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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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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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Cyr PEP, Lean RE, Kenley JK, Kaplan S, Meyer DE, Neil JJ, Alexopoulos D, Brady RG, Shimony JS, Rodebaugh TL, Rogers CE, Smyser CD. Neonatal motor functional connectivity and motor outcomes at age two years in very preterm children with and without high-grade brain injury. Neuroimage Clin 2022; 36:103260. [PMID: 36451363 PMCID: PMC9668638 DOI: 10.1016/j.nicl.2022.103260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/09/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
Preterm-born children have high rates of motor impairments, but mechanisms for early identification remain limited. We hypothesized that neonatal motor system functional connectivity (FC) would relate to motor outcomes at age two years; currently, this relationship is not yet well-described in very preterm (VPT; born <32 weeks' gestation) infants with and without brain injury. We recruited 107 VPT infants - including 55 with brain injury (grade III-IV intraventricular hemorrhage, cystic periventricular leukomalacia, post-hemorrhagic hydrocephalus) - and collected FC data at/near term-equivalent age (35-45 weeks postmenstrual age). Correlation coefficients were used to calculate the FC between bilateral motor and visual cortices and thalami. At two years corrected-age, motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development, 3rd edition. Multiple imputation was used to estimate missing data, and regression models related FC measures to motor outcomes. Within the brain-injured group only, interhemispheric motor cortex FC was positively related to gross motor outcomes. Thalamocortical and visual FC were not related to motor scores. This suggests neonatal alterations in motor system FC may provide prognostic information about impairments in children with brain injury.
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Affiliation(s)
- Peppar E P Cyr
- Washington University School of Medicine, Department of Neurology, United States.
| | - Rachel E Lean
- Washington University School of Medicine, Department of Psychiatry, United States
| | - Jeanette K Kenley
- Washington University School of Medicine, Department of Neurology, United States
| | - Sydney Kaplan
- Washington University School of Medicine, Department of Neurology, United States
| | - Dominique E Meyer
- Washington University School of Medicine, Department of Neurology, United States
| | - Jeffery J Neil
- Washington University School of Medicine, Department of Neurology, United States
| | | | - Rebecca G Brady
- Washington University School of Medicine, Department of Neurology, United States
| | - Joshua S Shimony
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, United States
| | - Thomas L Rodebaugh
- Washington University in St. Louis, Department of Psychology, United States
| | - Cynthia E Rogers
- Washington University School of Medicine, Department of Psychiatry, United States; Washington University School of Medicine, Department of Pediatrics, United States
| | - Christopher D Smyser
- Washington University School of Medicine, Department of Neurology, United States; Washington University School of Medicine, Mallinckrodt Institute of Radiology, United States; Washington University School of Medicine, Department of Pediatrics, United States
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Brun C, Traverse É, Granger É, Mercier C. Somatosensory deficits and neural correlates in cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:1382-1393. [PMID: 34145582 PMCID: PMC9290873 DOI: 10.1111/dmcn.14963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
AIM To synthetize studies assessing somatosensory deficits and alterations in cerebral responses evoked by somatosensory stimulation in individuals with cerebral palsy (CP) compared to typically developing individuals. METHOD A scoping review of the literature was performed in the MEDLINE, Embase, PsycInfo, CINAHL, Evidence-Based Medicine Reviews, and Web of Science databases (last search carried out on 6th and 7th August 2020) with a combination of keywords related to CP and somatosensory functions. Somatosensory deficits were measured with clinical tests and alterations in cerebral responses were measured with functional magnetic resonance imaging, electroencephalography, and magnetoencephalography. RESULTS Forty-eight articles were included. Overall, 1463 participants with CP (mean [SD] age 13y 1mo [4y 11mo], range 1-55y; 416 males, 319 females, sex not identified for the remaining participants) and 1478 controls (mean [SD] age 13y 1mo [5y 8mo], range 1-42y; 362 males, 334 females, sex not identified for the remaining participants) were included in the scoping review. For tactile function, most studies reported registration (8 out of 13) or perception (21 out of 21) deficits in participants with CP. For proprioception, most studies also reported registration (6 out of 8) or perception (10 out of 15) deficits. Pain function has not been studied as much, but most studies reported registration (2 out of 3) or perception (3 out of 3) alterations. Neuroimaging findings (18 studies) showed alterations in the somatotopy, morphology, latency, or amplitude of cortical responses evoked by somatosensory stimuli. INTERPRETATION Despite the heterogeneity in the methods employed, most studies reported somatosensory deficits. The focus has been mainly on tactile and proprioceptive function, whereas pain has received little attention. Future research should rigorously define the methods employed and include a sample that is more representative of the population with CP. What this paper adds Most of the papers reviewed found tactile registration and perception deficits in the upper limbs. Proprioceptive deficits were generally observed in cerebral palsy but results were heterogeneous. Pain has received little attention compared to tactile and proprioceptive functions. Neuroimaging studies supported behavioral observations. Alterations were observed for both the most and least affected limb.
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Affiliation(s)
- Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada
| | - Élodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
| | - Élyse Granger
- Centre IntégréUniversitaire de Santé et de Services Sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
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Chandwani R, Kline JE, Harpster K, Tkach J, Parikh NA. Early micro- and macrostructure of sensorimotor tracts and development of cerebral palsy in high risk infants. Hum Brain Mapp 2021; 42:4708-4721. [PMID: 34322949 PMCID: PMC8410533 DOI: 10.1002/hbm.25579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Infants born very preterm (VPT) are at high risk of motor impairments such as cerebral palsy (CP), and diagnosis can take 2 years. Identifying in vivo determinants of CP could facilitate presymptomatic detection and targeted intervention. Our objectives were to derive micro‐ and macrostructural measures of sensorimotor white matter tract integrity from diffusion MRI at term‐equivalent age, and determine their association with early diagnosis of CP. We enrolled 263 VPT infants (≤32 weeks gestational age) as part of a large prospective cohort study. Diffusion and structural MRI were acquired at term. Following consensus guidelines, we defined early diagnosis of CP based on abnormal structural MRI at term and abnormal neuromotor exam at 3–4 months corrected age. Using Constrained Spherical Deconvolution, we derived a white matter fiber orientation distribution (fOD) for subjects, performed probabilistic whole‐brain tractography, and segmented nine sensorimotor tracts of interest. We used the recently developed fixel‐based (FB) analysis to compute fiber density (FD), fiber‐bundle cross‐section (FC), and combined fiber density and cross‐section (FDC) for each tract. Of 223 VPT infants with high‐quality diffusion MRI data, 14 (6.3%) received an early diagnosis of CP. The cohort's mean (SD) gestational age was 29.4 (2.4) weeks and postmenstrual age at MRI scan was 42.8 (1.3) weeks. FD, FC, and FDC for each sensorimotor tract were significantly associated with early CP diagnosis, with and without adjustment for confounders. Measures of sensorimotor tract integrity enhance our understanding of white matter changes that antecede and potentially contribute to the development of CP in VPT infants.
