The prevalence and severity of dyskinetic cerebral palsy (DCP) in European children born 1976-1996 were analyzed in a multicenter study in Goteborg, Sweden; Cork, Ireland; Tubingen, Germany; and Grenoble, France. <Of 578 children with DCP, 70% were born at term. The prevalence per 1000 live births increased from 0.08 in the 1970s to 0.14 in the 1990s. In 386 children (70%) with a birth weight >2500 g the increase of DCP was significant (0.05 to 0.12), whereas neonatal mortality in this birth weight group decreased. Compared to children with bilateral spastic cerebral palsy (BSCP), children with DCP had more severe motor and cognitive impairments: 59% needed a wheelchair, 24% walked with aids, and 16% without aids; and 52% had severe learning disability. Epilepsy developed in 51%, and severe visual and hearing impairment in 19% and 6%, respectively. Cognitive impairments increased concurrently with severity of motor deficits. In children born 1991-1996, perinatal adverse events (Apgar score <5 at 5 min and convulsions before 72 h) had occurred more frequently in DCP children cf those with BSCP. [1]

COMMENT. Professor PO Pharoah, Department of Public Health, Liverpool, UK, in an editorial, comments as follows: Prevalence is determined by a function of incidence and duration of a disease; an increase in duration or survival results in increased prevalence without change in incidence. The authors consider the increase in prevalence of dyskinetic CP in term infants is significant because there was no concomitant increase among preterm infants. However, preterm infants contributed more to the decrease in neonatal mortality cf term infants, and therefore to the improved duration due to greater survival. The increasing trend in prevalence of dyskinetic CP may be related to the higher proportion of small for gestational age infants involved and a prepartum etiological factor. Epidemiological data and caveats are difficult to interpret, [2].

Professor TTS Ingram of Edinburgh University, in his classic studies of “Paediatric Aspects of Cerebral Palsy.” (E & S Livingstone, 1964;pp360-l), compares the prevalence of various types of CP in children under age 15 years in Edinburgh in 1951. Of total cases including all social classes, dyskinetic CP occurred in 0.17 and diplegia in 0.70 per 1000. Dyskinesia and diplegia are markedly more prevalent in Social Classes I and II than in III-V. Survival of kernicteric babies and dyskinetic cases was higher, due to better infant care in Social Classes I and II than in lower social classes.