Brain lesion scores obtained using a simple semi-quantitative scale from MR imaging are associated with motor function, communication and cognition in dyskinetic cerebral palsy

Abstract

PurposeTo characterise brain lesions in dyskinetic cerebral palsy (DCP) using the semi-quantitative scale for structural MRI (sqMRI) and to investigate their relationship with motor, communication and cognitive function.Materials and methodsThirty-nine participants (19 females, median age 21y) with DCP were assessed in terms of motor function, communication and a variety of cognitive domains. Whole-head magnetic resonance imaging (MRI) was performed including T1-MPRAGE, T2 turbo spin echo (axial plane), and fluid attenuated inversion recovery images (FLAIR). A child neurologist visually assessed images for brain lesions and scored these using the sqMRI. Ordinal, Poisson and binomial negative regression models identified which brain lesions accounted for clinical outcomes.ResultsBrain lesions were most frequently located in the ventral posterior lateral thalamus and the frontal lobe. Gross (B = 0.180, p < .001; B = 0.658, p < .001) and fine (B = 0.136, p = .003; B = 0.540, p < .001) motor function were associated with global sqMRI score and parietal involvement. Communication functioning was associated with putamen involvement (B = 0.747, p < .028). Intellectual functioning was associated with global sqMRI score and posterior thalamus involvement (B = −0.018, p < .001; B = −0.192, p < .001). Selective attention was associated with global sqMRI score (B = −0.035, p < .001), parietal (B = −0.063, p = .023), and corpus callosum involvement (B = −0.448, p < .001). Visuospatial and visuoperceptive abilities were associated with global sqMRI score (B = −0.078, p = .007) and medial dorsal thalamus involvement (B = −0.139, p < .012), respectively.ConclusionsKey clinical outcomes in DCP are associated with specific observable brain lesions as indexed by a simple lesion scoring system that relies only on standard clinical MRI.

Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy

“…However, the global total brain score in the total group did not correlate to the GMFCS. This is contradictory with recent findings in dyskinetic CP, where the global brain score was found to be a significant predictor for the GMFCS (Laporta-Hoyos et al, 2018). This difference might stem from several factors.…”

“…In the present study, only approximately 10% of the patients presented with such low global brain scores. Lastly, the total group in this study showed an equal distribution between bCP and uCP children, whereas the study of Laporta-Hoyos et al (2018) included mostly bCP dyskinetic children (Laporta-Hoyos et al, 2018).…”

“…In the present study, children of up to level III of the GMFCS were analyzed, whereas in the study of Laporta-Hoyos et al (2018), one third of the included children had GMFCS levels IV or V. Furthermore, one third of the patients in this study only had lesions in the basal ganglia or thalamus (Laporta-Hoyos et al, 2018), while all children enrolled in the present study had additional lesions. An additional explanation might be that lower global brain scores were reported by Laporta-Hoyos et al (2018), with 49% of the participants presenting with a total global brain score of ≤5.5 (out of 40) (Laporta-Hoyos et al, 2018). In the present study, only approximately 10% of the patients presented with such low global brain scores.…”

Children with dyskinetic cerebral palsy are severely affected as compared to bilateral spastic cerebral palsy

“…In another cohort of 56 patients with dyskinetic CP, many different cerebral lesions were likewise seen, and the authors report a normal MRI in 9.8% with the most frequent injuries seen in white matter (26.8%) and grey matter (31.7%) . In another cohort of 39 patients with dyskinetic CP, where images were re‐evaluated systematically with focus on basal ganglia, brain lesions were most frequently located in the ventral posterior lateral thalamus and frontal lobe . It is likely that the use of a standardised imaging protocol and central review of images would have affected the imaging results.…”

Treatment response prediction of rehabilitation program in children with cerebral palsy using radiomics strategy: protocol for a multicenter prospective cohort study in west China

“…Equipped also with advanced radiomics, researchers have made unprecedented progress in discovering biomarkers that can increasingly enable identification of individual patients (6)(7)(8)(9). However, it is still much more challenging to identify patients who will have effective treatment response (10,11). Using these biomarkers to make individual predictions of future treatment responses in the early phase of CP will be clinically important.…”