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Prato A, Cirnigliaro L, Maugeri F, Luca A, Giuliano L, Vitiello G, Errichiello E, Valente EM, Del Giudice E, Mostile G, Rizzo R, Barone R. Paroxysmal Dystonic Posturing Mimicking Nocturnal Leg Cramps as a Presenting Sign in an Infant with DCC Mutation, Callosal Agenesis and Mirror Movements. J Clin Med 2024; 13:1109. [PMID: 38398422 PMCID: PMC10889236 DOI: 10.3390/jcm13041109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Background/Objectives: Pathogenic variants in the deleted in colorectal cancer gene (DCC), encoding the Netrin-1 receptor, may lead to mirror movements (MMs) associated with agenesis/dysgenesis of the corpus callosum (ACC) and cognitive and/or neuropsychiatric issues. The clinical phenotype is related to the biological function of DCC in the corpus callosum and corticospinal tract development as Netrin-1 is implicated in the guidance of developing axons toward the midline. We report on a child with a novel inherited, monoallelic, pathogenic variant in the DCC gene. Methods: Standardized measures and clinical scales were used to assess psychomotor development, communication and social skills, emotional and behavioural difficulties. MMs were measured via the Woods and Teuber classification. Exome sequencing was performed on affected and healthy family members. Results: The patient's clinical presentation during infancy consisted of paroxysmal dystonic posturing when asleep, mimicking nocturnal leg cramps. A brain magnetic resonance imaging (MRI) showed complete ACC. He developed typical upper limb MMs during childhood and a progressively evolving neuro-phenotype with global development delay and behavioural problems. We found an intrafamilial clinical variability associated with DCC mutations: the proband's father and uncle shared the same DCC variant, with a milder clinical phenotype. The atypical early clinical presentation of the present patient expands the clinical spectrum associated with DCC variants, especially those in the paediatric age. Conclusions: This study underlines the importance of in-depth genetic investigations in young children with ACC and highlights the need for further detailed analyses of early motor symptoms in infants with DCC mutations.
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Affiliation(s)
- Adriana Prato
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.P.); (L.C.); (F.M.); (R.R.)
| | - Lara Cirnigliaro
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.P.); (L.C.); (F.M.); (R.R.)
| | - Federica Maugeri
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.P.); (L.C.); (F.M.); (R.R.)
| | - Antonina Luca
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, 95123 Catania, Italy; (A.L.); (L.G.); (G.M.)
| | - Loretta Giuliano
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, 95123 Catania, Italy; (A.L.); (L.G.); (G.M.)
| | - Giuseppina Vitiello
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy;
| | - Edoardo Errichiello
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy; (E.E.); (E.M.V.)
- Neurogenetics Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy; (E.E.); (E.M.V.)
- Neurogenetics Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Ennio Del Giudice
- Child Neurology, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Giovanni Mostile
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, 95123 Catania, Italy; (A.L.); (L.G.); (G.M.)
- Research Unit of Rare Diseases and Neurodevelopmental Disorders, OASI Research Institute-IRCCS, 94018 Troina, Italy
| | - Renata Rizzo
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.P.); (L.C.); (F.M.); (R.R.)
| | - Rita Barone
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.P.); (L.C.); (F.M.); (R.R.)
- Research Unit of Rare Diseases and Neurodevelopmental Disorders, OASI Research Institute-IRCCS, 94018 Troina, Italy
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Babik I, Cunha AB, Srinivasan S. Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy. Infant Behav Dev 2023; 73:101881. [PMID: 37643499 DOI: 10.1016/j.infbeh.2023.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, USA.
| | - Andrea B Cunha
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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3
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Jaatela J, Nurmi T, Vallinoja J, Mäenpää H, Sairanen V, Piitulainen H. Altered corpus callosum structure in adolescents with cerebral palsy: connection to gait and balance. Brain Struct Funct 2023; 228:1901-1915. [PMID: 37615759 PMCID: PMC10516810 DOI: 10.1007/s00429-023-02692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Cerebral palsy (CP) is the most common motor disorder in childhood. Recent studies in children with CP have associated weakened sensorimotor performance with impairments in the major brain white-matter (WM) structure, corpus callosum (CC). However, the relationship between CC structure and lower extremity performance, specifically gait and balance, remains unknown. This study investigated the transcallosal WM structure and lower limb motor stability performance in adolescents aged 10-18 years with spastic hemiplegic (n = 18) or diplegic (n = 13) CP and in their age-matched controls (n = 34). The modern diffusion-weighted MRI analysis included the diffusivity properties of seven CC subparts and the transcallosal lower limb sensorimotor tract of the dominant hemisphere. Children with CP had comprehensive impairments in the cross-sectional area, fractional anisotropy, and mean diffusivity of the CC and sensorimotor tract. Additionally, the extent of WM alterations varied between hemiplegic and diplegic subgroups, which was seen especially in the fractional anisotropy values along the sensorimotor tract. The diffusion properties of transcallosal WM were further associated with static stability in all groups, and with dynamic stability in healthy controls. Our novel results clarify the mechanistic role of the corpus callosum in adolescents with and without CP offering valuable insight into the complex interplay between the brain's WM organization and motor performance. A better understanding of the brain basis of weakened stability performance could, in addition, improve the specificity of clinical diagnosis and targeted rehabilitation in CP.
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Affiliation(s)
- Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland.
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
| | - Helena Mäenpää
- Department of Neurology, New Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland
| | - Viljami Sairanen
- Department of Clinical Neurophysiology, BABA Center, Pediatric Research Center, Children's Hospital and HUS Imaging, Helsinki University Central Hospital, 00029, Helsinki, Finland
- Department of Radiology, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland
| | - Harri Piitulainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 02150, Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
- Department of Neurology, New Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland
- Aalto NeuroImaging, Aalto University, 02150, Espoo, Finland
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Vuong A, Joshi SH, Staudt LA, Matsumoto JH, Fowler EG. Improved Myelination following Camp Leg Power, a Selective Motor Control Intervention for Children with Spastic Bilateral Cerebral Palsy: A Diffusion Tensor MRI Study. AJNR Am J Neuroradiol 2023; 44:700-706. [PMID: 37142433 PMCID: PMC10249693 DOI: 10.3174/ajnr.a7860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE Children with spastic cerebral palsy have motor deficits associated with periventricular leukomalacia indicating WM damage to the corticospinal tracts. We investigated whether practice of skilled lower extremity selective motor control movements would elicit neuroplasticity. MATERIALS AND METHODS Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia born preterm (mean age, 11.5 years; age range, 7.3-16.6 years) participated in a lower extremity selective motor control intervention, Camp Leg Power. Activities promoted isolated joint movement including isokinetic knee exercises, ankle-controlled gaming, gait training, and sensorimotor activities (3 hours/day, 15 sessions, 1 month). DWI scans were collected pre- and postintervention. Tract-Based Spatial Statistics was used to analyze changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity. RESULTS Significantly reduced radial diffusivity (P < . 05) was found within corticospinal tract ROIs, including 28.4% of the left and 3.6% of the right posterior limb of the internal capsule and 14.1% of the left superior corona radiata. Reduced mean diffusivity was found within the same ROIs (13.3%, 11.6%, and 6.6%, respectively). Additionally, decreased radial diffusivity was observed in the left primary motor cortex. Additional WM tracts had decreased radial diffusivity and mean diffusivity, including the anterior limb of the internal capsule, external capsule, anterior corona radiata, and corpus callosum body and genu. CONCLUSIONS Myelination of the corticospinal tracts improved following Camp Leg Power. Neighboring WM changes suggest recruitment of additional tracts involved in regulating neuroplasticity of the motor regions. Intensive practice of skilled lower extremity selective motor control movements promotes neuroplasticity in children with spastic bilateral cerebral palsy.
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Affiliation(s)
- A Vuong
- From the Departments of Bioengineering (A.V., S.H.J.)
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - S H Joshi
- From the Departments of Bioengineering (A.V., S.H.J.)
