Talk:Athetoid cerebral palsy

note
This is a part of a class project for Dr. Burdo at Boston College. This project aims to update existing neuroscience-related wikipedia stubs as initiated by the Society for Neuroscience. We will be updating the stub over several months. BSByrne (talk) 01:55, 5 November 2012 (UTC)

Classification
In the classification section, you make the claim that the current classification system "classifies CP as either spastic, dyskinetic, or ataxic." However, other sources have claimed that the three classes of cerebral palsy are spastic, ataxic, and choreoathetotic. Athetoid cerebral palsy would therefore fall under choreoathetotic cerebral palsy as it is characterized by damage to the basal ganglia.

1. Cheney, PD (1997). "Pathophysiology of the corticospinal system and basal ganglia in cerebral palsy". Mental Retardation and Developmental Disabilities Research Reviews 3: 153-167

Pieningd (talk) 23:27, 14 November 2012 (UTC)

Hello, thank you for the review! The classification of cerebral palsies varies quite a bit from source to source, as you've found out. We've found that when investigating these different classifications, there is no agreed upon classification system when it comes to categorizing the different forms of CP. O'Shea (2008) classifies choreo-athetotic CP under dyskinetic CP, and we agreed with this classification based on the research we have done. Thanks for the questions- the confusion of CP classification is an important medical issue. Bonnerry (talk) 22:45, 21 November 2012 (UTC)

Additionally, it should be noted that O'Shea discusses the SCPE classification mentioned on the page. Bonnerry (talk) 20:07, 2 December 2012 (UTC)

The classification section has been further modified to be more comprehensive and easily understood, specifically regarding the various methods of classification. Bonnerry (talk) 04:29, 3 December 2012 (UTC)

This article was extremely informative. It explained many essential facts about Athetoid cerebral palsy in a straightforward manner. The causes, symptoms, and treatments in particular were very descriptive and well-written. There are many sections in this article, and I understand how it could be difficult to fully expand on each and every topic. However, I do think that this article could benefit some from a few more additions. One section that seemed rather short was genetic factors. While it does give a brief description of how ADCP could be genetically linked within a family, I believe it could be a little more in depth. It might be beneficial to possibly add a pedigree chart showing the possible trend in which the disease travels in familial cases. Also, the epidemiology section at the end seemed a bit short and out of place. This section might be better off if it was simply consolidated with the introduction (and if not, then possible moved up so it comes right after the introduction). Other than that, I think this article was well done.Bhaktak (talk) 21:36, 15 November 2012 (UTC)

Thanks a lot for the comments. We've decided to make several changes based on what you have suggested. The epidemiology section was redundant, so it was removed. The genetic factors were reviewed, and the data involved in determining the genetic background of ADCP was weak and also based on primary literature, so it was excised as well. Thank you again for your review! Bonnerry (talk) 20:40, 2 December 2012 (UTC)

Very descriptive, well written article. The causes/etiology section, in particular, was detailed and provided a solid overview of the different types of potential causes for athetoid cerebral palsy. Two suggestions on additions that could be made to improve the quality of the article: The first would be that while you clearly defined the specific class of athetoid cerebral palsy (caused by damage to the basal ganglia) and also noted many of the associated effects of such damage (inability to control muscle tone, coupled with the potential for other speech and muscular problems) there wasn't a clear explanation given as to why such lesions or malformations to the basal ganglia lead to such effects. Although I suppose one could click through to the Wiki page for the basal ganglia and read about the role and function of this part of the brain, I think your article could be greatly improved by a brief discussion of the normal functions of the basal ganglia and why such lesions and malformation lead to the symptoms that you mentioned. Second, I think the paper could be improved with a brief discussion of the history of medical research and advancements made specifically in regards to athetoid cerebral palsy. You could talk about why it's important to research the disease and who the first people were to begin researching the disease, then discuss recent advancements and discoveries that have been made, and finally discuss where future research may be focused and what potential treatments may evolve over the next few decades. In addition, you could mention what live is like for a patient living with athetoid cerebral palsy. There could also be potential to discuss political issues, as the treatment of patients with cerebral palsy has been heavily debated in recent years. See the following article for more info: A Systematic Review of Neuroimaging for Cerebral Palsy by Steven Korzeniewski. Coburnt (talk) 02:43, 17 November 2012 (UTC)

Thank you for the comments. We added a picture of the basal ganglia and briefly commented on the basal function of this region of the brain. Regarding a history of athetoid cerebral palsy, we decided to not include this section. In our research, we did not find any information on the "discovery" of athetoid cerebral palsy specifically and only found literature on the discovery of cerebral palsy as a whole. A history of cerebral palsy (who discovered it, defined it. etc.) can be found on the general cerebral palsy wikipedia page. Since athetoid/ dyskinetic cerebral palsy is a subdivision of cerebral palsy, we also decided to not include political issues. The focus of this article is specifically on this subdivision of cerebral palsy and this information can be found on the general cerebral palsy wikipedia page.BSByrne (talk) 22:29, 2 December 2012 (UTC)  — Preceding unsigned comment added by BSByrne (talk • contribs) 22:26, 2 December 2012 (UTC)

Upon further consideration, we decided to not include a brief description of the function of basal ganglia. This information can be found on the basal ganglia wikipedia page.BSByrne (talk) 22:33, 2 December 2012 (UTC)

Peer Review for BI481
Overall, this article is detailed about many forms and classifications of CP and is generally quite well organized. However, it could be improved by fully developing and defining the class of ADCP itself more than the cursory definition given in the initial page summary. Although much information was given about how ADCP fits in among the many different forms of CP, this article could be more focused on ADCP itself.

