Dyskinesia and Cerebral Palsy
Dyskinesia by definition is a movement disorder. Involuntary (not within a person’s control) muscle contractions create uncontrollable bodily movements. These involuntary movements are often triggered when trying to perform everyday tasks, such as reaching for a glass of water. There are three general categories of dyskinetic movement disorders:
- Dystonia presents as twisting and repetitive type movement and/or abnormal posturing.
- Athetosis presents as slow convoluted or writhing movement.
- Chorea presents as involuntary, irregular and unpredictable movement (fidgety).
Diagnosing Dyskinesia in Children
Diagnosis is accomplished through observation and physical exam by qualified medical personnel. The involuntary movements caused by dyskinetic cerebral palsy can be focal (where just one body part is affected) or generalized (where multiple body parts are affected). These irregular movements may be repetitive, twisting, fast, or slow. They may also cause abnormal posture.
The range of dyskinetic movements can be severe and painful or quite mild. It’s not unusual for the frequency of movements to change based on the time of day. Feelings of stress, excitement, tiredness, anxiety, or other emotions can also increase the frequency of movements. Dyskinetic cerebral palsy may make normal daily activities difficult and disrupt sleep at night.
Often children with dyskinetic cerebral palsy are diagnosed by 2 years of age. A healthcare professional will rule out other possible diagnoses while looking at the child’s development, reflexes, muscle tone, growth, and movement. Some possible testing measures that may help determine if a child has dyskinetic cerebral palsy include:
- Brain imaging tests like an MRI or CT scan
- Blood and urine tests
- Electroencephalography (EEG) to check electrical activity in the brain
- Electromyography (EMG) to look at muscle weakness
- Hearing, speech, and vision testing
Causes of Dyskinesia in Children with Cerebral Palsy
Damage to the basal ganglia, the part of the brain responsible for regulating voluntary bodily movements, can sometimes result in dyskinetic cerebral palsy. The type of dyskinesia and the part of the body that is affected by it depends on what part of the basal ganglia is damaged. The basal ganglia is like the brain’s computer for interpreting messages between the movement centers and the spinal cord—it regulates voluntary movements. This type of brain damage can be caused by a number of factors, such as an infection during pregnancy, genetic disorders, stroke, injury during delivery, untreated jaundice, injury from an accident, or shaken baby syndrome.
Prevention of Dyskinesia
Since the brain damage that results in dyskinesia is often caused by illness or injury, the best preventive strategies should focus on the child’s general well-being during pregnancy, infancy, and early childhood. Prenatal and postnatal check-ups can help keep a child healthy and either prevent illnesses or treat them early. Maintaining a safe environment and taking safety precautions, like using the correct car seat for a child’s height and weight, may help prevent serious injury following an accident.
There is currently no cure for dyskinetic cerebral palsy or any other form of dyskinesia. In addition, each person’s dyskinesia symptoms are unique, so individual treatments may vary. Some of the factors considered when coming up with a treatment plan include:
- The severity and timing of the child’s symptoms
- The patient’s age
- Any medications the person may already be taking
- The type of dyskinesia present
Treatment of Dyskinesia
Once the above factors are considered, some possible treatments common to all dyskinesias include:
- Regular exercise or physical therapy
- Stress management techniques
- Pharmaceutical medications
Some people with dystonia notice that certain actions, known as sensory tricks, can help them temporarily suppress their unwanted movements. Some of these include touching their face or chin with a hand or finger, resting the back of their head against an object with firm support such as a door, tucking their hand under their chin or placing their hand under their leg or behind their back. When effective, these actions are able to suppress unwanted movement, usually in anticipation of desired movement. Electromyographic (EMG) feedback devices have also shown great promise, especially for the upper extremities. Very simply, these devices use vibration feedback to allow a patient to become aware of, and provide a vibratory response to, the activated muscle.
Unfortunately there is little a person can do to control athetosis and chorea that doesn’t include medication. They are both exacerbated by stressful situations, so avoidance of these is critical. Aside from medication, education in stress management techniques is oftentimes very helpful. Fortunately sleep either eliminates or markedly decreases such movements.
When conservative treatments or medications aren’t producing the desired results for your child, surgery may be an effective route. The first surgical option, orthopedic surgery, does not address the root cause of dyskinesia, rather it addresses some of the severe issues that can arise as complications of dyskinesia such as pain and physical deformity (back and limb structural defects caused by limited motion and involuntary muscle activity). While there are a number of different procedures available, they are all performed in an effort to substantially reduce or eliminate pain, as well as to increase mobility.
Currently, the only major surgical option available to address the damage in the basal ganglia is deep brain stimulation. Deep brain stimulation, a surgical procedure that involves implanting an electrode into the brain to control unwanted movement, is usually only considered after all other treatment options have been tried without success. A patient needs to meet specific criteria in order for deep brain stimulation to be an effective treatment. For example, the patient may not qualify for the procedure until pharmaceutical medications have proven to be ineffective at controlling symptoms.
During deep brain stimulation, a child is put under general anesthesia, then a neurosurgeon places electrodes connected to lead wires in the basal ganglia of the brain. Next, a battery-powered stimulator is connected to the wires and implanted just below the skin in the abdomen or chest. The stimulator delivers electrical pulses to the brain, which can help reduce dyskinetic movements and symptoms. Although currently considered a method of last resort, due in a large part to the complexity, risks and expense of the procedure, for some children the dramatic improvements have raised the possibility that this procedure could have wider applicability in the future.
Researchers are continually working to better understand dyskinesia and find newer and better treatments. Some drugs are going through clinical testing to target different brain pathways and brain chemicals. Medical devices like under-the-skin pumps are being designed to keep brain chemical levels regulated and consistent. Focused ultrasound may be a future non-invasive treatment to optimize deep brain stimulation. As with all medical treatments, side effects and treatment options should be discussed with your doctor.
Twenty-five to thirty percent of cerebral palsy cases have been linked to medical errors. These can occur during the prenatal period, labor and delivery, the nursery and/or neonatal intensive care unit (NICU) as well as during the first month or so of your baby’s life by a pediatrician or emergency room doctor. You are most likely reading this article as your child or someone you care about has a child with CP. Many families struggle with the diagnosis and cause of their loved one’s CP, and many times an adequate explanation is absent as many healthcare providers are reluctant to be totally open on this topic. Our Board Certified obstetrician/gynecologist can provide the missing pieces, put your mind at rest if no medical negligence is present, and if it is present, advocate for your child and family to receive the justice you deserve.
The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC have helped over 30,000 families decide how best to move forward with their CP case. We can help you uncover the true cause of your child’s cerebral palsy and seek the compensation that your family may be entitled to. Contact Janet, Janet & Suggs, LLC today to schedule an obligation-free consultation.
Giles H. Manley, M.D., J.D., F.A.C.O.G. | CPFN Medical Advisor
Board-Certified OBGYN | Medical Malpractice Attorney
Dr. Manley has delivered over 2,000 babies and uses his wealth of medical knowledge to uncover medical errors that were missed by others (keep in mind most CP cases involve errors committed at or around the time of birth). READ FULL BIO