Hemiplegic Cerebral Palsy: Mapping Brain Plasticity using Multimodal Neuroimaging

Abstract

Research Question: With the use of functional and structural neuroimaging, such as magnetoencephalography (MEG) combined with high-density electroencephalography (HD-EEG), and diffusor tensor imaging (DTI), can we map and better characterize brain plasticity changes in pediatric patients with hemiplegic cerebral palsy (HCP)? Are the delays in visuomotor tasks in children with HCP strictly due to musculoskeletal impairments or do cortical oscillations play a role? Additionally, this study aimed to assess possible alterations in the cortical oscillations of children with HCP during a visuomotor integration task using a unique experimental setup that integrates brain imaging with magnetoencephalography (MEG) and high-density electroencephalogram (HD-EEG).

Background, Significance, and Rationale for the Question: Cerebral Palsy (CP) is the most prevalent physical disability in early childhood in the United States. CP is deteriorating disease that affects both a child and a parent’s leading to functional and motor impairments, which begin in early childhood. One of the common forms of CP, HCP affects only one side of the body, usually both upper and lower extremities. HCP is often caused by a periventricular white matter injury (PV-WMI) of the developing brain. Here, we mapped functional changes that occur at the primary motor and somatosensory cortices, as well as the white matter fibers [corticospinal motor (CST) and thalamocortical sensory tracts (TST)]. A common deficit in children with hemiplegic cerebral palsy (HCP) is abnormal upper limb motor functioning. Although musculoskeletal impairments are seen in most of these children, musculoskeletal deformations may not be the sole reason for their motor aberrations. Alterations in brain activity likely contribute to motor deficits in children with HCP. A handful of previous studies have examined this altered brain activity but mostly focused on lower extremities.

Materials and Methods: A retrospective database was collected focusing on all children treated at Cook Children’s Health Care System satisfying the following inclusion criteria: (i) a diagnosis of HCP due to PV-WMI identified by a neurologist and confirmed through a brain MRI; (ii) capable of staying relatively still for several minutes in order to perform functional neuroimaging studies; and exclusion criteria: (i) no history of trauma or brain operations; (ii) absence of metal implants, braces, baclofen pumps, and seizure history; and (iii) receiving occupational upper extremity treatment We delineated the brain plasticity changes that occur in HCP with TD children. We assessed both functional and structural mapping of the primary motor (M1) and somatosensory (S1) cortices using MEG and HD-EEG. Additionally, DTI was used to detect the integrity of the descending CMT and the ascending TST.