms, anticholinergics are often prescribed to help control muscle spasms and pain. These types of drugs block off chemical messengers in the brain.[7]

Other medications doctors may prescribe for athetoid cerebral palsy include muscle relaxants, medicines for sleep problems, and gastric reflux medicines.

If oral medication doesn’t work, other treatment options may include a baclofen pump, in which a small pump is implanted in the child’s abdominal wall. The pump then disperses baclofen to the child’s central nervous system in regular increments.[8]

Surgery

In some instances, orthopedic surgery is recommended in order to correct limb deformities such as contractures. Surgery is generally reserved for children who have marked deformities or continue to experience pain when walking and moving.

Dyskinetic/Athetoid Cerebral Palsy Prognosis

The long-term outlook for children with dyskinetic cerebral palsy will depend upon the severity of the brain damage and how well the treatment works. For instance, this type of cerebral palsy can range from minor to severe.

Children with minor symptoms may respond well to treatment and lead an independent life, whereas those with more severe cases of the disorder will need in-depth, long-term, and ongoing medical care.[9]