Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Pediatrics, 76140Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India.
J Child Neurol. 2021 Aug;36(9):711-719. doi: 10.1177/0883073821993613. Epub 2021 Mar 12.
Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy.
To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy.
Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ test.
A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category).
Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.
很少有研究关注脑瘫患者磁共振成像（MRI）脑表现与功能移动性之间的关系。
确定脑瘫患者 MRI 表现与粗大运动功能分类系统（GMFCS）水平之间的关系。
在印度北部一所公立教学医院的儿科神经病学诊所进行前瞻性观察研究。每周在特定的神经诊所日招募脑瘫的前 3 例新病例，为期 1 年。根据 GMFCS 对功能移动性进行分类。使用 χ 检验评估 MRI 表现、脑瘫类型和 GMFCS 水平之间的关系。
共纳入 138 例病例（平均年龄 2.71 [标准差=1.91]岁；男性占 64.5%）。报告的脑瘫类型如下：痉挛性四肢瘫（47.8%）、痉挛性双瘫（28.35%）、痉挛性偏瘫（11.6%）、锥体外系（6.5%）和共济失调/低张型（5.8%）。GMFCS 分为 1 级（13%）、2 级（7.2%）、3 级（4.3%）、4 级（10.9%）和 5 级（64.5%）。痉挛性四肢瘫和锥体外系脑瘫与较高（严重）水平（IV 和 V）显著相关，而痉挛性双瘫和偏瘫与较低（轻度）水平（I-III）的 GMFCS 显著相关。脑室周围白质损伤、深部灰质损伤、基底节和丘脑改变以及表浅灰质损伤的 MRI 特征与 GMFCS 的严重水平（V 和 IV）显著相关。8 例患儿 MRI 正常（5 例为轻度，3 例为重度）。
严重脑瘫最常与痉挛性四肢瘫、锥体外系脑瘫、表浅灰质病变、深部灰质病变和脑室周围白质损伤相关。这些信息对于预测和满足脑瘫患儿的需求以及进行预后评估是有用的。
