Delayed-onset dystonia in patients with "static" encephalopathy.

Abstract

SUMMARYEight cases of persistent dystonia appearing one to 14 years after non-progressive cerebral insults are described. Five were due to perinatal anoxia, one to trauma, and two to cerebral infarction. This phenomenon of delayed-onset dystonia has not been described previously, although review of earlier literature reveals several probable examples. Delayed-onset dystonia due to perinatal anoxia is an important diagnostic alternative to dystonia musculorum deformans for dystonia occurring in childhood.Abnormal involuntary movements may he caused by non-progressive cerebral insults. Choreic, athetoid and dystonic movements due to perinatal anoxia or kericterus,l and ballistic, choreic and athetoid movements due to cerebral infarction2 have been documented. In addition, abnormal involuntary movements have been reported after trauma, anoxia or carbon monoxide poisoning in the adult.3In general, the abnormal involuntary movements in such cases appear either (1) at the time the insult occurs, (2) when the acute neurologic deficit resolves, or (3) when the patient matures neurologically, as in the case of perinatal insults. In a study of the natural history of choreoathetoid cerebral palsy, Polanil found that of 56 patients, 39 had abnormal involuntary movements by the age of 21 years, and the other 17 had abnormal involuntary movements by the age of 3j years. These data are supported by the observations of Crothers and Paine5 who noted that the majority of patients with "extrapyramidal" cerebral palsies were first seen between the ages of 10 and 18 months because of abnormal motor development. As these children grew older, abnormal involuntary movements developed. Paine¢ serially evaluated children with perinatal brain injury and noted that of those who ultimately developed choreo-athetosis or dystonia, 92% showed visible chorea or athetosis by the age of three years. The abnormal move-

Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function

“…As long as the relation between topography and age groups are concerned it is important to observe that the hypotonic group is found among children under the age of 2 and the dyskinetic group is identified later in life. There are few studies trying to establish the moment when the child moves from hypotonia to spastic hipertonia or dyskinesia [22][23][24] . According to those authors spasticity occurs during the three first months and dyskinesia occurs in up to three years in most of the cases.…”

Slowly Progressive Dystonia Following Central Pontine and Extrapontine Myelinolysis.

“…The classic athetotic form of cere- bral palsy is considered to result from the plastic remodeling of the residual neurons in the basal ganglia, as the insult is usually perinatal and the brain is yet premature. In our young patient, the damage might have modified the striatal functions for the proper execution of movements as the reorganization of neural networks; a slow process which has occurred over the subsequent several years (14).…”

Quantification of Neurocognitive Changes Before, During, and After Hyperbaric Oxygen Therapy in a Case of Fetal Alcohol Syndrome

“…24 Furthermore, stem or progenitor cells have been found in the adult brain in the past decade, and they can result in neural regeneration. 25 This recovery process is oxygen dependent and, on first principles, is much more likely to take place in a youngster than in an adult.…”