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Affiliation(s)
- Rahul Chandwani
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Jean Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Springer A, Dyck Holzinger S, Andersen J, Buckley D, Fehlings D, Kirton A, Koclas L, Pigeon N, Van Rensburg E, Wood E, Oskoui M, Shevell M. Profile of children with cerebral palsy spectrum disorder and a normal MRI study. Neurology 2019; 93:e88-e96. [PMID: 31127072 DOI: 10.1212/wnl.0000000000007726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/14/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This study looks at what profile can be expected in children with cerebral palsy spectrum disorder (CP) and a normal MRI. METHODS The data were excerpted from the Canadian Cerebral Palsy Registry database. Only patients who had undergone MRI were included in the analysis. Neuroimaging classification was ascertained by university-based pediatric neuroradiologists and split into 2 categories: normal and abnormal MRIs. Six factors were then compared between those 2 groups: prematurity, perinatal adversity, presence of more than 1 comorbidity, CP subtype, bimanual dexterity (Manual Ability Classification System [MACS]), and gross motor function (Gross Motor Function Classification System [GMFCS]). RESULTS Participants with no perinatal adversity were 5.518 times more likely to have a normal MRI (p < 0.0001, 95% confidence interval [CI] 4.153-7.330). Furthermore, participants with dyskinetic, ataxic/hypotonic, and spastic diplegic forms of CP were 2.045 times more likely to have a normal MRI than those with hemiplegia, triplegia, and quadriplegia (p < 0.0001, 95% CI 1.506-2.778). No significant difference was found in prematurity, GMFCS levels, MACS levels, and the number of comorbidities. CONCLUSIONS Normal MRIs were associated with lack of perinatal adversity as well as with the dyskinetic, ataxic/hypotonic, and spastic diplegic CP subtypes. As MRI normality is not strongly associated with the severity of CP, continuous follow-up in children with normal imaging appears warranted. Further advanced imaging modalities, as well as strong consideration for metabolic and genetic testing, may provide additional insights into causal pathways in this population.
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Affiliation(s)
- Arielle Springer
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Sasha Dyck Holzinger
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - John Andersen
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - David Buckley
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Darcy Fehlings
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Adam Kirton
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Louise Koclas
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Nicole Pigeon
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Esias Van Rensburg
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Ellen Wood
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Maryam Oskoui
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada
| | - Michael Shevell
- From the Faculty of Medicine (A.S.) and Departments of Pediatrics (M.O., M.S.) and Neurology & Neurosurgery (M.O., M.S.), McGill University; Canadian Cerebral Palsy Registry (S.D.H.), Research Institute of the McGill University Health Centre, Montreal; Department of Pediatrics (J.A.), University of Alberta, Edmonton; Janeway Children's Hospital (D.B.), St. John's; Department of Paediatrics (D.F.), Bloorview Research Institute, University of Toronto; Departments of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary; Centre de Réadaptation Marie Enfant du CHU Sainte-Justine (L.K.), Montreal; Centre Hospitalier Universitaire de Sherbrooke (N.P.); BC Children's Hospital (E.V.R.), Vancouver; and IWK Health Centre (E.W.), Halifax, Canada.
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7
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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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Aberrant Interhemispheric Functional Organization in Children with Dyskinetic Cerebral Palsy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4362539. [PMID: 31011574 PMCID: PMC6442313 DOI: 10.1155/2019/4362539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/21/2019] [Indexed: 12/04/2022]
Abstract
Background Hemispheric asymmetry is one fundamental principle of neuronal organization. Interhemispheric connectivity and lateralization of intrinsic networks in the resting-state brain demonstrate the interhemispheric functional organization and can be affected by disease processes. This study aims to investigate the interhemispheric organization in children with dyskinetic cerebral palsy (DCP) based on resting-state functional MRI (fMRI). Methods 24 children with DCP and 20 healthy children were included. Voxel-mirrored homotopic connectivity (VMHC) was calculated to detect the interhemispheric connectivity, and the lateralization of the resting-state networks was performed to examine the asymmetry of the intrinsic networks of brain. Results Decreased interhemispheric connectivity was found at visual, motor, and motor-control related regions in children with DCP, while high cognitive related networks including the central executive network, the frontoparietal network, and the salience network represented decreased asymmetry in children with DCP. Abnormal VMHC in visual areas, as well as the altered lateralization in inferior parietal lobule and supplementary motor area, showed correlation with the gross motor function and activities of daily living in children with DCP. Conclusion These findings indicate that the interhemispheric functional organization alteration exists in children with DCP, suggesting that abnormal interhemispheric interaction may be a pathophysiological mechanism of motor and cognitive dysfunction of CP.
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Papadelis C, Ahtam B, Feldman HA, AlHilani M, Tamilia E, Nimec D, Snyder B, Ellen Grant P, Im K. Altered White Matter Connectivity Associated with Intergyral Brain Disorganization in Hemiplegic Cerebral Palsy. Neuroscience 2019; 399:146-160. [PMID: 30593919 PMCID: PMC10716912 DOI: 10.1016/j.neuroscience.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023]
Abstract
Despite extensive literature showing damages in the sensorimotor projection fibers of children with hemiplegic cerebral palsy (HCP), little is known about how these damages affect the global brain network. In this study, we assess the relationship between the structural integrity of sensorimotor projection fibers and the integrity of intergyral association white matter connections in children with HCP. Diffusion tensor imaging was performed in 10 children with HCP and 16 typically developing children. We estimated the regional and global white-matter connectivity using a region-of-interest (ROI)-based approach and a whole-brain gyrus-based parcellation method. Using the ROI-based approach, we tracked the spinothalamic (STh), thalamocortical (ThC), corticospinal (CST), and sensorimotor U- (SMU) fibers. Using the whole-brain parcellation method, we tracked the short-, middle-, and long-range association fibers. We observed for the more affected hemisphere of children with HCP: (i) an increase in axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) for the STh and ThC fibers; (ii) a decrease in fractional anisotropy (FA) and an increase in MD and RD for the CST and SMU fibers; in (iii) a decrease in FA and an increase in AD, MD, and RD for the middle- and long-range association fibers; and (iv) an association between the integrity of sensorimotor projection and intergyral association fibers. Our findings indicate that altered structural integrity of the sensorimotor projection fibers disorganizes the intergyral association white matter connections among local and distant regions in children with HCP.
