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. 2022 Aug 15;43(12):3745-3758.
doi: 10.1002/hbm.25881. Epub 2022 Apr 22.

Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis

Hsing-Ching Kuo  1   2   3   4   5 , Ephrem Zewdie  1   2   3   4 , Adrianna Giuffre  1   2   3   4 , Liu Shi Gan  3 , Helen L Carlson  1   2   3   4 , James Wrightson  1   2   3   4 , Adam Kirton  1   2   3   4
Affiliations

Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis

Hsing-Ching Kuo et al. Hum Brain Mapp. .

Abstract

Brain stimulation combined with intensive therapy may improve hand function in children with perinatal stroke-induced unilateral cerebral palsy (UCP). However, response to therapy varies and underlying neuroplasticity mechanisms remain unclear. Here, we aimed to characterize robotic motor mapping outcomes in children with UCP. Twenty-nine children with perinatal stroke and UCP (median age 11 ± 2 years) were compared to 24 typically developing controls (TDC). Robotic, neuronavigated transcranial magnetic stimulation was employed to define bilateral motor maps including area, volume, and peak motor evoked potential (MEP). Map outcomes were compared to the primary clinical outcome of the Jebsen-Taylor Test of Hand Function (JTT). Maps were reliably obtained in the contralesional motor cortex (24/29) but challenging in the lesioned hemisphere (5/29). Within the contralesional M1 of participants with UCP, area and peak MEP amplitude of the unaffected map were larger than the affected map. When comparing bilateral maps within the contralesional M1 in children with UCP to that of TDC, only peak MEP amplitudes were different, being smaller for the affected hand as compared to TDC. We observed correlations between the unaffected map when stimulating the contralesional M1 and function of the unaffected hand. Robotic motor mapping can characterize motor cortex neurophysiology in children with perinatal stroke. Map area and peak MEP amplitude may represent discrete biomarkers of developmental plasticity in the contralesional M1. Correlations between map metrics and hand function suggest clinical relevance and utility in studies of interventional plasticity.

Keywords: cerebral palsy; motor mapping; perinatal stroke; plasticity; robotic TMS; transcranial magnetic stimulation.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A typical example of a three‐dimensional (3D) motor map. X and y axes are the coordinates from the mapping grid and the z axis represents the peak‐to‐peak averaged motor evoked potential (MEP) amplitude at the corresponding grid location. Color bar on the right represents the size of the MEP amplitude
FIGURE 2
FIGURE 2
Representative motor maps in the contralesional motor cortex in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). (a) two‐dimensional (2D) heat map of the affected (ipsilateral) first dorsal interosseous (FDI) from stimulating contralesional motor cortex. (c) This map is overlaid on the participant's magnetic resonance imaging (MRI). Both sub‐figures (a,c) represent the same child who has AIS. (b) Another 2D heat map of the affected FDI from stimulation of the contralesional motor cortex. (d) This map is overlaid on another participant's MRI. Both sub‐figures (b,d) represent the same child who has periventricular venous infarction (PVI). (d). Color bar represents the size of the MEP amplitude. Note that given the peak MEP amplitudes were very different between the two individuals (4.62 vs. 0.25 mV), we presented different scales for these two children to show detailed map topography
FIGURE 3
FIGURE 3
(a–c) Within‐subject comparison in motor map outcome in children with UCP. (d–f) Group comparison in motor map outcome between children with perinatal stroke‐induced UCP and TDC. (a) map area was larger in UFDI than AFDI. (b) Peak motor evoked potential (MEP) amplitude was larger in UFDI than AFDI. (c) No significant difference between affected and unaffected FDI volume. (d) No significant differences between TDC RFDI area and either FDI area in children with UCP. (e) Significant difference in peak MEP amplitude between TDC RFDI and AFDI in children with UCP. (f) No differences were observed in FDI volume between groups. AFDI, affected FDI; TDC, typically developing children; UCP, children with perinatal stroke‐induced UCP; UFDI, unaffected FDI. Dominant M1 represents the contralesional motor cortex in children with perinatal stroke‐induced UCP and left motor cortex in typically developing children. Box extends from 25 to 75th percentile and whiskers show 10–90th percentile
FIGURE 4
FIGURE 4
Lesioned hemisphere motor maps in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). (a–e): 2D heat maps of the affected first dorsal interosseous (FDI) from stimulating the lesioned motor cortex, (e–i) corresponding motor map overlap of the same participant in (a–e) on individual MRIs. Color bar on the right of individual figure represents the size of the motor evoked potential (MEP) amplitude
FIGURE 5
FIGURE 5
Correlations between motor mapping outcomes and Jebsen–Taylor Test of Hand Function (JTT). (a) Unaffected first dorsal interosseous (FDI) area was directly correlated with JTT of the unaffected hand, (b) unaffected FDI peak motor evoked potential (MEP) amplitude was correlated with JTT of the unaffected hand, (c) unaffected FDI volume was correlated with JTT of the unaffected hand. Note that the correlations in (b,c) trended toward significance when corrected for age (partial correlation = −.33, p = .07; partial correlation = −.35, p = .05, respectively)
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