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Hruby A, Joshi D, Dewald JPA, Ingo C. Characterization of Atypical Corticospinal Tract Microstructure and Hand Impairments in Early-Onset Hemiplegic Cerebral Palsy: Preliminary Findings. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083210 PMCID: PMC10842831 DOI: 10.1109/embc40787.2023.10340084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Unilateral brain injuries occurring before at or shortly after full-term can result in hemiplegic cerebral palsy (HCP). HCP affects one side of the body and can be characterized in the hand with measures of weakness and a loss of independent hand control resulting in mirror movements. Hand impairment severity is extremely heterogeneous across individuals with HCP and the neural basis for this variability is unclear. We used diffusion MRI and tractography to investigate the relationship between structural morphology of the supraspinal corticospinal tract (CST) and the severity of two typical hand impairments experienced by individuals with HCP, grasp weakness and mirror movements. Results from nine children with HCP and eight children with typical development show that there is a significant hemispheric association between CST microstructure and hand impairment severity that may be explained by atypical development and fiber distribution of motor pathways. Further analysis in the non-lesioned (dominant) hemisphere shows significant differences for CST termination in the cortex between participants with HCP and those with typical development. These findings suggest that structural disparities at the cellular level in the seemingly unaffected hemisphere after early unilateral brain injury may be the cause of heterogeneous hand impairments seen in this population.Clinical Relevance- Quantitative measurement of the variability in hand function in individuals with HCP is necessary to represent the distinct impairments experienced by each person. Further understanding of the structural neural morphology underlying distal upper extremity motor deficits after early unilateral brain injury will help lead to the development of more specific targeted interventions that increase functional outcomes.
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Damiano DL, Pekar JJ, Mori S, Faria AV, Ye X, Stashinko E, Stanley CJ, Alter KE, Hoon AH, Chin EM. Functional and Structural Brain Connectivity in Children With Bilateral Cerebral Palsy Compared to Age-Related Controls and in Response to Intensive Rapid-Reciprocal Leg Training. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:811509. [PMID: 36189020 PMCID: PMC9397804 DOI: 10.3389/fresc.2022.811509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
Background Compared to unilateral cerebral palsy (CP), less is known about brain reorganization and plasticity in bilateral CP especially in relation or response to motor training. The few trials that reported brain imaging results alongside functional outcomes include a handful of studies in unilateral CP, and one pilot trial of three children with bilateral CP. This study is the first locomotor training randomized controlled trial (RCT) in bilateral CP to our knowledge reporting brain imaging outcomes. Methods Objective was to compare MRI brain volumes, resting state connectivity and white matter integrity using DTI in children with bilateral CP with PVL and preterm birth history (<34 weeks), to age-related controls, and from an RCT of intensive 12 week rapid-reciprocal locomotor training using an elliptical or motor-assisted cycle. We hypothesized that connectivity in CP compared to controls would be greater across sensorimotor-related brain regions and that functional (resting state) and structural (fractional anisotropy) connectivity would improve post intervention. We further anticipated that baseline and post-intervention imaging and functional measures would correlate. Results Images were acquired with a 3T MRI scanner for 16/27 children with CP in the trial, and 18 controls. No conclusive evidence of training-induced neuroplastic effects were seen. However, analysis of shared variance revealed that greater increases in precentral gyrus connectivity with the thalamus and pons may be associated with larger improvements in the trained device speed. Exploratory analyses also revealed interesting potential relationships between brain integrity and multiple functional outcomes in CP, with functional connectivity between the motor cortex and midbrain showing the strongest potential relationship with mobility. Decreased posterior white matter, corpus callosum and thalamic volumes, and FA in the posterior thalamic radiation were the most prominent group differences with corticospinal tract differences notably not found. Conclusions Results reinforce the involvement of sensory-related brain areas in bilateral CP. Given the wide individual variability in imaging results and clinical responses to training, a greater focus on neural and other mechanisms related to better or worse outcomes is recommended to enhance rehabilitation results on a patient vs. group level.