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Affiliation(s)
- Christos Papadelis
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & 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
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & 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
| | - Henry A Feldman
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Michel AlHilani
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Donna Nimec
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Brian Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - P Ellen Grant
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & 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, 300 Longwood Ave, Boston, MA 02115, USA
| | - Kiho Im
- Laboratory of Children's Brain Dynamics, Fetal-Neonatal Neuroimaging & 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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10
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Functional Connectivity Alterations in Children with Spastic and Dyskinetic Cerebral Palsy. Neural Plast 2018; 2018:7058953. [PMID: 30186320 PMCID: PMC6114065 DOI: 10.1155/2018/7058953] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 01/28/2023] Open
Abstract
Cerebral palsy (CP) has long been investigated to be associated with a range of motor and cognitive dysfunction. As the two most common CP subtypes, spastic cerebral palsy (SCP) and dyskinetic cerebral palsy (DCP) may share common and distinct elements in their pathophysiology. However, the common and distinct dysfunctional characteristics between SCP and DCP on the brain network level are less known. This study aims to detect the alteration of brain functional connectivity in children with SCP and DCP based on resting-state functional MRI (fMRI). Resting-state networks (RSNs) were established based on the independent component analysis (ICA), and the functional network connectivity (FNC) was performed on the fMRI data from 16 DCP, 18 bilateral SCP, and 18 healthy children. Compared with healthy controls, altered functional connectivity within the cerebellum network, sensorimotor network (SMN), left frontoparietal network (LFPN), and salience network (SN) were found in DCP and SCP groups. Furthermore, the disconnections of the FNC consistently focused on the visual pathway; covariance of the default mode network (DMN) with other networks was observed both in DCP and SCP groups, while the DCP group had a distinct connectivity abnormality in motor pathway and self-referential processing-related connections. Correlations between the functional disconnection and the motor-related clinical measurement in children with CP were also found. These findings indicate functional connectivity impairment and altered integration widely exist in children with CP, suggesting that the abnormal functional connectivity is a pathophysiological mechanism of motor and cognitive dysfunction of CP.
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11
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Laporta-Hoyos O, Fiori S, Pannek K, Ballester-Plané J, Leiva D, Reid LB, Pagnozzi AM, Vázquez É, Delgado I, Macaya A, Pueyo R, Boyd RN. Brain lesion scores obtained using a simple semi-quantitative scale from MR imaging are associated with motor function, communication and cognition in dyskinetic cerebral palsy. Neuroimage Clin 2018; 19:892-900. [PMID: 30013928 PMCID: PMC6019264 DOI: 10.1016/j.nicl.2018.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/04/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022]
Abstract
Purpose To characterise brain lesions in dyskinetic cerebral palsy (DCP) using the semi-quantitative scale for structural MRI (sqMRI) and to investigate their relationship with motor, communication and cognitive function. Materials and methods Thirty-nine participants (19 females, median age 21y) with DCP were assessed in terms of motor function, communication and a variety of cognitive domains. Whole-head magnetic resonance imaging (MRI) was performed including T1-MPRAGE, T2 turbo spin echo (axial plane), and fluid attenuated inversion recovery images (FLAIR). A child neurologist visually assessed images for brain lesions and scored these using the sqMRI. Ordinal, Poisson and binomial negative regression models identified which brain lesions accounted for clinical outcomes. Results Brain lesions were most frequently located in the ventral posterior lateral thalamus and the frontal lobe. Gross (B = 0.180, p < .001; B = 0.658, p < .001) and fine (B = 0.136, p = .003; B = 0.540, p < .001) motor function were associated with global sqMRI score and parietal involvement. Communication functioning was associated with putamen involvement (B = 0.747, p < .028). Intellectual functioning was associated with global sqMRI score and posterior thalamus involvement (B = -0.018, p < .001; B = -0.192, p < .001). Selective attention was associated with global sqMRI score (B = -0.035, p < .001), parietal (B = -0.063, p = .023), and corpus callosum involvement (B = -0.448, p < .001). Visuospatial and visuoperceptive abilities were associated with global sqMRI score (B = -0.078, p = .007) and medial dorsal thalamus involvement (B = -0.139, p < .012), respectively. Conclusions Key clinical outcomes in DCP are associated with specific observable brain lesions as indexed by a simple lesion scoring system that relies only on standard clinical MRI.
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Affiliation(s)
- Olga Laporta-Hoyos
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; IRCCS Fondazione Stella Maris, Pisa, Italy; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | | | - Kerstin Pannek
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Júlia Ballester-Plané
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - David Leiva
- Departament de Psicologia Social i Psicologia Quantitativa, Universitat de Barcelona, Barcelona, Spain
| | - Lee B Reid
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Alex M Pagnozzi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Élida Vázquez
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Delgado
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alfons Macaya
- Grup de Recerca en Neurologia Pediàtrica, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roser Pueyo
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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12
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Cognitive functioning in dyskinetic cerebral palsy: Its relation to motor function, communication and epilepsy. Eur J Paediatr Neurol 2018; 22:102-112. [PMID: 29108712 DOI: 10.1016/j.ejpn.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/25/2017] [Accepted: 10/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a disorder of motor function often accompanied by cognitive impairment. There is a paucity of research focused on cognition in dyskinetic CP and on the potential effect of related factors. AIM To describe the cognitive profile in dyskinetic CP and to assess its relationship with motor function and associated impairments. METHOD Fifty-two subjects with dyskinetic CP (28 males, mean age 24 y 10 mo, SD 13 y) and 52 typically-developing controls (age- and gender-matched) completed a comprehensive neuropsychological assessment. Gross Motor Function Classification System (GMFCS), Communication Function Classification System (CFCS) and epilepsy were recorded. Cognitive performance was compared between control and CP groups, also according different levels of GMFCS. The relationship between cognition, CFCS and epilepsy was examined through partial correlation coefficients, controlling for GMFCS. RESULTS Dyskinetic CP participants performed worse than controls on all cognitive functions except for verbal memory. Milder cases (GMFCS I) only showed impairment in attention, visuoperception and visual memory. Participants with GMFCS II-III also showed impairment in language-related functions. Severe cases (GMFCS IV-V) showed impairment in intelligence and all specific cognitive functions but verbal memory. CFCS was associated with performance in receptive language functions. Epilepsy was related to performance in intelligence, visuospatial abilities, visual memory, grammar comprehension and learning. CONCLUSION Cognitive performance in dyskinetic CP varies with the different levels of motor impairment, with more cognitive functions impaired as motor severity increases. This study also demonstrates the relationship between communication and epilepsy and cognitive functioning, even controlling for the effect of motor severity.
