Objective: Investigate clinical motor patterns and evaluate symptom-specific functional motor networks in dyskinetic cerebral palsy.

Background: Dyskinetic cerebral palsy (DCP) is a complex movement disorder resulting from acquired damage to the developing brain as due to perinatal hypoxia. Dystonia and choreoathetosis predominate, but spasticity and axial hypotonia may co-exist. Imaging studies have shown that grey and white matter lesions underlying DCP affect a distributed functional motor network. Until now, symptom-specificity has not been adressed in clinico-imaging studies of DCP.

Method: In a mixed-design observational study, demographic and clinical features of patients with DCP were assessed. Movement disorder patterns were evaluated from video recordings using the dyskinesia impairment scale (DIS) and within patients comparisons performed using Wilcoxon matched-pairs signed-rank test. Individual patient lesions were traced from available MRI studies onto a pediatric template. Functional connectivity from lesions to all other brain voxels was calculated using a normative pediatric connectome and symptom-specific maps were calculated.

Results: A total of 46 patients (17 female) with DCP were included. Age at clinical exam comprised 14.9 ± 5.9 years, gross motor function classification scale 4.4 ± 0.9 (GMFCS), main cause was perinatal hypoxia (71.7%). Dystonia (D) sub-scores were higher than choreoathetosis (CA) (Avg_D= 69.2% ± 14.6, Avg_CA= 21.6% ± 15.2, p<0.0001) and total dyskinesia increased in action in comparison to rest (Avg_R= 39.1% ± 12.7, Avg_A=49.1%± 11.8, p<0.0001). Dystonia, but not choreoathetosis correlated with GMFCS-scores reflecting functional impairment (Spearman’s r=0.45, p=0.0018). Functional network mapping of DCP (N=35) revealed a motor network including basal ganglia, thalamus, motor cortex and brainstem. Spatial correlation of dystonia but not choreoathetosis severity maps was statistically significant after FSL PALM permutation corrected for multiple comparisons.

Conclusion: This study corroborates previous findings from clinical studies and literature-based lesion network mapping in a large, multi-center cohort and gives first insights into symptom-specific functional network properties in DCP. Further investigation of clinico-imaging patterns can contribute to improved pathophysiological understanding and outcome prediction in DCP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/from-clinical-patterns-to-symptom-specific-functional-networks-in-dyskinetic-cerebral-palsy/