Patterns of Structural Reorganization of the Corticospinal Tract in Children With Sturge-Weber Syndrome

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• 作者：David O. Kamson ; MD^a ; ^c ; Csaba Juh&aacute ; sz ; MD PhD^a ; ^b ; ^c ; Joseph Shin ; BS^c ; Michael E. Behen ; PhD^a ; ^c ; William C. Guy ; MA^c ; Harry T. Chugani ; MD^a ; ^b ; ^c ; Jeong-Won Jeong ; PhD^a ; ^b ; ^c ; ^{jeongwon@pet.wayne.edu" class="auth_mail}
• 关键词：Sturge-Weber syndrome ; corticospinal tract ; motor deficit ; reorganization ; diffusion tensor imaging ; tractography ; longitudinal study
• 刊名：Pediatric Neurology
• 出版年：April, 2014
• 年：2014
• 卷：50
• 期：4
• 页码：337-342
• 全文大小：822 K

文摘

Background

Reorganization of the corticospinal tract after early damage can limit motor deficit. In this study, we explored patterns of structural corticospinal tract reorganization in children with Sturge-Weber syndrome.

Methods

Five children (age 1.5-7聽years) with motor deficit resulting from unilateral Sturge-Weber syndrome were studied prospectively and longitudinally (1-2聽years follow-up). Corticospinal tract segments belonging to hand and leg movements were separated and their volume was measured by diffusion tensor imaging tractography using a recently validated method. Corticospinal tract segmental volumes were normalized and compared between the Sturge-Weber syndrome children and age-matched healthy controls. Volume changes during follow-up were also compared with clinical motor symptoms.

Results

In the Sturge-Weber syndrome children, hand-related (but not leg-related) corticospinal tract volumes were consistently decreased in the affected cerebral hemisphere at baseline. At follow-up, two distinct patterns of hand corticospinal tract volume changes emerged. (1) Two children with extensive frontal lobe damage showed a corticospinal tract volume decrease in the lesional hemisphere and a concomitant increase in the nonlesional (contralateral) hemisphere. These children developed good hand grasp but no fine motor skills. (2) The three other children, with relative sparing of the frontal lobe, showed an interval increase of the normalized hand corticospinal tract volume in the affected hemisphere; these children showed no gross motor deficit at follow-up.

Conclusions

Diffusion tensor imaging tractography can detect differential abnormalities in the hand corticospinal tract segment both ipsi- and contralateral to the lesion. Interval increase in the corticospinal tract hand segment suggests structural reorganization, whose pattern may determine clinical motor outcome and could guide strategies for early motor intervention.