Dyskinetic & Athetoid Cerebral Palsy: Legal Rights for Medical Errors

What Is Dyskinetic Cerebral Palsy?

Dyskinetic cerebral palsy is a type of CP characterized by involuntary, uncontrolled movements. These movements are caused by damage to the basal ganglia, which is part of the extrapyramidal motor system -- the part of the brain that controls involuntary and automatic movements.

The main types of dyskinetic movements include:

• Athetosis: Slow, writhing, continuous movements, particularly in the hands and feet. These movements are often more noticeable when the child is stressed or trying to move voluntarily.
• Dystonia: Sustained, involuntary muscle contractions that cause twisting, repetitive movements, and abnormal postures. Dystonia can be painful and can significantly affect function.
• Chorea: Brief, semi-directed, irregular movements that are not rhythmic, but flow from one muscle to the next.
• Ballismus: Large-amplitude, flailing movements, particularly of the arms and legs.

The Basal Ganglia and Extrapyramidal System

To understand dyskinetic CP, it helps to understand the relevant brain anatomy:

- Basal ganglia: A cluster of structures deep in the brain that control voluntary movement, motor learning, and routine behaviors. The basal ganglia are part of the extrapyramidal motor system -- the system that controls involuntary and automatic movements.

- Globus pallidus: One of the main structures of the basal ganglia. Damage to the globus pallidus is a hallmark of kernicterus and is a major cause of dyskinetic CP.

- Subthalamic nucleus: Another structure of the basal ganglia that helps control movement.

- Extrapyramidal system: The part of the motor system that controls involuntary movements (as opposed to the pyramidal system, which controls voluntary movements). The extrapyramidal system modulates and refines the voluntary movements initiated by the pyramidal system.

The basal ganglia are particularly vulnerable to damage from: - Bilirubin (kernicterus): High levels of bilirubin (from untreated jaundice) are toxic to the basal ganglia, particularly the globus pallidus. [Link to: /birth-injury/kernicterus-lawyer] - Hypoxia-ischemia: Reduced oxygen and blood flow can damage the basal ganglia (deep gray matter) -- this is called status marmoratus and is a hallmark of severe HIE. [Link to: /medical-malpractice/hie-claims] - Mitochondrial disorders: Certain metabolic conditions can affect the basal ganglia.

Causes of Dyskinetic CP

Dyskinetic CP can be caused by:

• Kernicterus (the most common cause): Brain damage from untreated severe jaundice (hyperbilirubinemia). High levels of bilirubin are toxic to the basal ganglia, particularly the globus pallidus. Kernicterus is almost always preventable with appropriate monitoring and treatment of jaundice. [Link to: /birth-injury/kernicterus-lawyer]
• Hypoxic-ischemic encephalopathy (HIE): Severe oxygen deprivation during birth can damage the basal ganglia (deep gray matter), causing a specific pattern of injury called status marmoratus. This is a hallmark of severe HIE and can cause dyskinetic CP. [Link to: /medical-malpractice/hie-claims]
• Neonatal hypoglycemia: Severe low blood sugar in the newborn can damage the basal ganglia.
• Infection: Certain infections (meningitis, encephalitis) can damage the basal ganglia. [Link to: /misdiagnosis/meningitis-misdiagnosis]
• Metabolic disorders: Certain metabolic conditions (mitochondrial disorders, organic acidemias) can affect the basal ganglia.
• Stroke: Certain types of neonatal stroke can affect the basal ganglia. [Link to: /birth-injury/neonatal-stroke-lawyer]

How Medical Negligence Causes Dyskinetic CP

Dyskinetic CP can be caused by medical negligence in several ways:

• Failure to diagnose and treat jaundice (kernicterus): The most common cause of dyskinetic CP. The standard of care requires healthcare providers to monitor bilirubin levels, recognize when they are dangerously high, and treat with phototherapy or exchange transfusion. Failure to do so can cause kernicterus and dyskinetic CP. [Link to: /birth-injury/kernicterus-lawyer]
• Failure to recognize and treat HIE: Severe HIE can damage the basal ganglia, causing dyskinetic CP. Failure to recognize fetal distress, delayed C-section, and failure to provide brain cooling can all contribute. [Link to: /medical-malpractice/hie-claims] [Link to: /medical-malpractice/delayed-c-section] [Link to: /birth-injury/brain-cooling-therapy]
• Failure to monitor and treat neonatal hypoglycemia: The standard of care requires monitoring blood sugar in at-risk infants (premature, small for gestational age, infants of diabetic mothers) and treating hypoglycemia promptly.
• Failure to diagnose and treat neonatal infections: Meningitis and encephalitis can damage the basal ganglia. [Link to: /misdiagnosis/meningitis-misdiagnosis]