From an outsider’s perspective, a few changes could be made to the classification section to improve its clarity. The phrase “anatomic, topographic distribution” is a little awkward and maybe somewhat redundant. You might consider simply saying topographic and then adding “in the brain” to the end of the sentence just to make your material as apprehensible as possible. Also, when discussing how ADCP is classified within the SCPE guidelines, it could be clearer to specify, once again, that ADCP falls under the dyskinetic umbrella of CP. This might be followed by describing the two additional categories of ADCP, dystonic and choreoathetotic, in the order that you mentioned them rather than in the reverse order as you have them now. Additionally, the phrase “the motor disorder” is vague, as you have just finished describing a number of different types of CP. Replacing that with “cerebral palsy” or “ADCP”, whichever you might mean, could be helpful. Finally, “involvement” is misspelled in the last paragraph of this section when describing diplegia.

The signs and symptoms section is great. I liked the detail given in each description and the overall well-spoken quality of the text. The phrase “small, rapid, random and repetitive uncontrolled movements” might be a little awkward, although this is understandable since there is a lot of information to organize in the sentence. You might consider saying “Random, uncontrollable movements known as chorea that tend to be small, rapid, and repetitive may also occur.” The causes/etiology and diagnosis sections are also very well written and are especially well developed, though I might reverse their order so that diagnosis comes right after signs and symptoms.

The organization of the treatments section is effective as well, though I might replace the word “Medical” with “Drug Therapy”, as the term medical is quite general and the discussion that follows seems to be very focused on drug treatments.

The final sections, Prognosis and Epidemiology, are short but not in a bad way. I think they are concise while still being useful. If you were to expand on a topic, however, you might consider Epidemiology. Does epidemiology change in certain regions of the world? Does the regional epidemiology at all help us to diagnosis or treat the disease?

Chavezmb (talk) 18:14, 18 November 2012 (UTC)

Hello, and thank you for the review. We're looking to focus each section on ADCP as much as possible (which I believe we have done), however when it comes to the classification system, some mention of other CP types must be mentioned to a degree in order to differentiate the various types. That being said, we are aiming to make some large changes to the classification section in order to make it more easily understood. The sentence describing chorea is, as you pointed out, necessary and complicated. We'll try to see if there are other ways that this could be phrased, but unfortunately all of those modifiers are necessary in describing chorea. The order of the sections has been reconsidered after your comments, however it will remain the same. This order is consistent with the general cerebral palsy page, and we feel that it makes the most sense to mention symptoms, then their associated causes, and then how the symptoms can be identified. Although it may make sense to order them so that it reads as the signs and symptoms, how to diagnose them, and why they occur, this fails to draw a connection between signs/symptoms and causes, which I feel the current order does significantly better. The "Medical"/"Drug Therapy" switch has been made, and makes substantially more sense than what was on the page before. Epidemiology was redundant and was removed recently (there is also limited information outside of small-sample studies from various populations in Asia, Europe, etc.). Thanks again for your review- it was extremely helpful and quite comprehensive. Bonnerry (talk) 21:15, 2 December 2012 (UTC)

Peer Review
Hey guys – I was extremely impressed with this article. I found it very straightforward, easy to understand, and well organized. I have some suggestions that I think will make the article easier to understand, specifically for those without much of a background in the sciences.

In the Introduction section, you made links to “spastic” and to “ataxic” but not to “spastic cerebral palsy” or to “ataxic cerebral palsy” which I think would be more relevant since this is what it seems you are referring to. I would also link “cerebral palsy” to its Wikipedia page.

In the classification section, your first sentence repeats information that is included in the Introduction section. I would be sure to remove this information from the Introduction section if it is to be included there. In the second paragraph, bullets might make the information more organized and easier to read. In the Causes section, I think you should consider linking the following to their respective Wikipedia pages: “prenatal period,” “blood brain barrier,” “bilirubin,” and “basal ganglia.”

Some additions that I think would augment your article include a video or picture (for example, you could include a brain scan of a brain without athenoid cerebral palsy and one with it, highlighting the differences) as well as a history section. I think that a history section which includes both old and recent developments in the history of cerebral palsy could prove extremely beneficial to your page.

Overall, the article is very impressive and you’re off to a great start.

