Clinico-Etiological and Radiological Evaluation of Dyskinetic Cerebral Palsy in a Tertiary Care Centre

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. Dyskinetic cerebral palsy is characterized by abnormal postures or movements with impaired muscle tone regulation, movement control, and coordination, comprising two major movement disorder patterns: dystonia and choreoathetosis. This study was conducted to study the etiological risk factors, clinical and radiological features of dyskinetic cerebral palsy. Methods: Children aged between 1 month and 18 years diagnosed with dyskinetic cerebral palsy, who presented to the tertiary care center, Bangalore in between November 2019 and May 2021, were studied. Clinical history, examination, and radiological characteristics were analyzed and interpreted. Results: Dyskinetic CP had a slight male predominance, with a higher incidence in children born at term gestation. The development of motor milestones was more affected than cognition. Perinatal asphyxia (66.6%) as a cause of CP was more common than bilirubin-induced neurologic dysfunction (BIND) (34%). Children with BIND showed a higher incidence of hearing impairment (13.7%), while visual impairment was seen more commonly with perinatal asphyxia. Both dystonia and spasticity were commonly seen in these children. In the MRI, changes involving the globus pallidus were seen in children with BIND, while posterior putamen and thalamus and cortical changes were associated with perinatal asphyxia. Conclusion: In Dyskinetic CP, perinatal asphyxia is more common than BIND. The history of birth asphyxia, neonatal hyperbilirubinemia, visual, and hearing impairment is helpful to differentiate these subcategories. MRI shows globus pallidus involvement in all children with BIND and posterior putamen and thalamus involvement in all cases of birth asphyxia, thus confirming dyskinetic CP due to BIND or birth asphyxia