Category: Meningitis

Cerebral Palsy – Athetoid

On By KennethIn Ataxia, Athetoid, Brain Trauma, Cerebral Palsy, Lack of oxygen, MeningitisLeave a comment

What is Athetoid Cerebral Palsy?

Athetoid cerebral palsy (also known as “dyskinetic cerebral palsy”) is a movement disorder caused by damage to the developing brain.

Children with athetoid CP fluctuate between hypertonia and hypotonia. Hypertonia is used to describe unusually high muscle tone, which creates stiffness and tension in the muscles. Hypotonia is used to describe unusually low muscle tone, which causes “floppiness” in the muscles. This inability to regulate muscle tone is what causes CP symptoms.

Athetoid CP can also result in issues surrounding voluntary movement in the hands, arms, feet and legs — making it hard to walk or grasp objects. Treatment for this type of cerebral palsy is centered on various therapies, medications and surgeries that can help to manage symptoms and prevent any future complications.

Types of Athetoid CP

Athetoid cerebral palsy may be given other distinctions to further classify the condition based on the specific type of involuntary movement.

The various types of athetoid CP include:

  • Dystonia – Slow, rotational movement of the torso, arm or leg.
  • Chorea – Sudden involuntary movements, especially in fingers and toes.
  • Athetosis – Sluggish, writhing movements, mainly in fingers and face.
  • Choreoathetoid – A combination of chorea and athetosis.
  • Ataxia – Loss of balance and coordination.
  • Rigidity – High muscle tone due to hypertonia causes restricted movement.
  • Dyskinesia – General term to describe involuntary movements. Athetoid CP is often interchangeably referred to as dyskinetic CP for this reason.

Causes and Risk Factors

Athetoid cerebral palsy is one of several types of movement disorders caused by a brain injury. Each type of cerebral palsy differs based on which part of the brain is damaged. 

Basal ganglia damage

The basal ganglia are a group of nuclei in the brain responsible for coordinating voluntary movement. The basal ganglia are located within the cerebral cortex, a part of the brain that helps control motor function. The basal ganglia also help regulate thinking and learning. Damage to the basal ganglia affects motor function development and causes involuntary movements.

Cerebellum damage

The cerebellum is responsible for regulating coordination and precision of movements — both of which are essential to fine motor skills and balance. When the cerebellum is damaged, balance and coordination become more challenging. The cerebellum is also an important part of cognitive functions, such as communication and attention. A damaged cerebellum can cause co-occurring disorders, such as autism or epilepsy.

Damage to the cerebellum and/or basal ganglia can be caused by:

Certain risk factors increase the chances of brain injuries that cause athetoid cerebral palsy. In general, the risk factors for all types of CP are the same, including: premature birth, severe infantile jaundice and blood clotting in the placenta.

Symptoms of Athetoid Cerebral Palsy

The signs and symptoms of athetoid CP vary based on the severity of the condition and location of movement issues. The symptoms of athetoid cerebral palsy are a result of problems with both high and low muscle tone, which can vary on a daily basis. High muscle tone causes stiffness and jerky movement. Low muscle tone causes floppiness in the muscles, characterized by issues such as trouble sitting up.

The most common symptoms associated with athetoid CP are:

  • Involuntary movement
  • Tremors
  • Poor posture
  • Unsteadiness
  • Twisting of the torso
  • Slow, writhing movements
  • Abrupt movements
  • Grimacing or drooling

The symptoms of athetoid CP depend on whether the damage was solely to the basal ganglia, or if both the cerebellum and basal ganglia were damaged. If both areas are damaged, this will likely cause problems with balance and coordination.

Parents and caregivers usually begin noticing signs of involuntary or jerky movements when their child is around 9 months or older. In many young children, irregular movement may be indicative of a developmental delay, but not necessarily a sign of cerebral palsy.

Athetoid cerebral palsy may be present in a child who:

  • Doesn’t kick legs
  • Seems stiff or rigid
  • Seems limp
  • Doesn’t hold up head at three months old
  • Doesn’t reach for objects
  • Doesn’t smile by three months old
  • Doesn’t roll over

Treatment for Athetoid CP

Although there is no cure for cerebral palsy at this time, children with this condition generally grow up to live healthy, meaningful lives as they transition into adulthood.

Treatment for cerebral palsy helps children with this disorder become more independent and confident in their abilities. Treatment methods such as physical therapy and speech therapy help improve existing symptoms, while also preventing any future complications later in life.

Physical therapy

Physical therapy typically incorporates a series of strength training exercises, resistance bands and machines to help improve low muscle tone. Physical therapists work with children and adults with CP to overcome any sensory impairments, such as touch and depth perception, that make movement more difficult.

Therapy for this type of CP is typically based on improving overall mobility. This includes exercising the face and tongue muscles, as grimacing and drooling is common in children with this type of CP. Athetoid CP can also cause difficulties holding posture or keeping the body in a steady, upright position. Physical therapists will use various exercises to increase the strength in these muscles and prevent any further complications.

Occupational therapy

Occupational therapy is used to enhance a child’s ability to independently play and learn. An occupational therapist will help to make everyday tasks, such as grasping objects, writing or using assistive mobility devices, easier on a child with this type of CP.