- Neurology (S.H.J.), Ahmanson Lovelace Brain Mapping Center
| | - L A Staudt
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - J H Matsumoto
- Pediatrics (J.H.M.), University of California Los Angeles, Los Angeles, California
| | - E G Fowler
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
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Jacobs NPT, Pouwels PJW, van der Krogt MM, Meyns P, Zhu K, Nelissen L, Schoonmade LJ, Buizer AI, van de Pol LA. Brain structural and functional connectivity and network organization in cerebral palsy: A scoping review. Dev Med Child Neurol 2023. [PMID: 36750309 DOI: 10.1111/dmcn.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 02/09/2023]
Abstract
AIM To explore altered structural and functional connectivity and network organization in cerebral palsy (CP), by clinical CP subtype (unilateral spastic, bilateral spastic, dyskinetic, and ataxic CP). METHOD PubMed and Embase databases were systematically searched. Extracted data included clinical characteristics, analyses, outcome measures, and results. RESULTS Sixty-five studies were included, of which 50 investigated structural connectivity, and 20 investigated functional connectivity using functional magnetic resonance imaging (14 studies) or electroencephalography (six studies). Five of the 50 studies of structural connectivity and one of 14 of functional connectivity investigated whole-brain network organization. Most studies included patients with unilateral spastic CP; none included ataxic CP. INTERPRETATION Differences in structural and functional connectivity were observed between investigated clinical CP subtypes and typically developing individuals on a wide variety of measures, including efferent, afferent, interhemispheric, and intrahemispheric connections. Directions for future research include extending knowledge in underrepresented CP subtypes and methodologies, evaluating the prognostic potential of specific connectivity and network measures in neonates, and understanding therapeutic effects on brain connectivity.
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Affiliation(s)
- Nina P T Jacobs
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Petra J W Pouwels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Pieter Meyns
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kangdi Zhu
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Loïs Nelissen
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Laura A van de Pol
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
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Kuo HC, Ferre CL, Chin KY, Friel KM, Gordon AM. Mirror movements and brain pathology in children with unilateral cerebral palsy. Dev Med Child Neurol 2023; 65:264-273. [PMID: 35751166 DOI: 10.1111/dmcn.15322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/04/2023]
Abstract
AIM We systematically examined the relationship between mirror movements and brain lesion type, corticospinal tract (CST) organization, and hand function to determine the relevance between mirror movements, brain lesion, the CST pattern, and hand function in children with unilateral cerebral palsy (CP). METHOD Forty-eight children (mean age 9y 9mo [SD 3y 3mo], range 6-18y; 30 males, 18 females) with unilateral CP participated. Mirror movements, brain lesion type, CST pattern identified by transcranial magnetic stimulation, and clinical outcomes were evaluated. Children performed four unilateral tasks: hand opening/closing, finger opposition, individuation, and finger 'walking'. Mirror movements induced in the contralateral hand were scored using standardized criteria (scores 0-4 using the Woods and Teuber scale). RESULTS We found that children with periventricular lesion may have stronger mirror movement scores induced in either hand than those with middle cerebral artery lesion (more affected hand: p=0.02; less affected hand: p<0.01). The highest mirror movement score a child exhibits across the tested tasks (i.e. scores of 3-4 using the Woods and Teuber scoring criteria) may potentially be an indicator of an ipsilateral CST connectivity pattern (p=0.03). Significant correlations were observed between higher mirror movement scores when performing hand opening/closing as well as finger walking and better unimanual dexterity (Spearman's rank correlation coefficient rs =0.44, p=0.002; rs =0.46, p=0.002 respectively). INTERPRETATION Brain lesions may be predictive of the strength of mirror movements in either hand in children with unilateral CP. Our findings warrant further studies to extensively investigate the relationship between mirror movements and the underlying brain pathology. WHAT THIS PAPER ADDS Brain lesion type may be predictive of mirror movement scores induced in either hand in children with unilateral cerebral palsy. The highest mirror movement score a child exhibits across the tested tasks may indicate corticospinal tract connectivity pattern in children with unilateral cerebral palsy.
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Affiliation(s)
- Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, CA, USA
| | - Claudio L Ferre
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Department of Occupational Therapy, Boston University, Boston, MA, USA
| | - Karen Y Chin
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | | | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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The impact of brain lesion characteristics and the corticospinal tract wiring on mirror movements in unilateral cerebral palsy. Sci Rep 2022; 12:16301. [PMID: 36175439 PMCID: PMC9522771 DOI: 10.1038/s41598-022-19920-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
Mirror movements (MM) influence bimanual performance in children with unilateral cerebral palsy (uCP). Whilst MM are related to brain lesion characteristics and the corticospinal tract (CST) wiring pattern, the combined impact of these neurological factors remains unknown. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity (MM-similarity) and strength (MM-intensity) of the MM activity. We used MRI data to evaluate lesion type (periventricular white matter, N = 30; cortico-subcortical, N = 19), extent of ipsilesional damage, presence of bilateral lesions, and damage to basal ganglia, thalamus and corpus callosum. The CST wiring was assessed with Transcranial Magnetic Stimulation (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral). Data was analyzed with regression analyses. In the more-affected hand, MM-similarity and intensity were higher with CSTbilateral/ipsilateral. In the less-affected hand, MM-similarity was higher in children with (1) CSTcontra with CSC lesions, (2) CSTbilat/ipsi with PVL lesions and (3) CSTbilat/ipsi with unilateralized lesions. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. A complex combination of neurological factors influences MM characteristics, and the mechanisms differ between hands.
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Robert MT, Gutterman J, Ferre CL, Chin K, Brandao MB, Gordon AM, Friel K. Corpus Callosum Integrity Relates to Improvement of Upper-Extremity Function Following Intensive Rehabilitation in Children With Unilateral Spastic Cerebral Palsy. Neurorehabil Neural Repair 2021; 35:534-544. [PMID: 33955304 PMCID: PMC8135240 DOI: 10.1177/15459683211011220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown. OBJECTIVES To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions. METHODS We retrospectively analyzed clinical and neuroimaging data from a sample of convenience of 44 participants (age 9.40 ± 3.10 years) from 2 larger trials. Participants received 90 hours of Hand-Arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Unimanual dexterity (Jebsen-Taylor Test of Hand Function [JTTHF]) and bimanual performance (Assisting Hand Assessment [AHA]) were assessed preintervention and postintervention. CC tractography was reconstructed with diffusion tensor imaging (DTI) and segmented into 3 regions (genu, midbody, splenium). Pearson correlations and regression were used to assess the relationship between outcomes and DTI parameters (ie, fractional anisotropy [FA], number of streamlines, and mean, radial, and axial diffusivity). RESULTS Both groups improved in bimanual performance (P < .01). The CIMT group improved in unimanual dexterity (P < .01). Baseline unimanual dexterity and bimanual performance correlated with FA and number of streamlines for most CC regions (P < .05). Following CIMT, pre-post changes in JTTHF were negatively correlated with axial and radial diffusivity of the CC, and AHA with splenium and number of streamlines for the CC, midbody, and splenium (all P < .05). Following HABIT, midbody FA was positively correlated with pre-post AHA changes (r = 0.417; P = .042). CONCLUSIONS CC integrity is important for UE function in children with USCP.
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Affiliation(s)
| | | | | | | | - Marina B. Brandao
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kathleen Friel
- Burke Neurological Institute, Weill Cornell Medicine, New York, NY, USA
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Keller JW, Fahr A, Balzer J, Lieber J, van Hedel HJA. Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Prog 2021; 104:368504211008058. [PMID: 33871293 PMCID: PMC10454990 DOI: 10.1177/00368504211008058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = -0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients' median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.
