title: The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging.
abstract: In the present study we investigated the nature and extent of clinical outcomes using various classifications and analyzed the relationship between brain magnetic resonance imaging (MRI) findings and the extent of clinical outcomes in children with cerebral palsy (CP) with deep gray matter injury. The deep gray matter injuries of 69 children were classified into hypoxic ischemic encephalopathy (HIE) and kernicterus patterns. HIE patterns were divided into four groups (I-IV) based on severity. Functional classification was investigated using the gross motor function classification system-expanded and revised, manual ability classification system, communication function classification system, and tests of cognitive function, and other associated problems. The severity of HIE pattern on brain MRI was strongly correlated with the severity of clinical outcomes in these various domains. Children with a kernicterus pattern showed a wide range of clinical outcomes in these areas. Children with severe HIE are at high risk of intellectual disability (ID) or epilepsy and children with a kernicterus pattern are at risk of hearing impairment and/or ID. Grading severity of HIE pattern on brain MRI is useful for predicting overall outcomes. The clinical outcomes of children with a kernicterus pattern range widely from mild to severe.
  
  
  CONCLUSIONS
  Delineation of the clinical outcomes of children with deep gray matter injury, which are a common abnormal brain MRI finding in children with CP, is necessary. The present study provides clinical outcomes for various domains in children with deep gray matter injury on brain MRI. The deep gray matter injuries were divided into two major groups; HIE and kernicterus patterns. Our study showed that severity of HIE pattern on brain MRI was strongly associated with the severity of impairments in gross motor function, manual ability, communication function, and cognition. These findings suggest that severity of HIE pattern can be useful for predicting the severity of impairments. Conversely, children with a kernicterus pattern showed a wide range of clinical outcomes in various domains. Children with severe HIE pattern are at high risk of ID or epilepsy and children with kernicterus pattern are at risk of hearing impairment or ID. The strength of our study was the assessment of clinical outcomes after 3 years of age using standardized classification systems in various domains in children with deep gray matter injury.
authors.affiliation: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: 0275502@yuhs.ac.
authors.forename: Ja Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: COSMOSPLANT@yuhs.ac.
authors.forename: Yoon Seong
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: MEDICUS@yuhs.ac.
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Rha
authors.affiliation: Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: pes1234@yuhs.ac.
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Park
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D003142:Communication; D002658:Developmental Disabilities / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D007223:Infant; D008607:Intellectual Disability / Q000000981:diagnostic imaging / Q000453:epidemiology; D007647:Kernicterus / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009048:Motor Skills; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Cerebral palsy; Clinical outcome; Deep gray matter; Magnetic resonance imaging