CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, Australia.
IRCCS Stella Maris Foundation, Pisa, Italy.
Hum Brain Mapp. 2020 Jul;41(10):2794-2807. doi: 10.1002/hbm.24978. Epub 2020 Mar 5.
The presence of bilateral brain injury in patients with unilateral cerebral palsy (CP) may impact neuroplasticity in the ipsilateral hemisphere; however, this pattern of injury is typically under-analyzed due to the lack of methods robust to severe injury. In this study, injury-robust methods have been applied to structural brain magnetic resonance imaging (MRI) data of a cohort of 91 children with unilateral CP (37 with unilateral and 54 with bilateral brain injury, 4-17 years) and 44 typically developing controls (5-17 years), to determine how brain structure is associated with concurrent motor function, and if these associations differ between patients with unilateral or bilateral injury. Regression models were used to associate these measures with two clinical scores of hand function, with patient age, gender, brain injury laterality, and interaction effects included. Significant associations with brain structure and motor function were observed (Pearson's r = .494-.716), implicating several regions of the motor pathway, and demonstrating an accurate prediction of hand function from MRI, regardless of the extent of brain injury. Reduced brain volumes were observed in patients with bilateral injury, including volumes of the thalamus and corpus callosum splenium, compared to those with unilateral injury, and the healthy controls. Increases in cortical thickness in several cortical regions were observed in cohorts with unilateral and bilateral injury compared to controls, potentially suggesting neuroplasticity might be occurring in the inferior frontal gyrus and the precuneus. These findings identify prospective useful target regions for transcranial magnetic stimulation intervention.
在单侧脑瘫（CP）患者中存在双侧脑损伤可能会影响对侧半球的神经可塑性；然而，由于缺乏对严重损伤具有鲁棒性的方法，这种损伤模式通常未得到充分分析。在这项研究中，对 91 名单侧 CP 患儿（单侧损伤 37 例，双侧损伤 54 例，年龄 4-17 岁）和 44 名正常发育对照者（年龄 5-17 岁）的结构性脑磁共振成像（MRI）数据应用了损伤鲁棒性方法，以确定脑结构与并发运动功能之间的关系，以及这些关联是否在单侧或双侧损伤的患者之间存在差异。使用回归模型将这些测量值与手部功能的两项临床评分相关联，其中包括患者年龄、性别、脑损伤侧别以及交互作用。观察到与脑结构和运动功能有显著关联（Pearson's r =.494-.716），涉及运动通路的多个区域，并且无论脑损伤程度如何，都能从 MRI 准确预测手部功能。与单侧损伤和健康对照组相比，双侧损伤患者的脑体积减小，包括丘脑和胼胝体压部的体积减小。与对照组相比，单侧和双侧损伤的患者在几个皮质区域的皮质厚度增加，这可能表明下额回和楔前叶可能正在发生神经可塑性。这些发现确定了经颅磁刺激干预的有前景的有用目标区域。