Specific exercises used in occupational therapy for athetoid CP include stretching with weights and resistive equipment, as well as incorporating functional and playful activities to keep children interested. Occupational therapy will allow children to form relationships and respond to the demands of daily life with increased mobility and confidence.

Speech therapy

For those diagnosed with CP, speaking, eating or breathing can be a challenge. Speech therapy is used to alleviate these problems, as well as increasing language and vocabulary development, articulation and breathing control.

After working with a speech therapist for a series of sessions, people with CP often begin to have more control over their face and tongue muscles. Speech therapy can also make daily tasks easier on a child with athetoid CP, allowing for increased independence.

Medication

Most of the medications prescribed for athetoid cerebral palsy are used to treat secondary conditions that result from developmental brain damage. For example, anticonvulsants are used to reduce seizures and over-the-counter acid reflux medications, such as Zantac, are prescribed for children with weak gastroesophageal muscles.

Ritalin and other medications treat attention deficit hyperactivity disorder (ADHD), which is diagnosed in up to 20 percent of children with CP. Medications to control drooling and incontinence are also useful for those with athetoid cerebral palsy.

Surgery

Surgery for children with cerebral palsy is used to correct and prevent issues with the joints, muscles and tendons by correctly aligning parts of the body to foster healthy growth. Although it is not common in athetoid CP, surgery can be used to correct joint deformities and dislocations due to high muscle tone.

Embracing A Life with CP

While a cerebral palsy diagnosis may come as a surprise to many families, this is a condition that can be managed effectively through proper treatment and continued care. There are bound to be some challenges along the way, however, maintaining a positive outlook can allow children and adults to embrace life with CP.

To learn more about athetoid cerebral palsy, try downloading our free Cerebral Palsy Guide. This guide includes 60 pages of in-depth information for families affected by cerebral palsy.

Epilepsy in childhood

On By KennethIn Children, Epilepsy, Epilepsy nurses, Meningitis, Seizure1 Comment

Information about the diagnosis and treatment of childhood epilepsy and how epilepsy may affect a child’s life.

In the UK, epilepsy affects around 60,000 children and young people under 18. Epilepsy can start at any age including childhood. Epilepsy can start at any age, including in childhood. If your child develops epilepsy you may have questions or concerns.

What is epilepsy?

Epilepsy is a neurological condition (affecting the brain and nervous system) where a person has a tendency to have seizures that start in the brain.

The brain is made up of millions of nerve cells that use electrical signals to control the body’s functions, senses and thoughts. If the signals are disrupted, the person may have an epileptic seizure.

Not all seizures are epileptic. Other conditions that can look like epilepsy include fainting (syncope) due to a drop in blood pressure, and febrile convulsions due to a sudden rise in body temperature when a young child is ill. These are not epileptic seizures because they are not caused by disrupted brain activity.

See more about what is epilepsy?

What happens during a seizure?

There are many different types of epileptic seizure. The type of epileptic seizure a child has depends on which area of their brain is affected.

There are two main types of seizure: focal seizures (previously called partial seizures) and generalised seizures. Focal seizures affect only one side of the brain and generalised seizures affect both sides of the brain. Generally, adults and children have the same types of seizure. However, some may be more common in childhood than adulthood (for example, absence seizures which can be very brief and are often mistaken for ‘daydreaming’ or not paying attention).

Different seizures include:

  • jerking of the body 
  • repetitive movements
  • unusual sensations such as a strange taste in the mouth or a strange smell, or a rising feeling in the stomach.

In some types of seizure, a child may be aware of what is happening. In other types, a child will be unconscious and have no memory of the seizure afterwards.

Some children may have seizures when they are sleeping (sometimes called ‘asleep’ or ‘nocturnal’ seizures). Seizures during sleep can affect sleep patterns and may leave a child feeling tired and confused the next day.

See more about seizures.

Why does my child have epilepsy?

Some children develop epilepsy as a result of their brain being injured in some way. This could be due to a severe head injury, difficulties at birth, or an infection which affects the brain such as meningitis. Epilepsy with a known structural cause like this is sometimes called symptomatic epilepsy.

Some researchers now believe that the chance of developing epilepsy is probably always genetic to some extent, in that anyone who starts having seizures has always had some level of genetic tendency to do so. This level can range from high to low and anywhere in between. 

Even if seizures start after a brain injury or other structural change, this may be due to both the structural change and the person’s genetic tendency to have seizures combined. This makes sense if we consider that many people might have a similar brain injury but not all of them develop epilepsy afterwards.

See more about causes of epilepsy.

How is epilepsy diagnosed?

A diagnosis of epilepsy may be considered if your child has had more than one seizure. The GP will usually refer them to a paediatrician (a doctor who specialises in treating children). You (and your child if they can) may be asked to describe in detail what happened before, during and after the seizure.

Having a video recording of the seizure can help the paediatrician understand what is happening.

The paediatrician may also suggest a few tests to help with the diagnosis. The tests alone cannot confirm or rule out epilepsy, but they can give extra information to help find out why your child is having seizures.

