Corticospinal Dysgenesis and Upper-Limb Deficits in Congenital Hemiplegia: A Diffusion Tensor Imaging Study

Abstract

OBJECTIVES: Precision grasping critically relies on the integrity of the corticospinal tract as evidenced in congenital hemiplegia by the correlation found between corticospinal dysgenesis and hand-movement deficits. Therefore, corticospinal dysgenesis could be used to anticipate upper-limb deficits in young infants with congenital hemiplegia. However, most studies have quantified corticospinal dysgenesis by measuring the cross-sectional area of cerebral peduncles on T1 MRI, a measure biased by other structures present in the peduncles. The purpose of this study was to evaluate the extent to which this may have hampered the conclusions of previous studies. We also aimed to investigate the relationship between upper-limb deficits and a more accurate measure of corticospinal dysgenesis to provide a tool for anticipating upper-limb deficits in infants with congenital hemiplegia. METHODS: To address this issue, we measured corticospinal tract areas in 12 patients with congenital hemipleg... Document type : Article de périodique (Journal article) Référence bibliographiqueBleyenheuft, Yannick ; Grandin, Cécile ; Cosnard, Guy ; Olivier, Etienne ; Thonnard, Jean-Louis. The authors have indicated they have no financial relationships relevant to this article to disclose. Corticospinal dysgenesis and upper-limb deficits in congenital hemiplegia ABSTRACTOBJECTIVES. Precision grasping critically relies on the integrity of the corticospinal tract as evidenced in congenital hemiplegia by the correlation found between corticospinal dysgenesis and hand-movement deficits. Therefore, corticospinal dysgenesis could be used to anticipate upper-limb deficits in young infants with congenital hemiplegia. However, most studies have quantified corticospinal dysgenesis by measuring the cross-sectional area of cerebral peduncles on T1 MRI, a measure biased by other structures present in the peduncles. The purpose of this study was to evaluate the extent to which this may have hampered the conclusions of previous studies. We also aimed to investigate the relationship between upper-limb deficits and a more accurate measure of corticospinal dysgenesis to provide a tool for anticipating upper-limb deficits in infants with congenital hemiplegia.

Advanced Fiber Tracking in Early Acquired Brain Injury Causing Cerebral Palsy

“…[14][15][16] In addition, correlations have been shown between diffusion measures in motor and sensory tracts and specific measures of sensory and/or motor functions. [5][6][7][17][18][19][20] Some studies suggest that sensory and motor functions correlate more strongly with changes in the sensory pathways (superior and posterior thalamic radiation) than changes in the motor pathways (CST). 6,19 These findings indicate that preservation of sensory pathways is important for motor function.…”

Motor, sensory and executive function brain networks in children with unilateral cerebral palsy

“…There were on average 1.6 males to each female. Four studies (18%) included participants with spasticity in any motor distribution 67,72,75,80 ; 14 studies (64%) investigated specific motor distributions of spasticity, including seven (32%) of children with spastic hemiplegia 48,64,65,[68][69][70]81 ; two studies (9%) of children with spastic diplegia 66,73 ; three studies (14%) of children with spastic quadriplegia 60,71,82 , one study of children with bilateral spasticity 77 ; and one study comparing spastic quadriplegia with diplegia 79 .…”

“…Twelve studies (55%) assessed correlations between imaging and clinical outcomes 48, 61, 64-66, 69, 71-73, 77, 81, 82 . Of these, six (50%) assessed GMFCS 65, 71-73, 77, 82 , three (25%) used other clinical measures of global function 64,69,82 , and five (42%) assessed upper limb function 48,61,65,66,81 .…”

“…No studies showed decreased MD. Three studies assessed the volume or cross-sectional area of the CST 75,76,81 , and all reported a decrease in children with CP. Four studies also reported on the number of tracts generated using tractography 48,69,72,77 , and all reported a decrease in the number of tracts in CST of CP groups.…”

“…Four studies used diffusion tensor imaging to identify the CST and assess symmetry of properties between ipsilateral and contralateral tracts in spastic hemiplegia 48,64,68,81 . Asymmetry was demonstrated in cross-sectional area 81 , FA 64,68 , MD 68 , and number of tracts 48 .…”