Recognizing the Signs

Signs that medical negligence may have caused your child dyskinetic CP include:

• Severe jaundice: Your baby had severe jaundice (yellow skin and eyes) in the first days of life, and the bilirubin level was high.
• Delayed treatment of jaundice: Phototherapy or exchange transfusion was delayed, or the bilirubin level was not monitored appropriately.
• Acute bilirubin encephalopathy: Your baby had signs of acute bilirubin encephalopathy (lethargy, poor feeding, high-pitched cry, arching of the back, seizures) in the first days of life.
• Low Apgar scores: Apgar scores of 5 or lower at 5 and 10 minutes after birth (suggesting HIE).
• Cord blood acidosis: Cord blood pH below 7.0 or base deficit of 12 or higher (suggesting HIE).
• Need for resuscitation: Your baby required resuscitation after birth.
• Brain cooling: Your baby received therapeutic hypothermia (indicating HIE was recognized). [Link to: /birth-injury/brain-cooling-therapy]
• Abnormal MRI: Imaging showing damage to the basal ganglia (globus pallidus in kernicterus, status marmoratus in HIE).
• Involuntary movements: Your child has writhing, twisting, or repetitive movements that they cannot control.
• Speech and feeding difficulties: Your child has difficulty with speech, swallowing, and feeding (common in dyskinetic CP due to involvement of the face and oral muscles).

When Dyskinetic CP Constitutes Medical Malpractice

Dyskinetic CP constitutes medical malpractice in New York when a healthcare provider deviated from the accepted standard of care and that deviation caused the brain damage. Key considerations include:

• Was jaundice monitored appropriately? The standard of care requires monitoring bilirubin levels in all newborns, particularly those with risk factors (prematurity, blood type incompatibility, bruising, exclusive breastfeeding). [Link to: /birth-injury/kernicterus-lawyer]
• Was severe jaundice treated promptly? The standard of care requires treatment with phototherapy or exchange transfusion when bilirubin levels reach dangerous thresholds (based on the bilirubin nomogram).
• Was HIE recognized and treated? The standard of care requires recognizing the signs of HIE and initiating brain cooling within 6 hours. [Link to: /birth-injury/brain-cooling-therapy]
• Was fetal distress recognized? Failure to recognize fetal distress and perform a timely C-section can cause HIE. [Link to: /labor-delivery-errors/failure-to-recognize-fetal-distress] [Link to: /medical-malpractice/delayed-c-section]
• Was neonatal hypoglycemia monitored and treated? The standard of care requires monitoring blood sugar in at-risk infants and treating hypoglycemia promptly.
• Were neonatal infections diagnosed and treated? The standard of care requires prompt diagnosis and treatment of meningitis and other infections. [Link to: /misdiagnosis/meningitis-misdiagnosis]
• Did the deviation cause the brain damage? The dyskinetic CP must be causally connected to the deviation.

Proving Your Case

To prove a dyskinetic CP malpractice case, you need:

- Medical records: Including prenatal records, labor and delivery records, neonatal records (including bilirubin levels, blood sugar levels), imaging studies (MRI), and developmental assessments. - Bilirubin records: Serial bilirubin levels and the timing of phototherapy or exchange transfusion (critical in kernicterus cases). - Imaging studies: The actual MRI images, which show the damage to the basal ganglia. [Link to: /radiology-errors/mri-malpractice] - Expert review: Independent review by board-certified neonatologists, pediatric neurologists, and obstetricians. - Standard of care evidence: Establishing what the standard of care requires and how the healthcare providers deviated from it. - Causation evidence: Establishing that the deviation caused the brain damage. - Life care plan: A detailed projection of the child future care needs. [Link to: /cerebral-palsy-lawyer/life-care-plan] - Expert testimony: From qualified experts.

[Link to: /resources/how-to-get-medical-records-for-a-lawsuit]

New York Statute of Limitations and the Infancy Toll

Dyskinetic CP malpractice claims are subject to the 2.5-year statute of limitations for medical malpractice (CPLR 214-a), running from the date of the negligent act.

