Clinical Features Distinguishing Peripheral and Central Hypotonias

Description

Kaler et al compared general clinical features that can help distinguish between peripheral and central hypotonia. The authors are from Xavier University (Oranjestad), Franklin University and Windsor University.

Patient selection: motor delay

Parameters:

(1) social and cognitive status

(2) dysmorphic features

(3) hands

(4) tendon reflexes

(5) vertical suspension

(6) features of spinal dysraphism

(7) seizures

(8) history

(9) posture and spontaneous movement

(10) range of joint mobility

Parameter	Peripheral Hypotonia	Central Hypotonia
social and cognitive status	impaired	relatively normal
dysmorphic features	with organ malformation suggest a syndrome	myopathic facies
hands	fisting
tendon reflexes	normal or brisk	reduced or absent deep tendon jerks
vertical suspension	crossed adductor response or scissoring	reduced or absent spontaneous antigravity movements
signs of spinal dysraphism	may be present	absent
seizures	present	absent
history	hypoxic-ischemic encephalopathy, birth trauma, hypoglycemia	family history of neuromuscular disorders OR maternal myotonia
posture		frog-leg posture or jug-handle posture of arms; paucity of spontaneous movement
range of joint mobility		increased

where:

• Myopathic facies: open mouth with tented upper lip, poor lip seal when sucking, lack of facial expression, ptosis, restricted ocular movements

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Clinical Features Distinguishing Peripheral and Central Hypotonias

Description

Specialty