Article

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.
CI - (c) 2016 The Authors. Developmental Medicine & Child Neurology published by John
Wiley & Sons Ltd on behalf of Mac Keith Press.

Langue : ANGLAIS