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Affiliation(s)
- Diane L. Damiano
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, United States
- *Correspondence: Diane L. Damiano
| | - James J. Pekar
- FM Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Susumu Mori
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andreia Vasconcellos Faria
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - X. Ye
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Elaine Stashinko
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
| | | | | | - Alec H. Hoon
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
| | - Eric M. Chin
- Johns Hopkins School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
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Amanat M, Majmaa A, Zarrabi M, Nouri M, Akbari MG, Moaiedi AR, Ghaemi O, Zamani F, Najafi S, Badv RS, Vosough M, Hamidieh AA, Salehi M, Montazerlotfelahi H, Tavasoli AR, Heidari M, Mohebi H, Fatemi A, Garakani A, Ashrafi MR. Clinical and imaging outcomes after intrathecal injection of umbilical cord tissue mesenchymal stem cells in cerebral palsy: a randomized double-blind sham-controlled clinical trial. Stem Cell Res Ther 2021; 12:439. [PMID: 34362453 PMCID: PMC8343813 DOI: 10.1186/s13287-021-02513-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study assessed the safety and efficacy of intrathecal injection of umbilical cord tissue mesenchymal stem cells (UCT-MSC) in individuals with cerebral palsy (CP). The diffusion tensor imaging (DTI) was performed to evaluate the alterations in white-matter integrity. METHODS Participants (4-14 years old) with spastic CP were assigned in 1:1 ratio to receive either UCT-MSC or sham procedure. Single-dose (2 × 107) cells were administered in the experimental group. Small needle pricks to the lower back were performed in the sham-control arm. All individuals were sedated to prevent awareness. The primary endpoints were the mean changes in gross motor function measure (GMFM)-66 from baseline to 12 months after procedures. The mean changes in the modified Ashworth scale (MAS), pediatric evaluation of disability inventory (PEDI), and CP quality of life (CP-QoL) were also assessed. Secondary endpoints were the mean changes in fractional anisotropy (FA) and mean diffusivity (MD) of corticospinal tract (CST) and posterior thalamic radiation (PTR). RESULTS There were 36 participants in each group. The mean GMFM-66 scores after 12 months of intervention were significantly higher in the UCT-MSC group compared to baseline (10.65; 95%CI 5.39, 15.91) and control (β 8.07; 95%CI 1.62, 14.52; Cohen's d 0.92). The increase was also seen in total PEDI scores (vs baseline 8.53; 95%CI 4.98, 12.08; vs control: β 6.87; 95%CI 1.52, 12.21; Cohen's d 0.70). The mean change in MAS scores after 12 months of cell injection reduced compared to baseline (-1.0; 95%CI -1.31, -0.69) and control (β -0.72; 95%CI -1.18, -0.26; Cohen's d 0.76). Regarding CP-QoL, mean changes in domains including friends and family, participation in activities, and communication were higher than the control group with a large effect size. The DTI analysis in the experimental group showed that mean FA increased (CST 0.032; 95%CI 0.02, 0.03. PTR 0.024; 95%CI 0.020, 0.028) and MD decreased (CST -0.035 × 10-3; 95%CI -0.04 × 10-3, -0.02 × 10-3. PTR -0.045 × 10-3; 95%CI -0.05 × 10-3, -0.03 × 10-3); compared to baseline. The mean changes were significantly higher than the control group. CONCLUSIONS The UCT-MSC transplantation was safe and may improve the clinical and imaging outcomes. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov ( NCT03795974 ).
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Affiliation(s)
- Man Amanat
- Department of Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran
| | - Anahita Majmaa
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Zarrabi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Masoumeh Nouri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Masood Ghahvechi Akbari
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Moaiedi
- Department of Pediatric Neurology, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abass, Iran
| | - Omid Ghaemi
- Pediatrics Center of Excellence, Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zamani
- Pediatrics Center of Excellence, Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharif Najafi
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatrics Center of Excellence Pediatric Hematology, Oncology and Stem Cell Transplantation Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Salehi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Montazerlotfelahi
- Department of Pediatrics, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Reza Tavasoli
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Heidari
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Mohebi
- Department of Pediatric Neurology, AJA University of Medical Sciences, Tehran, Iran
| | - Ali Fatemi
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Department of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Amir Garakani
