Dyskinetic cerebral palsy, also known as athetoid cerebral palsy or ADCP, is a form of the disorder marked by involuntary movement. It’s not as common as spastic cerebral palsy but it’s not as rare as ataxic CP.
What Causes Dyskinetic Cerebral Palsy?
Dyskinetic/Athetoid cerebral palsy is caused by damage to the brain’s basal ganglia. The basal ganglia is responsible for submitting messages to the body to help coordinate and control movements. When it’s damaged, voluntary movements are compromised, resulting in spasticity and other abnormal movements.
Characteristics and Symptoms of Dyskinetic Cerebral Palsy
There are three defining characteristics of cerebral palsy: dystonia, athetosis, and chorea. Each of these characteristics come with their own symptoms.
Dystonia is involuntary muscle contractions that are marked by writhing, slow movements. 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’s focalized 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).
Sensory tricks is a way many people with dystonia can help suppress involuntary movements. For example, resting against the wall or placing their hand behind their head can help some people with dystonia control the 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 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:
- Repetitive, jerky movements
- Face grimacing from lack of facial muscle control
- Difficulties grasping and holding small objects
- Difficulties with eating and drinking
- Involuntary movements may be continuous unless the child is totally relaxed
- Involuntary movements typically disappear when the child is asleep
- Arms, feet, hands, and legs may have writhing movements
- Breathing difficulties
- Difficulties with lip and tongue movement
- Fluctuating muscle tones (from stiff to floppy)
Chorea is a characteristic of dyskinetic cerebral palsy marked by irregular and involuntary movements. The name was derived from the Greek word, chorea, meaning “dance,” since the involuntary movements are often repetitive movements.
Chorea can also result in difficulties with chewing, drinking, swallowing, and speech.
Children with dyskinetic/athetoid cerebral are often behind in developmental milestones
Treatment Options for Dyskinetic/Athetoid Cerebral Palsy
Physical therapy is generally one of the first types of treatment advised for people with athetoid cerebral palsy. Physical therapy should be started as soon as possible, but once a child reaches school age, it may be incorporated into his/her daily schedule at school, along with weekly treatment sessions at a designated physical therapy center, doctor’s office, or even at home with a licensed physical therapist.
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, not only helps children learn to communicate more effectively, but it also with breathing and chewing problems by helping patients learn proper techniques through repetitive practice.
Medication may also be prescribed to children with athetoid/dyskinetic cerebral palsy. Since muscle spasms and stiffness are some of the primary symptoms, medications such as oral baclofen help ease these symptoms. For instance, trihexyphenidyl medications are often prescribed to help control muscle spasms and pain as these types of drugs block off chemical messengers in the brain.
Other forms of medications that are prescribed for athetoid cerebral palsy include muscle relaxants, botulinum injections (only when muscle relaxants are not effective), 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.
In some instances, orthopedic surgery is recommended in order to correct limb deformities and extreme spasticity. Surgery is generally reserved for children who continue to experience pain when walking and moving, and therefore increasing deformities.
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 treatment works. For instance, this type of cerebral palsy can range from minor to severe. Children with minor symptoms may take to treatment well and lead an independent life whereas those with more severe cases of the disorder will need in-depth, long-term, and ongoing medical care.