Contralesional Corticomotor Neurophysiology in Hemiparetic Children With Perinatal Stroke

Zewdie, Ephrem; Damji, Omar; Ciechanski, Patrick; Seeger, Trevor; Kirton, Adam

doi:10.1177/1545968316680485

Cited by 58 publications

(78 citation statements)

References 46 publications

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“…A larger cohort with more participants in each subgroup might make the outcomes more statistically significant, especially in case of the motor connectivity analysis which had relatively smaller effect sizes (d=0.5 to 1.2). Indeed, our group 25 and others 41 have shown that CST connectivity is significantly associated with hand function. In this study, many children had both contralateral and ipsilateral CSTs.…”

Section: Discussionmentioning

confidence: 53%

Effect of sensory and motor connectivity on hand function in pediatric hemiplegia

Gupta

Barachant

Gordon

et al. 2017

Annals of Neurology

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Objective We tested the hypothesis that somatosensory system injury would more strongly affect movement than motor system injury in children with unilateral cerebral palsy (USCP). This hypothesis was based on how somatosensory and corticospinal circuits adapt to injury during development: while the motor system can maintain connections to the impaired hand from the uninjured hemisphere, this doesn't occur in the somatosensory system. As a corollary, cortical injury strongly impairs sensory function, so we hypothesized that cortical lesions would impair hand function more than subcortical lesions. Methods Twenty-four children with unilateral CP had physiological and anatomical measures of the motor and somatosensory systems and lesion classification. Motor physiology was performed with transcranial magnetic stimulation and somatosensory physiology with vibration-evoked EEG potentials. Tractography of the corticospinal tract and the medial lemniscus were performed with diffusion tensor imaging, and lesions were classified by MRI. Anatomical and physiological results were correlated with measures of hand function using two independent statistical methods. Results Children with disruptions in the somatosensory connectivity, and cortical lesions had the most severe upper extremity impairments, particularly somatosensory function. Motor system connectivity was significantly correlated with bimanual function, but not unimanual function or somatosensory function. Interpretation Both sensory and motor connectivity impact hand function in children with USCP. Somatosensory connectivity could be an important target for recovery of hand function in children with USCP.

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Section: Discussionmentioning

confidence: 53%

Effect of sensory and motor connectivity on hand function in pediatric hemiplegia

Gupta

Barachant

Gordon

et al. 2017

Annals of Neurology

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“…Early insult to the corticomotor system leads to atypical developmental organization of the central nervous system, including the corticospinal tracts. 20,21 The presence of these ipsilateral projections have previously been considered the consequence of maladaptive plastic development of the corticospinal system. 18 When identified using TMS to evoke responses in the more affected hand, these projections have often been associated with poorer motor performance.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the common presence of ipsilateral projections to the more affected hand from the contralesional hemisphere, 21 MEP amplitude was measured in the affected hand during TMS of both hemispheres. These hotspots were used for all subsequent stimulations.…”

Section: Corticospinal Arrangement and Excitability Measuresmentioning

confidence: 99%

“…20,21 The excitability of corticospinal projections also appears to be related to motor performance in children with perinatal stroke. 21 There is growing evidence that identifying the causes and potential treatments for fatigue in children with CP should be a focus for rehabilitation. 10 Whether fatigue in children with perinatal stroke is associated with strength, motor performance, and corticospinal excitability has not been examined.…”

mentioning

confidence: 99%

“…10 Whether fatigue in children with perinatal stroke is associated with strength, motor performance, and corticospinal excitability has not been examined. Because corticospinal excitability and corticospinal tract organization in both hemispheres is associated with motor performance in children with perinatal stroke, 21 we also hypothesized that the presence and excitability of ipsilateral projections from the contralesional hemisphere would be associated with higher levels of fatigue. We hypothesized that high levels of fatigue would be associated with lower levels of strength, motor performance, and corticospinal excitability.…”

mentioning

confidence: 99%

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Fatigue in children with perinatal stroke: clinical and neurophysiological associations

Wrightson

Zewdie

Kuo

et al. 2019

Develop Med Child Neuro

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AHAAssisting Hand Assessment MEP Motor evoked potential PedsQL Pediatric Quality of Life Inventory Version 3.0 RMT Resting motor threshold TMS Transcranial magnetic stimulation AIM To characterize fatigue in children with hemiparesis with perinatal stroke and explore associations with measures of motor performance and corticospinal excitability. METHOD Forty-five children (16 females, 29 males), aged 6 to 18 years (mean [SD] 12y [4]), with magnetic resonance imaging-confirmed perinatal stroke participated. Associations between fatigue (Pediatric Quality of Life Inventory Version 3.0 cerebral palsy module fatigue subscale), motor performance (Assisting Hand Assessment [AHA], Box and Blocks Test, grip strength), and excitability of corticospinal projections to both hands were examined using ranked tests of correlation, robust regression, and the Mann-Whitney U test.RESULTS Nearly half of the participants (n=21) reported experiencing fatigue in the previous month. Function in the less affected hand (Box and Blocks Test, grip strength) was correlated with fatigue scores. Participants with preserved ipsilateral projections to the more affected hand had less fatigue, and scores correlated with the excitability of these projections. Fatigue scores were not associated with age, sex, or AHA score.INTERPRETATION Fatigue is common in children with hemiparesis with perinatal stroke and is associated with motor performance and the presence and excitability of ipsilateral corticospinal projections from the contralesional hemisphere to the more affected hand.

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Motor beta cortical oscillations are related with the gait kinematics of youth with cerebral palsy

Kurz

Bergwell

Spooner

et al. 2020

Ann Clin Transl Neurol

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Objective: It is widely believed that the perinatal brain injuries seen in youth with cerebral palsy (CP) impact neuronal processing of sensory information and the production of leg motor actions during gait. However, very limited efforts have been made to evaluate the connection between neural activity within sensorimotor networks and the altered spatiotemportal gait biomechanics seen in youth with CP. The objective of this investigation was to use magnetoencephalographic (MEG) brain imaging and biomechanical analysis to probe this connection. Methods: We examined the cortical beta oscillations serving motor control of the legs in a cohort of youth with CP (N = 20; Age = 15.5 AE 3 years; GMFCS levels I-III) and healthy controls (N = 15; Age = 14.1 AE 3 years) using MEG brain imaging and a goal-directed isometric knee target-matching task. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics. Results: Our MEG imaging results revealed that the participants with CP exhibited stronger sensorimotor beta oscillations during the motor planning and execution stages compared to the controls. Interestingly, we also found that those with the strongest sensorimotor beta oscillations during motor execution also tended to walk slower and have a reduced cadence. Interpretation: These results fuel the impression that the beta sensorimotor cortical oscillations that underlie leg musculature control may play a central role in the altered mobility seen in youth with CP.

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Contralesional Corticomotor Neurophysiology in Hemiparetic Children With Perinatal Stroke

Abstract: Neurophysiology of nonlesioned M1 and its relationship to motor function is measureable in children with perinatal stroke. Correlation of excitability and intracortical circuitry measures between contralateral and ipsilateral sides suggests common control mechanisms.

Cited by 58 publications

References 46 publications

Effect of sensory and motor connectivity on hand function in pediatric hemiplegia

Effect of sensory and motor connectivity on hand function in pediatric hemiplegia

Fatigue in children with perinatal stroke: clinical and neurophysiological associations

Motor beta cortical oscillations are related with the gait kinematics of youth with cerebral palsy

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