Download PDF
Neuropediatrics 2002; 33(2): 73-78
DOI: 10.1055/s-2002-32368
Original Article

Georg Thieme Verlag Stuttgart · New York

The Early Markers for Later Dyskinetic Cerebral Palsy are Different from Those for Spastic Cerebral Palsy

C. Einspieler1 , G. Cioni2 , P. B. Paolicelli2 , A. F. Bos3 , A. Dressler2 , F. Ferrari4 , M. F. Roversi4 , H. F. R. Prechtl1
  • 1 Department of Physiology, Karl Franzens University, Graz, Austria
  • 2 Division of Child Neurology and Psychiatry, University of Pisa and Stella Maris Scientific Institute, Pisa, Italy
  • 3 Department of Paediatrics, Division of Neonatology, Beatrix Children's Hospital, University Hospital, Groningen, The Netherlands
  • 4 Department of Obstetrical, Gynaecological and Paediatric Sciences, Division of Neonatology, University Hospital, Modena, Italy
Further Information

Publication History

Publication Date:
20 June 2002 (online)

    Permissions and Reprints

Abstract

Qualitative abnormalities of spontaneous motor activity in newborns and young infants are early predictive markers for later spastic cerebral palsy. Aim of this research was to identify which motor patterns may be specific for later dyskinetic cerebral palsy. In a large, prospectively performed longitudinal study involving four European hospitals we identified twelve cases with the relatively rare condition of dyskinetic cerebral palsy and compared their early motor development with twelve spastic cerebral palsy cases and twelve controls. From birth to the fifth month post-term, all infants were repeatedly videoed and their spontaneous motor patterns, including general movements, were assessed. Until the second month post-term, the infants that later became dyskinetic displayed a poor repertoire of general movements, “arm movements in circles” and finger spreading. Abnormal arm and finger movements remained until at least five months and were then concurrent with a lack of arm and leg movements towards the midline. Later dyskinetic infants share with later spastic infants the absence of fidgety movements, a spontaneous movement pattern that is normally present from three to five months. Qualitative assessment of spontaneous motor patterns enabled us to identify infants at high risk for dyskinetic cerebral palsy early in life. Additionally, we were able to discriminate them from those infants at high risk for later spastic cerebral palsy. This is a matter of significant clinical relevance because the two types of cerebral palsy ask for different management and early intervention.

Key words

General Movements - Cerebral Palsy - Dyskinetic Movements - Newborns - Fidgety Movements - Young Infants