However, the infancy toll (CPLR 208) is critical:

• Infancy toll: For injuries to a minor, the statute of limitations does not begin to run until the child reaches age 18. This means the child has until age 20.5 (18 + 2.5 years) to file a medical malpractice claim.
• Infancy toll does not apply to wrongful death: If the malpractice caused death, the wrongful death claim must be filed within 2 years of the date of death (without the infancy toll). [Link to: /wrongful-death-lawyer]
• Infancy toll does not apply to municipal notice of claim: If the malpractice occurred at a municipal hospital (NYC Health + Hospitals), the 90-day notice of claim deadline is not tolled. [Link to: /hospital-negligence/suing-nyc-h-h]
• MIF eligibility: If the child is eligible for the New York Medical Indemnity Fund (born on or after April 1, 2011, with a birth weight of at least 1,400 grams), the case must be structured to ensure MIF eligibility. [Link to: /birth-injury/medical-indemnity-fund]

Common Defense Arguments and How We Counter Them

Defense: The jaundice was not severe enough to cause kernicterus.

Defense attorneys use several arguments in dyskinetic CP cases:

• Our Counter: We use the serial bilirubin levels, the bilirubin nomogram (which shows the risk threshold based on the baby age and bilirubin level), and the clinical signs of acute bilirubin encephalopathy to establish that the bilirubin level was dangerously high. We also use the MRI findings (damage to the globus pallidus is a hallmark of kernicterus) to confirm the diagnosis.

Defense: The brain damage was caused by HIE, not by jaundice.

Our Counter: The pattern of brain damage on MRI differs between kernicterus (which affects the globus pallidus) and HIE (which affects the basal ganglia, thalamus, and watershed zones). We use the MRI findings, the clinical history (timing of jaundice vs. timing of HIE), and expert testimony to establish the cause. [Link to: /radiology-errors/mri-malpractice]

Defense: The child dyskinetic CP was caused by a genetic or metabolic condition.

Our Counter: We rule out genetic and metabolic causes through appropriate testing (metabolic workup, genetic testing). If the testing is normal and the clinical history and MRI findings support kernicterus or HIE, the cause is established.

Defense: The outcome would have been the same even with proper care.

Our Counter: Medical literature supports that prompt treatment of jaundice (with phototherapy or exchange transfusion) prevents kernicterus. We use this literature and expert testimony to establish that proper care would have prevented the brain damage.

Compensation Available

A successful dyskinetic CP malpractice claim in New York can provide compensation for:

• Medical expenses: Including past and future medical care, surgeries, rehabilitation, medications (including botulinum toxin injections, intrathecal baclofen), and assistive devices
• Special education: Specialized educational services for children with cognitive or developmental impairments
• Speech and feeding therapy: For the speech and feeding difficulties common in dyskinetic CP
• Lost earning capacity: For the child reduced ability to work
• Pain and suffering: NY has no cap on non-economic damages
• Permanent disability: For dyskinetic CP and associated conditions (seizures, cognitive impairment)
• Lifetime care costs: Based on a life care plan, discounted to present value
• Home modifications: Ramps, accessible bathrooms, and other modifications
• Loss of consortium: For the impact on family relationships
• MIF benefits: If the child is eligible for the New York Medical Indemnity Fund [Link to: /birth-injury/medical-indemnity-fund]

What to Expect Working with MDLaw Firm

When you contact MDLaw Firm about a potential dyskinetic CP malpractice case:

• Free Consultation: We listen to your story and review the basic facts.
• Immediate Deadline Assessment: We evaluate the 2.5-year statute of limitations, the infancy toll, and MIF eligibility.
• Record Retrieval: We obtain all prenatal records, labor and delivery records, neonatal records (including bilirubin levels), and imaging studies (MRI).
• Expert Review: We engage board-certified neonatologists, pediatric neurologists, and obstetricians to independently review the records.
• Causation Analysis: We establish the causal connection between the deviation and the dyskinetic CP.
• Life Care Plan: We engage a life care planner to project the child future care needs. [Link to: /cerebral-palsy-lawyer/life-care-plan]
• MIF Structuring: If the child is MIF-eligible, we structure the case to ensure MIF benefits. [Link to: /birth-injury/medical-indemnity-fund]
• Litigation: We file within the statute of limitations and handle all aspects of discovery and trial.
• Resolution: We pursue maximum compensation through settlement or verdict.

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.