Fatigue in children with perinatal stroke: clinical and neurophysiological associations

Abstract

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.

Fatigue in perinatal stroke is associated with resting-state functional connectivity

“…The median age for the full sample was 11 years, range 7-19 years, and 35% were female. Fifty-three percent (32/60) of the participants with perinatal stroke reported experiencing problems with fatigue (PESQL-CP fatigue score ≤68.75) and were assigned to the "Fatigued" group (Wrightson et al, 2019) and the remaining 28 participants were assigned to the "Not Fatigued" group. There was no difference in age between the stroke groups or between stroke and TDC participants.…”

Participation Restrictions among Children and Young Adults with Acquired Brain Injury in a Pediatric Outpatient Rehabilitation Cohort: The Patients’ and Parents’ Perspective

“…Other studies based on hospital-based cohorts, report that 25-80% of children and young adults with either TBI (mild/moderate/severe) or nTBI (i.e., stroke, tumor) experience participation restrictions after ABI [2,6,7,9,10,14,16,17,[25][26][27][28][29][30][31][32][33][34][35][36]. This wide range is due to differences in definition of participation, outcome measures, inclusion criteria (i.e., age, type and severity, hospital based) and time points (i.e., time since onset of ABI) used in these studies [36].…”

Factors associated with fatigue in children with perinatal stroke

“…As such, the use of the Pediatric Quality of Life Inventory 4 in addition to the potential cognitive impairments in the children studied. 1 Hence, Wrightson et al 3 should be congratulated for highlighting fatigue in children with perinatal stroke. 2 Accurate assessment necessitates acknowledgment of the developmental or cognitive stages and reference to age and sex norms.…”

“…Of note, fatigue has been reported as a particularly debilitating symptom for children with physical disabilities, and this holds true for children with perinatal stroke as well, with multiple and wide-reaching consequences. 1,2 The study by Wrightson et al 3 is the first to examine the correlates of fatigue in children with hemiparetic perinatal stroke. In their sample (n=45; age 6-18y), nearly half of the participants (n=21) reported fatigue symptoms above clinical cut-off levels.…”

“…4 Increasing understanding about fatigue is important as it may interfere with daily activities, ability to succeed at school, and mobility, as well as compromise independence. 1 Hence, Wrightson et al 3 should be congratulated for highlighting fatigue in children with perinatal stroke. Importantly, their findings contribute to awareness about fatigue and fatigue-associated factors, such as motor performance and clinical neurophysiology.…”