To the Editor: Dystonia is among the most frequently occurring pediatric movement disorders [1, 2], with heterogeneous etiology [3]. There is paucity of large-scale Indian data on its clinic-etiological profile.

A cross-sectional study was conducted at Kalawati Saran Children’s Hospital, New Delhi, India after institutional ethical clearance. Informed consent was obtained from parents and assent from the child whenever applicable. Children between one month to 18 y of age with dystonia were recruited from pediatric services. Presence of dystonia was identified as per Taskforce on Childhood Motor Disorders definition [4]. Patients with fixed limb contractures, pseudodystonia or non-dystonia movement disorders were excluded.

Ninety-nine children (males = 33; 33.3%) were enrolled. Median age (IQR) at symptom onset and enrolment were 0.2 (0.1-1) y and 2 (1.2-4) y respectively. Median duration of symptoms was 1.2 (0.6-3) y. Comorbidities included global developmental delay (70, 70.7%), seizures (54, 54.5%), and microcephaly (38, 38.3%). Focal onset dystonia was present in 53 (53.5%) and generalized onset dystonia in 42.1%. The most frequent age group affected was infancy (77, 81.1%). In terms of body distribution, multifocal dystonia was most frequent (47, 49.5%) followed by generalized dystonia (43, 45.3%). Static course occurred in 93 (97.8%) and persistent dystonia in 93 (97.8%) children. Isolated dystonia was seen in 85 (89.5%) and combined dystonia in 10 (10.5%) children. Evidence of structural lesion was present in 86 (86.9%). Genetic etiology occurred in 15 (15.1%) and acquired in 79 (79.8%) children. Of acquired causes, most frequent was perinatal brain injury, seen in 79 (79.8%) children. These included birth asphyxia [46, 46.5%], neonatal hyperbilirubinemia [20, 20.2%] and neonatal hypoglycemia [5, 5.1%].

To conclude, dystonia in our pediatric cohort occurred chiefly in infants and younger children. It was predominantly focal onset, static and persistent. The dominant etiology was cerebral palsy (CP) due to perinatal brain injury. Larger multicentric studies may further clarify the spectrum of pediatric dystonia.