Meyns Pieter, Van Gestel Leen, Leunissen Inge, De Cock Paul, Sunaert Stefan, Feys Hilde, Duysens Jacques, Desloovere Kaat, Ortibus Els
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium Movement control and neuroplasticity, Department of Kinesiology, KU Leuven, Belgium
Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium The Scottish Centre for Children with Motor Impairments, Cumbernauld, United Kingdom.
Neurorehabil Neural Repair. 2016 Oct;30(9):817-33. doi: 10.1177/1545968315624782. Epub 2016 Jan 20.
Background Even though lower-limb motor disorders are core features of spastic cerebral palsy (sCP), the relationship with brain lesions remains unclear. Unraveling the relation between gait pathology, lower-limb function, and brain lesions in sCP is complex for several reasons; wide heterogeneity in brain lesions, ongoing brain maturation, and gait depends on a number of primary motor functions/deficits (eg, muscle strength, spasticity). Objective To use a comprehensive approach combining conventional MRI and diffusion tensor imaging (DTI) in children with sCP above 3 years old to relate quantitative parameters of brain lesions in multiple brain areas to gait performance. Methods A total of 50 children with sCP (25 bilateral, 25 unilateral involvement) were enrolled. The investigated neuroradiological parameters included the following: (1) volumetric measures of the corpus callosum (CC) and lateral ventricles (LVs), and (2) DTI parameters of the corticospinal tract (CST). Gait pathology and primary motor deficits, including muscle strength and spasticity, were evaluated by 3D gait analysis and clinical examination. Results In bilateral sCP (n = 25), volume of the LV and the subparts of the CC connecting frontal, (pre)motor, and sensory areas were most related to lower-limb functioning and gait pathology. DTI measures of the CST revealed additional relations with the primary motor deficits (n = 13). In contrast, in unilateral sCP, volumetric (n = 25) and diffusion measures (n = 14) were only correlated to lower-limb strength. Conclusions These results indicate that the combined influence of multiple brain lesions and their impact on the primary motor deficits might explain a large part of the gait pathology in sCP.
尽管下肢运动障碍是痉挛型脑瘫（sCP）的核心特征，但与脑损伤的关系仍不明确。由于多种原因，阐明sCP患者的步态病理、下肢功能和脑损伤之间的关系较为复杂；脑损伤存在广泛异质性、大脑持续发育，且步态取决于多种主要运动功能/缺陷（如肌肉力量、痉挛）。目的：采用综合方法，将传统MRI和弥散张量成像（DTI）相结合，研究3岁以上sCP儿童多个脑区脑损伤的定量参数与步态表现的关系。方法：共纳入50例sCP儿童（25例双侧受累，25例单侧受累）。研究的神经放射学参数包括：（1）胼胝体（CC）和侧脑室（LVs）的体积测量，以及（2）皮质脊髓束（CST）的DTI参数。通过三维步态分析和临床检查评估步态病理和主要运动缺陷，包括肌肉力量和痉挛。结果：在双侧sCP（n = 25）中，LV体积以及连接额叶、（前）运动区和感觉区的CC各部分与下肢功能和步态病理最为相关。CST的DTI测量结果显示与主要运动缺陷（n = 13）存在额外关联。相比之下，在单侧sCP中，体积测量（n = 25）和弥散测量（n = 14）仅与下肢力量相关。结论：这些结果表明，多种脑损伤的综合影响及其对主要运动缺陷的作用可能在很大程度上解释了sCP的步态病理。
