Developmental neuroplasticity of the white matter connectome in children with perinatal stroke

Abstract

ObjectiveWe aimed to employ diffusion imaging connectome methods to explore network development in the contralesional hemisphere of children with perinatal stroke and its relationship to clinical function. We hypothesized alterations in global efficiency of the intact hemisphere would correlate with clinical disability.MethodsChildren with unilateral perinatal arterial (n = 26) or venous (n = 27) stroke and typically developing controls (n = 32) underwent 3T diffusion and T1 anatomical MRI and completed established motor assessments. A validated atlas co-registered to whole-brain tractography for each individual was used to estimate connectivity between 47 regions. Graph theory metrics (assortativity, hierarchical coefficient of regression, global and local efficiency, and small worldness) were calculated for the left hemisphere of controls and the intact contralesioned hemisphere of both stroke groups. Validated clinical motor assessments were then correlated with connectivity outcomes.ResultsGlobal efficiency was higher in arterial strokes compared to venous strokes (p < 0.001) and controls (p < 0.001) and was inversely associated with all motor assessments (all p < 0.012). Additional graph theory metrics including assortativity, hierarchical coefficient of regression, and local efficiency also demonstrated consistent differences in the intact hemisphere associated with clinical function.ConclusionsThe structural connectome of the contralesional hemisphere is altered after perinatal stroke and correlates with clinical function. Connectomics represents a powerful tool to understand whole brain developmental plasticity in children with disease-specific cerebral palsy.

Imaging Developmental and Interventional Plasticity Following Perinatal Stroke

“…We have recently confirmed that a structural connectomics approach is feasible in perinatal stroke. 144 When investigating the non-lesioned hemisphere, we revealed modest but consistent relationships between baseline clinical motor function and some graph theory metrics. 144 Advanced diffusion imaging methods may therefore open the door for investigating how structural and whole-brain connectivity change following intensive occupational therapy or noninvasive brain stimulation.…”

“…144 When investigating the non-lesioned hemisphere, we revealed modest but consistent relationships between baseline clinical motor function and some graph theory metrics. 144 Advanced diffusion imaging methods may therefore open the door for investigating how structural and whole-brain connectivity change following intensive occupational therapy or noninvasive brain stimulation. Baseline microstructural variables in the lesioned CST correlated with larger gains in rehabilitation in children with unilateral cerebral palsy 145 though results vary.…”

Effects of Daily Iron Supplementation on Motor Development and Brain Connectivity in Preterm Infants: A Diffusion Magnetic Resonance Study

“…Previous studies have found that structural connections between motor-related brain regions play an important role in movement development ( Craig et al, 2020 ). Only 32 of A-LF infants and 17 of NA-HF infants had qualified MRI examination.…”

“…Clinical neuroimaging research on early motor abilities is still limited. Previous studies have found that structural connections between motor-related brain regions play an important role in movement development ( Craig et al, 2020 ). Cranial magnetic resonance (MRI) is a common and valuable method to study the infant brain functions, and diffusion tensor imaging (DTI) is a non-invasive method to study the white matter of the brain.…”

Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke

“…Our group and others have demonstrated the ability of tractography to better understand sensory and motor functions in children with perinatal stroke (Hodge et al, 2017;Kuczynski et al, 2017;Kuczynski et al, 2018;van der Aa et al, 2011). Furthermore, recent evidence has emphasized the essential role of widespread network alterations in the nonlesioned hemisphere in determining perinatal stroke outcomes (Craig et al, 2020), emphasizing the importance of interhemispheric connectivity.…”