title: Clinical patterns of dystonia and choreoathetosis in participants with dyskinetic cerebral palsy.
abstract: OBJECTIVE
  The aim of the study was to map clinical patterns of dystonia and choreoathetosis and to assess the relation between functional classifications and basal ganglia and thalamus lesions in participants with dyskinetic cerebral palsy (CP).
  
  
  METHODS
  In this cross-sectional study, 55 participants with dyskinetic CP (mean age 14y 6mo, SD 4y 1mo; range 6-22y) were assessed with the Dyskinesia Impairment Scale and classified with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS).
  
  
  RESULTS
  Dystonia and choreoathetosis are simultaneously present. Median levels of dystonia (70.2%) were significantly higher than levels of choreoathetosis (26.7%) and both were significantly higher during activity than at rest (both p<0.01). High correlations were found between dystonia levels and GMFCS level (Spearman's rank correlation coefficient, rS =0.70; 95% confidence interval [CI] 0.53-0.81; p<0.01) and MACS (rS =0.65; 95% CI 0.47-0.81; p<0.01), and fair correlation with CFCS (rs =0.36; 95% CI=0.11-0.57; p<0.05). No significant correlation was found between choreoathetosis levels and motor classifications. Finally, higher choreoathetosis levels were found in participants with pure thalamus and basal ganglia lesions (p=0.03) than mixed lesions, but not for dystonia (p=0.41).
  
  
  CONCLUSIONS
  Dystonia and choreoathetosis increase during activity. However, dystonia predominates and seems to have a larger impact on functional abilities. Our findings further suggest that choreoathetosis seems to be more linked to pure thalamus and basal ganglia lesions than dystonia.
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Elegast
authors.initials: E
authors.lastname: Monbaliu
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: de Cock
authors.affiliation: Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Ortibus
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Heyrman
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Katrijn
authors.initials: K
authors.lastname: Klingels
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Feys
mesh_terms: D000293:Adolescent; D000328:Adult; D001264:Athetosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D001480:Basal Ganglia Diseases / Q000473:pathology; D002547:Cerebral Palsy / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D002819:Chorea / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004421:Dystonia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013788:Thalamus / Q000473:pathology; D055815:Young Adult