title: Macrostructural and Microstructural Brain Lesions Relate to Gait Pathology in Children With Cerebral Palsy.
abstract: Background Even though lower-limb motor disorders are core features of spastic cerebral palsy (sCP), the relationship with brain lesions remains unclear. Unraveling the relation between gait pathology, lower-limb function, and brain lesions in sCP is complex for several reasons; wide heterogeneity in brain lesions, ongoing brain maturation, and gait depends on a number of primary motor functions/deficits (eg, muscle strength, spasticity). Objective To use a comprehensive approach combining conventional MRI and diffusion tensor imaging (DTI) in children with sCP above 3 years old to relate quantitative parameters of brain lesions in multiple brain areas to gait performance. Methods A total of 50 children with sCP (25 bilateral, 25 unilateral involvement) were enrolled. The investigated neuroradiological parameters included the following: (1) volumetric measures of the corpus callosum (CC) and lateral ventricles (LVs), and (2) DTI parameters of the corticospinal tract (CST). Gait pathology and primary motor deficits, including muscle strength and spasticity, were evaluated by 3D gait analysis and clinical examination. Results In bilateral sCP (n = 25), volume of the LV and the subparts of the CC connecting frontal, (pre)motor, and sensory areas were most related to lower-limb functioning and gait pathology. DTI measures of the CST revealed additional relations with the primary motor deficits (n = 13). In contrast, in unilateral sCP, volumetric (n = 25) and diffusion measures (n = 14) were only correlated to lower-limb strength. Conclusions These results indicate that the combined influence of multiple brain lesions and their impact on the primary motor deficits might explain a large part of the gait pathology in sCP.
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium Movement control and neuroplasticity, Department of Kinesiology, KU Leuven, Belgium Pieter.meyns@gmail.com.
authors.forename: Pieter
authors.initials: P
authors.lastname: Meyns
authors.affiliation: Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium The Scottish Centre for Children with Motor Impairments, Cumbernauld, United Kingdom.
authors.forename: Leen
authors.initials: L
authors.lastname: Van Gestel
authors.affiliation: Movement control and neuroplasticity, Department of Kinesiology, KU Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Leunissen
authors.affiliation: Center for Developmental Disabilities, University Hospitals Leuven, Belgium Department of Public Health, Faculty of Medicine, KU Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: De Cock
authors.affiliation: Department of Radiology, University Hospitals Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sunaert
authors.affiliation: Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Feys
authors.affiliation: Movement control and neuroplasticity, Department of Kinesiology, KU Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duysens
authors.affiliation: Neuromotor Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium Clinical Motion Analysis Laboratory, CERM, University Hospital Leuven, KU Leuven, Belgium.
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
authors.affiliation: Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Ortibus
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002547:Cerebral Palsy / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D007839:Functional Laterality; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000473:pathology*; D018709:Statistics, Nonparametric
keywords: MRI; cerebral palsy; diffusion tensor imaging; gait; volumetry