Division of Neurology, Department of Psychology, The Hospital for Sick Children , Toronto, Ontario, Canada.
Department of Psychology, York University , Toronto, Ontario, Canada.
Child Neuropsychol. 2020 Jul;26(5):691-710. doi: 10.1080/09297049.2020.1721453. Epub 2020 Jan 30.
Pediatric arterial ischemic stroke involving the basal ganglia and/or thalamus is one of the most common causes of dystonia in children. Dystonia is a movement disorder in which excessive, involuntary muscle contractions result in twisting or repetitive movements, and abnormal posturing. The basal ganglia have been implicated in mood functioning and difficulties in these domains have been noted in adults with dystonia, yet little is currently known about these outcomes in children with dystonia following stroke. The objective of this study was to explore mental health outcomes in children with basal ganglia stroke and to determine whether children with post-stroke dystonia experience additional mental health difficulties. We also examined associations between mental health, cognitive, and motor outcomes. Participants were 75 children with stroke involving the basal ganglia and/or thalamus (dystonia n = 24, no dystonia n = 51). Results supported the presence of greater levels of anxiety and depression symptoms in children with post-stroke dystonia after stroke relative to those with similar patterns of stroke, but no dystonia. There were no significant associations between motor, cognitive, and mental health outcomes in children with post-stroke dystonia aside from depression and behavioral regulation. Motor and cognitive outcome were significantly associated in the stroke only group. These findings suggest maladaptive reorganization after stroke may contribute to motor, cognitive, and mental health outcomes in children with post-stroke dystonia, and that these outcomes are independent from one another.
儿童基底节和/或丘脑动脉缺血性脑卒中是儿童肌张力障碍的最常见原因之一。肌张力障碍是一种运动障碍，其中过度的、不自主的肌肉收缩导致扭曲或重复运动和异常姿势。基底节与情绪功能有关，肌张力障碍成年人在这些领域存在困难，但目前对于脑卒中后儿童肌张力障碍的这些结果知之甚少。本研究的目的是探讨基底节卒中儿童的心理健康结果，并确定卒中后发生肌张力障碍的儿童是否存在额外的心理健康困难。我们还检查了心理健康、认知和运动结果之间的关联。参与者为 75 名基底节和/或丘脑卒中的儿童（肌张力障碍组 n = 24，无肌张力障碍组 n = 51）。结果支持卒中后出现肌张力障碍的儿童在卒中后比具有相似卒中模式但无肌张力障碍的儿童表现出更高水平的焦虑和抑郁症状。除了抑郁和行为调节外，卒中后伴发肌张力障碍儿童的运动、认知和心理健康结果之间没有显著关联。在仅有卒中的组中，运动和认知结果显著相关。这些发现表明，卒中后适应性重组可能导致卒中后伴发肌张力障碍儿童的运动、认知和心理健康结果，并且这些结果彼此独立。
