Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia

Jong Doo Lee, Hae Jeong Park, Eun Sook Park, Maeng Keun Oh, Bumhee Park, Dong Wook Rha, Sung-Rae Cho, Eung Yeop Kim, Junyong Park, Chul Hoon Kim, Dong Goo Kim, Chang Il Park

Research output: Contribution to journalArticle

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Abstract

Periventricular leucomalacia has long been investigated as a leading cause of motor and cognitive dysfunction in patients with spastic diplegic cerebral palsy. However, patients with periventricular leucomalacia on conventional magnetic resonance imaging do not always have motor dysfunction and preterm children without neurological abnormalities may have periventricular leucomalacia. In addition, it is uncertain whether descending motor tract or overlying cortical injury is related to motor impairment. To investigate the relationship between motor pathway injury and motor impairment, we conducted voxelwise correlation analysis using tract-based spatial statistics of white matter diffusion anisotropy and voxel-based-morphometry of grey matter injury in patients with periventricular leucomalacia and spastic diplegia (n=43, mean 12.86±4.79 years, median 12 years). We also evaluated motor cortical and thalamocortical connectivity at resting state in 11 patients using functional magnetic resonance imaging. The functional connectivity results of patients with spastic diplegic cerebral palsy were compared with those of age-matched normal controls. Since γ-aminobutyric acidA receptors play an important role in the remodelling process, we measured neuronal γ-aminobutyric acidA receptor binding potential with dynamic positron emission tomography scans (n=27) and compared the binding potential map of the patient group with controls (n=20). In the current study, white matter volume reduction did not show significant correlation with motor dysfunction. Although fractional anisotropy within most of the major white matter tracts were significantly lower than that of age-matched healthy controls (P<0.05, family wise error corrected), fractional anisotropy mainly within the bilateral corticospinal tracts and posterior body and isthmus of the corpus callosum showed more significant correlation with motor dysfunction (P<0.03) than thalamocortical pathways (P<0.05, family-wise error corrected). Cortical volume of the pre- and post-central gyri and the paracentral lobule tended to be negatively correlated with motor function. The motor cortical connectivity was diminished mainly within the bilateral somatosensory cortex, paracentral lobule, cingulate motor area and visual cortex in the patient group. Thalamovisual connectivity was not diminished despite severe optic radiation injury. γ-aminobutyric acidA receptor binding potential was focally increased within the lower extremity homunculus, cingulate cortex, visual cortex and cerebellum in the patient group (P<0.05, false discovery rate corrected). In conclusion, descending motor tract injury along with overlying cortical volume reduction and reduced functional connectivity appears to be a leading pathophysiological mechanism of motor dysfunction in patients with periventricular leucomalacia. Increased regional γ-aminobutyric acidA receptor binding potential appears to result from a compensatory plasticity response after prenatal brain injury.

Original languageEnglish
Pages (from-to)1199-1210
Number of pages12
JournalBrain
Volume134
Issue number4
DOIs
Publication statusPublished - 2011 Apr 1

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Periventricular Leukomalacia
Efferent Pathways
Cerebral Palsy
Wounds and Injuries
Anisotropy
Somatosensory Cortex
Gyrus Cinguli
Motor Cortex
Visual Cortex
Prenatal Injuries
Magnetic Resonance Imaging
Radiation Injuries
Pyramidal Tracts
Corpus Callosum
Positron-Emission Tomography
Brain Injuries
Cerebellum
Lower Extremity

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Lee, J. D., Park, H. J., Park, E. S., Oh, M. K., Park, B., Rha, D. W., ... Park, C. I. (2011). Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia. Brain, 134(4), 1199-1210. https://doi.org/10.1093/brain/awr021
Lee, Jong Doo ; Park, Hae Jeong ; Park, Eun Sook ; Oh, Maeng Keun ; Park, Bumhee ; Rha, Dong Wook ; Cho, Sung-Rae ; Kim, Eung Yeop ; Park, Junyong ; Kim, Chul Hoon ; Kim, Dong Goo ; Park, Chang Il. / Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia. In: Brain. 2011 ; Vol. 134, No. 4. pp. 1199-1210.
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Lee, JD, Park, HJ, Park, ES, Oh, MK, Park, B, Rha, DW, Cho, S-R, Kim, EY, Park, J, Kim, CH, Kim, DG & Park, CI 2011, 'Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia', Brain, vol. 134, no. 4, pp. 1199-1210. https://doi.org/10.1093/brain/awr021

Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia. / Lee, Jong Doo; Park, Hae Jeong; Park, Eun Sook; Oh, Maeng Keun; Park, Bumhee; Rha, Dong Wook; Cho, Sung-Rae; Kim, Eung Yeop; Park, Junyong; Kim, Chul Hoon; Kim, Dong Goo; Park, Chang Il.

In: Brain, Vol. 134, No. 4, 01.04.2011, p. 1199-1210.

Research output: Contribution to journalArticle

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AU - Rha, Dong Wook

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N2 - Periventricular leucomalacia has long been investigated as a leading cause of motor and cognitive dysfunction in patients with spastic diplegic cerebral palsy. However, patients with periventricular leucomalacia on conventional magnetic resonance imaging do not always have motor dysfunction and preterm children without neurological abnormalities may have periventricular leucomalacia. In addition, it is uncertain whether descending motor tract or overlying cortical injury is related to motor impairment. To investigate the relationship between motor pathway injury and motor impairment, we conducted voxelwise correlation analysis using tract-based spatial statistics of white matter diffusion anisotropy and voxel-based-morphometry of grey matter injury in patients with periventricular leucomalacia and spastic diplegia (n=43, mean 12.86±4.79 years, median 12 years). We also evaluated motor cortical and thalamocortical connectivity at resting state in 11 patients using functional magnetic resonance imaging. The functional connectivity results of patients with spastic diplegic cerebral palsy were compared with those of age-matched normal controls. Since γ-aminobutyric acidA receptors play an important role in the remodelling process, we measured neuronal γ-aminobutyric acidA receptor binding potential with dynamic positron emission tomography scans (n=27) and compared the binding potential map of the patient group with controls (n=20). In the current study, white matter volume reduction did not show significant correlation with motor dysfunction. Although fractional anisotropy within most of the major white matter tracts were significantly lower than that of age-matched healthy controls (P<0.05, family wise error corrected), fractional anisotropy mainly within the bilateral corticospinal tracts and posterior body and isthmus of the corpus callosum showed more significant correlation with motor dysfunction (P<0.03) than thalamocortical pathways (P<0.05, family-wise error corrected). Cortical volume of the pre- and post-central gyri and the paracentral lobule tended to be negatively correlated with motor function. The motor cortical connectivity was diminished mainly within the bilateral somatosensory cortex, paracentral lobule, cingulate motor area and visual cortex in the patient group. Thalamovisual connectivity was not diminished despite severe optic radiation injury. γ-aminobutyric acidA receptor binding potential was focally increased within the lower extremity homunculus, cingulate cortex, visual cortex and cerebellum in the patient group (P<0.05, false discovery rate corrected). In conclusion, descending motor tract injury along with overlying cortical volume reduction and reduced functional connectivity appears to be a leading pathophysiological mechanism of motor dysfunction in patients with periventricular leucomalacia. Increased regional γ-aminobutyric acidA receptor binding potential appears to result from a compensatory plasticity response after prenatal brain injury.

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Lee JD, Park HJ, Park ES, Oh MK, Park B, Rha DW et al. Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia. Brain. 2011 Apr 1;134(4):1199-1210. https://doi.org/10.1093/brain/awr021