Dyskinetic cerebral palsy in Europe: trends in prevalence and severity

Kate Himmelmann ^1*, Vicki McManus ², Gudrun Hagberg ¹, Paul Uvebrant ¹, Ingeborg Krägeloh-Mann ³ and Christine Cans ⁴

¹ The Queen Silvia Children’s Hospital/Sahlgrenska University Hospital, Sweden
² Catherine McAuley School of Nursing and Midwifery, Eire
³ Universitätsklinik für Kinder- und Jugendmedizin, Tübingen, Germany
⁴ Unité d'Exploitation de l'Information Médicale, France

^* To whom correspondence should be addressed. E-mail: kate.himmelmann{at}vgregion.se.

Accepted 20 April 2009

Abstract

Objective: To describe the trends for and severity of dyskinetic cerebral palsy (CP) in a European collaborative study between CP registers, the Surveillance of Cerebral Palsy in Europe (SCPE).

Methods: In children born in 1976-1996, the prevalence of dyskinetic CP was calculated. Walking ability, accompanying impairments and perinatal adverse events were analysed.

Results: There were 578 children with dyskinetic CP. Seventy per cent were born at term. The prevalence per 1,000 live births increased from 0.08 in the 1970s to 0.14 in the 1990s. For the 386 children (70%) with a birth weight of 2,500 g, the increase was significant (0.05 to 0.12). There was a contemporary decrease in neonatal mortality among children with a birth weight of 2,500 g. Sixteen per cent of the children walked without aids, 24% with aids and 59% needed a wheelchair. Severe learning disability was present in 52%, epilepsy in 51% and severe visual and hearing impairment in 19% and 6% respectively. Accompanying impairments increased with motor severity. Perinatal adverse events, i.e. an Apgar score of < 5 at five minutes and convulsions before 72 hours, in children born in 1991-1996, had occurred more frequently compared to children with bilateral spastic CP (BSCP). Children with dyskinetic CP had more severe cognitive and motor impairments than children with BSCP.

Conclusions: The prevalence of dyskinetic CP appears to increase in children with a normal birth weight. They have frequently experienced perinatal adverse events. Most children have a severe motor impairment and several accompanying impairments.