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13
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Ballester-Plané J, Schmidt R, Laporta-Hoyos O, Junqué C, Vázquez É, Delgado I, Zubiaurre-Elorza L, Macaya A, Póo P, Toro E, de Reus MA, van den Heuvel MP, Pueyo R. Whole-brain structural connectivity in dyskinetic cerebral palsy and its association with motor and cognitive function. Hum Brain Mapp 2017; 38:4594-4612. [PMID: 28608616 DOI: 10.1002/hbm.23686] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
Abstract
Dyskinetic cerebral palsy (CP) has long been associated with basal ganglia and thalamus lesions. Recent evidence further points at white matter (WM) damage. This study aims to identify altered WM pathways in dyskinetic CP from a standardized, connectome-based approach, and to assess structure-function relationship in WM pathways for clinical outcomes. Individual connectome maps of 25 subjects with dyskinetic CP and 24 healthy controls were obtained combining a structural parcellation scheme with whole-brain deterministic tractography. Graph theoretical metrics and the network-based statistic were applied to compare groups and to correlate WM state with motor and cognitive performance. Results showed a widespread reduction of WM volume in CP subjects compared to controls and a more localized decrease in degree (number of links per node) and fractional anisotropy (FA), comprising parieto-occipital regions and the hippocampus. However, supramarginal gyrus showed a significantly higher degree. At the network level, CP subjects showed a bilateral pathway with reduced FA, comprising sensorimotor, intraparietal and fronto-parietal connections. Gross and fine motor functions correlated with FA in a pathway comprising the sensorimotor system, but gross motor also correlated with prefrontal, temporal and occipital connections. Intelligence correlated with FA in a network with fronto-striatal and parieto-frontal connections, and visuoperception was related to right occipital connections. These findings demonstrate a disruption in structural brain connectivity in dyskinetic CP, revealing general involvement of posterior brain regions with relative preservation of prefrontal areas. We identified pathways in which WM integrity is related to clinical features, including but not limited to the sensorimotor system. Hum Brain Mapp 38:4594-4612, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Júlia Ballester-Plané
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ruben Schmidt
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olga Laporta-Hoyos
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carme Junqué
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Élida Vázquez
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Delgado
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Leire Zubiaurre-Elorza
- Departamento de Fundamentos y Métodos de la Psicología, Facultad de Psicología y Educación, Universidad de Deusto, Bilbo-Bizkaia, Spain
| | - Alfons Macaya
- Grup de Recerca en Neurologia Pediàtrica, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Póo
- Servei de Neurologia, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Esther Toro
- Servei de Rehabilitació i Medicina Física, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marcel A de Reus
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn P van den Heuvel
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roser Pueyo
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
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14
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Laporta-Hoyos O, Pannek K, Ballester-Plané J, Reid LB, Vázquez É, Delgado I, Zubiaurre-Elorza L, Macaya A, Póo P, Meléndez-Plumed M, Junqué C, Boyd R, Pueyo R. White matter integrity in dyskinetic cerebral palsy: Relationship with intelligence quotient and executive function. Neuroimage Clin 2017; 15:789-800. [PMID: 28702354 PMCID: PMC5496484 DOI: 10.1016/j.nicl.2017.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dyskinetic cerebral palsy (CP) is one of the most disabling motor types of CP and has been classically associated with injury to the basal ganglia and thalamus. Although cognitive dysfunction is common in CP, there is a paucity of published quantitative analyses investigating the relationship between white matter (WM) microstructure and cognition in this CP type. AIMS This study aims (1) to compare brain WM microstructure between people with dyskinetic CP and healthy controls, (2) to identify brain regions where WM microstructure is related to intelligence and (3) to identify brain regions where WM microstructure is related to executive function in people with dyskinetic CP and (4) to identify brain regions where the correlations are different between controls and people with CP in IQ and executive functions. PATIENTS AND METHODS Thirty-three participants with dyskinetic CP (mean ± SD age: 24.42 ± 12.61, 15 female) were age and sex matched with 33 controls. Participants underwent a comprehensive neuropsychological battery to assess intelligence quotient (IQ) and four executive function domains (attentional control, cognitive flexibility, goal setting and information processing). Diffusion weighted MRI scans were acquired at 3T. Voxel-based whole brain groupwise analyses were used to compare fractional anisotropy (FA) and of the CP group to the matched controls using a general lineal model. Further general linear models were used to identify regions where white matter FA correlated with IQ and each of the executive function domains. RESULTS White matter FA was significantly reduced in the CP group in all cerebral lobes, predominantly in regions connected with the parietal and to a lesser extent the temporal lobes. There was no significant correlation between IQ or any of the four executive function domains and WM microstructure in the control group. In participants with CP, lower IQ was associated with lower FA in all cerebral lobes, predominantly in locations that also showed reduced FA compared to controls. Attentional control, goal setting and information processing did not correlate with WM microstructure in the CP group. Cognitive flexibility was associated with FA in regions known to contain connections with the frontal lobe (such as the superior longitudinal fasciculus and cingulum) as well as regions not known to contain tracts directly connected with the frontal lobe (such as the posterior corona radiata, posterior thalamic radiation, retrolenticular part of internal capsule, tapetum, body and splenium of corpus callosum). CONCLUSION The widespread loss in the integrity of WM tissue is mainly located in the parietal lobe and related to IQ in dyskinetic CP. Unexpectedly, executive functions are only related with WM microstructure in regions containing fronto-cortical and posterior cortico-subcortical pathways, and not being specifically related to the state of fronto-striatal pathways which might be due to brain reorganization. Further studies of this nature may improve our understanding of the neurobiological bases of cognitive impairments after early brain insult.
