The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review—Part B diffusion imaging and tractography

Abstract

BackgroundDiffusion magnetic resonance imaging (dMRI) is able to detect, localize and quantify subtle brain white matter abnormalities that may not be visible on conventional structural MRI. Over the past years, a growing number of studies have applied dMRI to investigate structure-function relationships in children with cerebral palsy (CP). AimsTo provide an overview of the recent literature on dMRI and motor function in children with CP. MethodsA systematic literature search was conducted in PubMed, Embase, Cochrane Central Register of Controlled trials, Cinahl and Web of Science from 2012 onwards. ResultsIn total, 577 children with CP in 19 studies were included. Sixteen studies only included unilateral CP, while none included dyskinetic CP. Most studies focused on specific regions/tracts of interest (n=17) versus two studies that investigated the whole brain. In unilateral and bilateral CP, white matter abnormalities were widespread including non-motor areas. In unilateral CP, consistent relationships were found between white matter integrity of the corticospinal tract and somatosensory pathways (e.g. thalamocortical projections, medial lemniscus) with upper limb sensorimotor function. The role of commissural and associative tracts remains poorly investigated. Also results describing structurefunction relationships in bilateral CP are scarce (n=3). ConclusionsThis review underlines the importance of both the motor and somatosensory tracts for upper limb sensorimotor function in unilateral CP. However, the exact contribution of each tract requires further exploration. In addition, research on the relevance of non-motor pathways is warranted, as well as studies including other types of CP. What this paper adds• An overview of the current literature investigating the relationship between diffusion MRI based measures of white matter tract integrity and motor function in CP.• Current gaps and future recommendations to further improve our insights into these structurefunction relationships. Highlights• In unilateral and bilateral CP, white matter microstructural abnormalities are widespread including non-motor areas.• In unilateral CP, dMRI reveals a relationship between the microstructural properties of motor and somatosensory tracts and upper limb sensorimotor function.• The contribution of motor versus somatosensory tracts needs further clarification.• There are limited studies in bilateral spastic CP and in children with dyskinetic CP.

Upper Limb Motor Planning in Individuals with Cerebral Palsy Aged between 3 and 21 Years Old: A Systematic Review

“…Most studies focused on hemiplegia, but other CP subtypes should be acknowledged as well, such as bilateral CP [ 129 ]. The etiology of CP was not explored in relation to motor planning, despite the fact that its impact on motor function has been established [ 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ]. This is further supported by studies on other pediatric populations which have shown that damage to certain neurological networks is associated with motor planning deficits in children with tumors [ 133 , 134 ] or in children with neurodevelopmental disorders [ 135 , 136 ].…”

Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities

“…Nonetheless, the neural network anomalies have some disorder-specific characteristics. For instance, the network anomalies reported in children with CP virtually always include lesions of the white matter of the sensorimotor areas, often comprising the periventricular white matter [11,14], whereas those reported in children with ASD virtually always include abnormalities in the networks of the so-called 'social brain', that comprise the fronto-temporal and fronto-parietal regions [13,15].…”

Editorial: Cerebral Palsy: New Developments

“…Wu F. et al analyzed the most cited imaging articles in CP over three decades and concluded that multi-modality neuroimaging and high-level evidence-based methodologies could be used in future research to further elucidate pathophysiology, prognosis and efficacy of proposed treatments. Reviews emphasized the need for uniform procedures of MRI classification ( 8 ), image acquisition, and common outcome measures ( 9 , 10 ). A common data language for research, such as the common data elements for CP proposed by the AACPDM, will facilitate comparison between studies ( 11 ).…”