Athetoid cerebral palsy (ACP) is a lifelong neurological condition that is present at birth. It causes uncontrolled movements, including slow writhing of the hands and feet.

ACP is a type of dyskinetic cerebral palsy, which is the second most common type of cerebral palsy. People with ACP can also have spastic cerebral palsy.

This article details its symptoms, causes, and risk factors. It also looks at how doctors diagnose and treat this congenital condition before discussing the outlook for people with ACP and how caregivers can get support.

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The symptoms of ACP are present at birth or during early infancy.

In early infancy, up to the ages of 2–3 years, ACP can present with the following symptoms:

  • delayed development of motor functions
  • fewer spontaneous movements than usual
  • persisting early age reflexes
  • persistently turning head to one side
  • bending arms or legs
  • shoulder retraction
  • stretching when lying on the back

The hallmark symptom of ACP is athetosis. Athetosis is a specific kind of involuntary movement. It involves slow, writhing motions in the hands and feet.

ACP is a congenital neurological condition. It is present during the very early stages of brain development.

ACP can develop during pregnancy and childbirth, or after childbirth. ACP develops during pregnancy or birth in around 85–95% of cases. It is also possible to develop this condition within the first 5 years of life.

Some research suggests that brief but serious periods of oxygen deprivation could lead to ACP. A different cause may be hyperbilirubinemia, which is when there is too much bilirubin in a baby’s blood. The accumulation of bilirubin, a byproduct of red blood cells breaking down, can cause brain damage.

ACP can also result from stroke, brain hemorrhage, and brain infections that occur at a very early stage before the brain is formed.

Risk factors

A risk factor for ACP is anything that indicates someone has an elevated risk of having or developing ACP. However, having these risk factors does not mean a person will always develop ACP.

The Centers for Disease Control and Prevention (CDC) lists the following risk factors for ACP:

  • premature birth
  • low birth weight
  • multiple births, such as twins or triplets
  • use of assisted reproductive technology (ART) during birth
  • jaundice
  • infections during the pregnancy, including:
  • complications that can happen during birth, such as rupture of the uterus or detachment of the placenta

Doctors make an ACP diagnosis during early childhood. A doctor needs to perform the following:

  • Medical history: Doctors will determine whether the child has any ACP risk factors. They will also discuss the child’s medical history to rule out any other movement or neurological disorders.
  • Physical exam: A physical exam can check for signs of ACP.
  • Brain MRI test: Around 70% of people with ACP have areas of brain damage or malformations in parts of the brain called the thalamus or the basal ganglia. Brain MRI scans can pick up on these areas of damage.

Treatment for ACP aims to manage its symptoms to improve quality of life. Doctors will also treat conditions that can occur alongside ACP, such as epilepsy, depression, and cognitive problems.

An ACP care team may comprise clinicians, therapists, and behavioral health specialists.


Doctors may recommend medications, which can limit the severity of uncontrolled movements.

Doctors have used many oral medications in an attempt to treat ACP. The most commonly prescribed oral medication is baclofen.

Alternatively, a doctor may administer intrathecal baclofen. This involves inserting the medication into the cerebrospinal fluid.

However, medications do not appear to be very effective. Medications may not benefit everyone, and they can have side effects.

Doctors weigh the risks and benefits for each person before prescribing medication. If a person is prescribed medication, a doctor will wait and see whether the medication is helping before deciding to continue it.

Deep brain stimulation (DBS)

DBS is a surgical procedure.

In DBS, doctors insert some electrodes into the brain. Using some fine wires, doctors connect these electrodes to a small electrical impulse generator, which they place under the skin of the chest or abdomen.

Doctors can program this generator to stimulate the brain via the electrodes. Evidence suggests that DBS can reduce some involuntary movements in people with ACP.

Botulinum toxin

Botulinum toxin is a neurotoxin that can cause paralysis. By injecting it into specific sites, doctors can reduce the capacity for movement around that site.

Doctors can use botulinum toxin to decrease pain and muscle spasms. This treatment may benefit people who experience involuntary movements in a few muscles.

ACP is a permanent condition that does not progress.

People with ACP have a reduced life expectancy compared with the general population.

However, according to a 2019 study, life expectancy is highly correlated with the severity of a person’s condition. For instance, people with milder cerebral palsy have a statistically typical likelihood of reaching age 58.

Moreover, the study notes 80% of people with cerebral palsy have a life expectancy of over 58 years.

As with any serious and chronic condition, it can be challenging to care for someone with ACP. Although this is not always easy to do, it is important for caregivers to remember their own needs and seek support where possible.

Caregivers for people with ACP can find information about help and support at United Cerebral Palsy. United Cerebral Palsy provides helpful guidance for caregivers and links to other potentially useful organizations.

ACP is present in infancy. It initially presents with delayed motor functions, fewer spontaneous movements, and persisting early age reflexes.

People with ACP experience involuntary movements, including athetosis. Athetosis is slow writhing of the outer extremities.

ACP can stem from atypical brain development or damage to the developing brain. This may arise due to prenatal or early infancy oxygen deprivation, hyperbilirubinemia, stroke, brain hemorrhage, or brain infections. There are several other risk factors for ACP.

Diagnosis involves a review of medical history, a physical exam, and possibly a brain MRI scan.

Treatment aims to manage symptoms to improve quality of life. Oral medications are not always beneficial. Sometimes interventions such as DBS, intrathecal baclofen, and botulism toxin can be effective when ACP affects one or a few areas of the body.