TY  - JOUR
T1  - White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy
A1  - Mailleux, Lisa
A1  - Simon-Martinez, Cristina
A1  - Radwan, Ahmed
A1  - Blommaert, Jeroen
A1  - Gooijers, Jolien
A1  - Wenderoth, Nicole
A1  - Klingels, Katrijn
A1  - Ortibus, Els
A1  - Sunaert, Stefan
A1  - Feys, Hilde
JA  - Brain Structure and Function
Y1  - 2020
VL  - 225
SP  - 1495
EP  - 1509
M2  - doi: https://doi.org/10.1007/s00429-020-02070-1
KW  - Brain injuries
KW  - Diffusion magnetic resonance imaging
KW  - Transcranial magnetic stimulation
KW  - Unilateral cerebral palsy
KW  - Upper extremity
N2  - 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.
ER  -