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Affiliation(s)
- Jeffrey W Keller
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Doctoral Program Clinical Science, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Annina Fahr
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Julia Balzer
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Jan Lieber
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hubertus JA van Hedel
- Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
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10
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Neurophysiological Approaches to Understanding Motor Control in DCD: Current Trends and Future Directions. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00161-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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11
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Samsir S, Zakaria R, Razak SA, Ismail MS, Rahim MZA, Lin CS, Osman NMFN, Asri MA, Ahmad AH. Characterisation of the Corticospinal Tract Using Diffusion Magnetic Resonance Imaging in Unilateral and Bilateral Cerebral Palsy Patients. Malays J Med Sci 2019; 25:68-78. [PMID: 30914864 PMCID: PMC6419886 DOI: 10.21315/mjms2018.25.5.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/05/2018] [Indexed: 11/06/2022] Open
Abstract
Background Neuroimaging is increasingly used to locate the lesion that causes cerebral palsy (CP) and its extent in the brains of CP patients. Conventional structural magnetic resonance imaging (MRI) does not indicate the connectional pattern of white matter; however, with the help of diffusion MRI, fibre tracking of white matter can be done. Methods We used diffusion MRI and probabilistic tractography to identify the putative white matter connectivity in the brains of 10 CP patients. We tracked the corticospinal tract (CST) of the patients’ upper and lower limbs and calculated the white matter connectivity, as indexed by streamlines representing the probability of connection of the CST. Results Our results show that diffusion MRI with probabilistic tractography, while having some relation with the clinical diagnosis of CP, reveals a high degree of individual variation in the streamlines representing the CST for upper and lower limbs. Conclusion Diffusion MRI with probabilistic tractography provides the state of connectivity from lesioned areas to other parts of the brain and is potentially beneficial to be used as an adjunct to the clinical management of CP, providing a means to monitor intervention outcomes.
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Affiliation(s)
- Safwan Samsir
- Faculty of Psychology & Education, Universiti Malaysia Sabah, Sabah, Malaysia.,Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Rahimah Zakaria
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Salmi Abdul Razak
- Department of Paediatrics, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohamed Saat Ismail
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Zulkifli Abdul Rahim
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Nik Mohammad Faez Nik Osman
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohammad Afiq Asri
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Asma Hayati Ahmad
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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12
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Condliffe EG, Jeffery DT, Emery DJ, Treit S, Beaulieu C, Gorassini MA. Full Activation Profiles and Integrity of Corticospinal Pathways in Adults With Bilateral Spastic Cerebral Palsy. Neurorehabil Neural Repair 2018; 33:59-69. [DOI: 10.1177/1545968318818898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Dysfunction of corticospinal pathways has been implicated in motor impairments in people with bilateral spastic cerebral palsy (CP). While structural damage to corticospinal pathways in people with CP is known, its impact on the activation of these pathways is not. Objective. To provide the first, complete activation profile of corticospinal pathways in adults with CP using a full range of transcranial magnetic stimulation (TMS) intensities and voluntary contractions. Methods. TMS targeted the soleus muscle of 16 adults with bilateral spastic CP and 15 neurologically intact (NI) control participants. Activation profiles were generated using motor-evoked potentials (MEPs) produced by varying both stimulation intensity and degree of voluntary muscle activity. Anatomical integrity of corticospinal pathways was also measured with diffusion tractography. Results. Participants with CP had smaller MEPs produced by TMS at 1.2× active motor threshold during submaximal (20%) muscle activity and smaller maximal MEPs produced under any combination of stimulation intensity and voluntary muscle activity. At a fixed stimulation intensity, increasing voluntary muscle activity facilitated MEP amplitudes to a lesser degree in the participants with CP. Consistent differences in diffusion tractography suggested structural abnormalities in the corticospinal pathways of participants with CP that correlated with maximal MEPs. Conclusion. People with bilateral spastic CP have impaired activation of low and high-threshold corticospinal pathways to soleus motoneurons by TMS and reduced facilitation by voluntary activity that may be associated with structural damage to these pathways. These impairments likely contribute to impaired voluntary movement.
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Affiliation(s)
- Elizabeth G. Condliffe
- University of Calgary, Calgary, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Sarah Treit
- University of Alberta, Edmonton, Alberta, Canada
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KUO HSINGCHING, FRIEL KATHLEENM, GORDON ANDREWM. Neurophysiological mechanisms and functional impact of mirror movements in children with unilateral spastic cerebral palsy. Dev Med Child Neurol 2018; 60:155-161. [PMID: 28884806 PMCID: PMC8331099 DOI: 10.1111/dmcn.13524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 12/01/2022]
Abstract
UNLABELLED Children with unilateral spastic cerebral palsy (CP) often have mirror movements, i.e. involuntary imitations of unilateral voluntary movements of the contralateral upper extremity. The pathophysiology of mirror movements has been investigated in small and heterogeneous cohorts in the literature. Specific pathophysiology of mirror movements and their impact on upper extremity function require systematic investigation in larger and homogeneous cohorts of children with unilateral spastic CP. Here we review two possible neurophysiological mechanisms underlying mirror movements in children with CP and those with typical development: (1) an ipsilateral corticospinal tract projecting from the contralesional motor cortex (M1) to both upper extremities; (2) insufficient interhemispheric inhibition between the two M1s. We also discuss clinical implications of mirror movements in children with unilateral CP and suggest that a thorough examination of the relationship between the pathophysiology and clinical manifestations of mirror movements is warranted. We suggest two premises: (1) the presence of mirror movements is indicative of an ipsilateral corticospinal tract reorganization; and (2) the corticospinal tract organization may affect patients' responses to certain treatment. If these premises are supported through future research, mirror movements should be clinically evaluated for patient selection to maximize benefits of therapy, hence promoting individualized medicine in this population. WHAT THIS PAPER ADDS Mirror movements may be indicative of the underlying corticospinal tract reorganization in children with unilateral spastic cerebral palsy (CP). Future research will benefit from systematic investigations of the relationship between mirror movements and its pathophysiology. Mirror movements may be a potential biomarker for individualized medicine in children with unilateral spastic CP.
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Affiliation(s)
- HSING-CHING KUO
- University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | | | - ANDREW M GORDON
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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14
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Groeschel S, Hertz-Pannier L, Delion M, Loustau S, Husson B, Kossorotoff M, Renaud C, Nguyen The Tich S, Chabrier S, Dinomais M. Association of transcallosal motor fibres with function of both hands after unilateral neonatal arterial ischemic stroke. Dev Med Child Neurol 2017; 59:1042-1048. [PMID: 28815625 DOI: 10.1111/dmcn.13517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 12/30/2022]
Abstract
AIM The objective of this study was to investigate the involvement of the motor fibres of the corpus callosum after unilateral neonatal arterial ischemic stroke (NAIS) of the middle cerebral artery territory and the relationship to both ipsilesional and contralesional hand function. METHOD Using high-resolution structural magnetic resonance imaging (MRI), functional MRI, and magnetic resonance diffusion-tractography, we compared the midsagittal area of the motor part of the corpus callosum (defined by the fibres connecting the precentral gyri) between 33 7-year-old children after unilateral NAIS and 31 typically developing 7-year-old children. Hand motor performance was assessed by the box and blocks test. RESULTS Children after NAIS showed on average significantly smaller motor corpus callosum area compared to typically developing children (p<0.001, without differences of the non-motor corpus callosum area). In addition, there was a significant positive association between the motor part of the corpus callosum and both contralesional (Pr(>|t|)=0.034) and ipsilesional hand motor performance (Pr(>|t|)=0.006) after controlling for lesion volume and sex. In a post-hoc analysis the additional contribution of corticospinal tract damage was evaluated. INTERPRETATION Compared to typically developing children, children after NAIS exhibited a smaller motor part of their corpus callosum associated with reduced contralesional but also ipsilesional manual dexterity. These results indicate that the affection of transcallosal motor fibres in unilateral NAIS might be of functional relevance and an important part of the involved structural network that should be elucidated in further studies.
