Current diagnosis and treatment of Cerebral Palsy : An observational study

Haufs, H.S.M. (Hannah) (2015) Current diagnosis and treatment of Cerebral Palsy : An observational study. thesis, Medicine.

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Abstract

Aim: Cerebral palsy (CP) is one of the most common forms of motor disability in children, going along with highly impaired quality of life. CP subtypes are classified by means of the neurological symptoms as spastic, dyskinetic, ataxic or a combination of those. Despite the evidence that subtypes may be associated with different etiological aspects and might each require their own treatment approach, current Dutch guidelines solely focus on the care for spastic CP. Moreover, extrapyramidal symptoms (dyskinesia and ataxia) may be under- recognized in this patient population. Therefore, we aimed to explore the differences between spastic, dyskinetic and mixed CP with regard to clinical presentation, diagnostic features (birth characteristics, etiology, neuroimaging) and management. To investigate the clinical phenotyping, in 15 CP patients the documented subtype from the medical record was compared to that of a blinded neurologist specialized in movement disorders. Method: In this observational study, consisting of a retrospective and prospective part, records of CP patients aged from 3 to 25 years, known at the outpatient clinic for rehabilitation medicine of the University Medical Center Groningen, were reviewed. Information regarding neurological classification, birth and etiological characteristics, clinical picture and treatment of each patient was obtained from the past medical history. A movement disorder expert classified 15 patients who were videotaped as spastic, dyskinetic, ataxic or mixed. Results: A total of 125 patients (63% males) were included with a mean age of 11 years and 10 months. Spastic patients were significant more often male (p=0,047) and received less frequently pharmacological treatment, such as baclofen (p=0,002) and benzodiazepines (p=0,017). Dyskinetic patients, similar to mixed patients, had a significantly worse fine (p=0,005) and gross motor function (p=0,002) than spastic patients and received less locally working botulinum toxin injections (p=0,018). Patients with a mixed subtype had a younger age at diagnosis than spastic patients (p=0,003) and received less benzodiazepines (p=0,001). Botulinum toxin injections and baclofen were predominantly administered by physiatrists, while trihexyphenidyl was mainly prescribed by neurologists. The movement disorder expert disagreed with the originally recorded diagnosis in 3 of the 15 patients (κ=0,676, p<0,001). She classified all three patients, documented as pure spastic, as mixed subtype of CP. Conclusion: Despite the fact that current guidelines focus on spastic CP, this study underscores that multiple aspects, such as gender, motor function, age at diagnosis and management approach, in spastic CP differ from dyskinetic and mixed CP in clinical practice. The identification of extrapyramidal features seems to be controversial. Yet, they need to be identified, as they may have implications not only for prognosis but also for treatment choice. We plead for a multidisciplinary approach, possible leading to a better recognition of extrapyramidal symptoms and also optimized management for children with CP

Item Type:	Thesis (Thesis)
Supervisor name:	supervised by: and Eggink H. MSc Department of Rehabilitation Medicine and and Brouwer Prof. Dr. O.F. Department of Neurology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:53
Last Modified:	25 Jun 2020 10:53
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1386

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