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Liu J, Tsuboyama M, Jannati A, Kaye HL, Hipp JF, Rotenberg A. Shortened Motor Evoked Potential Latency in the Epileptic Hemisphere of Children With Focal Epilepsy. J Clin Neurophysiol 2024; 41:530-536. [PMID: 37820241 DOI: 10.1097/wnp.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Motor evoked potential (MEP) amplitude and latency are acquired routinely during neuronavigated transcranial magnetic stimulation, a method of functional mapping of the motor cortex before epilepsy surgery. Although MEP amplitude is routinely used to generate a motor map, MEP latency in patients with focal epilepsy has not been studied systematically. Given that epilepsy may alter myelination, we tested whether intrinsic hand muscle MEPs obtained from the hemisphere containing a seizure focus differ in latency from MEPs collected from the opposite hemisphere. METHODS Latencies of abductor pollicis brevis MEPs were obtained during routine motor mapping by neuronavigated transcranial magnetic stimulation in children with intractable, unihemispheric focal epilepsy. The primary motor cortex was stimulated bilaterally in all cases. Only data from patients without a lesion involving the corticospinal tract were included. We tested whether abductor pollicis brevis MEP latency varied as a function of seizure focus lateralization. RESULTS In the 17 patients who met the inclusion criteria, the mean latency of MEPs with amplitudes in the top and bottom quartiles was shorter in the epileptic hemisphere. Interhemispheric latency difference was greater in patients with lesional epilepsy than in those with nonlesional epilepsy (0.7 ± 0.4 vs. 0.1 ± 0.6 milliseconds, P = 0.02). CONCLUSIONS Motor evoked potential latency was shortened in the epileptic hemisphere of children with focal epilepsy.
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Affiliation(s)
- Jingjing Liu
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Neurology, Peking University International Hospital, Beijing, China
| | - Melissa Tsuboyama
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ali Jannati
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Harper Lee Kaye
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Boston University School of Medicine, Behavioral Neuroscience Program, Boston, Massachusetts, U.S.A.; and
| | - Joerg F Hipp
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
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Kim SY, Roh CH, Kim DS, Kim GW, Won YH, Ko MH, Seo JH, Park SH. Ipsilateral Motor Evoked Potentials in a Preschool-age Child With Traumatic Brain Injury: A Case Report. BRAIN & NEUROREHABILITATION 2023; 16:e20. [PMID: 37554259 PMCID: PMC10404811 DOI: 10.12786/bn.2023.16.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
To the best of our knowledge, the upper age limit at which post-neonatal cerebral palsy (CP) can manifest remains uncertain. This uncertainty is attributed to the lack of objective parameters for assessing the developing brain. In a previous study, we reported that an ipsilateral corticospinal projection associated with brain injury, as manifested in the paretic hand of a CP patient, had never been observed in individuals aged > 2 years. In this case report, we present an instance of ipsilateral motor evoked potential (iMEP) in a girl whose traumatic brain injury occurred at the age of 4 years. This case is the oldest in which brain injury occurred and iMEP was maintained. In conclusion, iMEP can be a valuable indicator of motor system plasticity in the developing brain.
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Affiliation(s)
- Seong-Yeol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
| | - Choong-Hee Roh
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Roh CH, Kim DS, Kim GW, Won YH, Ko MH, Seo JH, Park SH. Motor organization of unilateral polymicrogyria associated with ipsilateral brainstem atrophy - a case report. BMC Neurol 2022; 22:303. [PMID: 35982397 PMCID: PMC9386979 DOI: 10.1186/s12883-022-02795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Polymicrogyria refers to the disruption of normal cerebral cortical development late in neuronal migration or in early cortical organization. Although patients with polymicrogyria feature relatively favorable motor outcomes, polymicrogyric lesions accompanied by extensive unilateral hemispheric atrophy and ipsilateral brainstem atrophy may induce poorer motor outcomes. This study is the first to employ transcranial magnetic stimulation (TMS) and diffusion tensor imaging (DTI) to characterize changes to motor organization and white matter tracts induced by polymicrogyria. Case presentation We document a case of a 16-year-old female with left hemiplegic unilateral polymicrogyria associated with ipsilateral brainstem atrophy. Magnetic resonance imaging (MRI) of the brain revealed unilateral polymicrogyria to have affected anterior cortical areas, including the perisylvian region on the right side. The right halves of the brain and brainstem were significantly smaller than the left halves. Although our patient was found to exhibit cortical dysplasia of the right frontoparietal and sylvian fissure areas and a decreased number of fibers in the corticospinal tract (CST) of the affected side on DTI, the connectivity of the CST was preserved up to the motor cortex. We also measured the cross-sectional area of the CST at the level of the pons. In TMS, contralateral motor evoked potentials (MEPs) were evoked from both hands, but the ipsilateral MEPs were evoked only from the left hand. The left hand featured a long duration, polyphasic pattern of contralateral MEPs. Discussion and conclusion TMS revealed that the concurrent bilateral projections to the paretic hand from the affected and unaffected hemispheres and contralateral MEPs in the paretic hand were polyphasic, indicating delayed electrophysiological maturation or a pathologic condition of the corticospinal motor pathways. In DTI, the cross-sectional area of the CST at the level of the pons on the affected side was smaller than that on the unaffected side. These DTI findings reveal an inadequate CST volume. Despite extensive brain malformation and ipsilateral brainstem atrophy, our patient had less severe motor dysfunction and presented with involuntary mirror movements. Mirror movements in the paretic hand are considered to indicate ipsilateral corticospinal projections from the unaffected hemisphere and may suggest favorable motor outcomes in early brain injury.