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Affiliation(s)
- Samuel Groeschel
- Experimental Pediatric Neuroimaging, Department of Child Neurology, University Hospital Tübingen, Tuebingen, Germany
| | | | - Matthieu Delion
- Département de neurochirurgie and Laboratoire d'anatomie, Faculté de médecine Angers, LUNAM Université d'Angers, Angers, France
| | - Sébastien Loustau
- Laboratoire Angevin de Recherche en Maths (LAREMA), LUNAM Université d'Angers, Angers, France
| | - Béatrice Husson
- Pediatric Radiology Department, University Hospital Bicêtre, Assistance-Publique-Hopitaux de Paris, Paris-Sud University, Paris, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, French Center for Paediatric Stroke, University Hospital Necker-Enfants-Malades, AP-HP, Paris, France
| | - Cyrille Renaud
- CHU Saint-Étienne, Inserm, Univ Lyon, Centre national de référence de l'AVC de L'Enfant, Service de médecine physique et de réadaption pédiatrique, Saint-Étienne, France
| | - Sylvie Nguyen The Tich
- Pediatric Neurology Department and Environment Périnatale et Santé, University Hospital, Lille, France
| | - Stéphane Chabrier
- CHU Saint-Étienne, Inserm, Univ Lyon, Centre national de référence de l'AVC de L'Enfant, Service de médecine physique et de réadaption pédiatrique, Saint-Étienne, France
| | - Mickael Dinomais
- CHU Angers, Département de Médecine Physique et de Réadaption and LUNAM, Université d'Angers, Laboratoire Angevin de Rechereche en Ingénierie des Systèmes (LARIS), Angers, France
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15
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Gordon AM. Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 957:291-311. [PMID: 28035572 DOI: 10.1007/978-3-319-47313-0_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, New York, Box 93, 10027, USA.
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16
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Scheef L, Nordmeyer-Massner JA, Smith-Collins APR, Müller N, Stegmann-Woessner G, Jankowski J, Gieseke J, Born M, Seitz H, Bartmann P, Schild HH, Pruessmann KP, Heep A, Boecker H. Functional Laterality of Task-Evoked Activation in Sensorimotor Cortex of Preterm Infants: An Optimized 3 T fMRI Study Employing a Customized Neonatal Head Coil. PLoS One 2017; 12:e0169392. [PMID: 28076368 PMCID: PMC5226735 DOI: 10.1371/journal.pone.0169392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 12/16/2016] [Indexed: 12/27/2022] Open
Abstract
Background Functional magnetic resonance imaging (fMRI) in neonates has been introduced as a non-invasive method for studying sensorimotor processing in the developing brain. However, previous neonatal studies have delivered conflicting results regarding localization, lateralization, and directionality of blood oxygenation level dependent (BOLD) responses in sensorimotor cortex (SMC). Amongst the confounding factors in interpreting neonatal fMRI studies include the use of standard adult MR-coils providing insufficient signal to noise, and liberal statistical thresholds, compromising clinical interpretation at the single subject level. Patients / methods Here, we employed a custom-designed neonatal MR-coil adapted and optimized to the head size of a newborn in order to improve robustness, reliability and validity of neonatal sensorimotor fMRI. Thirteen preterm infants with a median gestational age of 26 weeks were scanned at term-corrected age using a prototype 8-channel neonatal head coil at 3T (Achieva, Philips, Best, NL). Sensorimotor stimulation was elicited by passive extension/flexion of the elbow at 1 Hz in a block design. Analysis of temporal signal to noise ratio (tSNR) was performed on the whole brain and the SMC, and was compared to data acquired with an ‘adult’ 8 channel head coil published previously. Task-evoked activation was determined by single-subject SPM8 analyses, thresholded at p < 0.05, whole-brain FWE-corrected. Results Using a custom-designed neonatal MR-coil, we found significant positive BOLD responses in contralateral SMC after unilateral passive sensorimotor stimulation in all neonates (analyses restricted to artifact-free data sets = 8/13). Improved imaging characteristics of the neonatal MR-coil were evidenced by additional phantom and in vivo tSNR measurements: phantom studies revealed a 240% global increase in tSNR; in vivo studies revealed a 73% global and a 55% local (SMC) increase in tSNR, as compared to the ‘adult’ MR-coil. Conclusions Our findings strengthen the importance of using optimized coil settings for neonatal fMRI, yielding robust and reproducible SMC activation at the single subject level. We conclude that functional lateralization of SMC activation, as found in children and adults, is already present in the newborn period.
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Affiliation(s)
- Lukas Scheef
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | | | - Nicole Müller
- Department of Neonatology, University of Bonn, Bonn, Germany
| | | | | | | | - Mark Born
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hermann Seitz
- Department of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
| | - Peter Bartmann
- Department of Neonatology, University of Bonn, Bonn, Germany
| | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Klaas P. Pruessmann
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Axel Heep
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- Department of Neonatology, University of Bonn, Bonn, Germany
- * E-mail:
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17
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Arrigoni F, Peruzzo D, Gagliardi C, Maghini C, Colombo P, Iammarrone FS, Pierpaoli C, Triulzi F, Turconi AC. Whole-Brain DTI Assessment of White Matter Damage in Children with Bilateral Cerebral Palsy: Evidence of Involvement beyond the Primary Target of the Anoxic Insult. AJNR Am J Neuroradiol 2016; 37:1347-53. [PMID: 26988814 DOI: 10.3174/ajnr.a4717] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral palsy is frequently associated with both motor and nonmotor symptoms. DTI can characterize the damage at the level of motor tracts but provides less consistent results in nonmotor areas. We used a standardized pipeline of analysis to describe and quantify the pattern of DTI white matter abnormalities of the whole brain in a group of children with chronic bilateral cerebral palsy and periventricular leukomalacia. We also explored potential correlations between DTI and clinical scale metrics. MATERIALS AND METHODS Twenty-five patients (mean age, 11.8 years) and 25 healthy children (mean age, 11.8 years) were studied at 3T with a 2-mm isotropic DTI sequence. Differences between patients and controls were assessed both voxelwise and in ROIs obtained from an existing DTI atlas. Clinical metrics included the Gross Motor Function Classification System, the Manual Ability Classification System, and intelligence quotient. RESULTS The voxel-level and ROI-level analyses demonstrated highly significant (P < .001) modifications of DTI measurements in patients at several levels: cerebellar peduncles, corticospinal tracts and posterior thalamic radiations, posterior corpus callosum, external capsule, anterior thalamic radiation, superior longitudinal fasciculi and corona radiata, optic nerves, and chiasm. The reduction of fractional anisotropy values in significant tracts was between 8% and 30%. Statistically significant correlations were found between motor impairment and fractional anisotropy in corticospinal tracts and commissural and associative tracts of the supratentorial brain. CONCLUSIONS We demonstrated the involvement of several motor and nonmotor areas in the chronic damage associated with periventricular leukomalacia and showed new correlations between motor skills and DTI metrics.
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Affiliation(s)
| | - D Peruzzo
- From the Neuroimaging Lab (F.A., D.P.)
| | - C Gagliardi
- Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.)
| | - C Maghini
- Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.)
| | - P Colombo
- Child Psychopathology Unit (P.C.), Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | | - C Pierpaoli
- National Institutes of Health (C.P.), Bethesda, Maryland
| | - F Triulzi
- Department of Neuroradiology (F.T.), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - A C Turconi
- Functional Neurorehabilitation Unit (C.G., C.M., F.S.I., A.C.T.)
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18
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Chang MC, Jang SH, Seo JP, Lee E, Kim S, Won YH, Son SM. Degenerative changes of the corticospinal tract in pediatric patients showing deteriorated motor function: A diffusion tensor tractography study. Dev Neurorehabil 2016; 18:290-5. [PMID: 23957254 DOI: 10.3109/17518423.2013.821538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We attempted to demonstrate the corresponding degenerative changes of the affected corticospinal tract (CST) in pediatric patients with deteriorated motor function using diffusion tensor tractography (DTT). METHODS We recruited three pediatric patients (corrected age: 2, 6 and 47 months, respectively) who showed impaired motor function. RESULTS DTT in each patient showed interruption of the CSTs of the hemisphere contralateral to the side of motor impairment. Despite motor impairment and abnormal DTT findings, none of the three patients received rehabilitative therapy. The patients (corrected age: 9, 53 and 59 months, respectively) and their parents visited our clinic again due to deterioration of motor functions. Follow-up DTT of all evaluated patients showed significant degenerative changes in the affected CSTs in accordance with the aggravation of motor impairment. CONCLUSION We presented degenerative changes of the affected CSTs in pediatric patients according to the deterioration of motor function.
