An Australian population study of factors associated with MRI patterns in cerebral palsy

Abstract

ABBREVIATIONS GMIGrey RESULTS White matter injury was the most common MRI pattern (45%), followed by grey matter injury (14%), normal imaging (13%), malformations (10%), focal vascular insults (9%), and miscellaneous patterns (7%). Parity, birth gestation, level of neonatal care, Apgar score, and time to established respiration varied between MRI patterns (p<0.01). Nulliparity was most strongly associated with focal vascular insults, whereas multiparity was associated only with malformations. Grey matter injury was not associated with birth in a tertiary unit, but was strongly associated with severe perinatal compromise. The frequency of neonatal seizures and of nursery admissions was lowest among children with malformations.INTERPRETATION As known risk factors for CP are differentially associated with specific MRI patterns, future exploration of causal pathways might be facilitated when performed in pathogenically defined groups.Cerebral palsy (CP) is a disorder of movement and posture that results from a non-progressive disturbance to the developing brain. 1 The condition encompasses a variety of aetiological pathways, pathogenic mechanisms, and clinical manifestations. Magnetic resonance imaging (MRI) provides an in vivo view of brain structure and plays a pivotal role in identification of the most likely pathogenic mechanism. Particular patterns of abnormality on neuroimaging can provide clues as to the nature, timing, and severity of the cerebral injury. Consequently, investigation of potentially preventable antecedent factors is likely to be most informative when performed in subgroups based on neuroimaging patterns. Clinically defined subgroups are less useful for this purpose as different types of adverse event may result in the same clinical pattern of CP and a similar aetiology may produce variable outcomes. 2Three systematic reviews have amalgamated imaging data and determined the proportion of abnormal scans in children with CP; however, few of the included studies used population samples or included all CP subtypes. 2-4More recently, CP registries have adopted comparable classification systems for imaging findings in CP. This has enabled comparison of imaging findings between contemporary population cohorts and has resulted in a small number of papers reporting associations between imaging patterns, birth gestation, and clinical variables. [5][6][7][8] In this study, we aimed to describe the distribution of MRI patterns in a large population-based sample of children with CP and to examine associations between neuroimaging patterns, and antenatal and perinatal factors typically recorded by CP registries. The strength of evidence for causality was also considered, particularly with respect to strength of association, consistency of findings between studies, and biological plausibility. We built on previous work by using a larger, geographically defined cohort, including a range of antenatal and perinatal variables, in addition to birth gestation, and through the use of population comparison data. Our ...

MRIclassification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations

“…This manual was included in the Reference and Training Manual of the SCPE (www.scpenetwork.eu/en/rtm/). 2 The literature review for other classification systems of MRI findings in CP identified 49 publications, 10 of which qualified for further analysis because they used specific classification systems: two were reviews, 8,9 five population based studies, 11,[21][22][23][24] and three focused on a specific CP subtype. [25][26][27] All these studies had in common a high proportion of abnormal MRIs (83-87%).…”

Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol

“…An insult close to term causes predominantly cortical and subcortical grey matter lesions (e.g. injuries involving the thalamus and basal ganglia) [9, 10]. The timing of the brain disturbance, in addition to its size and location, has been reported to be closely related to the severity of motor impairments [9, 11].…”

The influence of early modified constraint‐induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy

“…This was based on the earlier described assumption that the basic pattern of brain lesion in this group is WMDI. 22 The medical records also confirmed the children's history supporting this decision. A bivariate model was run in which the limit and rate were assumed to depend on both the basic pattern of brain lesion and the intervention with an interaction, i.e.…”