TITLE
Using Diffusion Tensor Imaging to Identify Corticospinal Tract Projection Patterns in Children with Unilateral Spastic Cerebral Palsy
AUTHORS
Kuo HC; Ferre CL; Carmel JB; Gowatsky JL; Stanford AD; Rowny SB; Lisanby SH; Gordon AM; Friel KM. Institution Kuo, Hsing-Ching. Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA. Ferre, Claudio L. Burke-Cornell Medical Research Institute, White Plains, NY, USA. Carmel, Jason B. Burke-Cornell Medical Research Institute, White Plains, NY, USA. Carmel, Jason B. Brain Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY, USA. Carmel, Jason B. Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA. Gowatsky, Jaimie L. New York State Psychiatric Institute, Columbia University, New York, NY, USA. Stanford, Arielle D. Clinical Science, Alkermes Inc., Waltham, MA, USA. Rowny, Stefan B. New York State Psychiatric Institute, Columbia University, New York, NY, USA. Lisanby, Sarah H. Division of Translational Research, National Institutes of Health, Rockville, MD, USA. Gordon, Andrew M. Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA. Friel, Kathleen M. Burke-Cornell Medical Research Institute, White Plains, NY, USA. Friel, Kathleen M. Brain Mind Research ITITLEnstitute and Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
SOURCE
Developmental Medicine & Child Neurology. 59(1):65-71, 2017 Jan.
AIM
To determine whether diffusion tensor imaging (DTI) can be an independent assessment for identifying the corticospinal tract (CST) projecting from the more-affected motor cortex in children with unilateral spastic cerebral palsy (CP).
METHOD
Twenty children with unilateral spastic CP participated in this study (16 males, four females; mean age 9y 2mo [standard deviation (SD) 3y 2mo], Manual Ability Classification System [MACS] level I-III). We used DTI tractography to reconstruct the CST projecting from the more-affected motor cortex. We mapped the motor representation of the more-affected hand by stimulating the more- and the less-affected motor cortex measured with single-pulse transcranial magnetic stimulation (TMS). We then verified the presence or absence of the contralateral CST by comparing the TMS map and DTI tractography. Fisher’s exact test was used to determine the association between findings of TMS and DTI.
RESULTS
DTI tractography successfully identified the CST controlling the more-affected hand (sensitivity=82%, specificity=78%).
INTERPRETATION
Contralateral CST projecting from the lesioned motor cortex assessed by DTI is consistent with findings of TMS mapping. Since CST connectivity may be predictive of response to certain upper extremity treatments, DTI-identified CST connectivity may potentially be valuable for determining such connectivity where TMS is unavailable or inadvisable for children with seizures.
Copyright © 2016 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.
Publication Type Journal Article.