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Affiliation(s)
- Min Cheol Chang
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Sung Ho Jang
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Jeong Pyo Seo
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
| | - Eusil Lee
- b Department of Pediatrics , College of Medicine, Yeungnam University , Taegu , Republic of Korea , and
| | - Saeyoon Kim
- b Department of Pediatrics , College of Medicine, Yeungnam University , Taegu , Republic of Korea , and
| | - Yu Hui Won
- c Department of Physical Medicine and Rehabilitation , College of Medicine, Ewha Womans University , Seoul , Republic of Korea
| | - Su Min Son
- a Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Taegu , Republic of Korea
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19
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Gosling AS. Recent advances in the neuroimaging and neuropsychology of cerebral palsy. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:55-63. [DOI: 10.1080/21622965.2015.1074914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Corticospinal Tract Injury Precedes Thalamic Volume Reduction in Preterm Infants with Cystic Periventricular Leukomalacia. J Pediatr 2015; 167:260-8.e3. [PMID: 26054943 PMCID: PMC4520861 DOI: 10.1016/j.jpeds.2015.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/03/2015] [Accepted: 05/07/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To measure both fractional anisotropy (FA) values in the corticospinal tracts (CSTs) and volume of the thalami in preterm infants with cystic periventricular leukomalacia (c-PVL) and to compare these measurements with control infants. STUDY DESIGN Preterm infants with c-PVL and controls with magnetic resonance imaging data acquired between birth and term equivalent age (TEA) were retrospectively identified in 2 centers. Tractography of the CST and segmentation of the thalamus were performed, and values from infants with c-PVL and controls were compared. RESULTS Thirty-three subjects with c-PVL and 31 preterm controls were identified. All had at least 1 scan up to TEA, and multiple scans were performed in 31 infants. A significant difference in FA values of the CST was found between cases and controls on the scans both before and at TEA. Absolute thalamic volumes were significantly reduced at TEA but not on the earlier scans. Data acquired in infancy showed lower FA values in infants with c-PVL. CONCLUSIONS Damage to the CST can be identified on the early scan and persists, whereas the changes in thalamic volume develop in the weeks between the early and term equivalent magnetic resonance imaging. This may reflect the difference between acute and remote effects of the extensive injury to the white matter caused by c-PVL.
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Key Words
- ad, axial diffusivity
- auc, area under the curve
- cp, cerebral palsy
- c-pvl, cystic periventricular leukomalacia
- cst, corticospinal tract
- dti, diffusion tensor imaging
- fa, fractional anisotropy
- ga, gestational age
- gmfcs, gross motor function classification system
- md, mean diffusivity
- mri, magnetic resonance imaging
- npv, negative predictive value
- plic, posterior limb of the internal capsule
- pma, postmenstrual age
- ppv, positive predictive value
- pvl, periventricular leukomalacia
- rd, radial diffusivity
- tbv, total brain volume
- te, echo time
- tea, term equivalent age
- tr, repetition time
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Kim JH, Kwon YM, Son SM. Motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment: a diffusion tensor imaging study. Neural Regen Res 2015; 10:624-30. [PMID: 26170825 PMCID: PMC4424757 DOI: 10.4103/1673-5374.155438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/09/2022] Open
Abstract
Previous diffusion tensor imaging (DTI) studies regarding pediatric patients with motor dysfunction have confirmed the correlation between DTI parameters of the injured corticospinal tract and the severity of motor dysfunction. There is also evidence that DTI parameters can help predict the prognosis of motor function of patients with cerebral palsy. But few studies are reported on the DTI parameters that can reflect the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment. In the present study, 36 pediatric patients with hemiplegic cerebral palsy were included. Before and after rehabilitation treatment, DTI was used to measure the fiber number (FN), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of bilateral corticospinal tracts. Functional Level of Hemiplegia scale (FxL) was used to assess the therapeutic effect of rehabilitative therapy on clinical hemiplegia. Correlation analysis was performed to assess the statistical interrelationship between the change amount of DTI parameters and FxL. DTI findings obtained at the initial and follow-up evaluations demonstrated that more affected corticospinal tract yielded significantly decreased FN and FA values and significantly increased ADC value compared to the less affected corticospinal tract. Correlation analysis results showed that the change amount of FxL was positively correlated to FN and FA values, and the correlation to FN was stronger than the correlation to FA. The results suggest that FN and FA values can be used to evaluate the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment and FN is of more significance for evaluation.
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Affiliation(s)
- Jin Hyun Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Yong Min Kwon
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
| | - Su Min Son
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea
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Fiori S, Pannek K, Pasquariello R, Ware RS, Cioni G, Rose SE, Boyd RN, Guzzetta A. Corticopontocerebellar Connectivity Disruption in Congenital Hemiplegia. Neurorehabil Neural Repair 2015; 29:858-66. [PMID: 25613985 DOI: 10.1177/1545968314568726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Crossed cerebellar diaschisis is the disruption of functional connectivity between cerebrum and cerebellum after hemispheric unilateral brain lesions. In adults and to a lesser extent in children, crossed cerebellar diaschisis has been largely investigated by functional connectivity and demonstrated to influence paretic hand function. OBJECTIVE We aim to demonstrate a disruption in structural corticopontocerebellar (CPC) connectivity in children with congenital brain lesions and examine its correlation with paretic hand motor function. METHODS Thirty-six children (Manual Ability Classification System: I, n = 21; II, n = 15) with unilateral brain lesions and 18 controls were analyzed in a case-control study, and diffusion magnetic resonance imaging data were acquired at 3T. High angular resolution diffusion imaging probabilistic tractography was employed for the region of interest-based reconstruction of CPC tracts. To identify statistical differences in structural cerebrocerebellar connectivity between case and control groups, an asymmetry index based on the number of streamlines of CPC tracts was used. In the case group, the correlation between asymmetry index and hand function measures was also determined. RESULTS Projections through the middle cerebellar peduncle to the contralateral cerebral cortex showed greater asymmetry in children with congenital unilateral brain lesion compared to controls (P = .03), thus indicating a disruption of structural cerebrocerebellar connectivity. The degree of asymmetry index showed a correlation (P < .03; r = -0.31) with impaired hand abilities in bimanual tasks. CONCLUSIONS Disruption of structural cerebrocerebellar connectivity is present in patients with congenital unilateral brain injury and might be related to impaired hand function in bimanual skills, with potential implication in tailoring early intervention strategies.
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Affiliation(s)
- Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Rosa Pasquariello
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stephen E Rose
- The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Abdelsalam EM, Gomaa M, Elsorougy L. Diffusion tensor imaging of periventricular leukomalacia – Initial experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Li J, McDonald CA, Fahey MC, Jenkin G, Miller SL. Could cord blood cell therapy reduce preterm brain injury? Front Neurol 2014; 5:200. [PMID: 25346720 PMCID: PMC4191167 DOI: 10.3389/fneur.2014.00200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/19/2014] [Indexed: 12/25/2022] Open
Abstract
Major advances in neonatal care have led to significant improvements in survival rates for preterm infants, but this occurs at a cost, with a strong causal link between preterm birth and neurological deficits, including cerebral palsy (CP). Indeed, in high-income countries, up to 50% of children with CP were born preterm. The pathways that link preterm birth and brain injury are complex and multifactorial, but it is clear that preterm birth is strongly associated with damage to the white matter of the developing brain. Nearly 90% of preterm infants who later develop spastic CP have evidence of periventricular white matter injury. There are currently no treatments targeted at protecting the immature preterm brain. Umbilical cord blood (UCB) contains a diverse mix of stem and progenitor cells, and is a particularly promising source of cells for clinical applications, due to ethical and practical advantages over other potential therapeutic cell types. Recent studies have documented the potential benefits of UCB cells in reducing brain injury, particularly in rodent models of term neonatal hypoxia–ischemia. These studies indicate that UCB cells act via anti-inflammatory and immuno-modulatory effects, and release neurotrophic growth factors to support the damaged and surrounding brain tissue. The etiology of brain injury in preterm-born infants is less well understood than in term infants, but likely results from episodes of hypoperfusion, hypoxia–ischemia, and/or inflammation over a developmental period of white matter vulnerability. This review will explore current knowledge about the neuroprotective actions of UCB cells and their potential to ameliorate preterm brain injury through neonatal cell administration. We will also discuss the characteristics of UCB-derived from preterm and term infants for use in clinical applications.