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mahmoud Reza Ashrafi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Tso WWY, Hui ESK, Lee TMC, Liu APY, Ip P, Vardhanabhuti V, Cheng KKF, Fong DYT, Chang DHF, Ho FKW, Yip KM, Ku DTL, Cheuk DKL, Luk CW, Shing MK, Leung LK, Khong PL, Chan GCF. Brain Microstructural Changes Associated With Neurocognitive Outcome in Intracranial Germ Cell Tumor Survivors. Front Oncol 2021; 11:573798. [PMID: 34164332 PMCID: PMC8216078 DOI: 10.3389/fonc.2021.573798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Childhood intracranial germ cell tumor (GCT) survivors are prone to radiotherapy-related neurotoxicity, which can lead to neurocognitive dysfunctions. Diffusion kurtosis imaging (DKI) is a diffusion MRI technique that is sensitive to brain microstructural changes. This study aimed to investigate the association between DKI metrics versus cognitive and functional outcomes of childhood intracranial GCT survivors. Methods DKI was performed on childhood intracranial GCT survivors (n = 20) who had received cranial radiotherapy, and age and gender-matched healthy control subjects (n = 14). Neurocognitive assessment was performed using the Hong Kong Wechsler Intelligence Scales, and functional assessment was performed using the Lansky/Karnofsky performance scales (KPS). Survivors and healthy controls were compared using mixed effects model. Multiple regression analyses were performed to determine the effects of microstructural brain changes of the whole brain as well as the association between IQ and Karnofsky scores and the thereof. Results The mean Intelligence Quotient (IQ) of GCT survivors was 91.7 (95% CI 84.5 – 98.8), which was below the age-specific normative expected mean IQ (P = 0.013). The mean KPS score of GCT survivors was 85.5, which was significantly lower than that of controls (P < 0.001). Cognitive impairments were significantly associated with the presence of microstructural changes in white and grey matter, whereas functional impairments were mostly associated with microstructural changes in white matter. There were significant correlations between IQ versus the mean diffusivity (MD) and mean kurtosis (MK) of specific white matter regions. The IQ scores were negatively correlated with the MD of extensive grey matter regions. Conclusion Our study identified vulnerable brain regions whose microstructural changes in white and grey matter were significantly associated with impaired cognitive and physical functioning in survivors of pediatric intracranial GCT.
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Affiliation(s)
- Winnie Wan Yee Tso
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edward Sai Kam Hui
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.,Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony Pak Yin Liu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Vince Vardhanabhuti
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Dorita Hue Fung Chang
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Psychology, The University of Hong Kong, Hong, Kong, Hong Kong
| | - Frederick Ka Wing Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ka Man Yip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dennis Tak Loi Ku
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Daniel Ka Leung Cheuk
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Chung Wing Luk
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Ming Kong Shing
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Lok Kan Leung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pek Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Neurophysiological Assessments of Brain and Spinal Cord Associated with Lower Limb Functions in Children with Cerebral Palsy: A Protocol for Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11050628. [PMID: 34068265 PMCID: PMC8153104 DOI: 10.3390/brainsci11050628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Task-dependent neurophysiological adaptations in people with cerebral palsy have been examined using various techniques such as functional magnetic resonance imaging, peripheral nerve stimulation in order to assess H-reflexes, and transcranial magnetic stimulation. This activity-dependent plasticity is hypothesized to improve specific gross motor function in individuals with cerebral palsy. Although these adaptations have been examined extensively, most studies examined tasks utilizing the upper limbs. The aim of this review is to assess the neurophysiological adaptations of the central nervous system in individuals with cerebral palsy during lower limb functional tasks. Methods: A systematic review and meta-analysis will be conducted to evaluate the neurophysiological changes in the brain and spinal cord associated with lower extremity tasks in individuals with cerebral palsy. We will search within PubMed, MEDLINE, Embase, PsychINFO, and CINAHL using a predetermined search string to identify and evaluate relevant studies. Two independent reviewers will screen these studies against our inclusion criteria and risks of bias, and will extract the data from each study. A third reviewer will be used to resolve any disagreement regarding the inclusion of a study between reviewers. Randomized controlled trials as well as cross-sectional studies published in English 10 years before May 2021 that investigate the neurophysiological adaptations in the brain and spinal cord in people with cerebral palsy will be included if they meet the eligibility criteria. Primary outcomes will include scalar values of fractional anisotropy (FA), H-reflex gains or measures of amplitude, as well as motor cortex (M1) cortical excitability as measured by transcranial magnetic stimulation. Discussion: Since no identifiable data will be involved in this study, no ethical approval is required. Our results will provide insight into the neurophysiological adaptations in children with cerebral palsy, which will be useful in guiding directions for clinical decision making and future development of targeted interventions in pediatrics rehabilitation for children with cerebral palsy. Systematic review registration: The protocol for this systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215902).