References

  • 1 Aicardi J, Bax M. Cerebral palsy. Aicardi J Diseases of the Nervous System in Childhood. 2nd ed. Cambridge; MacKeith Press 1998: 210-240
    Google Scholar
  • 2 Allen M C, Alexander G R. Using motor milestones as a multistep process to screen preterm infants for cerebral palsy.  Dev Med Child Neurol. 1997;  39 12-16
    PubMedGoogle Scholar
  • 3 Amiel-Tison C, Grenier A. Neurological Assessment During the First Year of Life. New York, Oxford; Oxford University Press 1986
    Google Scholar
  • 4 Bayley N. Bayley Scales of Infant Development. Berkeley; The Psychological Corporation 1969
    Google Scholar
  • 5 Bobath B. Abnormal Postural Reflex Activity Caused by Brain Lesions. London; Heinemann 1971
    Google Scholar
  • 6 Cioni G, Bos A F, Einspieler C, Ferrari F, Martijn A, Paolicelli P B, Rapisardi G, Roversi M F, Prechtl H FR. Early neurological signs in preterm infants with unilateral intraparenchymal echodensity.  Neuropediatrics. 2000;  31 240-251
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Cioni G, Ferrari F, Einspieler C, Paolicelli P B, Barbani M T, Prechtl H FR. Comparison between observation of spontaneous movements and neurological examination in preterm infants.  J Pediatr. 1997;  130 704-711
    PubMedGoogle Scholar
  • 8 Cioni G, Prechtl H FR, Ferrari F, Paolicelli P B, Einspieler C, Roversi M F. Which better predicts later outcome in fullterm infants: quality of general movements or neurological examination?.  Early Hum Dev. 1997;  50 71-85
    CrossrefPubMedGoogle Scholar
  • 9 Colver A F, Gibson M, Hey E N, Jarvis S N, Mackie P C, Richmond S. Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964 - 1993. The North of England Collaborative Cerebral Palsy Survey.  Arch Dis Child Fetal Neonatal Ed. 2000;  83 F7-F12
    PubMedGoogle Scholar
  • 10 Dubowitz L MS, Dubowitz V, Mercuri E. The Neurological Assessment of the Preterm and Full-Term Newborn Infant. Clinics in Developmental Medicine. 2nd ed. Cambridge; University Press 1999: 148
    Google Scholar
  • 11 Einspieler C, Prechtl H FR, Ferrari F, Cioni G, Bos A F. The qualitative assessment of general movements in preterm, term and young infants - review of the methodology.  Early Hum Dev. 1997;  50 47-60
    CrossrefPubMedGoogle Scholar
  • 12 Ellenberg J H, Nelson K B. Early recognition of infants at risk for cerebral palsy.  Dev Med Child Neurol. 1981;  23 705-716
    PubMedGoogle Scholar
  • 13 Ferrari F, Gioni C, Prechtl H FR. Qualitative changes of general movements in preterm infants with brain lesions.  Early Hum Dev. 1990;  23 193-233
    CrossrefPubMedGoogle Scholar
  • 14 Hadders-Algra M, Klip-van den Nieuwendijk A W, Martijn A, van Eykern L A. Assessment of general movements: towards a better understanding of a sensitive method to evaluate brain function in young infants.  Dev Med Child Neurol. 1997;  39 88-98
    PubMedGoogle Scholar
  • 15 Hagberg B, Hagberg G. The origins of cerebral palsy. David TJ Recent Advances in Paediatrics. XI. Edinburgh, London; Churchill Livingston 1993: 67-83
    Google Scholar
  • 16 Harris S. Early neuromotor predictors of cerebral palsy in low-birthweight infants.  Dev Med Child Neurol. 1987;  29 508-519
    PubMedGoogle Scholar
  • 17 Hopkins B, Prechtl H FR. A qualitative approach to the development of movements during early infancy. Prechtl HFR Continuity of Neural Functions from Prenatal to Postnatal Life. Clinics in Developmental Medicine. Vol. 94. Oxford; Blackwell Scientific Publications 1984: 179-197
    Google Scholar
  • 18 Illingworth R S. The diagnosis of cerebral palsy in the first year of life.  Dev Med Child Neurol. 1966;  8 178-194
    PubMedGoogle Scholar
  • 19 Konishi Y, Prechtl H FR. Finger movements and finger postures in pre-term infants are not a good indicator of brain damage.  Early Hum Dev. 1994;  36 89-100
    CrossrefPubMedGoogle Scholar
  • 20 Kyllermann M, Bager B, Bensch J, Bille B, Olow I, Voss H. Dyskintic cerebral palsy.  Acta Paediatr Scand. 1982;  71 543-550
    PubMedGoogle Scholar
  • 21 Mercuri E, Guzzetta A, Haataja L, Cowan F, Rutherford M, Counsell S, Papadimitriou M, Cioni G, Dubowitz L. Neonatal neurological examination in infants with hypoxic ischaemic encephalopathy: correlation with MRI findings.  Neuropediatrics. 1999;  2 83-89
    PubMedGoogle Scholar
  • 22 Palisano R, Rosenbaum P, Walter S, Russel S, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy.  Dev Med Child Neurol. 1997;  39 214-223
    CrossrefPubMedGoogle Scholar
  • 23 Polani P E. The natural clinical history of choreathetoid cerebral palsy.  Guy's Hosp Rep. 1959;  108 32-43
    PubMedGoogle Scholar
  • 24 Prechtl H FR, Einspieler C, Cioni G, Bos A F, Ferrari F, Sontheimer D. An early marker for neurological deficits after perinatal brain lesions.  Lancet. 1997;  349 1361-1363
    CrossrefPubMedGoogle Scholar
  • 25 Prechtl H FR. Qualitative changes of spontaneous movements in fetus and preterm infants are a marker of neurological dysfunction.  Early Hum Dev. 1990;  23 151-159
    CrossrefPubMedGoogle Scholar
  • 26 Prechtl H FR. State of the art of a new functional assessment of the young nervous system. An early predictor of cerebral palsy.  Early Hum Dev. 1997;  50 1-11
    CrossrefPubMedGoogle Scholar
  • 27 Prechtl H FR. The Neurological Examination of the Full-Term Newborn Infant. Clinics in Developmental Medicine. 2nd ed. London; Heinemann 1977: 63
    Google Scholar
  • 28 Swanson M W, Bennett F C, Shy K K, Whitfield M F. Identification of neurodevelopmental abnormality at four and eight months by the movement assessment of infants.  Dev Med Child Neurol. 1992;  34 321-337
    PubMedGoogle Scholar
  • 29 Taft L T. Cerebral palsy.  Pediatr Rev. 1995;  16 411-418
    PubMedGoogle Scholar
  • 30 Thompson C M, Puterman A S, Linley L L, Hann F M, van der Elst C W, Molteno C D. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome.  Acta Paediatr. 1997;  86 757-761
    CrossrefPubMedGoogle Scholar
  • 31 Touwen B CL. Neurological Development in Infancy. Clinics in Developmental Medicine. London; Heinemann 1976
    Google Scholar
  • 32 Vining E PG, Accardo P J, Rubenstein J E, Farrell S E, Roizen N J. Cerebral palsy. A pediatric developmentalist's overview.  Am J Dis Child. 1976;  130 643-649
    PubMedGoogle Scholar

Prof. M. D., D. Phil. Heinz F. R. Prechtl

Department of Physiology, Karl-Franzens-University of Graz

Harrachgasse 21/5

8010 Graz

Austria

Email: christa.einspieler@kfunigraz.ac.at

      >