The Role of the Corpus Callosum in Pediatric Dysphagia: Preliminary Findings from a Diffusion Tensor Imaging Study in Children with Unilateral Spastic Cerebral Palsy

Abstract

The purpose of this study is to determine the relationship between the structural integrity of the corpus callosum (CC) and clinical feeding/swallowing performance in children with unilateral spastic cerebral palsy (USCP). Twenty children with USCP, (11 males, 5.11-17.6 yoa) were assessed via the Dysphagia Disorder Survey (DDS) and diffusion tensor imaging. Children were grouped into left hemisphere lesion (LHL; n = 13) and right hemisphere lesion (RHL; n = 7) groups. DTI variables analyzed for three CC regions (anterior, middle, posterior) were: fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and fibers count. Children with RHL presented with higher clinical dysphagia severity (p = 0.03). Six of seven children with RHL had lesions affecting periventricular/subcortical areas, and 8/13 children with LHL had lesions affecting the sensorimotor cortex. In the LHL group, as FA and fiber count of the anterior CC decreased and RD increased (all indicating reduced CC structural integrity), signs of dysphagia increased (r = -0.667, p = 0.013; r = -0.829, p ≤ 0.001; r = 0.594, p = 0.032, respectively). Reduced fiber count in the middle and posterior CC was also significantly associated with increased DDS scores (r = -0.762, p = 0.002; r = -0.739, p = 0.004, respectively). For the RHL group no significant correlations were observed. We provide preliminary evidence that corpus callosum integrity correlates with feeding/swallowing performance in children with USCP, especially when cortical sensorimotor areas of the left hemisphere are impacted. In this sample, CC integrity appeared to enable interhemispheric cortical plasticity for swallowing, but was not as critical when intrahemispheric connections were disrupted, as seen in the RHL group.

Feeding and swallowing impairment in children with stroke and unilateral cerebral palsy: a systematic review

“…The DMSS was used for this study as it provided data regarding presence/absence of dysphagia in all participants. Neither of these two studies clearly reported the time of dysphagia assessment after unilateral CP diagnosis.…”

“…Across the five included studies, there were 411 participants ranging from sample sizes of 14 to 248 (Table ). Three studies included patients from the United States, one from Poland, and one was conducted in Canada but enrolled patients from 10 different countries using an international registry…”

“…Two of the included studies identified children with unilateral CP and were prospective in design, with one study further specifying CP type as unilateral CP. Neither study clearly reported the etiology of CP; however, one study reported the diagnosis as congenital. This same study also documented lesion type and laterality.…”

“…Dysphagia was captured in one study by caregiver observation and clinical swallowing assessment. The other study captured dysphagia characteristics using the Dysphagia Disorder Survey (DDS), and dysphagia presence/severity using the Dysphagia Management Staging Scale (DMSS) . The DDS and the DMSS clinically evaluated feeding and swallowing performance, which was scored during observation of a child's regular lunchtime meal.…”

Developmental Features of Corpus Callosum in Children Revealed by MRI

“…При этом показатели фракционной анизотропии этих структур статистически значимо коррелируют с тяжестью двигательных нарушений при одной из самых распространенных форм ДЦП -спа-стической диплегии [27]. Высказывается мнение, что сниженный КФА именно мозолистого тела, а не кортикоспинальных трактов является точным индикатором моторного дефицита у детей с ди-плегической формой ДЦП, особенно в отношении тонких мануальных навыков [24,29,46]. Мозоли-стое тело при ДЦП тоньше, чем у неврологиче-ски здоровых детей, что соотносится с диффуз-ной потерей всего белого вещества полушарий мозга.…”