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Structural network performance for early diagnosis of spastic cerebral palsy in periventricular white matter injury. Brain Imaging Behav 2021; 15:855-864. [PMID: 32306282 DOI: 10.1007/s11682-020-00295-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Periventricular white matter injury (PWMI) is a common cause of spastic cerebral palsy (SCP). Diffusion tensor imaging (DTI) shows high sensitivity but moderate specificity for predicting SCP. The limited specificity may be due to the diverse and extensive brain injuries seen in infants with PWMI. We enrolled 72 infants with corrected age from 6 to 18 months in 3 groups: PWMI with SCP (n = 20), non-CP PWMI (n = 19), and control (n = 33) groups. We compared DTI-based brain network properties among the three groups and evaluated the diagnostic performance of brain network properties for SCP in PWMI infants. Our results show abnormal global parameters (reduced global and local efficiency, and increased shortest path length), and local parameters (reduced node efficiency) in the PWMI with SCP group. On logistic regression, the combined node efficiency of the bilateral precentral gyrus and right middle frontal gyrus had a high sensitivity (90%) and specificity (95%) for differentiating PWMI with SCP from non-CP PWMI, and significantly correlated with the Gross Motor Function Classification System scores. This study confirms that DTI-based brain network has great diagnostic performance for SCP in PWMI infants, and the combined node efficiency improves the diagnostic accuracy.
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Hyde C, Fuelscher I, Sciberras E, Efron D, Anderson VA, Silk T. Understanding motor difficulties in children with ADHD: A fixel-based analysis of the corticospinal tract. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110125. [PMID: 33031859 DOI: 10.1016/j.pnpbp.2020.110125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Abstract
AIMS Children with attention deficit hyperactivity disorder (ADHD) often present with deficits in fine motor control. The cortico-spinal tract (CST) is critical for voluntary motor control. Although neuroimaging work has identified anomalous microstructural properties in the CST in ADHD, no study to date has attempted to investigate the link between deficits in fine motor performance and microstructural properties of the CST in children with ADHD. This study aimed to address this gap using a novel fixel-based analysis (FBA). METHODS Participants were 50 right-handed medication naïve children with a history of ADHD and 56 non-ADHD controls aged 9-11 years. Fine motor control was assessed using the Grooved Pegboard task. Children underwent high angular resolution diffusion MRI. Following pre-processing, FBA was performed and the semi-automated deep-learning TractSeg was used to delineate the CST bilaterally. Fibre density (FD), fibre cross-section (FC-log), and fibre density/cross-section (FDC) were extracted for each tract. RESULTS Children with ADHD performed significantly worse than non-ADHD children on the Grooved Pegboard task when using their non-dominant hand. They also demonstrated widespread significantly lower diffusion metrics in both CSTs compared to non-ADHD controls. However, no correlations were observed between Grooved Pegboard performance and diffusion metrics for the CST in either hemisphere. CONCLUSIONS While we failed to detect a significant relationship between fine motor skill and FBA metrics in either group, this paper extends previous work by showing that children with ADHD and reduced fine motor competence demonstrate atypical microstructure within the CST relative to non-ADHD controls.
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Affiliation(s)
- Christian Hyde
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Ian Fuelscher
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Emma Sciberras
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daryl Efron
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.; Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Tim Silk
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia; Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat 2020; 16:1505-1518. [PMID: 32606703 PMCID: PMC7297454 DOI: 10.2147/ndt.s235165] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/28/2020] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. According to the up-to-date definition, CP is a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The CP definition has evolved over time; the problem is aetiologically and clinically very heterogeneous. According to European data, the average frequency of CP is 2.08 per 1000 live births, but in the group of children born with a body weight below 1500 g, the frequency is 70 times higher when compared with the group of children with a body weight over 2500 g at birth. The risk factors for CP can be divided into pre-conception, prenatal, perinatal and postnatal ones. CP commonly co-exists with epilepsy, in particular drug-resistant epilepsy, but also with mental retardation, visual and hearing impairment, as well as feeding and behavioral disorders. The degree of motor problem varies from mild to very severe making the child totally dependent on caregivers. Cerebral palsy is divided into forms depending on the type of motor disorders which dominate the clinical presentation; the traditional classifications by Ingram and Hagberg have now been replaced by the Surveillance of Cerebral Palsy in Europe classification which divides CP into spastic, dyskinetic and ataxic forms. Although cerebral palsy is a clinical diagnosis, modern diagnostic imaging provides information that allows the division of the results of magnetic resonance imaging in children with cerebral palsy into five groups according to the magnetic resonance imaging classification system. Just as the clinical presentation and the factors predisposing for CP are very diverse, treatment is also a very complex problem. Modern treatment of spasticity includes both botulinum toxin therapies and surgical techniques, eg, rhizotomy. The authors present current views on definitions, risk factors, diagnostics and treatment of CP as well as comorbid problems, eg, drug-resistant epilepsy.
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Affiliation(s)
- Małgorzata Sadowska
- Department of Paediatrics and Developmental Age Neurology, Upper Silesian Child Health Centre, Katowice, Poland
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, School of Pharmacy with the Division of Laboratory Medicine, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
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