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Affiliation(s)
- Jingang Li
- The Ritchie Centre, MIMR-PHI Institute , Clayton, VIC , Australia
| | | | - Michael C Fahey
- The Ritchie Centre, MIMR-PHI Institute , Clayton, VIC , Australia ; Department of Paediatrics, Monash University , Clayton, VIC , Australia
| | - Graham Jenkin
- The Ritchie Centre, MIMR-PHI Institute , Clayton, VIC , Australia ; Department of Obstetrics and Gynaecology, Monash University , Clayton, VIC , Australia
| | - Suzanne L Miller
- The Ritchie Centre, MIMR-PHI Institute , Clayton, VIC , Australia ; Department of Obstetrics and Gynaecology, Monash University , Clayton, VIC , Australia
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Papadelis C, Ahtam B, Nazarova M, Nimec D, Snyder B, Grant PE, Okada Y. Cortical somatosensory reorganization in children with spastic cerebral palsy: a multimodal neuroimaging study. Front Hum Neurosci 2014; 8:725. [PMID: 25309398 PMCID: PMC4162364 DOI: 10.3389/fnhum.2014.00725] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/28/2014] [Indexed: 12/17/2022] Open
Abstract
Although cerebral palsy (CP) is among the most common causes of physical disability in early childhood, we know little about the functional and structural changes of this disorder in the developing brain. Here, we investigated with three different neuroimaging modalities [magnetoencephalography (MEG), diffusion tensor imaging (DTI), and resting-state fMRI] whether spastic CP is associated with functional and anatomical abnormalities in the sensorimotor network. Ten children participated in the study: four with diplegic CP (DCP), three with hemiplegic CP (HCP), and three typically developing (TD) children. Somatosensory (SS)-evoked fields (SEFs) were recorded in response to pneumatic stimuli applied to digits D1, D3, and D5 of both hands. Several parameters of water diffusion were calculated from DTI between the thalamus and the pre-central and post-central gyri in both hemispheres. The sensorimotor resting-state networks (RSNs) were examined by using an independent component analysis method. Tactile stimulation of the fingers elicited the first prominent cortical response at ~50 ms, in all except one child, localized over the primary SS cortex (S1). In five CP children, abnormal somatotopic organization was observed in the affected (or more affected) hemisphere. Euclidean distances were markedly different between the two hemispheres in the HCP children, and between DCP and TD children for both hemispheres. DTI analysis revealed decreased fractional anisotropy and increased apparent diffusion coefficient for the thalamocortical pathways in the more affected compared to less affected hemisphere in CP children. Resting-state functional MRI results indicated absent and/or abnormal sensorimotor RSNs for children with HCP and DCP consistent with the severity and location of their lesions. Our findings suggest an abnormal SS processing mechanism in the sensorimotor network of children with CP possibly as a result of diminished thalamocortical projections.
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Affiliation(s)
- Christos Papadelis
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Maria Nazarova
- Department of Neurorehabilitation and Physiotherapy, Research Center of Neurology , Moscow , Russia ; Centre for Cognition and Decision Making, Faculty of Psychology, Higher School of Economics , Moscow , Russia
| | - Donna Nimec
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Brian Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Patricia Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Radiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Yoshio Okada
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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Pannek K, Boyd RN, Fiori S, Guzzetta A, Rose SE. Assessment of the structural brain network reveals altered connectivity in children with unilateral cerebral palsy due to periventricular white matter lesions. NEUROIMAGE-CLINICAL 2014; 5:84-92. [PMID: 25003031 PMCID: PMC4081979 DOI: 10.1016/j.nicl.2014.05.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Abstract
Background Cerebral palsy (CP) is a term to describe the spectrum of disorders of impaired motor and sensory function caused by a brain lesion occurring early during development. Diffusion MRI and tractography have been shown to be useful in the study of white matter (WM) microstructure in tracts likely to be impacted by the static brain lesion. Aim The purpose of this study was to identify WM pathways with altered connectivity in children with unilateral CP caused by periventricular white matter lesions using a whole-brain connectivity approach. Methods Data of 50 children with unilateral CP caused by periventricular white matter lesions (5–17 years; manual ability classification system [MACS] I = 25/II = 25) and 17 children with typical development (CTD; 7–16 years) were analysed. Structural and High Angular Resolution Diffusion weighted Images (HARDI; 64 directions, b = 3000 s/mm2) were acquired at 3 T. Connectomes were calculated using whole-brain probabilistic tractography in combination with structural parcellation of the cortex and subcortical structures. Connections with altered fractional anisotropy (FA) in children with unilateral CP compared to CTD were identified using network-based statistics (NBS). The relationship between FA and performance of the impaired hand in bimanual tasks (Assisting Hand Assessment—AHA) was assessed in connections that showed significant differences in FA compared to CTD. Results FA was reduced in children with unilateral CP compared to CTD. Seven pathways, including the corticospinal, thalamocortical, and fronto-parietal association pathways were identified simultaneously in children with left and right unilateral CP. There was a positive relationship between performance of the impaired hand in bimanual tasks and FA within the cortico-spinal and thalamo-cortical pathways (r2 = 0.16–0.44; p < 0.05). Conclusion This study shows that network-based analysis of structural connectivity can identify alterations in FA in unilateral CP, and that these alterations in FA are related to clinical function. Application of this connectome-based analysis to investigate alterations in connectivity following treatment may elucidate the neurological correlates of improved functioning due to intervention. Alterations in FA in children with CP were assessed using the connectome approach. FA is reduced in corticospinal, thalamocortical, and association tracts in CP. Higher FA is associated with better performance in bimanual tasks.
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Key Words
- AHA, assisting hand assessment
- CDGM, cortical and deep grey matter
- CP, cerebral palsy
- CTD, children with typical development
- Congenital hemiplegia
- Connectome
- DROP-R, detection and replacement of outliers prior to resampling
- Diffusion MRI
- FA, fractional anisotropy
- FMAM, fit model to all measurements
- GMFCS, gross motor function classification system
- HARDI, high angular resolution diffusion imaging
- HOMOR, higher order model outlier rejection
- MACS, manual ability classification system
- NBS, network based statistic
- PWM, periventricular white matter
- Tractography
- Unilateral cerebral palsy
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Affiliation(s)
- Kerstin Pannek
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia ; The University of Queensland, School of Medicine, Brisbane, Australia ; The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
| | | | - Andrea Guzzetta
- Stella Maris Scientific Institute, Pisa, Italy ; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stephen E Rose
- The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
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Nevalainen P, Lauronen L, Pihko E. Development of Human Somatosensory Cortical Functions - What have We Learned from Magnetoencephalography: A Review. Front Hum Neurosci 2014; 8:158. [PMID: 24672468 PMCID: PMC3955943 DOI: 10.3389/fnhum.2014.00158] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/03/2014] [Indexed: 01/01/2023] Open
Abstract
The mysteries of early development of cortical processing in humans have started to unravel with the help of new non-invasive brain research tools like multichannel magnetoencephalography (MEG). In this review, we evaluate, within a wider neuroscientific and clinical context, the value of MEG in studying normal and disturbed functional development of the human somatosensory system. The combination of excellent temporal resolution and good localization accuracy provided by MEG has, in the case of somatosensory studies, enabled the differentiation of activation patterns from the newborn’s primary (SI) and secondary somatosensory (SII) areas. Furthermore, MEG has shown that the functioning of both SI and SII in newborns has particular immature features in comparison with adults. In extremely preterm infants, the neonatal MEG response from SII also seems to potentially predict developmental outcome: those lacking SII responses at term show worse motor performance at age 2 years than those with normal SII responses at term. In older children with unilateral early brain lesions, bilateral alterations in somatosensory cortical activation detected in MEG imply that the impact of a localized insult may have an unexpectedly wide effect on cortical somatosensory networks. The achievements over the last decade show that MEG provides a unique approach for studying the development of the somatosensory system and its disturbances in childhood. MEG well complements other neuroimaging methods in studies of cortical processes in the developing brain.
