Mental health outcomes in children with acquired dystonia after basal ganglia stroke and associations with cognitive and motor outcomes

ABSTRACT

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.

KEYWORDS:

• Pediatric stroke
• basal ganglia
• dystonia
• depression
• anxiety

Acknowledgments

The authors wish to thank Dr. Kyla McDonald for her assistance in data management. The authors would like to acknowledge the support and mentorship of Drs. Gabrielle deVeber, Daune MacGregor, Mahendranath Moharir for their continuous support of children with stroke and their families.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was supported by funding from the Auxilium Foundation, Centre for Brain and Mental Health Kimel Family Health Outcomes Grant, The Ontario Graduate Scholarship, The March of Dimes Canada Graduate Scholarship, and The Canadian Psychological Association Section for Clinical Neuropsychology Research Award.