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Affiliation(s)
- Olga Laporta-Hoyos
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Kerstin Pannek
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Júlia Ballester-Plané
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lee B Reid
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Élida Vázquez
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Delgado
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Leire Zubiaurre-Elorza
- Departamento de Fundamentos y Métodos de la Psicología, Facultad de Psicología y Educación. Universidad de Deusto, Bilbo-Bizkaia, Spain
| | - Alfons Macaya
- Grup de Recerca en Neurologia Pediàtrica, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Póo
- Servei de Neurologia, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Mar Meléndez-Plumed
- Servei de Rehabilitació i Medicina Física, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carme Junqué
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roser Pueyo
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain.
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15
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Vargas Canas A, Rivas M, Guerrero Torrealba R, Francisca Fajre Caamano M. Marchiafava-Bignami's Disease, as Etiologic Diagnosis of Athetosis. Ann Neurosci 2017; 24:57-60. [PMID: 28588358 DOI: 10.1159/000464424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022] Open
Abstract
The Marchiafava-Bignami disease, characterized by demyelination and necrosis of the corpus callosum, has typically been associated with chronic alcohol intake, and clinically has various symptoms and signs. However, several cases have been reported without alcohol association, and these - according to several publications - have some common points, such as preference for female, related to malnutrition, and radiological involvement of the splenium of the corpus callosum. We report a case of a patient with the characteristics described above and whose clinical manifestation was Athetosis. The authors associate this manifestation with the somatotopic distribution of the corpus callosum, and contribute to the etiologic diagnosis of Athetosis as a manifestation of the Marchiafava-Bignami disease, which has not been reported in the medical literature according to our review of the database.
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Affiliation(s)
- Alberto Vargas Canas
- Unidad de Neurología Hospital Santiago Oriente "Dr. Luis Tisné", Santiago, Chile.,Investigador Internacional Universidad Autónoma del Caribe, Santiago, Chile
| | - Mario Rivas
- Unidad de Neurología Hospital Santiago Oriente "Dr. Luis Tisné", Santiago, Chile
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Combined Diffusion Tensor Imaging and Arterial Spin Labeling as Markers of Early Parkinson's disease. Sci Rep 2016; 6:33762. [PMID: 27646647 PMCID: PMC5028727 DOI: 10.1038/srep33762] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022] Open
Abstract
This study aimed to identify a PD-specific MRI pattern using combined diffusion tensor imaging (DTI) and arterial spin labeling (ASL) to discriminate patients with early PD from healthy subjects and evaluate disease status. Twenty-one early and 22 mid-late PD patients, and 22 healthy, age/gender-matched controls underwent 3-T MRI with apparent diffusion coefficient (ADC), fractional anisotropy (FA), fiber number (FN) and cerebral blood flow (CBF) measurements. We found that compared with healthy subjects, there was a profound reduction in FN passing through the SN in PD. FA in the SN and CBF in the caudate nucleus were inversely correlated with motor dysfunction. A negative correlation was observed between FA in the hippocampus (Hip) and the NMSS-Mood score, whereas CBF in the Hip and the prefrontal cortex(PFC) correlated with declined cognition. Stratified five-fold cross-validation identified FA in the SN(FA-SNAv), CBF in the PFC(CBF-PFCAv) and FA in the parietal white matter(FA-PWMAv), and the combination of these measurements offered relatively high accuracy (AUC 0.975, 90% sensitivity and 100% specificity) in distinguishing those with early PD from healthy subjects. We demonstrate that the decreased FNs through SN in combination with changes in FA-SNAv, CBF-PFCAv and FA-PWMAv values might serve as potential markers of early-stage PD.
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Ballester-Plané J, Laporta-Hoyos O, Macaya A, Póo P, Meléndez-Plumed M, Vázquez É, Delgado I, Zubiaurre-Elorza L, Narberhaus A, Toro-Tamargo E, Russi ME, Tenorio V, Segarra D, Pueyo R. Measuring intellectual ability in cerebral palsy: The comparison of three tests and their neuroimaging correlates. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 56:83-98. [PMID: 27262445 DOI: 10.1016/j.ridd.2016.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/22/2015] [Accepted: 04/18/2016] [Indexed: 05/09/2023]
Abstract
Standard intelligence scales require both verbal and manipulative responses, making it difficult to use in cerebral palsy and leading to underestimate their actual performance. This study aims to compare three intelligence tests suitable for the heterogeneity of cerebral palsy in order to identify which one(s) could be more appropriate to use. Forty-four subjects with bilateral dyskinetic cerebral palsy (26 male, mean age 23 years) conducted the Raven's Coloured Progressive Matrices (RCPM), the Peabody Picture Vocabulary Test-3rd (PPVT-III) and the Wechsler Nonverbal Scale of Ability (WNV). Furthermore, a comprehensive neuropsychological battery and magnetic resonance imaging were assessed. The results show that PPVT-III gives limited information on cognitive performance and brain correlates, getting lower intelligence quotient scores. The WNV provides similar outcomes as RCPM, but cases with severe motor impairment were unable to perform it. Finally, the RCPM gives more comprehensive information on cognitive performance, comprising not only visual but also verbal functions. It is also sensitive to the structural state of the brain, being related to basal ganglia, thalamus and white matter areas such as superior longitudinal fasciculus. So, the RCPM may be considered a standardized easy-to-administer tool with great potential in both clinical and research fields of bilateral cerebral palsy.
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Affiliation(s)
- Júlia Ballester-Plané
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Olga Laporta-Hoyos
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Alfons Macaya
- Grup de Recerca en Neurologia Pediàtrica, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Póo
- Servei de Neurologia, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Mar Meléndez-Plumed
- Servei de Rehabilitació i Medicina Física, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Élida Vázquez
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Delgado
- Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Leire Zubiaurre-Elorza
- Departamento de Fundamentos y Métodos de la Psicología, Facultad de Psicología y Educación, Universidad de Deusto, Bilbo-Bizkaia, Spain
| | - Ana Narberhaus
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
| | - Esther Toro-Tamargo
- Servei de Rehabilitació i Medicina Física, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Eugenia Russi
- Servei de Neurologia, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Violeta Tenorio
- Servei de Neonatologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Segarra
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
| | - Roser Pueyo
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain; Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain.
