Mourão Lucia Figueiredo, Friel Kathleen M, Sheppard Justine Joan, Kuo Hsing-Ching, Luchesi Karen Fontes, Gordon Andrew M, Malandraki Georgia A
Speech, Language and Hearing Sciences, University of Campinas, Av. Tessalia Vieira de Camargo, 126, Campinas, SP, 13083-887, Brazil.
Speech, Language and Hearing Sciences, Purdue University, 715 Clinic Drive/Lyles-Porter Hall Rm. 3152, West Lafayette, IN, 47907, USA.
Dysphagia. 2017 Oct;32(5):703-713. doi: 10.1007/s00455-017-9816-0. Epub 2017 Jun 8.
The purpose of this study is to determine the relationship between the structural integrity of the corpus callosum (CC) and clinical feeding/swallowing performance in children with unilateral spastic cerebral palsy (USCP). Twenty children with USCP, (11 males, 5.11-17.6 yoa) were assessed via the Dysphagia Disorder Survey (DDS) and diffusion tensor imaging. Children were grouped into left hemisphere lesion (LHL; n = 13) and right hemisphere lesion (RHL; n = 7) groups. DTI variables analyzed for three CC regions (anterior, middle, posterior) were: fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and fibers count. Children with RHL presented with higher clinical dysphagia severity (p = 0.03). Six of seven children with RHL had lesions affecting periventricular/subcortical areas, and 8/13 children with LHL had lesions affecting the sensorimotor cortex. In the LHL group, as FA and fiber count of the anterior CC decreased and RD increased (all indicating reduced CC structural integrity), signs of dysphagia increased (r = -0.667, p = 0.013; r = -0.829, p ≤ 0.001; r = 0.594, p = 0.032, respectively). Reduced fiber count in the middle and posterior CC was also significantly associated with increased DDS scores (r = -0.762, p = 0.002; r = -0.739, p = 0.004, respectively). For the RHL group no significant correlations were observed. We provide preliminary evidence that corpus callosum integrity correlates with feeding/swallowing performance in children with USCP, especially when cortical sensorimotor areas of the left hemisphere are impacted. In this sample, CC integrity appeared to enable interhemispheric cortical plasticity for swallowing, but was not as critical when intrahemispheric connections were disrupted, as seen in the RHL group.
本研究的目的是确定单侧痉挛性脑瘫（USCP）患儿胼胝体（CC）的结构完整性与临床进食/吞咽表现之间的关系。通过吞咽障碍调查（DDS）和扩散张量成像对20名USCP患儿（11名男性，年龄5.11 - 17.6岁）进行评估。患儿被分为左半球病变组（LHL；n = 13）和右半球病变组（RHL；n = 7）。分析的三个CC区域（前部、中部、后部）的DTI变量包括：各向异性分数（FA）、径向扩散率（RD）、平均扩散率（MD）和纤维计数。RHL组患儿的临床吞咽障碍严重程度更高（p = 0.03）。7名RHL组患儿中有6名的病变影响脑室周围/皮质下区域，13名LHL组患儿中有8名的病变影响感觉运动皮层。在LHL组中，随着前部CC的FA和纤维计数减少以及RD增加（所有这些均表明CC结构完整性降低），吞咽障碍的体征增加（r分别为 - 0.667，p = 0.013；r = - 0.829，p≤0.001；r = 0.594，p = 0.032）。中部和后部CC纤维计数减少也与DDS评分增加显著相关（r分别为 - 0.762，p = 0.002；r = - 0.739，p = 0.004）。对于RHL组，未观察到显著相关性。我们提供了初步证据，表明胼胝体完整性与USCP患儿的进食/吞咽表现相关，特别是当左半球的皮质感觉运动区域受到影响时。在本样本中，CC完整性似乎能够实现半球间皮质对吞咽的可塑性，但在RHL组中，当半球内连接中断时，其重要性则没那么关键。
