Dyskinetic Cerebral Palsy

Dystonic Cerebral Palsy / Cerebral Palsy Athetosis

If you have a child with dyskinetic cerebral palsy, your child may have

• Presence of muscle spasms which can be difficult to control and the spasm can be painful
• Unwanted movements which appear in combination with high and low muscle tone
• Presence of athetosis where whole body passes into a state of slow, writhing muscular contractions when the child attempts any voluntary movement
• Athetosis where the child may show undue persistence of primitive reflexes like the Moro reflex and the asymmetric tonic neck reflex(ATNR)
• A sudden noise may send him into severe spasm, involving the whole body and if he is able to stand, he may lose his balance.
• Normal tone of all the body musculature during sleep.
• Never suck his thumb and is unable to puts toys in his mouth.
• Difficulties in feeding. Bottle feeding, chewing and swallowing is always problematic

Causes of Dyskinetic Cerebral Palsy
Dyskinetic / Dystonic cerebral palsy is generally caused due to

• Damage to the basal ganglia - part of the brain involved in the recruitment of muscles of movement. It can be due to neonatal jaundice or neonatal hypoxia
• Neonatal jaundice, which is  due to maternal rhesus or ABO incompatibility, or to glucose - 6 phosphate dehydrogenase insufficiencies)
• Neonatal hypoxia following a premature birth
• Birth of twins and of breech, forceps and Caesarian births.

Associated Problems / Factors with Dyskinetic Cerebral Palsy
Children with dyskinetic cerebral palsy may have any combination of associated problems such as

• Speech problems
• Hearing deficits
• visual disorder
• Epilepsy
• Drooling
• Intellectual disability
• Learning disability, etc

Treatment / Management of Dyskinetic Cerebral Palsy
Comparing with other varieties of Cerebral palsy, the management of children with Dystonia is very challenging. Traditional physiotherapy does not work so much. Management requires a multidisciplinary team and multimodal therapies. Parents should be educated about the fluctuation of tone and its complications. The therapeutic approach of children with generalized dystonia should be combination therapy, since each discipline makes a contribution to improving functional performance. Nearly all children with dystonia require medicinal support

Treatment systems generally used are

• Habilitation Therapies
• Use of medicines
• Injection Therapies-Botox Therapy
• Orthopedic Surgeries
• OSSCS-Orthopedic selected Spasticity Control Surgery
• Conventional Surgery
•  Neurosurgery
• Selective Motor Fasciculotomy
• Deep brain stimulation
•  Intrathecal baclofen pump therapy
•  Hyperbaric Oxygen Therapy
•  Stem Cell Therapy
•  Alternative and Complementary Medicines

Role of Habilitation / Re-habilitation Therapies in the management of Dyskinetic Cerebral Palsy
Habilitation strategies are generally considered cornerstones in the management of dyskinetic CP.  Our habilitation therapies emphasizes on-

• Optimization of postural stability with minimum support
• Reducing asymmetry and promoting symmetrical positioning
• Using orthoses and splints to increase stability and coordination
• Enhancing communication skills
• Goal oriented functional therapy to be independent in ADL and mobility
• Use of intact intelligence in academic and vocational purposes
• We train parents / care givers to optimize postures while daily activities such as feeding, toileting, dressing-undressing, reading, writing and play. ICD’s specialize professionals prescribe need based use of Assistive technology- Aids & Appliances ( Postural aids, Mobility aids, Orthotic aids, Adaptive aids, Assistive aids, visual aids, hearing aids, etc)

Role of Oral Medicines in the management of Dyskinetic Cerebral Palsy
ICD’s neurologists assess the condition and prescribe need based medications to manage:

• Dystonia: Benztropine mesylate, Carbidopa-levodopa (Sinemet),
• Procyclidine hydrochloride (Kemadrin, Trihexyphenidyl hydrochloride, etc
• Spasticity: Baclofen, Diazepam (Valium), Dantrolene, Flexeril (Cyclobenzadrine)
• Dantrium (Dantrolene), Tizanidine, etc

(Please don’t start medication without consulting a neurologist)

Role of Injection Therapies (Botulinum) in the management of Dyskinetic Cerebral Palsy
Botox has a great role in the management of children with dyskinetic CP. Due to side effects of oral medications, Botulinum Toxin A injection is a better choice. Fluctuate tone of both upper limbs and lower limbs with cervical dystonia can be managed efficiently with Bonta A.     

Role of Orthopedic Surgery in the management of Dyskinetic Cerebral Palsy
The occurrence of hip subluxation or dislocation is very high in this category. So an experienced orthopedic surgeon should be included in the team for hip surveillance. In some cases, the child may need surgery for the equinus, flexed knee deformity, mid arm pronated deformity, etc. ICD practices advance orthopedic surgical procedure such as SEMLARRS, OSSCS, etc.

Role of Intrathecal Baclofen in the management of Dyskinetic Cerebral Palsy
This is one of the techniques which can do miracle in selective cases of Dyskinetic CP. As mostly children with Dyskinetic CP are intelligent and motivated, they can be highly benefited with ITBP. Nowadays 20 ml smaller size pumps are also available so younger children can be also intervened. Post Intrathecal therapy should be intensive for 9-12 months at least.

Role of Neurosurgeries in the management of Dyskinetic Cerebral Palsy
ICD always screen children with Dystonia to have the benefit of SMF (Selective Motor Fasciculotomy) and DBS (Deep Brain Stimulator). DBS is a very sophisticated neurosurgical technique where the neurosurgeon puts a device in the brain with neurosurgical procedure. SMF is another neurosurgical procedure which helps to reduce involuntary movements in upper and lower limbs

Role of Hyperbaric Oxygen Therapy in the management of Dyskinetic Cerebral Palsy
Like all other forms of cerebral palsy, Children with Dyskinetic CP are also get benefited with HBOT. Case selection is very important to get optimal improvement. HBOT should be accompanied with intensive therapy to harvest the effects of HBOT. 40 Sessions of HBOT require 9 months intensive therapy to sustain the benefits of HBOT.

Role of Stem Cell Therapy (SCT) in the management of Dyskinetic Cerebral Palsy
Stem Cells are considered as repairing cells and Dyskinetic CP is due to damage to insult to the brain cells so stem cells can be helpful. Stem Cell therapy is always incorporated with intensive therapy. The duration of post stem cell therapy should be 12-18 months to actualize the effect of stem cell injections. 

Role of Exploratory Therapies in the management of Dyskinetic Cerebral Palsy
ICD practices combination or multimodal therapy. It amalgamates need based therapies like Homeopathy, Ayurveda, Unani, Acupuncture, Acupressure, Hippo-therapy, Hydrotherapy, Yoga, etc with the standard habilitation therapies to have extra benefits and speed up the recovery. While combining the therapies, it is very important to have constant coordination between professionals and care givers.   

Prognosis and employment opportunities for Person / Adult / Individual with Dyskinetic CP
It was found that about 50% of cases walked before 5 years, and a further 20 - 25% before 11 years. Some cases achieve independent walking in late adolescence, may be at 15 years of age.
Because of fluctuate tone; these intelligent cerebral palsied people are not considered better workers in open market. Their education should be aimed at more intellectual pursuits such as computer job, etc. If they have educational skills such as reading they will have much greater insight into their problems and will find it easier to adjust. Some of these people have shown the maturity to make a happy marriage with another similarly disable person. The whole of this prognosis depends on early diagnosis of the condition and the determination of professionals involved giving them the best environment for full development. 

If you want to know which treatment or therapies is best suited for your child / ward, please contact us and get free technical support

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