Dyskinetic cerebral palsy (CP) is described as movements that are made by the whole body, or parts of it, and not done with purpose. This means they are not voluntary. This includes dystonia, athetosis, and chorea. About 10 to 20 percent have this type of cerebral palsy. These random movements are seen more when the person starts to move. Dyskinetic movements often are seen with spasticity which is called mixed cerebral palsy.
Dyskinetic cerebral palsy is from injury to the basal ganglia of the brain. This area of the brain can be described as the switchboard for taking information to and from the movement center, and the spinal cord. The basal ganglia are in charge of purposeful movements. The different forms of dyskinesia are from injury to slightly different areas in the basal ganglia.
This type of cerebral palsy is typically not linked with preterm birth problems.
Dyskinetic Cerebral Palsy: Types of Movement Disorders
- Dystonia– Symptoms of dystonia are involuntary movements that are triggered by a variety of circumstances such as initiating voluntary movement or stress. Dystonia can be in one part of the body, known as focal dystonia, or the whole body, known as generalized dystonia. Approximately 70 percent of people with CP have at least some dystonia.
- Athetosis– People with athetosis have changes in muscle tone, changing between being floppy (hypotonia) and extreme random motion (hyperkinesias).
- Chorea– Identified by movements made that are not with purpose, that are quick, abrupt, without a pattern and not predictable. Those with mild chorea might look fidgety or clumsy. Those with a more severe type of chorea, choreiform, make movements that can be wild and violent, that are large in magnitude (ballism). Chorea can affect many body parts and cause issues with movement, speech and swallowing;Choreiform movements slow down during sleep. Can be found with athetosis, called choreoathetosis, and may occur with dystonia.
Dystonia Treatment Options
- A baclofen pump (as discussed in the spasticity treatment section) may be considered by medical team members for the treatment of secondary dystonia, or dystonia due to CP, particularly after medications have been tried. It is not FDA approved yet for this indication (but has been for spasticity). Discuss potential side effects, risks, “off-label” use, and appropriate candidacy with your medical team.
- Deep Brain Stimulation (DBS) delivers electrical impulses (beats of electric sent out), through electrodes implanted (put in) within targeted areas of the brain. It has been used to treat neurological conditions such as essential tremor, Parkinson’s, and certain forms of dystonia, particularly genetic forms. Deep brain stimulation is being explored as a potential treatment for dyskinetic cerebral palsy, but more research is needed, particularly for use in children. Since there are very limited treatment options available for dystonia due to CP, we chose to highlight DBS here for you to discuss developments in research with your medical team. Discuss potential side effects, risks, and appropriate candidacy with your medical team.
- Some oral medications that you may hear about as a potential treatment of dystonia in CP are trihexyphenidyl (Artane), L-dopa or carbidopa-levodopa (Sinemet), clonazepam (Klonopin). Research in other populations have shown tetrabenazine (Xenazine) and zolpidem (Ambien) to be effective in treating some forms of dystonia. Discuss potential side effects, risks, “off-label” use and appropriate candidacy with your medical team.
- Reducing stress and anxiety by incorporating things like breathing techniques or psychological approaches such as cognitive behavioral therapy (CBT).
- Positioning strategies provided through a seating clinic or clinician knowledgeable about dystonia.
- Physicians and therapists may also use manual/hands on strategies to manage certain dystonic symptoms.
Chorea Treatment Options
- One medication (Oral), Tetrabenazine (Xenazine), is FDA approved to treat Chorea associated with Huntington’s disease but has not been specifically studied in people who have chorea due to cerebral palsy. Discuss potential side effects, risks, “off-label” use and appropriate candidacy with your medical team.
Athetosis Treatment Options
- No effective and widely used treatments known at this time.
The information from this page appears in our free and downloadable cerebral palsy tool kit.
