Transcript Dyskinetic CP

Dyskinetic Cerebral Palsy
Greater Manchester Cerebral Palsy Network Meeting
7th November 2013
Dr Martin Smith
Consultant Paediatric Neurologist
Birmingham Children’s Hospital
Athetosis
Chorea
Unsustained;
flowing
Intermittent;
irregular
Dystonia
Sustained postures
Abnormal
(usually high)
muscle tone
Weakness
Impaired motor control
Dystonia
Involuntary sustained or
intermittent muscle contractions
cause twisting and repetitive
movements, and/or abnormal
postures
‘Inserted postures and movements’
Chorea
•Greek, khoreia, meaning dance
•Involuntary, random (appearing), quick
jerking movements
•Abrupt, non-repetitive and arrthymic
•Variable frequency and intensity
Athetosis
•Described by Hammond (1871) as “an inability to
retain the fingers and toes in any position they might
be placed, and by their continual motion”
•Hyperkinetic movement disorder characterised by
involuntary writhing movements of the distal
extremities and peri-oral muscles
•Some consider athetosis as a variant of dystonia
Symmetrical high
signal in ventrolateral thalamus
and putamen
following acute near
total hypoxicischaemic injury in
term infant
Treatments
Orthosis e.g. lycra, second skin etc
Medication for dystonia e.g. Trihexiphenidyl, Clonidine, L-Dopa
Medication for chorea e.g. Levitarecetam, Valproate, Tetrabenzine
Intra-thecal Baclofen
Deep brain stimulation
Stem cells ???
Thanks to children and families for allowing me to use videos for teaching and education
Thanks to Birmingham colleagues past and present
Dr Hardev Pall
Dr Manju Kurian
Dr Stuart Green