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01-06-2020 | Transcranial Magnetic Stimulation | Original Article

White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy

Authors: Lisa Mailleux, Cristina Simon-Martinez, Ahmed Radwan, Jeroen Blommaert, Jolien Gooijers, Nicole Wenderoth, Katrijn Klingels, Els Ortibus, Stefan Sunaert, Hilde Feys

Published in: Brain Structure and Function | Issue 5/2020

Abstract

This study explored the role of lesion timing (periventricular white matter versus cortical and deep grey matter lesions) and type of corticospinal tract (CST) wiring pattern (contralateral, bilateral, ipsilateral) on white matter characteristics of the CST, medial lemniscus, superior thalamic radiations and sensorimotor transcallosal fibers in children with unilateral cerebral palsy (CP), and examined the association with upper limb function. Thirty-four children (mean age 10 years 7 months ± 2 years 3 months) with unilateral CP underwent a comprehensive upper limb evaluation and diffusion weighted imaging (75 directions, b value 2800). Streamline count, fractional anisotropy and mean diffusivity were extracted from the targeted tracts and asymmetry indices were additionally calculated. Transcranial magnetic stimulation was applied to assess the CST wiring pattern. Results showed a more damaged CST in children with cortical and deep grey matter lesions (N = 10) and ipsilateral CST projections (N = 11) compared to children with periventricular white matter lesions (N = 24; p < 0.02) and contralateral CST projections (N = 9; p < 0.025), respectively. Moderate to high correlations were found between diffusion metrics of the targeted tracts and upper limb function (r = 0.45–0.72; p < 0.01). Asymmetry indices of the CST and sensory tracts could best explain bimanual performance (74%, p < 0.0001) and unimanual capacity (50%, p = 0.004). Adding lesion timing and CST wiring pattern did not further improve the model of bimanual performance, while for unimanual capacity lesion timing was additionally retained (58%, p = 0.0002). These results contribute to a better understanding of the underlying neuropathology of upper limb function in children with unilateral CP and point towards a clinical potential of tractography.

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Title: White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy
Authors: Lisa Mailleux
Cristina Simon-Martinez
Ahmed Radwan
Jeroen Blommaert
Jolien Gooijers
Nicole Wenderoth
Katrijn Klingels
Els Ortibus
Stefan Sunaert
Hilde Feys
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation
Published in: Brain Structure and Function / Issue 5/2020
Print ISSN: 1863-2653
Electronic ISSN: 1863-2661
DOI: https://doi.org/10.1007/s00429-020-02070-1

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White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy

Abstract

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