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Stefanou MI, Lumsden DE, Ashmore J, Ashkan K, Lin JP, Charles-Edwards G. Tensor and non-tensor tractography for the assessment of the corticospinal tract of children with motor disorders: a comparative study. Neuroradiology 2016; 58:1005-1016. [PMID: 27447871 DOI: 10.1007/s00234-016-1721-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Non-invasive measures of corticospinal tract (CST) integrity may help to guide clinical interventions, particularly in children and young people (CAYP) with motor disorders. We compared diffusion tensor imaging (DTI) metrics extracted from the CST generated by tensor and non-tensor based tractography algorithms. METHODS For a group of 25 CAYP undergoing clinical evaluation, the CST was reconstructed using (1) deterministic tensor-based tractography algorithm, (2) probabilistic tensor-based, and (3) constrained spherical deconvolution (CSD)-derived tractography algorithms. RESULTS Choice of tractography algorithm significantly altered the results of tracking. Larger tracts were consistently defined with CSD, with differences in FA but not MD values for tracts to the pre- or post-central gyrus. Differences between deterministic and probabilistic tensor-based algorithms were minimal. Non-tensor reconstructed tracts appeared to be more anatomically representative. Examining metrics along the tract, difference in FA values appeared to be greatest in voxels with predominantly single-fibre orientations. Less pronounced differences were seen outwith of these regions. CONCLUSION With an increasing interest in the applications of tractography analysis at all stages of movement disorder surgery, it is important that clinicians remain alert to the consequences of choice of tractography algorithm on subsequently generated tracts, including differences in volumes, anatomical reconstruction, and DTI metrics, the latter of which will have global as well as more regional effects. Tract-wide analysis of DTI based metrics is of limited utility, and a more segmental approach to analysis may be appropriate, particularly if disruption to a focal region of a white matter pathway is anticipated.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Daniel E Lumsden
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK.
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminister Bridge Road, London, SE1 7EH, UK.
| | - Jonathan Ashmore
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Functional Neurosurgery, Department of Neurosurgery, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
- Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminister Bridge Road, London, SE1 7EH, UK
| | - Geoffrey Charles-Edwards
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
- Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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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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Aravamuthan BR, Waugh JL. Localization of Basal Ganglia and Thalamic Damage in Dyskinetic Cerebral Palsy. Pediatr Neurol 2016; 54:11-21. [PMID: 26706479 DOI: 10.1016/j.pediatrneurol.2015.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/01/2015] [Accepted: 10/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dyskinetic cerebral palsy affects 15%-20% of patients with cerebral palsy. Basal ganglia injury is associated with dyskinetic cerebral palsy, but the patterns of injury within the basal ganglia predisposing to dyskinetic cerebral palsy are unknown, making treatment difficult. For example, deep brain stimulation of the globus pallidus interna improves dystonia in only 40% of patients with dyskinetic cerebral palsy. Basal ganglia injury heterogeneity may explain this variability. METHODS To investigate this, we conducted a qualitative systematic review of basal ganglia and thalamic damage in dyskinetic cerebral palsy. Reviews and articles primarily addressing genetic or toxic causes of cerebral palsy were excluded yielding 22 studies (304 subjects). RESULTS Thirteen studies specified the involved basal ganglia nuclei (subthalamic nucleus, caudate, putamen, globus pallidus, or lentiform nuclei, comprised by the putamen and globus pallidus). Studies investigating the lentiform nuclei (without distinguishing between the putamen and globus pallidus) showed that all subjects (19 of 19) had lentiform nuclei damage. Studies simultaneously but independently investigating the putamen and globus pallidus also showed that all subjects (35 of 35) had lentiform nuclei damage (i.e., putamen or globus pallidus damage); this was followed in frequency by damage to the putamen alone (70 of 101, 69%), the subthalamic nucleus (17 of 25, 68%), the thalamus (88 of 142, 62%), the globus pallidus (7/35, 20%), and the caudate (6 of 47, 13%). Globus pallidus damage was almost always coincident with putaminal damage. CONCLUSIONS Noting consistent involvement of the lentiform nuclei in dyskinetic cerebral palsy, these results could suggest two groups of patients with dyskinetic cerebral palsy: those with putamen-predominant damage and those with panlenticular damage involving both the putamen and the globus pallidus. Differentiating between these groups could help predict response to therapies such as deep brain stimulation.
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Affiliation(s)
- Bhooma R Aravamuthan
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jeff L Waugh
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
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21
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Lumsden DE, Ashmore J, Ball G, Charles-Edwards G, Selway R, Ashkan K, Lin JP. Fractional anisotropy in children with dystonia or spasticity correlates with the selection for DBS or ITB movement disorder surgery. Neuroradiology 2016; 58:401-8. [PMID: 26759316 PMCID: PMC4819774 DOI: 10.1007/s00234-015-1639-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There is increasing interest in neurosurgical interventions for hypertonicity in children and young people (CAYP), which often presents with a mixture of dystonia and spasticity. Significant spasticity would usually be considered a contraindication for deep brain stimulation (DBS) and more suitably treated with intrathecal baclofen (ITB). We aimed to explore whether white matter microstructure, as measured by Fractional Anisotropy (FA), differed between CAYP selected for DBS compared to ITB surgery. METHODS We retrospectively analysed Diffusion Tensor Imaging for 31 CAYP selected for DBS surgery (14 primary dystonia, 17 secondary dystonia) and 10 CAYP selected for ITB surgery. A voxel-wise comparison of FA values was performed using tract-based spatial statistics, comparing primary and secondary dystonia groups to the ITB group, and the two dystonia groups. RESULTS Widespread areas of reduced FA were demonstrated in ITB compared to either DBS group and in CAYP with secondary compared to primary dystonia. These changes were not restricted to motor pathways. Region of interest (ROI) analysis from the corticospinal tract (CST) demonstrated groupwise differences but overlapping values at the individual level. CONCLUSIONS DTI measures may contribute to decision making for CAYP selection for movement disorder surgery. Significant differences in CAYP with secondary dystonia selected for DBS surgery compared to CAYP selected for ITB pump implants, suggesting that more extensive white matter injury may be a feature of the spastic motor phenotype. Altered white matter microstructure could potentially explain the reduced responsiveness to interventions such as DBS in secondary compared to primary dystonia.
