Athetoid Dyskinetic

Cerebral palsy is a disorder in which brain damage or brain abnormalities interfere with the normal transmission of nerve signals from the brain to the spinal cord and limbs. Researchers have divided CP into nine forms for ease of diagnosis and treatment. Some people have a mixture of these forms. The spastic forms of CP are most common, followed by the dyskenetic forms: athetoid, choreoathetiod, and dystonic. Athetoid dyskinetic cerebral palsy is the most common of the dyskinetic forms. Athetoid is derived from athetonia, a medical term which means characterized by slow, involuntary movements. Dyskinetic is a compound word derived from Greek; dys means ill and kinetic refers to movement.

Distinct Symptoms of Athetoid Dyskinetic Cerebral Palsy

People with athetoid dyskinetic cerebral palsy experience slow, involuntary, writhing movements of the arms, hands and legs. They may also experience involuntary facial grimaces and drooling. Sitting straight or walking are difficult. Holding on to objects or performing deliberate actions, such as brushing the hair, are difficult. Some people with the disorder have difficulty speaking. Eating and swallowing can be impaired, making it difficult for the patient to get adequate nutrients.

The mixed muscle tone caused by the disorder contributes to these problems; muscle tone fluctuates between being too tight and being too loose. Muscle spasms are sometimes caused by the fluctuating muscle tone.

Despite these severe disabilities, the mental ability of patients with athetoid dyskenetic cerebral palsy is seldom affected. These patients usually have normal or even above average intelligence.

Possible Complications of Athetoid Dyskenetic Cerebral Palsy

Patients with athetoid dyskinetic cerebral palsy have a tendency to develop problems in the cervical spine which can cause them to be entirely disabled. Although the neurological status of athetoid patients is considered stable, they tend to develop functional problems because of cervical myelopathy. The neurons that relay messages from the brain to the spine and rest of the nervous system are covered in a special insulating tissue called myelin; injury to the myelin of the back is called cervical myelopathy. Cervical myelopathy can lead to narrowing of the spinal canal and to disc degeneration.

Other possible complications include foot deformities and hip dislocation. Ankle equinus, a condition in which the ankle joint is stiff and the patient walks on the toes, may occur. Foot drop or drop foot, a condition which makes lifting the front of the foot difficult can also occur. Hip dislocations can be caused by the unbalanced muscle tension on the femur. Joint deformities and dislocation are generally more likely in the spastic forms of CP, rather than in athetoid dyskinetic CP, because the spastic forms of CP place more stress on the bones and joints.

Causes of Athetoid Dyskenetic Cerebral Palsy

All forms of cerebral palsy are caused by brain damage or by malformations in the brain. The form which CP takes is determined by the extent and location of the brain damage. Brain damage can occur before or during birth or shortly thereafter. Athetoid dyskinetic cerebral palsy is usually caused by damage to the cerebellum or the basal ganglia.

Brain damage to an unborn baby may be due to several causes. Maternal or fetal infections can cause brain damage because they trigger inflammation; inflammation is part of the immune process, but being exposed to it can lead to brain damage and cerebral palsy in the unborn baby.

Fetal strokes which cause bleeding in the baby’s brain can lead to athetoid dyskinetic cerebral palsy. Blood clots in the placenta can block the baby’s circulation and lead to strokes. Circulation problems and weak or abnormal brain blood vessels can also cause unborn babies to have a stroke.

Unborn babies are also at increased risk of strokes if the mother has high blood pressure. Low maternal blood pressure also causes problems. Close monitoring of the blood pressure is vital part of good prenatal care. In addition, infections in the mother, especially inflammatory pelvic disease, increase the risk of a baby having a stroke.

Athetoid dyskinetic cerebral palsy may also be caused by severe jaundice. Jaundice is a common problem in newborn babies; it is a condition in which excess bilirubin collects in the blood. Mild cases of jaundice may disappear without treatment, but severe cases can lead to brain damage, and cerebral palsy; severe cases of jaundice should always be treated.

Rh incompatibility, in which the mother’s and fetus’s blood types are in conflict, can cause severe jaundice. In the United States testing for Rh incompatibility is a routine part of prenatal care; once detected the condition can be successfully treated.

Age at Diagnosis

Developmental delays—not sitting up, reaching for toys, crawling, standing, or walking at the expected age, are usually the main clues that a baby may have athetoid dyskenetic cerebral palsy or some other form of CP. Diagnosing any form of cerebral palsy can sometimes be tricky and time-consuming, since there are many conditions which can cause similar symptoms. Delays in diagnosing the disorder are understandably frustrating and anguishing for parents, who want to know what is wrong with their child so that treatment can be begun.

Most cases of cerebral palsy are diagnosed by the time the child is eighteen months old. The diagnosis is confirmed through brain imaging tests, combined with observations of the child’s actions. An early diagnosis is important because physical therapy is most effective when it is begun early in the child’s life.

Treatments for Athetoid Dyskenetic Cerebral Palsy

Physical therapy is the cornerstone of therapy for athetoid dyskinetic cerebral palsy and all other forms of CP. Therapy for school-aged children with CP is incorporated into the schoolday along with the appropriate educational experiences. This combination of school and therapy may be begun in early childhood.

Speech therapy can help improve communication skills. Some patients with athetoid dyskenetic CP have difficulty chewing and swallowing and may benefit from therapy for these problems. Surgery many be used to correct or prevent limb deformities. Medications may help control or prevent spasms.

Alternative medicine practices such as massage and yoga have been found to ease symptoms for some CP patients, but caution should be used when selecting appropriate options; alternative therapies are a supplement to standard medical treatments for athetoid dyskinetic cerebral palsy and should be used only with the advice of qualified physicians.


Sources

“Ankle Equinus: in CP” Wheeless’ Textbook of Orthopaedics. Retrieved March 29, 2009 from the World Wide Web: http://www.wheelessonline.com/ortho/ankle_equinus_in_cp

Banta, John V. “Cerebral Palsy, Myelodysplasia, Hydrosyringomylia, Rett Syndrome, and Muscular Dystrophies” in Spinal Deformities: the comprehensive text. Ronald L. Dewald, ed. New York: Thieme, 2003.

“Cerebral Palsy: Hope Through Research” National Institute of Neurological Disorders and Stroke. Retrieved March 27, 2009 from the World Wide Web: http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy....

“Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web: http://www.marchofdimes.com/pnhec/4439_1208.asp#types

“Cerebral Palsy” MayoClinic.com Retrieved March 27, 2009 from the World Wide Web: http://www.mayoclinic.com/health/cerebral-palsy?DS00302

“Foot drop” The Mayo Clinic. Retrieved March 30, 2009 from the World Wide Web: http://www.mayoclinic.com/health/foot-drop/DS01031

Harado, Takeo, et al. “The Cervical Spine in Athetoid Cerebral Palsy” Osaka Police Hospital and Osaka University Medical School. Retrieved from the World Wide Web April 1, 2009: http://www.jbjs.org.uk/cgi/reprint/78-B/4/613.pdf