Bethanychaves (talk) 20:51, 19 November 2012 (UTC)

Thanks for the review! I've taken care of some of the errors you mentioned, specifically the various linking problems. I've also handled the repetition of the statistic you mentioned. We've received several comments regarding the inclusion of a picture and a "history" section, and we are working to improve these holes. They should be improved soon. Thanks again! Bonnerry (talk) 21:47, 21 November 2012 (UTC)

As described below, we have abstained from including a "history" section, as the history of the discovery and treatment methods regarding ADCP are extremely similar to the history of discovery and treatment of general CP, which can be found at cerebral palsy. A picture has been included. Thanks again! Bonnerry (talk) 04:26, 3 December 2012 (UTC)

Peer Review
I think you have a very well written and well organized article. Your information is presented in a clear and straight forward format.

I would review some of your links, it does appear that some of them are linking to articles that aren't exactly the focus of the section. Also, there is some room for additional links as your article does have a wealth of information that is relevant to many other topics and references others as well.

Some more diagrams and pictures would also be useful, however I do like what you have in this regard so far.

DanielNAraujo (talk) 00:14, 20 November 2012 (UTC)

Thanks for the review! I've checked on many of the links, and we're making progress in making sure all the links are appropriate. We're moving towards adding a picture, as it is something that has been mentioned repeatedly. Thanks again! Bonnerry (talk) 22:22, 21 November 2012 (UTC)

A picture has been added. Bonnerry (talk) 04:27, 3 December 2012 (UTC)

Peer Review
Hey Guys. Great job on this article it is well written, informative, and it has a logical flow. The first section where you repeat the percentage of people with ADCP was the only thing that seemed repetitive, otherwise each topic mentioned in the introduction was adequately discussed. A couple suggestions to make this article even better would be to explain what a lesion (in the Causes section) is in the brain when you first mention it, otherwise it might not be clear to an ordinary reader. I liked the discussion of the treatments but was a little confused by the deep brain stimulation section, maybe you could expand this and explain when this is done instead of other techniques. You also mention "dystonia" without really defining what it is. Lastly I was shocked when I read the prognosis section and you said "Mortality is strongly associated with both the level of functional impairments", do people really die from this? When and how often? I assumed it was a form of CP people could live with while I was reading the article. I think you guys could maybe expand the prognosis section a little and this would be more clear, and if it is fatal maybe spell that out more clearly in the introduction. Overall though great job guys the article is very interesting you guys did a great job. Dfarrell007 (talk) 02:41, 20 November 2012 (UTC)

Thank you very much for the review. After looking over the repetitive sections you mentioned, I agreed with your comment. I've removed the first mention of this statistic and kept the second, as it seemed like it belonged best in the classification section. I think a discussion of lesions outside of an internal link to the "Lesion" wikipedia page may be unnecessary and may distract from the discussion of ADCP. I'll examine the holes regarding deep brain stimulation and dystonia and make the required changes. Thanks again! Bonnerry (talk) 20:57, 21 November 2012 (UTC)

Although mortality may occur based on the level of functional and cognitive impairment, we don't intend on putting this in the introduction, as it is dependent on the severity of disease and not simply having any degree of it. For additional info regarding the risk of mortality, see "O'Shea (2008)", reference #3 at the bottom of the page. Bonnerry (talk) 21:34, 2 December 2012 (UTC)

As recently described in an updated version of the page, it is unclear the direct mechanism that underlies the therapeutic effects of deep brain stimulation, so the best possible description is a brief overview of DBS with an within-wikipedia link to the DBS page. As far as mentioning dystonia without a detailed description, there is a description of dystonic cerebral palsy in the "Classification" section, which provides a good idea of how dystonia fits into the classification of cerebral palsies. Bonnerry (talk) 04:22, 3 December 2012 (UTC)

Review
The first thing I would like to point out is the organization of some of your sections. I would place something such as epidemiology under the causes heading based upon its size. I don't think that a single sentence or two should get its own main section, but rather a subset under the causes. You may also be able to put prognosis under the treatment section as they are connected. As more information on prognosis is added it may be able to have its own main section, but not quite yet.

In your classification section you say, "CP is classified based on the nature of the movement disorder as well as the anatomic, topographic distribution of motor abnormalities. Currently there is no broadly agreed upon topographic classification of cerebral palsy." How is it classified if there is no classification method? This is confusing and occurs a couple times throughout your writing.

One of the main things I would point out for your sections is to make sure that all of the writing for each section is only what the section header is and nothing else. That makes it easier to read, more coherent, and have a better flow. The rest of it looks good though! — Preceding unsigned comment added by AdamMJenks (talk • contribs) 19:48, 28 November 2012 (UTC)

Adam thank you for the comments. There are several different methods for classifying CP. The issue we have been struggling with is that in one method athetoid/ dyskinetic cerebral palsy is a subdivision, but in other methods it is not. We have edited our classification section to better explain this issue. We also moved prognosis to the treatment section and reviewed each section to make sure the information is connected to the topic. BSByrne (talk) 22:53, 2 December 2012 (UTC)

The occupational therapy section has been removed, as no citations could be found and was somewhat supérfluous/redundant. Additionally, there was no mention of the addition on this talk page by the author. Bonnerry (talk) 04:07, 3 December 2012 (UTC)