Ann Rehabil Med.  2014 Apr;38(2):189-199.

Neuroradiological and Neurophysiological Characteristics of Patients With Dyskinetic Cerebral Palsy

• Park BH
• Park SH
• Seo JH
• Ko MH
• Chung GH

Abstract

OBJECTIVE
To investigate neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy (CP), by using magnetic resonance imaging (MRI), voxel-based morphometry (VBM), diffusion tensor tractography (DTT), and motor evoked potential (MEP).
METHODS
Twenty-three patients with dyskinetic CP (13 males, 10 females; mean age 34 years, range 16-50 years) were participated in this study. Functional evaluation was assessed by the Gross Motor Functional Classification System (GMFCS) and Barry-Albright Dystonia Scale (BADS). Brain imaging was performed on 3.0 Tesla MRI, and volume change of the grey matter was assessed using VBM. The corticospinal tract (CST) and superior longitudinal fasciculus (SLF) were analyzed by DTT. MEPs were recorded in the first dorsal interossei, the biceps brachii and the deltoid muscles.
RESULTS
Mean BADS was 16.4+/-5.0 in ambulatory group (GMFCS levels I, II, and III; n=11) and 21.3+/-3.9 in non-ambulatory group (GMFCS levels IV and V; n=12). Twelve patients showed normal MRI findings, and eleven patients showed abnormal MRI findings (grade I, n=5; grade II, n=2; grade III, n=4). About half of patients with dyskinetic CP showed putamen and thalamus lesions on MRI. Mean BADS was 20.3+/-5.7 in normal MRI group and 17.5+/-4.0 in abnormal MRI group. VBM showed reduced volume of the hippocampus and parahippocampal gyrus. In DTT, no abnormality was observed in CST, but not in SLF. In MEPs, most patients showed normal central motor conduction time.
CONCLUSION
These results support that extrapyramidal tract, related with basal ganglia circuitry, may be responsible for the pathophysiology of dyskinetic CP rather than CST abnormality.

Keyword

Cerebral palsy; Diffusion tensor imaging; Motor evoked potentials; Magnetic resonance imaging

MeSH Terms

Basal Ganglia
Cerebral Palsy*
Classification
Deltoid Muscle
Diffusion
Diffusion Tensor Imaging
Dystonia
Evoked Potentials, Motor
Extrapyramidal Tracts
Female
Hippocampus
Humans
Magnetic Resonance Imaging
Male
Neuroimaging
Parahippocampal Gyrus
Putamen
Pyramidal Tracts
Thalamus

Figure

• 

  Fig. 1 There was a significant difference in Barry-Albright Dystonia Scale (BADS) scores between the ambulatory group and non-ambulatory group. *p<0.05.

• 

  Fig. 2 Axial T2-weighted image. (A) No evidence of abnormality in patient no. 9. (B) Bilateral focal hyperintensities in the thalamus (white arrows) in patient no. 19. (C) Bilateral focal hyperintensities in the putamen (black arrows) in patient no. 17. (D) Bilateral focal hyperintensities in the putamen (black arrows) and thalamus (white arrows) in patient no. 21. (E-1) Bilateral focal hyperintensities in the putamen (black arrows) and thalamus (white arrows) in patient no. 1. (E-2) Bilateral diffuse hyperintensities in the periventricular white matter (white arrow heads) in patient no. 1.

• 

  Fig. 3 Voxel-based morphometry analysis showed the regions with significantly reduced grey matter volumes in patients with dyskinetic cerebral palsy in yellow color (p<0.05, corrected for multiple comparison, familywise error rate).

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