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Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways |
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| Authors: | ALEXANDER H HOON JR MD MPH, ELAINE E STASHINKO PHD, LIDIA M NAGAE MD, DORIS DM LIN MD PHD, JENNIFER KELLER MS PT, AMY BASTIAN PHD, MICHELLE L CAMPBELL MS, ERIC LEVEY MD, SUSUMU MORI PHD, MICHAEL V JOHNSTON MD |
| Affiliation: | Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.; Hospital Israelita Albert Einstein, São Paulo, Brazil.; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, USA.; Motion Analyses Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA.; Departments of Neurology, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA. |
| Abstract: | Aim Cerebral palsy (CP) is frequently linked to white matter injury in children born preterm. Diffusion tensor imaging (DTI) is a powerful technique providing precise identification of white matter microstructure. We investigated the relationship between DTI-observed thalamocortical (posterior thalamic radiation) injury, motor (corticospinal tract) injury, and sensorimotor function. Method Twenty-eight children born preterm (16 males, 12 females; mean age 5y 10mo, SD 2y 6mo, range 16mo–13y; mean gestational age at birth 28wks, SD 2.7wks, range 23–34wks) were included in this case–control study. Twenty-one children had spastic diplegia, four had spastic quadriplegia, two had hemiplegia, and one had ataxic/hypotonic CP; 15 of the participants walked independently. Normative comparison data were obtained from 35 healthy age-matched children born at term (19 males, 16 females; mean age 5y 9mo, SD 4y 4mo, range 15mo–15y). Two-dimensional DTI color maps were created to evaluate 26 central white matter tracts, which were graded by a neuroradiologist masked to clinical status. Quantitative measures of touch, proprioception, strength (dynamometer), and spasticity (modified Ashworth scale) were obtained from a subset of participants. Results All 28 participants with CP had periventricular white-matter injury on magnetic resonance imaging. Using DTI color maps, there was more severe injury in the posterior thalamic radiation pathways than in the descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity, whereas corticospinal tract injury did not correlate with motor or sensory outcome measures. Interpretation These findings extend previous research demonstrating that CP in preterm children reflects disruption of thalamocortical connections as well as descending corticospinal pathways. |
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