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Affiliation(s)
- Päivi Nevalainen
- BioMag Laboratory, Hospital District of Helsinki and Uusimaa, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland ; Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
| | - Leena Lauronen
- BioMag Laboratory, Hospital District of Helsinki and Uusimaa, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland ; Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
| | - Elina Pihko
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science , Espoo , Finland
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Groeschel S, Tournier JD, Northam GB, Baldeweg T, Wyatt J, Vollmer B, Connelly A. Identification and interpretation of microstructural abnormalities in motor pathways in adolescents born preterm. Neuroimage 2013; 87:209-19. [PMID: 24185027 DOI: 10.1016/j.neuroimage.2013.10.034] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022] Open
Abstract
There has been extensive interest in assessing the long-term effects of preterm birth on brain white matter microstructure using diffusion MRI. Our aim in this study is to explore diffusion MRI differences between adolescents born preterm and term born controls, with a specific interest in characterising how such differences are manifested in white matter regions containing predominantly single or crossing fibre populations. Probabilistic high angular resolution tractography together with large deformation spatial normalisation were used to objectively investigate diffusion tensor parameters at regular intervals along fibre tracts of 45 adolescents born before 33 weeks of gestation and 30 term-born typically developing adolescents. Diffusion parameters were significantly different between preterms and controls at several levels along the cortico-spinal, thalamo-cortical and transcallosal pathways. Within the predominantly single fibre regions of the corpus callosum and internal capsule, in the preterms mean diffusivity (MD) was found to be increased while fractional anisotropy (FA) was decreased compared to controls. In contrast, however, where these pathways traversed the centrum semiovale, FA and MD were both significantly increased. The major contributor to reduced FA in preterms in predominantly single fibre regions was the increased radial eigenvalue (i.e. increased radial diffusivity). In predominantly crossing-fibre regions, the tensor eigenvalues are not meaningful, and the observed increase in FA is likely to be due to a decrease in anisotropy in one of the contributing fibre bundles. Similar differences (although less pronounced) were observed after excluding preterms with radiological signs of preterm brain injury from the sample. In summary, white matter microstructure was found to be altered in motor pathways in adolescents born preterm. Disruption of white matter (WM) microstructure in a single fibre region with resulting higher radial diffusivity leads to lower FA, whereas selective disruption of one fibre population in a crossing fibre region is observed to lead to higher FA. These findings challenge the common simplistic interpretation of FA as a measure of WM tract integrity.
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Affiliation(s)
| | - J-Donald Tournier
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | | | | | | | - Brigitte Vollmer
- Karolinska Institutet, Stockholm, Sweden; University of Southampton, Southampton, UK
| | - Alan Connelly
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Baek SO, Jang SH, Lee E, Kim S, Hah JO, Park YH, Lee JM, Son SM. CST recovery in pediatric hemiplegic patients: Diffusion tensor tractography study. Neurosci Lett 2013; 557 Pt B:79-83. [PMID: 24176879 DOI: 10.1016/j.neulet.2013.10.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
Many diffusion tensor imaging (DTI) studies have reported an association between corticospinal tract (CST) injury and motor dysfunction. In this study, we investigated CST recovery in 29 pediatric patients with clinical hemiplegia using DTI. We measured the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and asymmetric anisotropy (AA) of both CSTs. The patients were classified into three groups according to severity of CST disruption of the more affected hemisphere. DTI was followed up for 9.34 ± 2.07 months after initial evaluation. The FA value of the more affected CST showed a significant decrease compared to the opposite side at initial and follow up evaluation, respectively (p<0.05). The FA value of both CSTs showed a significant increase at follow up compared to the initial evaluation, while more changes were observed on the more affected side, compared with the less affected side (p<0.05). AA showed a significant decrease at follow up, and showed significant correlation with interval change of FA value of the more affected side, not with that of the less affected side (r=0.543, p<0.05). 19 patients showed change of CST integrity. In the current study, the results of DTI showed recovery of the CST and provided radiologic evidence for a scientific basis of brain plasticity in pediatric patients.
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Affiliation(s)
- Seung Ok Baek
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
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30
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Weinstein M, Green D, Geva R, Schertz M, Fattal-Valevski A, Artzi M, Myers V, Shiran S, Gordon AM, Gross-Tsur V, Bashat DB. Interhemispheric and intrahemispheric connectivity and manual skills in children with unilateral cerebral palsy. Brain Struct Funct 2013; 219:1025-40. [PMID: 23571779 DOI: 10.1007/s00429-013-0551-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 03/26/2013] [Indexed: 01/16/2023]
Abstract
This study investigated patterns of motor brain activation, white matter (WM) integrity of inter- and intrahemispheric connectivity and their associations with hand function in children with unilateral cerebral palsy (CP-U). Fourteen CP-U (mean age 10.6 ± 2.7 years) and 14 typically developing children (TDC) underwent magnetic resonance imaging. CP-U underwent extensive motor evaluation. Pattern of brain activation during a motor task was studied in 12 CP-U and six TDC, by calculating laterality index (LI) and percent activation in the sensorimotor areas (around the central sulcus), and quantifying the activation in the supplementary motor area (SMA). Diffusivity parameters were measured in CP-U and eight other TDC for the corpus callosum (CC), affected and less affected cortico-spinal tracts (CST), and posterior limb of the internal capsule (PLIC). Abnormal patterns of brain activation were detected in areas around the central sulcus in 9/12 CP-U, with bilateral activation and/or reduced percent activation. More activation in areas around the central sulcus of the affected hemisphere was associated with better hand function. CP-U demonstrated more activation in the SMA when moving the affected hand compared to the less affected hand. CP-U displayed reduced WM integrity compared to TDC, in the midbody and splenium of the CC, affected CST and affected PLIC. WM integrity in these tracts was correlated with hand function. While abnormal pattern of brain activation was detected mainly when moving the affected hand, the integrity of the CC was correlated with function of both hands and bimanual skills. This study highlights the importance of interhemispheric connectivity for hand function in CP-U, which may have clinical implications regarding prognosis and management.
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Affiliation(s)
- Maya Weinstein
- Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Abstract
Diffusion tensor imaging (DTI) is an MRI technique that can measure the macroscopic structural organization in brain tissues. DTI has been shown to provide information complementary to relaxation-based MRI about the changes in the brain's microstructure. In the pediatric population, DTI enables quantitative observation of the maturation process of white matter structures. Its ability to delineate various brain structures during developmental stages makes it an effective tool with which to characterize both the normal and abnormal anatomy of the developing brain. This review will highlight the advantages, as well as the common technical pitfalls of pediatric DTI. In addition, image quantification strategies for various DTI-derived parameters and the normal brain developmental changes associated with these parameters are discussed.
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Pitcher JB, Schneider LA, Burns NR, Drysdale JL, Higgins RD, Ridding MC, Nettelbeck TJ, Haslam RR, Robinson JS. Reduced corticomotor excitability and motor skills development in children born preterm. J Physiol 2012; 590:5827-44. [PMID: 22966161 DOI: 10.1113/jphysiol.2012.239269] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The mechanisms underlying the altered neurodevelopment commonly experienced by children born preterm, but without brain lesions, remain unknown. While individuals born the earliest are at most risk, late preterm children also experience significant motor, cognitive and behavioural dysfunction from school age, and reduced income and educational attainment in adulthood. We used transcranial magnetic stimulation and functional assessments to examine corticomotor development in 151 children without cerebral palsy, aged 10-13 years and born after gestations of 25-41 completed weeks. We hypothesized that motor cortex and corticospinal development are altered in preterm children, which underpins at least some of their motor dysfunction. We report for the first time that every week of reduced gestation is associated with a reduction in corticomotor excitability that remains evident in late childhood. This reduced excitability was associated with poorer motor skill development, particularly manual dexterity. However, child adiposity, sex and socio-economic factors regarding the child's home environment soon after birth were also powerful influences on development of motor skills. Preterm birth was also associated with reduced left hemisphere lateralization, but without increasing the likelihood of being left handed per se. These corticomotor findings have implications for normal motor development, but also raise questions regarding possible longer term consequences of preterm birth on motor function.
