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We studied 53 patients(64%females)with static brain lesions who developed progressive movement disorders.Of these,50(94%)had dystonia,17(32%)tremor, eight(15%)parkinsonism,seven(13%)myoclonus,and three(6%)chorea.The precipitating insults included perinatal hypoxia/ischemia in 22(42%), stroke in 12(23%),head injury in eight(15%),encephalitis in eight(15%),and carbon monoxide poisoning,kernicterus,and radiation necrosis in one patient(2%)each.Among the 30 patients with initial insult occurring at age 2 years or younger(Infant group),distribution of dystonia at follow-up was focal in three(10%),segmental in eight(27%),unilateral in 10(33%),and generalized in nine(30%).The mean latency between the original injury and onset of movement disorder was 25.5+/-16.7 years.Among the nine patients who developed dystonia after an insult occurring between ages 6 and 17 (Childhood group),the distribution of dystonia at follow-up was segmental in two(22%)and unilateral in seven(78%);the mean latency of dystonia onset was 4.9+/-7.8 years.Of the 14 patients in the Adult group(injury at age 25 or older),11 developed dystonia,two developed parkinsonism,and one had carbon monoxide encephalopathy and parkinsonism.The distribution of dystonia in the 11 patients at follow-up was segmental in three(27%)and unilateral in eight(73%).The mean latency of movement disorder onset in the 14 patients of the Adult group was 2.5+/-4.9 years.No individuals in the Childhood or Adult groups became left-handed dominant;by comparison, nine of the 30 individuals in the Infant group became left-handed.In conclusion,brain injury at a young age is associated with a longer latency to onset of subsequent movement disorder,a greater tendency to development of generalized dystonia,and a greater probability of altered handedness. These tendencies may result from differences in age-related neuroplasticity. |
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cerebrovascular accident
chorea
dystonia
dystonia,delayed onset
dystonia,focal
encephalitis
encephalopathy
encephalopathy,post anoxic
handedness
head injury
hypoxia,newborn
hypoxic encephalopathy
left handedness
movement disorder
movement disorder,delayed onset
myoclonus
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