Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients: a diffusion tensor tractography imaging study

Abstract

The less affected hemisphere is important in motor recovery in mature brains. However, in terms of motor outcome in immature brains, no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients. Therefore, we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients. Forty patients with hemiplegia due to perinatal or prenatal injury (13.7 ± 3.0 months) and 40 age-matched typically developing controls were recruited. These patients were divided into two age-matched groups, the high functioning group (20 patients) and the low functioning group (20 patients) using functional level of hemiplegia scale. Diffusion tensor tractography images showed that compared with the control group, the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value. Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group. These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.

Keywords: corticospinal tract; diffusion tensor imaging; hemiplegia; motor function; nerve regeneration; neural regeneration; unaffected hemisphere.

Figure 1

Flow chart of patient grouping. FxL: Functional level of hemiplegia.

Figure 2

Conventional T2-weighted brain magnetic resonance images and diffusion tensor images for the corticospinal tract (CST) of a patient in the high functioning group (A), low functioning group (B), and a control subject (C). (A) The less affected CST (red colored) of a patient with better upper extremity function. (B) The less affected CST of a patient with worse upper extremity function. (C) The CST of a control subject. The fiber number of the less affected CST of a high functioning patient (A) was increased compared with that of a control subject (C), however it was decreased compared with that of a low functioning patient (B). In A and B, red colored tract (sky blue arrow) indicates less affected CST, and yellow colored tract indicates more affected CST. R: Right; A: anterior; P: posterior.