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Affiliation(s)
- Julia B Pitcher
- Research Centre for Early Origins of Health and Disease, Robinson Institute, School of Paediatrics & Reproductive Health, University of Adelaide, SA 5005, Australia.
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Progression of corpus callosum diffusion-tensor imaging values during a period of signal changes consistent with myelination. AJR Am J Roentgenol 2012; 198:1403-8. [PMID: 22623555 DOI: 10.2214/ajr.11.7849] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Changes in signal intensity on T1- and T2-weighted MR images consistent with myelination in the corpus callosum occur during months 3-9 of postnatal life and occur earlier in the splenium than in the genu. We hypothesized that the rate of change in diffusion-tensor imaging parameters in the first year of life would be greater in the splenium, especially during months 3-9. SUBJECTS AND METHODS Fifty-two infants (age range, 0-52 weeks) underwent one MRI examination with a six-direction diffusion-tensor imaging sequence. Fractional anisotropy, apparent diffusion coefficient, radial diffusivity, and axial diffusivity were measured in the genu and splenium of the corpus callosum. For each parameter, the slopes of change in the splenium and in the genu were measured for the entire first year of life and for the age period 3-9 months. The ratios of slope of change in the splenium to that in the genu in these two periods were compared. RESULTS For fractional anisotropy, the ratio of slope of change in the splenium to that in the genu was 1.67 in the first year and 4.00 for 3-9 months; apparent diffusion coefficient, 2.00 in the first year and 4.33 for 3-9 months; radial diffusivity, 1.75 in the first year and 4.40 for 3-9 months; and axial diffusivity, 3.25 in the first year and 4.86 for 3-9 months. CONCLUSION Rates of change were always greater in the splenium. For the age period 3-9 months, the splenium-to-genu ratio was approximately 1.5- to 2.5-fold as high as that for the entire year. These findings correspond well with the sequence of signal intensity changes in the corpus callosum.
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Scheck SM, Boyd RN, Rose SE. New insights into the pathology of white matter tracts in cerebral palsy from diffusion magnetic resonance imaging: a systematic review. Dev Med Child Neurol 2012; 54:684-96. [PMID: 22646844 DOI: 10.1111/j.1469-8749.2012.04332.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM Structural connectivity analysis using diffusion magnetic resonance imaging (dMRI) and tractography has become the method of choice for studying white matter pathology and reorganization in children with congenital hemiplegia. To evaluate its role in the research domain, we systematically reviewed the literature about children with cerebral palsy (CP) to document common findings and identify strengths and possible limitations of this neuroimaging technology. METHOD A literature search was performed for peer-reviewed studies pertaining to dMRI and CP. RESULTS Twenty-two studies met the inclusion criteria. The corticospinal tract was studied in greatest detail (18/22). The most common finding was decreased fractional anisotropy and/or increased mean diffusivity, indicating significant loss in the integrity of these corticomotor pathways. Fewer studies assessed ascending sensorimotor pathways including the posterior and superior thalamic radiations, which also showed decreased fractional anisotropy. Anisotropy indices (fractional anisotropy, mean diffusivity) obtained for both corticomotor and sensorimotor tracts were repeatedly shown to correlate with clinical measures. Other tracts studied included commissural and association fibres, which showed conflicting results. INTERPRETATION There is sound evidence that dMRI-based connectivity techniques are useful for improving our understanding of the structure-function relationships of corticomotor and sensorimotor neural networks in CP.
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Affiliation(s)
- Simon M Scheck
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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Provenzale JM, Isaacson J, Stinnett S, Chen S. Analysis of corpus callosum diffusion tensor imaging parameters in infants. Neuroradiol J 2012; 25:342-50. [PMID: 24028988 DOI: 10.1177/197140091202500310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/31/2012] [Indexed: 11/15/2022] Open
Abstract
Radial diffusivity is a diffusion tensor imaging (DTI) metric that has received increased attention in recent studies as a parameter that may better reflect myelination than the more commonly-used fractional anisotropy (FA). This study compared rates of radial diffusivity decrease against FA increase and axial diffusivity decrease on DTI maps in the corpus callosum of normal infants during the first postnatal year. Fifty-three normal infants (range: 0-52 weeks adjusted for gestational age) underwent six-direction DTI on a 1.5 Tesla scanner (b= 1,000 s/mm(2), one excitation). A single individual placed regions of interest on FA maps in the genu 1) and radial diffusivity (i.e., λ and splenium to obtain axial (i.e., 3)/2]), FA and ADC. We calculated mean and median values for FA, λ 2+λ[ ADC, radial diffusivity and axial diffusivity in each of four 13-week epochs and measured the percent change over the first year of life. Within the genu, radial diffusivity decreased 36%, FA increased 25%, ADC decreased 22% and axial diffusivity decreased 10%. Within the splenium, radial diffusivity decreased 53%, FA increased 43%, ADC decreased 38%, and axial diffusivity decreased 23%. For both genu and splenium, the greatest difference was seen in radial diffusivity values, followed in order by FA, ADC and axial diffusivity. Furthermore, decreases in radial diffusivity were on the order of two to threefold greater than those in axial diffusivity. The high rate of radial diffusivity decrease compared to axial diffusivity decrease is consistent with myelination. Decreases in radial diffusivity were greater than increases in FA values. This finding is further support of the concept that radial diffusivity and FA values represent two different types of microstructural change during development of white matter.
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Affiliation(s)
- J M Provenzale
- Department of Radiology, Duke University and Emory University; Durham, NC, USA -
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Rha DW, Chang WH, Kim J, Sim EG, Park ES. Comparing quantitative tractography metrics of motor and sensory pathways in children with periventricular leukomalacia and different levels of gross motor function. Neuroradiology 2011; 54:615-21. [PMID: 22170081 DOI: 10.1007/s00234-011-0996-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/30/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The neural tracts responsible for gross motor dysfunction in children with spastic cerebral palsy (CP) caused by periventricular leukomalacia remain unknown. This study investigated both sensory and motor tracts using diffusion tensor tractography (DTT). METHODS Brain MRIs with diffusion tensor imaging (DTI) performed on 19 children (ten boys and nine girls) with bilateral spastic CP were analyzed. DTT was reconstructed from DTI. Participants were classified according to gross motor function measured with Gross Motor Function Classification System (GMFCS). Those with GMFCS levels I-III comprised the high-functioning group (n = 11), and those with GMFCS levels IV-V comprised the low-functioning group (n = 8). We compared DTT-based metrics, such as fractional anisotropy, apparent diffusion coefficient, and fiber number and volume, between the groups. RESULTS In the corticospinal tract, the volume and number of fibers were significantly higher in the high-functioning group (p < 0.001), whereas the fractional anisotropy and apparent diffusion coefficient of the corticospinal tract did not differ significantly between the groups. In the somotosensory tract and posterior thalamic radiation, none of the DTT parameters differed significantly between the groups. CONCLUSIONS Children with bilateral spastic CP with differing levels of gross motor function have corresponding differences detectable on DTT in their corticospinal tracts but not in their somatosensory tracts and posterior thalamic radiations. In addition, the number and volume of fibers, but not fractional anisotropy values or apparent diffusion coefficients, are lower in the corticospinal tracts in children with low gross motor function than in those with high gross motor function.
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Affiliation(s)
- Dong-wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Yoshida S, Hayakawa K, Oishi K, Mori S, Kanda T, Yamori Y, Yoshida N, Hirota H, Iwami M, Okano S, Matsushita H. Athetotic and Spastic Cerebral Palsy: Anatomic Characterization Based on Diffusion-Tensor Imaging. Radiology 2011; 260:511-20. [DOI: 10.1148/radiol.11101783] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Congenital mirror movements: a clue to understanding bimanual motor control. J Neurol 2011; 258:1911-9. [DOI: 10.1007/s00415-011-6107-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
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