PREDICTORS OF DYSTONIA IN CHILDHOOD BASAL GANGLIA STROKE

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Abstract
Objectives: Dystonia may result from focal lesions of the basal ganglia secondary to ischemia. The purpose of this study was to establish the incidence, course, outcome and predictors of dystonia in basal ganglia stroke in children. Understanding the predictors may lead to earlier diagnosis and treatment of dystonia in this population. Methods: A consecutive cohort study of children with basal ganglia stroke seen at two North American children's tertiary care centers from January 1992 to December 2004 was undertaken. Children aged 6 months to 17 years with basal ganglia lesions were included in the study. Data were collected on age, gender, etiology, initial clinical presentation, radiographic findings and outcome on follow-up. The mean time for follow-up was 4.5 years (range 1 month-10.5years). Results: Of 100 children with basal ganglia stroke 21% went on to develop dystonia. 20/90 (23%) of the children who developed dystonia were under age 10 at the time of stroke, 1/10 (10%) children was over 10. (p=0.09, odds ratio 2.5) More girls were found to develop dystonia 10/35 (29%) as compared to 11/65 males (17%) [OR=1.96]. Infarcts in the left basal ganglia were found to result in dystonia more often (24%) than right basal ganglia lesions (16%). The median time of onset of dystonia after stroke was 6–12 months (range 0–8years). In 14 children (67%) dystonia was severe requireing medical treatment. Conclusion: Dystonia occurs in 21% of childhood basal ganglia strokes. There is a trend that it is more likely to occur in younger children and in girls (statistically not significant). Onset is frequently 6–12 months after stroke. In two-thirds of children treatment was warranted. Studies with greater number of children will be useful in enabling us to predict the outcome of basal ganglia AIS, better out-patient surveillance and earlier treatment of dystonia to reduce morbidity in this population.

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