See more about how epilepsy is diagnosed.

What is a childhood epilepsy syndrome?

If your child is diagnosed with a childhood epilepsy syndrome, this means their epilepsy has specific characteristics. These can include the type of seizure or seizures they have, the age when the seizures started and the specific results of an electroencephalogram (EEG).

An EEG test is painless, and it records the electrical activity of the brain.

Syndromes follow a particular pattern, which means that the paediatrician may be able to predict how your child’s condition will progress. Syndromes can vary greatly. Some are called ‘benign’ which means they usually have a good outcome and usually go away once the child reaches a certain age. Other syndromes are severe and difficult to treat. Some may include other disabilities and may affect a child’s development.

Treatment for children

Your child’s GP is normally responsible for their general medical care. The GP may refer your child to a paediatrician or paediatric neurologist (a children’s doctor who specialises in the brain and nervous system). An epilepsy specialist nurse may also be involved in their care.

Young people usually start to see a specialist in adult services (a neurologist) from around 16 years old.

Anti-epileptic drugs

Most people with epilepsy take anti-epileptic drugs (AEDs) to control their seizures. The paediatrician can discuss with you whether AEDs are the best option for your child. Although AEDs aim to stop seizures from happening, they do not stop seizures while they are happening, and they do not cure epilepsy.

Most children stop having seizures once they are on an AED that suits them. Like all drugs, AEDs can cause side effects for some children. Some side effects go away as the body gets used to the medication, or if the dose is adjusted. If you are concerned about your child taking AEDs you can talk to their paediatrician, epilepsy nurse, GP or pharmacist. Changing or stopping your child’s medication without first talking to the doctor can cause seizures to start again or make seizures worse.

Although AEDs work well for many children, this doesn’t happen for every child. If AEDs don’t help your child, their doctor may consider other ways to treat their epilepsy.

Ketogenic diet

For some children who still have seizures even though they have tried AEDs, the ketogenic diet may help to reduce the number or severity of their seizures. The diet is a medical treatment, often started alongside AEDs and is supervised by trained medical specialists and dietitians. 

Epilepsy surgery

It may be possible for some children to have epilepsy surgery depending on the type of epilepsy they have and where in the brain their seizures start. Epilepsy surgery involves removing a part of the brain to stop or reduce the number of seizures a child has.

Will epilepsy affect my child’s life?

You may not be able to predict how epilepsy will affect your child’s life. However helping your child to manage their seizures and be open about their feelings can make a positive difference. Help your child’s school understand their condition to ensure they get the most out of their school and education.

Triggers for seizures

Some children’s seizures happen in response to triggers such as stress, excitement, boredom, missed medication, or lack of sleep. Keeping a diary of their seizures can help to see if there are any patterns to when seizures happen. If you recognise triggers, avoiding them as far as possible may help to reduce the number of seizures your child has.

Getting enough sleep, and well-balanced meals, will help keep your child healthy and may help to reduce their seizures.

See more about triggers. 

Immunisation (vaccination)

Some parents are nervous about immunisation, whether or not their child has epilepsy. The Department of Health recommends that every child is immunised against infectious diseases. This includes children who have epilepsy. If you are concerned about immunisations, your child’s GP or paediatrician can give you more information.

Behaviour

For some children, having epilepsy and taking AEDs will not affect their behaviour. However, some people may notice a change in their child’s mood or behaviour such as becoming irritable or withdrawn. Some children may be responding to how they feel about having epilepsy and how it affects them. They may also want to be treated the same as their siblings or friends and to feel that epilepsy isn’t holding them back. Encouraging your child to talk about their epilepsy may help them feel better.

Behaviour changes and problems can happen for all children regardless of having epilepsy and for many, may just be part of growing up. In a few children, irritable or hyperactive behaviour may be a side effect of AEDs. If you have concerns about changes in your child’s behaviour, you may want to talk to their doctor or epilepsy specialist nurse. 

Leisure activities

Most children with epilepsy can take part in the same activities as other children. Simple measures can help make activities such as swimming and cycling safer. For example, making sure there is someone with your child who knows how to help if a seizure happens.

See more about leisure and safety.

Can epilepsy change as children get older?

Seizures may change over time, either in type or frequency. Some children outgrow their epilepsy by their mid to late teens. This is called ‘spontaneous remission’. If they are taking AEDs and have been seizure-free for over two years, their doctor may suggest slowly stopping medication.

How might my child feel?

Having epilepsy can affect a child in different ways. Depending on their age and the type of seizures your child has, the impact may vary.

For some children having a diagnosis of epilepsy will not affect their day-to-day lives. For others it may be frightening or difficult to understand. They may feel embarrassed, isolated or different in front of their peers. Encouraging your child to talk about their concerns may help them to feel more positive.

Most children with epilepsy will have the same hopes and dreams as other children and seizures may not necessarily prevent them from reaching their goals.

See also Epilepsy in adolescence.

Your feelings as a parent

If your child is diagnosed with epilepsy you may have mixed emotions – for your child and for yourself. It can take time to come to terms with a diagnosis and how it may affect family life. You may feel worried or relieved. How you feel about the diagnosis may also change over time.