Prevalence, birth, and clinical characteristics of dyskinetic cerebral palsy compared with spastic cerebral palsy subtypes: A Norwegian register-based study

Lesion distribution and network mapping in dyskinetic cerebral palsy

Dyskinetic cerebral palsy encompasses a group of predominantly perinatally acquired complex motor disorders that present with dystonia and/or choreoathetosis and are frequently associated with brain lesions in neuroimaging. Recently, lesion network mapping provided a tool to redefine neurological disorders as circuitopathies. Elucidating the common networks impacted by lesions in this condition could pave the way to identify new targets for neuromodulatory therapeutic approaches. In this study, we aim to assess lesion distribution in dyskinetic cerebral palsy and identify a related functional network derived from lesions. Here, we review the literature of MRI findings in dyskinetic cerebral palsy and perform literature-based lesion network mapping. Articles reporting conventional MRI findings clearly attributable to affected patients were included for review. Imaging findings and their anatomical distribution were extracted and quantified according to an established MRI classification system for cerebral palsy. Reviewed articles were searched for figures depicting lesions and these were traced onto a paediatric template. Whole-brain functional connectivity from lesions causing dyskinetic cerebral palsy was calculated using a paediatric resting-state functional MRI connectome. Individual maps were thresholded and later overlapped to derive a common network map associated with dyskinetic cerebral palsy. Results were contrasted with two control datasets for spatial specificity. Review of 48 selected articles revealed that grey matter injury predominated (51%), followed by white matter injury (28%). In 16% of cases MRI was normal. Subcortical lesions affected the thalamus, pallidum and putamen in >40% of reported patients, respectively. Figures available from 23 literature cases were used to calculate the lesion netwok map of dyskinetic cerebral palsy. The lesion-derived map revealed functional connectivity to a wide network including the brainstem, cerebellum, basal ganglia, cingulate and sensorimotor cortices. The strongest connectivity was found for the motor thalamus. This study confirms subcortical grey matter lesions as the most common MRI finding in dyskinetic cerebral palsy. The neural network identified with lesion network mapping includes areas previously implicated in hyperkinetic disorders and highlights the motor thalamus as a common network node. These results should be validated and their therapeutic implications explored in prospective trials.

The UK C-BiLLT: Validity and reliability of an online assessment of spoken language comprehension for children with severe motor disorders

BACKGROUND

Current UK measures of early spoken language comprehension require manipulation of toys and/or verbal responses and are not accessible to children with severe motor impairments. The Computer-Based Instrument for Low motor Language Testing (C-BiLLT) (originally validated in Dutch) is a computerized test of spoken language comprehension that children with motor disorders control using their usual response methods.

AIMS

To create a UK version of the C-BiLLT, evaluate its validity and reliability, and assess its practicability for children with motor disorders.

METHODS & PROCEDURES

The C-BiLLT was translated into British English and items were adapted to ensure familiarity to UK children. A total of 424 children (233 females, 191 males) aged 1:6-7:5 (years:months) without developmental disabilities were recruited from North East England. Children completed the UK C-BiLLT and Preschool Language Scales 5 (PLS-5) for convergent validity evaluation and either the visual reception subtest of the Mullen Scales of Early Learning (MSEL) (children aged 1:8-5:5) or Ravens Coloured Progressive Matrices (CPM) (ages 5:6-7:5) to assess divergent validity. A total of 33 children completed the UK C-BiLLT within 4 weeks of initial assessment for test-retest reliability assessment (intraclass correlation coefficient-ICC). Internal consistency was assessed using Cronbach's alpha and exploratory factor analysis examined structural validity. A total of 24 children (10 female, 14 male; aged 4-12 years) with non-progressive motor disorders who use augmentative and alternative communication (AAC), rated the UK C-BiLLT's ease of use and completed British Picture Vocabulary Scales (BPVS) and CPM as for convergent and divergent validity testing.

OUTCOMES & RESULTS

Internal consistency was high for children without motor disorders (α = 0.96). Exploratory factor analysis extracted two factors, together explaining 68% of the total variance. Test-retest reliability was excellent (ICC = 0.95; 0.90-0.98 95% confidence interval-CI). UK C-BiLLT scores correlated highly with PLS-5 (r = 0.91) and MSEL (r = 0.81), and moderately with CPM (r = 0.41); and increased across full-year age-bands (F(6, 407) = 341.76, p = < 0.001, η2 = 0.83). A total of 19 children with motor disorders rated the UK C-BiLLT as easy/ok to use; two judged it hard; three declined to rate the ease of use. Their UK C-BiLLT scores correlated highly with BPVS (r = 0.77) and moderately with CPM (r = 0.57).

CONCLUSIONS & IMPLICATIONS

The UK C-BiLLT is a valid, reliable measure of early spoken language development and is potentially practicable for children with motor disorders. It may facilitate international research on the language development of children with motor disorders and evaluation of intervention at the national level.

WHAT THIS PAPER ADDS

What is already known on the subject Young children with motor disorders have difficulties accessing standardized assessments of language comprehension that require children to handle objects or to speak a response. What this paper adds to the existing knowledge This study demonstrates the validity and reliability of a UK translation of the C-BiLLT and suggests that the measure is feasible for children with motor disorders who use AAC and have a reliable method of response via computer access. What are the potential or clinical implications of this work? The UK C-BiLLT is a useful addition to the limited tools currently available to assess early spoken language comprehension of children with motor disorders.

