Cerebral palsy and other pediatric movement disorders

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The overall aim of the research conducted is to better understand and explain pathophysiological mechanisms behind as well as the resulting limitations and problems caused by a variety of symptoms that child, adolescents and adults with cerebral palsy (CP), primary movement disorders and other rare neurodevelopmental conditions experience. Moreover we evaluate –short as well as long-term- new and more established interventions aiming to provide a safe, efficient and cost-effective, evidence based treatment.

The research Group is multiprofessional and professions represented include; pediatric neurologists, pediatric orthopaedic surgeons, adult physiatrists, paediatrician, neurosurgeon, clinical psychologists, adult and pediatric physiotherapists, neuro optometrist, health economic and computational linguists. Most researchers are clinically active and see patients at a daily basis .

Research group leader:

Senior research fellow, clin.

Kristina Tedroff

Phone: 08-517 773 74
E-mail: Kristina.Tedroff@ki.se

Research projects

Research Projects in Cerebral palsy

We aim to better understand often comorbid aspects of cerebral palsy and moreover evaluate, change and improve interventions aimed to improve health for individuals with CP. The long standing goal is that social integration and adult life for people with CP will ultimately result in better social integration and better health. Several different projects are currently ongoing. Results can provide important impact for the individual, the socio-economic situation as well as health policy makers.

  • A large proportion of adults with CP are unemployed, single and living with their parents despite the fact that > 50% walks unaided in all surroundings and 2/3 have completed mainstream schooling. In a population based cohort study young people (20-22 years of age) with CP and living in Stockholm are invited to participate in a study where aspects of health, activity, fatigue, education, personal life, economic situation as well as demographic data are obtained through an extensive interview. We hope that information from this study will not only provide information about young adults in Sweden but also deliver hypotheses for future interventions and actions.
  • We are validating a new method, the Neuroflexor® to objectively assess spasticity in the lower extremity of adults with CP. Spasticity is one of the most common motor symptoms in CP but tools for objective measurements are lacking.
  • Children with CP are slow readers. Studies exploring the pathophysiology are scarce and vision has not been simultaneously explored. In a joint project with Bernadotte laboratory at S:t Eriks Eye hospital and optometrists and computer linguistics are we currently investigating young adults and children as well as typically developed healthy controls in order to better understand how and why reading differs between the group with CP and typically developed individuals and if simple and cheap seeing aids ( such as over the counter reading glasses can provide improvement).
  • Studies have revealed that as many as 75% of adults with CP suffer from chronic pain. However in adults with CP up until today not a single clinical study has evaluated the analgesic effect of any pharmacological agent. We have started a placebo controlled RCT trial where chronic pain in adults with CP is treated. The study is an academic non Pharmaceutical industry funded study.
  • In a study with health Economist competence are we evaluating the Stockholm county initiated switch between the two biological drugs Botox® and Dysport®. The two substances are not dose equivalent and limited information is available about conversion factors in children with CP. We have developed a model for the switch and the evaluation to ensure all aspects of the procedure. If effective the model can later be utilized for planned switches between other so called biosimilar drugs.

Responsible researcher: Kristina Tedroff, Associate professor, PhD, pediatric neurologist

Dan Jacobson, PhD student, paediatrician
Kicki Löwing, PhD, Physiotherapist
Johan Gäverth, PhD, Physiotherapist
Tony Pansell, Associate professor, neuro optometrist
Gustaf Öqvist Seimyr, Senior researcher, computer linguist
Mattias Nilsson, Post doc, computer linguist
Jörgen Borg, Professor, Specialist in rehabilitation medicine
Kjell Kullander, Specialist in rehabilitation medicine 
Camilla Svensson, Associate professor, molecular pain researcher
Britt Marie Rydh Berner, Physiotherapist
Malin Ljung, Registered Nurse
Stefan Gantelius, PhD student, Pediatric orthopedic surgeon
Gustaf Befrits , Msc, health Economist
Carl Johan Tedroff, BA, Economist
Anja Berglund, Registered Pediatric nurse

Research Projects in Pediatric Movement disorders

Movement disorders in childhood are distinct from those seen in adults in terms of pathogenesis and even treatment. We have been studying one of the most common childhood movement disorders for more than a decade; Idiopathic toe walking or ITW.  A state in which a child, in absence of a known cause, walks on his or hers toes, as compared to the normal heel-toe gait. We have conducted several treatment studies and the first population based prevalence study worldwide. At present we are following the longitudinal development of children who was diagnosed as ITW at an early age. Particular interest are being paid to co morbid problems such as pain and neuropsychiatric symptoms.

In another project a rare paroxysmal form of movement disorder affecting babies and small children is being investigated. Benign paroxysmal torticollis of infancy (BPTI) is correlated to later development of other paroxysmal disorders such as benign paroxysmal vertigo, migraine and epilepsy. A population based cohort has been followed for more than a decade and genetic analysis are being performed.

Valid and reliable assessment instruments are lacking for both childhood paroxysmal disorders and dystonias. This makes evaluating clinical treatment as well as research assessments hard. In a multicenter study joint project with Katholieke Universiteit Leuven or KU Leuven in Belgium are we presently validating a new assessment instrument for these symptoms.

Responsible researcher: Kristina Tedroff, Associate professor, PhD, pediatric neurologist

Pähr Engström, PhD, Pediatric orthopedic surgeon                                                       
Annika Danielsson, Research student, pediatric neurologist
Britt-Marie Anderlid, PhD, clinical genetics and paediatrician
Cecilia Lidbeck, PhD student , pediatric physiotherapist

Research Project in children with Archnoidalcysts

Arachnoidalcysts are benign, often congenital, cysts that often are localized temporally in the central nervous system. “Accidental findings” has revealed that as many as 2,6 % of all children have these cysts and many are believed to be asymptomatic. However some case reports have described improvement in learning abilities after neurosurgical cyst removals. Other studies have shown a correlation with headache, seizures, developmental delay and concentration problems. Consensus is lacking whether cysts should or should not be surgically reduced and if children might have any other symptom than headache from a arachnoidal cyst. A project is now running where children with temporal cysts are being extensively cognitively evaluated before and after neurosurgery. Particular interest is being put on language, memory and executive functioning.

Responsible researcher: Ulrika Sandvik, Post doc, neurosurgeon

Kristina Tedroff
, Associate professor, PhD, pediatric neurologist
Tomas Alfredsson, Clinical Phycologist
Bengt Gustavsson, Neurosurgeon

Research Project in Prader Willi syndrome

Prader-Willi syndrome (PWS) is a rare genetic disorder. It is complex and affects many areas of the body and development. It is typically characterized by low muscle tone, short stature (when not treated with growth hormone), incomplete sexual development, cognitive disabilities, behavioral problems, and the hallmark characteristics – chronic feelings of insatiable hunger and a slowed metabolism that can lead to excessive eating and life-threatening obesity. The risk of developing a psychiatric severe morbidity such as psychosis and OCD is high. In a project with several studies a large population based cohort of patients with PWS all born in Stockholm during 25 years are being investigated. Several aspects of the disorder are being investigated but we are specifically focusing on the development of psychiatric co morbid conditions. In collaboration with Professor Sven Böltes group at KIND a new tool for evaluating the empathic ability is being translated and adapted to Swedish with the aim of trying this out in PWS patients.

Responsible researcher: Kristina Tedroff, Associate professor, PhD, pediatric neurologist

Ricard Nergårdh, PhD, pediatric endocrinologist
Petra Boström, Research student, Clinical Phycologist
Sven Bölte, Professor, Clinical neuropsychologist