Whole-brain structural connectivity in dyskinetic cerebral palsy and its association with motor and cognitive function

Abstract

Dyskinetic cerebral palsy (CP) has long been associated with basal ganglia and thalamus lesions. Recent evidence further points at white matter (WM) damage. This study aims to identify altered WM pathways in dyskinetic CP from a standardized, connectome-based approach, and to assess structure-function relationship in WM pathways for clinical outcomes. Individual connectome maps of 25 subjects with dyskinetic CP and 24 healthy controls were obtained combining a structural parcellation scheme with whole-brain deterministic tractography. Graph theoretical metrics and the network-based statistic were applied to compare groups and to correlate WM state with motor and cognitive performance. Results showed a widespread reduction of WM volume in CP subjects compared to controls and a more localized decrease in degree (number of links per node) and fractional anisotropy (FA), comprising parieto-occipital regions and the hippocampus. However, supramarginal gyrus showed a significantly higher degree. At the network level, CP subjects showed a bilateral pathway with reduced FA, comprising sensorimotor, intraparietal and fronto-parietal connections. Gross and fine motor functions correlated with FA in a pathway comprising the sensorimotor system, but gross motor also correlated with prefrontal, temporal and occipital connections. Intelligence correlated with FA in a network with fronto-striatal and parieto-frontal connections, and visuoperception was related to right occipital connections. These findings demonstrate a disruption in structural brain connectivity in dyskinetic CP, revealing general involvement of posterior brain regions with relative preservation of prefrontal areas. We identified pathways in which WM integrity is related to clinical features, including but not limited to the sensorimotor system. Hum Brain Mapp 38:4594-4612, 2017. © 2017 Wiley Periodicals, Inc.

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

“…With regards to cerebral lobes, results agreed with previous reports that white matter injury can occur in all cerebral lobes ( Ballester-Plané et al, 2017 ; Laporta-Hoyos et al, 2017b ). Frontal lobe damage was the second most common observable lesion (but the most common lobar involvement).…”

“…dyskinetic symptoms) ( Monbaliu et al, 2017 ). Quantitative neuroimaging analyses previously reported associations between parietal structural connectivity and motor function in dyskinetic ( Ballester-Plané et al, 2017 ), and in spastic CP ( Arrigoni et al, 2016 ; Pannek et al, 2014 ; Tsao et al, 2015 ). The present study focused on motor severity in terms of GMFCS, rather than severity of dystonia which may explain why the association was not found with deep grey matter injury.…”

“…In order to assist in the earlier detection of DCP, the frequency and location of brain lesions and their relationships with clinical outcomes should be understood. Previous neuroimaging studies of DCP have been based on qualitative analyses of pathogenesis ( Himmelmann and Uvebrant, 2011 ; Krägeloh-Mann and Cans, 2009 ; Towsley et al, 2011 ) or advanced neuroimaging protocols that cannot be easily utilised in a clinical context ( Ballester-Plané et al, 2017 ; Laporta-Hoyos et al, 2017b ; Yoshida et al, 2011 ). To enable clinical translation, in the present study brain lesions and their association with clinical outcomes have been characterized using a semi-quantitative scale for brain lesion severity on MRI, that is clinically accessible due to its relative simplicity and reliance only on standard clinical images.…”

“…These findings have provided critical insights, but the literature currently lacks quantitative analyses for moderately sized DCP cohorts. Quantitative neuroimaging studies in DCP have shed light on the pathogenesis of different CP subtypes ( Ballester-Plané et al, 2017 ; Laporta-Hoyos et al, 2017b ; Yoshida et al, 2011 ) but their translatability to routine clinical settings is limited. Ideally, such findings are best translated into clinical practice in a manner that utilises tools and imaging that clinicians are already familiar with.…”

A combined diffusion‐weighted and electroencephalography study on age‐related differences in connectivity in the motor network during bimanual performance

“…The adopted DTI approach is widely used one for modeling of white matter microstructural organization, see, for example, Basser, Mattiello, and LeBihan (); Berman, Berger, Mukherjee, and Henry (), and Weiss et al () or more recent applications in the motor network (Ballester‐Plane et al, ; Eixarch, Munoz‐Moreno, Bargallo, Batalle, & Gratacos, ; Galantucci et al, ; Jarbo & Verstynen, ; Lee et al, ; Lee, Park, Park, & Hong, ; Misaghi, Zhang, Gracco, De Nil, & Beal, ). Unfortunately, as of yet there is no “gold standard” for DW‐MRI based in vivo fiber tractography assessments (Farquharson et al, ; Jones, ; Tournier et al, ).…”