Worse Outcomes With Dyskinesia Than With Spasticity in Cerebral Palsy

Predominant dyskinesia in children with cerebral palsy is associated with poorer functional ability compared with cerebral palsy with predominant spasticity, according to a cross-sectional study published in the Journal of Child Neurology. Additionally, predominant dyskinesia in children with cerebral palsy is more likely to be associated with the need for ambulatory assistance but less likely to be associated with severe communication and eating or drinking difficulties compared with predominant spasticity.

A total of 264 pediatric patients with cerebral palsy from the Victorian Cerebral Palsy Register were enrolled in the observational study. Patients participated in the study within 6 months of their 5th, 10th, or 15th birthday. At baseline assessment, researchers identified the participants’ predominant and secondary motor types (eg, spastic, dyskinetic, ataxic, or hypotonic). Functional profiles, including those related to motor function, manual ability, communication, eating and drinking, and speech skills, were also assessed with standardized and reliable rating scales.

Across the entire cohort, the predominant motor types featured were 70% spastic, 22% dyskinetic (21% dystonic and 1% choreoathetotic), 6% hypotonic, and 2% ataxic. In the adjustment analysis for motor function classification, the distributions of predominant motor symptoms were 73% spastic, 18% dyskinetic, 6% hypotonic, and 2% ataxic.

Approximately 92% (n=243) of patients had dyskinesia and/or spasticity. Of these, 61% (n=149) had a spastic motor type only, 32% (n=78) had a mixed spastic-dystonic motor type, and 7% (n=16) had dystonia or choreoathetosis without discernible spasticity. Spasticity was the predominant motor type in 44% (n=34) and dyskinesia was the predominant motor type in 51% (n=40) of patients with mixed spastic-dyskinetic motor type. Predominant dyskinesia (odds ratio [OR] 3.2; 95% CI, 1.4-7.5; P =.007) and any dyskinesia (OR 4.3; 95% CI, 1.8-10.5; P =.001) were associated with predominant gray matter injury on magnetic resonance imaging.

Predominant dyskinesia was associated with worse functional abilities compared with predominant spasticity. Children with predominant dyskinesia were significantly more likely to require physical assistance than those with predominant spasticity, according to the Gross Motor Function Classification System levels IV and V (OR 5.6; 95% CI, 2.9-10.8; P <.001) and Manual Ability Classification System levels IV and V (OR 5.1; 95% CI, 2.7-9.8; P <.001).

Additionally, patients with predominant dyskinesia were significantly less likely to have severe communication difficulties (Communication Function Classification System levels IV and V; OR 0.2; 95% CI, 0.1-0.6; P =.002) and eating or drinking challenges (Eating and Drinking Ability Classification System levels III and IV; OR 0.3; 95% CI, 0.1-0.9; P =.037) compared with patients with predominant spasticity. Predominant dyskinesia was also associated with a lower epilepsy frequency (OR 0.2; 95% CI 0.1-0.6; P =.004).

A limitation of the study is missing data on speech and eating and drinking abilities because of the late introduction of the assessment scales during the analysis.

The new information this study provides “suggests that practical tools to facilitate accurate and reliable classification of predominant and secondary motor types, topography, and functional abilities beyond gross motor function need to be incorporated into clinical practice to better meet the needs of families, clinicians, cerebral palsy registers, and researchers.”

Reference

Reid SM, Meehan EM, Reddihough DS, Harvey AR. Dyskinetic vs spastic cerebral palsy: a cross-sectional study comparing functional profiles, comorbidities, and brain imaging patterns. J Child Neurol. 2018;33:593-600.