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Affiliation(s)
- Choong-Hee Roh
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea
| | - Da-Sol Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea
| | - Jeoung-Hwan Seo
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea
| | - Sung-Hee Park
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, Republic of Korea. .,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, 54907, Republic of Korea.
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Feng L, Zhang X, Guo D, Li C, Qi X, Bai Y, Cao J, Sun B, Yao Z, Gao J, Cui L, Guo L. Utilization of intraoperative neuromonitoring during the Woodward procedure for treatment of Sprengel deformity. J Shoulder Elbow Surg 2022; 31:e405-e412. [PMID: 35121118 DOI: 10.1016/j.jse.2021.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/18/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachial plexus injury (BPI) leading to palsy of the upper extremities is the most serious complication of the Woodward procedure for treatment of Sprengel deformity. Intraoperative neuromonitoring (IONM) is widely used for detecting emerging spinal cord or peripheral nerve injury during spinal and shoulder surgery. However, to date, its utilization in pediatric patients with Sprengel deformity is limited. Furthermore, it remains unclear whether IONM can help prevent BPI during surgery. The purpose of the current study was to assess the feasibility and effectiveness of IONM for early identification and prevention of nerve injury during the Woodward procedure. METHODS We retrospectively reviewed the records of patients who underwent the Woodward procedure for Sprengel deformity at our institution between January 2017 and January 2020. IONM, including somatosensory evoked potentials (SEP) and motor evoked potentials (MEPs), was performed in all patients. Detailed IONM data were collected and analyzed. Preoperative and postoperative cosmetic appearance (according to the Cavendish classification), shoulder joint abduction function, and radiologic evaluation of the scapula were reviewed. Surgical complications were recorded. RESULTS Forty-six patients (19 girls, 27 boys) were included (mean age, 5.1 ± 2.1 years). Both SEP and MEP (amplitude of the abductor pollicis) were successfully performed (100%). MEP alerts occurred in 3 patients (6.5%). After scapula position adjustment, signals recovered in 2 patients and remained unchanged in 1 patient-this patient exhibited postoperative motor deficits that resolved completely by 4 months recovery. The SEP amplitudes decreased in all 3 patients but did not reach the warning criteria. Forty patients were classified as grade III and 6 as grade IV in the Cavendish classification, whereas 35 patients were classified as grade II and 11 as grade III in the Rigault scale. The preoperative Cavendish grade was III (III, IV) and the postoperative Cavendish grade was I (I, II) (χ2 = 88.098, P < .001). The preoperative Rigault grade was II (II, III) and the postoperative Rigault grade was I (I, II) (χ2 = 62.133, P < .001). The mean arc of shoulder joint abduction improved from 99° ± 8° to 167° ± 7° (t = -45.871, P < .001) after surgery. Except for temporary motor deficits detected in 1 patient, no other postoperative complications were observed through the time of final follow-up. CONCLUSION IONM during the Woodward procedure for Sprengel deformity is feasible and effective in detecting intraoperative neurologic changes and may be effective in preventing BPI associated with surgery.
