Clinical Phenotype, Predictors and Early Biomarkers of Dyskinetic Cerebral Palsy Prognosis

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-08-14 DOI:10.1016/j.pediatrneurol.2025.08.008

Victoria D'Amours , Nafisa Husein , Mary Dunbar MD , Darcy Fehlings MD , Ram Mishaal MD , Michael Shevell MD

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引用次数: 0

Abstract

Background

Dyskinetic cerebral palsy (DCP) is a severe subtype of cerebral palsy in which children often present substantial functional impairment and multiple comorbidities. Our knowledge of the clinical picture of DCP is limited and our understanding of which markers best predict later impairment is scarce. This study aims to describe the presentation of DCP and examine the value of gestational age (GA) and magnetic resonance imaging (MRI) findings as early markers of eventual DCP prognosis.

Methods

Data from 170 children with DCP were extracted from the Canadian Cerebral Palsy Registry. Participants were classified as preterm or full-term and were divided into two groups based on MRI results: (1) normal/nonspecific, white matter injury, watershed injury, focal insult, malformation and (2) deep grey matter injury, and near total grey matter injury. Pearson Chi-square analyses were carried out to examine how DCP-associated risk factors and comorbidities vary with GA and MRI findings.

Results

Most children with DCP are born at term (69%), experience severe motor impairments (70% with Gross Motor Function Classification System and 73% with Manual Ability Classification System Levels IV-V), and present more than one comorbidity (46%). GA is associated with neonatal encephalopathy, hyperbilirubinemia, perinatal adversity, higher Manual Ability Classification System level, epilepsy and deafness (P < 0.01, P = 0.04, P < 0.01, P < 0.01, respectively). MRI findings are associated with neonatal encephalopathy, and perinatal adversity (P = 0.003), but not motor and speech impairment or any of the DCP-associated comorbidities.

Conclusions

DCP is a severe form of CP affecting predominantly term-born infants. Relative to MRI findings, GA is a stronger predictor of eventual DCP prognosis.

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运动障碍脑瘫预后的临床表型、预测因素和早期生物标志物

失动性脑瘫（DCP）是脑瘫的一种严重亚型，患儿通常表现为严重的功能障碍和多种合并症。我们对DCP的临床表现的了解是有限的，我们对哪些标记物最能预测后来的损害的理解是稀缺的。本研究旨在描述DCP的表现，并检查胎龄（GA）和磁共振成像（MRI）结果作为最终DCP预后的早期标志的价值。方法从加拿大脑瘫登记处提取170例DCP患儿的数据。参与者被分类为早产儿或足月早产儿，并根据MRI结果分为两组：(1)正常/非特异性，白质损伤，分水岭损伤，局灶性损伤，畸形和(2)深部灰质损伤和近全灰质损伤。Pearson卡方分析检验了与dcp相关的危险因素和合并症如何随GA和MRI结果而变化。结果大多数DCP患儿足月出生（69%），有严重的运动障碍（70%为大运动功能分类系统，73%为手动能力分类系统IV-V级），并有一种以上的合并症（46%）。GA与新生儿脑病、高胆红素血症、围产期逆境、较高的Manual Ability Classification System水平、癫痫和耳聋相关（P < 0.01, P = 0.04, P < 0.01, P < 0.01）。MRI发现与新生儿脑病和围产期逆境相关（P = 0.003），但与运动和语言障碍或任何与dcp相关的合并症无关。结论sdcp是一种以足月儿为主的重症CP。相对于MRI结果，GA是最终DCP预后的一个更强的预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.