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Affiliation(s)
- Daniel E. Lumsden
- Complex Motor Disorders Service, Evelina Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH UK ,Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Jonathan Ashmore
- Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Gareth Ball
- Centre for the Developing Brain, King’s College London, London, UK
| | - Geoffrey Charles-Edwards
- Imaging Sciences and Biomedical Engineering, King’s College London, London, UK ,Medical Physics, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Richard Selway
- Functional Neurosurgery, King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Functional Neurosurgery, King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK ,Clinical Neuroscience, Institute of Psychiatry, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Evelina Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH UK
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22
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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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23
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Lee J, Hustad KC, Weismer G. Predicting speech intelligibility with a multiple speech subsystems approach in children with cerebral palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:1666-78. [PMID: 24824584 PMCID: PMC4192090 DOI: 10.1044/2014_jslhr-s-13-0292] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/08/2014] [Indexed: 05/06/2023]
Abstract
PURPOSE Speech acoustic characteristics of children with cerebral palsy (CP) were examined with a multiple speech subsystems approach; speech intelligibility was evaluated using a prediction model in which acoustic measures were selected to represent three speech subsystems. METHOD Nine acoustic variables reflecting different subsystems, and speech intelligibility, were measured in 22 children with CP. These children included 13 with a clinical diagnosis of dysarthria (speech motor impairment [SMI] group) and 9 judged to be free of dysarthria (no SMI [NSMI] group). Data from children with CP were compared to data from age-matched typically developing children. RESULTS Multiple acoustic variables reflecting the articulatory subsystem were different in the SMI group, compared to the NSMI and typically developing groups. A significant speech intelligibility prediction model was obtained with all variables entered into the model (adjusted R2 = .801). The articulatory subsystem showed the most substantial independent contribution (58%) to speech intelligibility. Incremental R2 analyses revealed that any single variable explained less than 9% of speech intelligibility variability. CONCLUSIONS Children in the SMI group had articulatory subsystem problems as indexed by acoustic measures. As in the adult literature, the articulatory subsystem makes the primary contribution to speech intelligibility variance in dysarthria, with minimal or no contribution from other systems.
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Kolobe THA, Christy JB, Gannotti ME, Heathcock JC, Damiano DL, Taub E, Majsak MJ, Gordon AM, Fuchs RK, O'Neil ME, Caiozzo VJ. Research summit III proceedings on dosing in children with an injured brain or cerebral palsy: executive summary. Phys Ther 2014; 94:907-20. [PMID: 24525862 PMCID: PMC4078265 DOI: 10.2522/ptj.20130024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/10/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Thubi H A Kolobe
- T.H.A. Kolobe, PT, PhD, FAPTA, Department of Rehabilitation Science, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK 73104 (USA).
| | - Jennifer Braswell Christy
- J.B. Christy, PT, PhD, Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary E Gannotti
- M.E. Gannotti, PT, PhD, Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
| | - Jill C Heathcock
- J.C. Heathcock, PT, PhD, Division of Physical Therapy, Ohio State University Medical Center, Columbus, Ohio
| | - Diane L Damiano
- D.L. Damiano, PT, PhD, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Edward Taub
- E. Taub, PhD, Department of Psychology, University of Alabama at Birmingham
| | - Michael J Majsak
- M.J. Majsak, PT, EdD, Program in Physical Therapy, School of Public Health, New York Medical College, Valhalla, New York
| | - Andrew M Gordon
- A.M. Gordon, PhD, Department of Biobehavioral Sciences, Columbia University, New York, New York
| | - Robyn K Fuchs
- R.K. Fuchs, PhD, Department of Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana
| | - Margaret E O'Neil
- M.E. O'Neil, PT, PhD, MPH, Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Vincent J Caiozzo
- V.J. Caiozzo, PhD, Department of Orthopedics and Physiology & Biophysics, School of Medicine, University of California-Irvine, Irvine, California
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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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Reid SM, Dagia CD, Ditchfield MR, Carlin JB, Reddihough DS. Population-based studies of brain imaging patterns in cerebral palsy. Dev Med Child Neurol 2014; 56:222-32. [PMID: 23937113 DOI: 10.1111/dmcn.12228] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to review the distribution of neuroimaging findings from a contemporary population cohort of individuals with cerebral palsy (CP) and to facilitate standardization of imaging classification. METHOD Publications from 1995 to 2012 reporting imaging findings in population cohorts were selected through a literature search, and review of the titles, abstracts, and content of studies. Relevant data were extracted, including unpublished data from Victoria, Australia. The proportions for each imaging pattern were tabulated, and heterogeneity was assessed for all individuals with CP, and for subgroups based on gestational age, CP subtype, and Gross Motor Function Classification System level. RESULTS Studies from three geographic regions met the inclusion criteria for individuals with CP, and two additional studies reported on specific CP subtypes. Brain abnormalities were observed in 86% of scans, but were observed least often in children with ataxia (24-57%). White matter injury was the most common imaging pattern (19-45%), although the proportions showed high heterogeneity. Additional patterns were grey matter injury (21%), focal vascular insults (10%), malformations (11%), and miscellaneous findings (4-22%). INTERPRETATION This review suggests areas where further dialogue will facilitate progress towards standardization of neuroimaging classification. Standardization will enable future collaborations aimed at exploring the relationships among magnetic resonance imaging patterns, risk factors, and clinical outcomes, and, ultimately, lead to better understanding of causal pathways and opportunities for prevention.