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Affiliation(s)
- Lei Feng
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuejun Zhang
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| | - Dong Guo
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chengxin Li
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinyu Qi
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yunsong Bai
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Cao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Baosheng Sun
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ziming Yao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jingchun Gao
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lanyue Cui
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lanjun Guo
- Department of Surgical Neuromonitoring, University of California, San Francisco, CA, USA
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Kim ED, Kim GW, Won YH, Ko MH, Seo JH, Park SH. Ten-Year Follow-Up of Transcranial Magnetic Stimulation Study in a Patient With Congenital Mirror Movements: A Case Report. Ann Rehabil Med 2019; 43:524-529. [PMID: 31499606 PMCID: PMC6734025 DOI: 10.5535/arm.2019.43.4.524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/06/2018] [Indexed: 12/02/2022] Open
Abstract
Most studies concerning congenital mirror movements (CMMs) have been focused on the motor organization in the distal hand muscles exclusively. To the best of our knowledge, there is no data on motor organization pattern of lower extremities, and a scarcity of data on the significance of forearm and arm muscles in CMMs. Here, we describe the case of a 19-year-old boy presenting mirror movements. In these terms, a 10-year transcranial magnetic stimulation study demonstrated that the motor organization pattern of the arm muscles was different from that of distal hand and forearm muscles even in the same upper extremity, and that the lower extremities showed the same pathways as healthy children. Moreover, in this case, an ipsilateral motor evoked potentials (MEPs) for distal hand muscles increased in amplitude with age, even though the intensity of mirror movements decreased. In the arm muscles, however, it was concluded that the contralateral MEPs increased in amplitude with age.
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Affiliation(s)
- Eu-Deum Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Abstract
This study describes the longitudinal changes of resting motor threshold (RMT) and central motor conduction time (CMCT) in 18 patients with Wilson's disease (WD). The RMT, CMCT, and Global Assessment Scale for Wilson Disease (GAS-WD) were measured at baseline and at follow-up after 12.94 ± 7.23 months. There was a significant decrease in the RMT (72.11 ± 18.62 vs. 63.7 ± 15.52%; p-value = 0.002) and GAS-WD scores (14.38 ± 5.35 vs. 9.77 ± 6.47 ms; p-value = 0.04). CMCT did not improve despite chelation therapy. Hence, RMT may serve as a marker of chelation efficacy in WD.
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Kim DS, Kim ED, Kim GW, Won YH, Ko MH, Seo JH, Park SH. Motor Evoked Potentials in the Upper Extremities of Children with Spastic Hemiplegic Cerebral Palsy. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Eu-Deum Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jeon-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Park BH, Park SH, Seo JH, Ko MH, Chung GH. Neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy. Ann Rehabil Med 2014; 38:189-99. [PMID: 24855613 PMCID: PMC4026605 DOI: 10.5535/arm.2014.38.2.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/10/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy (CP), by using magnetic resonance imaging (MRI), voxel-based morphometry (VBM), diffusion tensor tractography (DTT), and motor evoked potential (MEP). METHODS Twenty-three patients with dyskinetic CP (13 males, 10 females; mean age 34 years, range 16-50 years) were participated in this study. Functional evaluation was assessed by the Gross Motor Functional Classification System (GMFCS) and Barry-Albright Dystonia Scale (BADS). Brain imaging was performed on 3.0 Tesla MRI, and volume change of the grey matter was assessed using VBM. The corticospinal tract (CST) and superior longitudinal fasciculus (SLF) were analyzed by DTT. MEPs were recorded in the first dorsal interossei, the biceps brachii and the deltoid muscles. RESULTS Mean BADS was 16.4±5.0 in ambulatory group (GMFCS levels I, II, and III; n=11) and 21.3±3.9 in non-ambulatory group (GMFCS levels IV and V; n=12). Twelve patients showed normal MRI findings, and eleven patients showed abnormal MRI findings (grade I, n=5; grade II, n=2; grade III, n=4). About half of patients with dyskinetic CP showed putamen and thalamus lesions on MRI. Mean BADS was 20.3±5.7 in normal MRI group and 17.5±4.0 in abnormal MRI group. VBM showed reduced volume of the hippocampus and parahippocampal gyrus. In DTT, no abnormality was observed in CST, but not in SLF. In MEPs, most patients showed normal central motor conduction time. CONCLUSION These results support that extrapyramidal tract, related with basal ganglia circuitry, may be responsible for the pathophysiology of dyskinetic CP rather than CST abnormality.
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Affiliation(s)
- Byung-Hyun Park
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Korea
| | - Gyung-Ho Chung
- Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea
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