Papageorgiou Eirini, De Beukelaer Nathalie, Simon-Martinez Cristina, Mailleux Lisa, Van Campenhout Anja, Desloovere Kaat, Ortibus Els
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium.
Front Hum Neurosci. 2020 Jul 9;14:275. doi: 10.3389/fnhum.2020.00275. eCollection 2020.
The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [ = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: = 0.404, ≤ 0.001; bCP: = 0.335, ≤ 0.05; uCP: = 0.493, ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: = 0.392, ≤ 0.001; bCP: = 0.316, ≤ 0.05; uCP: = 0.331, ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level ( = -0.523, ≤ 0.001) and the GVS-knee sagittal ( = -0.311, ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS ( = 0.321, ≤ 0.001) and between periventricular layer damage and the GMFCS ( = 0.348, ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: = 0.495, ≤ 0.001; bCP: = 0.357, ≤ 0.05; uCP: = 0.641, ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension ( ≤ 0.001 and ≤ 0.001) and flexion ( = 0.016 and = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.
痉挛型脑瘫（CP）患儿脑损伤与运动功能之间的相互作用尚未完全明确。因此，本研究采用半定量MRI（sqMRI）量表，探究该人群中已确定的脑损伤是否与功能能力及步态病理相关。选取了一组回顾性队列研究中的门诊痉挛型CP患儿[n = 104；52例双侧（bCP）和52例单侧（uCP）]。根据sqMRI量表指南定义范围和特定部位评分。将粗大运动功能分类系统（GMFCS）、步态轮廓评分（GPS）、各运动平面的GPS、步态变量评分（GVS）和多关节（MJ）步态模式与脑损伤评分相关联。在所有组中，全脑总评分与GPS相关（总体：r = 0.404，P≤0.001；bCP：r = 0.335，P≤0.05；uCP：r = 0.493，P≤0.001）。全脑半球总评分与GMFCS相关（总体：r = 0.392，P≤0.001；bCP：r = 0.316，P≤0.05；uCP：r = 0.331，P≤0.05）。总体组中半球的偏侧性评分与GMFCS水平呈负相关（r = -0.523，P≤0.001）以及与GVS-膝关节矢状面呈负相关（r = -0.311，P≤0.01）。总体组中，病变部位显示顶叶受累与GPS呈正相关（r = 0.321，P≤0.001）以及脑室周围层损伤与GMFCS呈正相关（r = 0.348，P≤0.001）。胼胝体前部（CC）受累在所有组中均与GVS-髋关节矢状面相关（总体：r = 0.495，P≤0.001；bCP：r = 0.357，P≤0.05；uCP：r = 0.641，P≤0.001）。总体组中全脑半球总评分和半球偏侧性评分在轻微与伸展（分别为P≤0.001和P≤0.001）及屈曲（分别为r = 0.016和r = 0.013）MJ模式之间存在差异。最大脑室周围受累和CC完整分别与伸展模式相关（P≤0.05和P≤0.001）。当前研究结果表明，在这组CP患儿中，脑结构与运动功能以及病理步态之间存在关联。这些结果可能有助于及时识别步态病理，并最终指导CP患儿步态障碍的个体化治疗方案制定。
