Dystonia and Movement Disorders in Children with Cerebral Palsy

Abstract

Movement disorders are primary problems related to the ability of children to develop and control smooth targeted motor movement. The specific description of these abnormalities is somewhat confusing and varies among authors of different texts. The main movement disorders in children with cerebral palsy (CP) that impair function are dystonia and choreoathetosis. These disorders are often combined with spasticity and are termed mixed movement disorder. There are many varieties of dystonic movements, sometimes involving only one limb, but in most children with CP, there is involvement of the whole body. Choreoathetosis also involves the whole body, often being more disabling in the upper extremities then the lower extremities, and usually has significant facial and oral motor involvement. Treatment for dystonia requires a complete medical evaluation, to exclude progressive neurodegenerative disorders. For children with CP, treatments include good stable seating, comfortable orthotics, and exercise. A range of medications have been proven to be helpful in some circumstances. When they are not, intrathecal baclofen therapy and deep brain stimulation are currently the main alternative options. Treatment of choreoathetosis also should focus on therapy options such as good seating support, weighted vests, wrist or ankle weights, and exploring the best posture for an individual patient.