Dyskinetic Cerebral Palsy in Children: Clinical Perspectives on Common Comorbidities and Health-Related Quality of Life

BACKGROUND

The data on specific comorbidities in children with dyskinetic cerebral palsy (DCP) is limited. We evaluated the pattern of comorbidities and health related quality of life (HRQOL) in these children and compared them between etiological and motor impairment subgroups.

METHODOLOGY

This cross-sectional study was conducted over 18 months in children with DCP of both sex, and age between one and 14 years. Comorbidities were assessed using standardized scales such as gross motor functioning scale (GMFCS), developmental profile-3 (DP-3), developmental behaviour checklist, sleep behaviour questionnaire (SBQ), and caregiver questionnaire.

RESULTS

Sixty-five children with DCP were evaluated (hyperbilirubinemia n = 43, 66% and perinatal asphyxia n = 19, 29%). The majority of children were severely affected in gross motor functioning (level IV 29.2% and level V 53.8%). Epilepsy was seen in 21.5% of cases (19% in hyperbilirubinemia and 32% in asphyxia, p = 0.4). The mean age of onset of seizures was 15.4 + 20.6 months (range 2-72). Visual problems were seen in 54% of cases and included upgaze palsy, squint, refractive error, optic atrophy and cortical blindness. A significant proportion of children with hyperbilirubinemia had upgaze palsy as compared to those with perinatal asphyxia (70% vs. 32%, p 0.01). Rest of the visual problems were not significantly different between the two etiological subgroups. Drooling (87.6%), protein-energy malnutrition (66.6%), and reflux (57%) were the most common gastrointestinal problems in children with DCP. Children with DCP showed problems in social relating (33.8%), anxiety (26.2%), and self-absorbed behaviour (7.7%). However, there were no statistically significant differences between the etiological, motor impairment and age-based subgroups. Children with DCP had high scores on SBQ, suggesting sleep problems. Sleep scores were similar in the hyperbilirubinemia and perinatal asphyxia subgroups. Greater sleep problems were noted in children aged < 4y (70.6 + 10.1 vs. 56.5 + 11.3, p < 0.05 as compared to children above 4y of age) and severe motor impairments (68.2 + 11.3 vs. 57.2 + 13.1, p 0.008 as compared to mild-moderate motor impairment). Poor overall developmental scores were seen in 61.5% children and were significantly associated with GMFCS (p 0.04). The majority of children showed impairments in physical (58.5%), adaptive behaviour (58.5%), social-emotional (50.8%), cognitive (60%) and communication (52%) subscales of DP-3. Cognitive impairment was similar in the etiological (hyperbilirubinemia vs. perinatal asphyxia, p = 0.3), and motor impairment (mild-moderate vs. severe, p = 0.9) subgroups. HRQOL was significantly affected by motor impairment in positioning-transfer (p value 0.0001), and interaction-communication domains (p value 0.0001), however, there was no difference based on the etiology of hyperbilirubinemia and asphyxia.

CONCLUSION

Children with DCP demonstrate several comorbidities and impaired quality of life. These are similar in hyperbilirubinemia and perinatal asphyxia cohorts, expect for significant proportion of upgaze palsy in DCP secondary to hyperbilirubinemia. Younger children have more problematic behaviour and impaired sleep quality. Severe motor disability influences the developmental outcomes, cognition, sleep and HRQOL in children with DCP.

Post-term Birth and Developmental Coordination Disorder: A Narrative Review of Motor Impairments in Children

A prevalent long-term medical condition in children that is rarely understood and acknowledged in educational contexts is developmental coordination disorder (DCD), which is one of the most prevalent conditions in school-aged children. Mild-to-severe abnormalities in muscle tone, posture, movement, and the learning of motor skills are associated with motor disorders. Early detection of developmental abnormalities in children is crucial as delayed motor milestones during infancy might indicate a delay in both physical and neurological development. To overcome the current condition of motor impairment, obstructing their risk factors is important to prevent the development of disability, which is already determined in the prenatal and perinatal period. Concerning the relationship with gestational age, the majority of the studies reported a relationship between DCD and preterm children. However, the entire range of gestational age, including post-term birth, has not been studied. The risk of developmental consequences such as cognitive impairments, major mental diseases, attention-deficit/hyperactivity disorder, autism spectrum disorder, and other behavioral and emotional problems increases in post-term birth, according to prior studies. Thus, this review aims to provide an overview of information linking post-term birth to children's motor impairment, with a focus on DCD. A thorough systemic review was conducted on online databases, and only a few studies were found on the association with post-term children. Insufficient evidence made it necessary to examine more post-term cohorts in adolescence to fully determine the long-term health concerns and develop therapies to mitigate the detrimental effects of post-term deliveries.

The Placenta and Neonatal Encephalopathy with a Focus on Hypoxic-Ischemic Encephalopathy

Background: Placental examination is important for its diagnostic immediacy to correlate with maternal and/or fetal complications and parturitional difficulties. In a broader context, clinicopathologic studies of the placenta have addressed a range of pathogenetic questions that have led to conclusive and inconclusive results and interpretations. Methods: Recent standardized morphologic criteria and terminology of placental lesions have facilitated the ability to compare findings from studies that have focused on complications and outcomes of pregnancy. This review is an evaluation of recent studies on placental lesions associated with hypoxic-ischemic encephalopathy (HIE). Conclusion: No apparent consensus exists on whether it is fetal inflammation with the release of cytokines or chronic maternal and/or fetal vascular malperfusion is responsible for HIE with a lowering of the threshold for hypoxic ischemia. The counter argument is that HIE occurs solely as an intrapartum event. Additional investigation is necessary.