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Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy
Frontiers in Human Neuroscience ( IF 2.9 ) Pub Date : 2020-07-09 , DOI: 10.3389/fnhum.2020.00275
Eirini Papageorgiou 1, 2 , Nathalie De Beukelaer 1, 2 , Cristina Simon-Martinez 1, 3 , Lisa Mailleux 1 , Anja Van Campenhout 4, 5 , Kaat Desloovere 1, 2 , Els Ortibus 4
Affiliation  

The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [N = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: rs = 0.404, p ≤ 0.001; bCP: rs = 0.335, p ≤ 0.05; uCP: rs = 0.493, p ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: rs = 0.392, p ≤ 0.001; bCP: rs = 0.316, p ≤ 0.05; uCP: rs = 0.331, p ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level (rs = −0.523, p ≤ 0.001) and the GVS-knee sagittal (rs = −0.311, p ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS (rs = 0.321, p ≤ 0.001) and between periventricular layer damage and the GMFCS (rs = 0.348, p ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: rpb = 0.495, p ≤ 0.001; bCP: rpb = 0.357, p ≤ 0.05; uCP: rpb = 0.641, p ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension (p ≤ 0.001 and p ≤ 0.001) and flexion (p = 0.016 and p = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.

中文翻译:

痉挛性脑瘫患儿的结构性脑损伤和步态病理学

痉挛性脑瘫 (CP) 儿童的脑损伤与运动功能之间的相互作用尚未完全清楚。因此,使用半定量 MRI (sqMRI) 量表来探索是否在该人群中发现了与功能能力和步态病理相关的脑损伤。选择了具有痉挛性 CP 的非卧床儿童的回顾性队列 [N = 104;52 双边 (bCP) 和 52 单边 (uCP)]。根据 sqMRI 量表指南定义了范围和位置特定的分数。粗大运动功能分类系统 (GMFCS)、步态轮廓评分 (GPS)、每个运动平面的 GPS、步态变量评分 (GVS) 和多关节 (MJ) 步态模式与脑损伤评分相关。在所有组中,全球总大脑得分与​​ GPS 相关(总分:rs = 0.404,p ≤ 0.001;bCP:rs = 0.335,p ≤ 0.05;uCP:rs = 0.493,p ≤ 0.001)。全球总半球分数与 GMFCS 相关(总分:rs = 0.392,p ≤ 0.001;bCP:rs = 0.316,p ≤ 0.05;uCP:rs = 0.331,p ≤ 0.05)。总组中半球的偏侧性评分与 GMFCS 水平(rs = -0.523,p ≤ 0.001)和 GVS 膝关节矢状面(rs = -0.311,p ≤ 0.01)呈负相关。对于整个组,病变位置显示顶叶受累与 GPS 之间(rs = 0.321,p ≤ 0.001)以及脑室周围层损伤与 GMFCS 之间(rs = 0.348,p ≤ 0.001)呈正相关。胼胝体 (CC) 前部受累与所有组的 GVS 髋矢状面相关(总计:rpb = 0.495,p ≤ 0.001;bCP:rpb = 0.357,p ≤ 0.05;uCP:rpb = 0.641, p ≤ 0.001)。总半球的整体总半球和半球的偏侧评分在总组中的小和伸展(p ≤ 0.001 和 p ≤ 0.001)和屈曲(分别为 p = 0.016 和 p = 0.013)MJ 模式之间有所不同。最大的脑室周围受累和 CC 完整性与扩展模式相关(分别为 p ≤ 0.05 和 p ≤ 0.001)。目前的研究结果表明,在这组 CP 儿童中,大脑结构与运动功能以及病理步态之间存在关系。这些结果可能有助于及时识别步态病理,并最终指导 CP 儿童步态障碍的个体化治疗计划。最大的脑室周围受累和 CC 完整性与扩展模式相关(分别为 p ≤ 0.05 和 p ≤ 0.001)。目前的研究结果表明,在这组 CP 儿童中,大脑结构与运动功能以及病理步态之间存在关系。这些结果可能有助于及时识别步态病理,并最终指导 CP 儿童步态障碍的个体化治疗计划。最大的脑室周围受累和 CC 完整性与扩展模式相关(分别为 p ≤ 0.05 和 p ≤ 0.001)。目前的研究结果表明,在这组 CP 儿童中,大脑结构与运动功能以及病理步态之间存在关系。这些结果可能有助于及时识别步态病理,并最终指导 CP 儿童步态障碍的个体化治疗计划。
更新日期:2020-07-09
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