Westmacott Robyn, McDonald Kyla P, deVeber Gabrielle, MacGregor Daune, Moharir Mahendranath, Dlamini Nomazulu, Askalan Rand, Williams Tricia S
a Children's Stroke Program, The Hospital for Sick Children, Division of Neurology, Department of Pediatrics, Faculty of Medicine , University of Toronto , Toronto , ON , Canada.
Child Neuropsychol. 2018 Oct;24(7):923-937. doi: 10.1080/09297049.2017.1353073. Epub 2017 Jul 12.
Dystonia is a movement disorder that involves excessive, involuntary muscle contractions resulting in repetitive movements and/or abnormal posturing. One common cause of unilateral dystonia in childhood is ischemic stroke involving the basal ganglia and/or thalamus. Virtually nothing is known about neuropsychological outcomes in children who have dystonia following basal ganglia stroke. The present study explored whether or not children with secondary dystonia experience additional cognitive challenges when compared to children with similar patterns of brain injury, but no dystonia. We examined intellectual function, academics, and several aspects of executive function in children with unilateral basal ganglia stroke during childhood, comparing those with dystonia and those without. Although groups did not differ in terms of lesion size, we found significantly lower performance on measures of verbal and nonverbal reasoning, inhibitory control, and academic ability in children with secondary dystonia compared to those without. In contrast, there were no significant group differences on parent ratings of their child's executive function in daily life. These findings suggest that maladaptive reorganization following basal ganglia stroke may contribute to the development of secondary dystonia and also to poor intellectual and academic outcomes in this group.
肌张力障碍是一种运动障碍，涉及过度的、不自主的肌肉收缩，导致重复性运动和/或异常姿势。儿童单侧肌张力障碍的一个常见原因是累及基底神经节和/或丘脑的缺血性中风。对于基底神经节中风后出现肌张力障碍的儿童的神经心理学结果，实际上人们知之甚少。本研究探讨了与具有相似脑损伤模式但无肌张力障碍的儿童相比，继发性肌张力障碍儿童是否会经历额外的认知挑战。我们检查了儿童期单侧基底神经节中风患儿的智力功能、学业情况和执行功能的几个方面，比较了有肌张力障碍和无肌张力障碍的患儿。尽管两组在病灶大小方面没有差异，但我们发现，与无继发性肌张力障碍的儿童相比，有继发性肌张力障碍的儿童在言语和非言语推理、抑制控制和学业能力测试中的表现显著更低。相比之下，在家长对孩子日常生活中执行功能的评分方面，两组没有显著差异。这些发现表明，基底神经节中风后的适应性不良重组可能导致继发性肌张力障碍的发展，也导致该组儿童智力和学业成绩不佳。