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Affiliation(s)
- Susan M Reid
- Developmental Disability & Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia
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Li W, Wu B, Batrachenko A, Bancroft-Wu V, Morey RA, Shashi V, Langkammer C, De Bellis MD, Ropele S, Song AW, Liu C. Differential developmental trajectories of magnetic susceptibility in human brain gray and white matter over the lifespan. Hum Brain Mapp 2013; 35:2698-713. [PMID: 24038837 DOI: 10.1002/hbm.22360] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/02/2013] [Accepted: 06/17/2013] [Indexed: 12/24/2022] Open
Abstract
As indicated by several recent studies, magnetic susceptibility of the brain is influenced mainly by myelin in the white matter and by iron deposits in the deep nuclei. Myelination and iron deposition in the brain evolve both spatially and temporally. This evolution reflects an important characteristic of normal brain development and ageing. In this study, we assessed the changes of regional susceptibility in the human brain in vivo by examining the developmental and ageing process from 1 to 83 years of age. The evolution of magnetic susceptibility over this lifespan was found to display differential trajectories between the gray and the white matter. In both cortical and subcortical white matter, an initial decrease followed by a subsequent increase in magnetic susceptibility was observed, which could be fitted by a Poisson curve. In the gray matter, including the cortical gray matter and the iron-rich deep nuclei, magnetic susceptibility displayed a monotonic increase that can be described by an exponential growth. The rate of change varied according to functional and anatomical regions of the brain. For the brain nuclei, the age-related changes of susceptibility were in good agreement with the findings from R2* measurement. Our results suggest that magnetic susceptibility may provide valuable information regarding the spatial and temporal patterns of brain myelination and iron deposition during brain maturation and ageing.
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Affiliation(s)
- Wei Li
- Brain Imaging and Analysis Center, School of Medicine, Duke University, Durham, North Carolina
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Arnfield E, Guzzetta A, Boyd R. Relationship between brain structure on magnetic resonance imaging and motor outcomes in children with cerebral palsy: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2234-2250. [PMID: 23643774 DOI: 10.1016/j.ridd.2013.03.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/19/2013] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Magnetic resonance imaging (MRI) is recommended in all children with cerebral palsy (CP) where the aetiology has not been established, and the major presenting problem in CP is reduced motor capacity. A systematic review of the literature was performed to investigate the relationship between brain structure on MRI and motor outcomes in children with CP. A total of 37 studies met inclusion criteria, and were analysed in terms of (a) population characteristics, (b) MRI data, (c) motor outcome data, and (d) the relationship between MRI data and motor outcomes. All studies used a qualitative system to classify brain lesions; however, few reported information about the location and extent of lesions. Valid and reliable classifications of motor abilities were not always used, and three studies did not link motor findings to MRI features. There was, however, a relationship between the type of brain lesion on MRI and two specific motor outcomes, namely gross motor functional classification (using GMFCS) and motor type. This relationship could aid in the prediction and optimisation of early interventions for children with CP. There is also need for a quantitative MRI classification measure which includes detailed information about the location and severity of lesions.
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Affiliation(s)
- Evyn Arnfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Yoshida S, Faria AV, Oishi K, Kanda T, Yamori Y, Yoshida N, Hirota H, Iwami M, Okano S, Hsu J, Li X, Jiang H, Li Y, Hayakawa K, Mori S. Anatomical characterization of athetotic and spastic cerebral palsy using an atlas-based analysis. J Magn Reson Imaging 2013; 38:288-98. [PMID: 23737247 DOI: 10.1002/jmri.23931] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/02/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze diffusion tensor imaging (DTI) in two types of cerebral palsy (CP): the athetotic-type and the spastic-type, using an atlas-based anatomical analysis of the entire brain, and to investigate whether these images have unique anatomical characteristics that can support functional diagnoses. MATERIALS AND METHODS We retrospectively analyzed the DTI of seven children with athetotic-type, 11 children with spastic-type, and 20 healthy control children, all age-matched. The severity of motor dysfunction was evaluated with the Gross Motor Function Classification System (GMFCS). The images were normalized using a linear transformation, followed by large deformation diffeomorphic metric mapping. For 205 parcellated brain areas, the volume, fractional anisotropy, and mean diffusivity were measured. Principal component analysis (PCA) was performed for the Z-scores of these parameters. RESULTS The GMFCS scores in athetotic-type were significantly higher than those in spastic-type (P < 0.001). PCA extracted anatomical components that comprised the two types of CP, as well as the severity of motor dysfunction. In the athetotic group, the abnormalities were more severe than in the spastic group. In the spastic group, significant changes were concentrated in the lateral ventricle and periventricular structures. CONCLUSION Our results quantitatively delineated anatomical characteristics that reflected the functional findings in two types of CP.
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Affiliation(s)
- Shoko Yoshida
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Benini R, Dagenais L, Shevell MI. Normal imaging in patients with cerebral palsy: what does it tell us? J Pediatr 2013; 162:369-74.e1. [PMID: 22944004 DOI: 10.1016/j.jpeds.2012.07.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/14/2012] [Accepted: 07/19/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify distinctive clinical features characterizing children with cerebral palsy (CP) and normal-appearing magnetic resonance imaging (MRI) findings. STUDY DESIGN Using a population-based CP registry, the Registre de la Paralysie Cérébrale au Québec (Quebec Cerebral Palsy Registry), various antenatal, perinatal, and postnatal predictor variables, as well as current phenotype, were compared in patients with normal-appearing MRI findings and those with abnormal MRI findings. RESULTS Of the 213 patients evaluated, 126 (60%) had MRI imaging results available and were included in our analysis. Of these 126 patients, 90 (71%; 51 males, 39 females) had abnormal findings and 36 (29%; 17 males and 19 females) had normal-appearing findings. Compared with other CP variants, normal-appearing MRI was more prevalent (P = .001) in dyskinetic CP (72.7%; 8 of 11) and less prevalent (P = .002) in spastic hemiplegic CP (10%; 4 of 40). There were no significant differences between the 2 groups (P > .05) in terms of the prevalence of perinatal or postnatal clinical features or clinical outcomes. Furthermore, 42% (15 of 36) of the children with normal-appearing MRI exhibited a high degree of functional disability (Gross Motor Functional Classification System IV-V), compared with 33% (30 of 90) with abnormal MRI. CONCLUSION No clinical features, except a higher prevalence of dyskinetic CP, was identified in the children with normal-appearing MRI. More refined imaging techniques may be needed to evaluate patients with normal-appearing MRI findings. Furthermore, genetic or functional, rather than gross structural lesions, may underlie the pathophysiology of CP in this cohort. Finally, the high proportion of substantial functional disability underscores the importance of continuous follow-up even in the absence of early structural abnormalities on imaging.
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Affiliation(s)
- Ruba Benini
- Division of Pediatric Neurology, McGill University, Montreal, Canada
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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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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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