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. 2022 Feb;37(2):105-111.
doi: 10.1177/08830738211059683. Epub 2021 Dec 6.

Spasticity and Dystonia are Underidentified in Young Children at High Risk for Cerebral Palsy

Hanyang Miao  1 , Amit M Mathur  2 , Bhooma R Aravamuthan  1
Affiliations

Spasticity and Dystonia are Underidentified in Young Children at High Risk for Cerebral Palsy

Hanyang Miao et al. J Child Neurol. 2022 Feb.

Abstract

Background: Early spasticity and dystonia identification in cerebral palsy is critical for guiding diagnostic workup and prompting targeted treatment early when it is most efficacious. However, differentiating spasticity from dystonia is difficult in young children with cerebral palsy.

Methods: We sought to determine spasticity and dystonia underidentification rates in children at high risk for cerebral palsy (following neonatal hypoxic-ischemic encephalopathy) by assessing how often child neurologists identified hypertonia alone versus specifying the hypertonia type as spasticity and/or dystonia by age 5 years.

Results: Of 168 children, 63 developed cerebral palsy and hypertonia but only 19 (30%) had their hypertonia type specified as spasticity and/or dystonia by age 5 years.

Conclusions: Child neurologists did not specify the type of hypertonia in a majority of children at high risk of cerebral palsy. Because early tone identification critically guides diagnostic workup and treatment of cerebral palsy, these results highlight an important gap in current cerebral palsy care.

Keywords: cerebral palsy; developmental disability; dystonia; hypoxic-ischemic encephalopathy; spasticity.

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Figures

Figure 1.
Figure 1.
Spasticity diagnosis. 38/63 (60%) children with hypertonia had documented hyperreflexia. However, only 15/38 (39%) had spasticity identified by neurologists.
Figure 2.
Figure 2.
Age of motor normality & abnormality diagnosis. 46/63 (73%) children with persistent hypertonia had their hypertonia identified by 6 months of age. In contrast, only 2/19 (11%) children with spasticity or dystonia had either dignosed by 6 months of age.
Figure 3.
Figure 3.
Encephalopathy severity during the neonatal period based on the Sarnat grading scale. Spasticity/Dystonia group had significantly more severe encephalopathy than the other groups (p=0.002).
Figure 4.
Figure 4.
Seizure ocurrence during the neonatal period. Spasticity/Dystonia group were more likely to have serizures during the neonatal period compared to the other groups (p=0.017).
See this image and copyright information in PMC

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