Cerebral Blood Flow and DTI metrics changes in children with cerebral palsy following therapy

Abstract

It is known that patients with chronic hypoxia have regional changes in their cerebral blood flow (CBF). The purpose of this study was to observe the CBF and diffusion tensor imaging (DTI) metrics changes in children with cerebral palsy (CP) at baseline and after 6 months of treatment. Thirty-eight children with cerebral diplegia (mean age = 6.4 yr) and twenty-one age/sex matched controls (mean age = 7.5 yr) were evaluated by the Gross Motor Function Classification System (GMFCS) scoring of motor disability and modified Ashworth scoring of spasticity. All subjects underwent pseudo-continuous arterial spin labeling (PCASL) and DTI, in addition to conventional magnetic resonance imaging (MRI). Significant increase in CBF values was observed in several grey and white matter regions (including areas of abnormal T2 hyperintensity in the periventricular white matter) in CP children as compared to controls based upon voxel-wise analysis. Low fractional anisotropy (FA) and high apparent diffusion coefficient (ADC) values were observed in these areas of high CBF, using a region of interest (ROI) based analysis. On follow-up study, CBF values were found to be significantly higher in two grey matter areas and lower in three white matter regions in comparison to baseline; however no significant changes in DTI indices were observed in these regions. CBF values are high in CP children as compared to controls and show alteration following therapy even when the DTI metrics remain unchanged. Arterial spin labeling (ASL) may be added to the advanced imaging protocol for studying brain plasticity in such children in future.

Rehabilitation‐induced brain changes detected through magnetic resonance imaging in children with neurodevelopmental disorders: A systematic review

“…Moderate to significant improvement in functional abilities. (Jain et al, 2014) No significant change in white matter connectivity. Improvement in GMFCS scores.…”

“…We calculated dose of intervention [dose = duration in weeks * number of sessions per week * length of each session in minutes] for each study and converted that to hours for easier interpretation. Seven studies on children with CP and apraxia didn't provide sufficient information to calculate intervention dose (Jain et al, 2014; Kadis et al, 2014; Kim et al, 2015; Englander et al, 2015; Phillips et al, 2007; Sutcliffe et al, 2009; Baek et al, 2013). Across the remaining 20 studies that reported intervention details, participants received an average of 54.81 h of intervention (intervention range: 3–200 h).…”

“…Younger participants and longer intervention duration may explain the positive brain changes in Kwon and colleagues’ study. It is, however, more complicated to explain the conflicting results of the studies on Botulinum toxin injection followed by physiotherapy since one of the studies did not provide adequate information about the intervention (Jain et al, 2014).…”

“…Only a few studies had a control group of the similar clinical population (Kwon et al, 2014; Manning et al, 2016; Hoekzema et al, 2010; Murdaugh et al, 2016, 2015; Soh et al, 2015; Chaturvedi et al, 2013; Hoekzema et al, 2011) or typically developing children (Trivedi et al, 2008) to allow comparison between different conditions and interventions. Some studies did not describe the intervention in sufficient detail to help calculate intervention dose required to induce rehabilitation‐induced plastic changes (Jain et al, 2014; Kadis et al, 2014; Phillips et al, 2007; Sutcliffe et al, 2009; Baek et al, 2013).…”

Motor, sensory and executive function brain networks in children with unilateral cerebral palsy

“…Resting state motor networks were shown to be altered in both unilateral and bilateral CP, with greater change in the non-dominant hemisphere in unilateral CP 171 . Perfusion MRI was also used to show that regions with diffusion MRI changes demonstrate reduced perfusion 189 .…”