Lesion mapping and functional characterization of hemiplegic children with different patterns of hand manipulation

• Published in: NeuroImage clinical 2024, Vol.41, p.103575-103575, Article 103575
• Main Authors: Errante, Antonino, Bozzetti, Francesca, Piras, Alessandro, Beccani, Laura, Filippi, Mariacristina, Costi, Stefania, Ferrari, Adriano, Fogassi, Leonardo
• Format: Article
• Language: English
• Subjects: Action execution; Cerebral palsy; Functional reorganization; Lesion classification; Upper limb; Voxel-based morphometry
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2024.103575

[Display omitted] •Lesion of subcortical structures is more frequent in patients with synergic hand.•Sparing of subcortical white matter connections predicts hand impairment.•Children with semi-functional hand exhibit bilateral activations during grasping execution.•Patients with synergic hand show activations lateralized to the damaged hemisphere.•Lesion localization, rather than type (timing), predicts the manipulation level. Brain damage in children with unilateral cerebral palsy (UCP) affects motor function, with varying severity, making it difficult the performance of daily actions. Recently, qualitative and semi-quantitative methods have been developed for lesion classification, but studies on mild to moderate hand impairment are lacking. The present study aimed to characterize lesion topography and preserved brain areas in UCP children with specific patterns of hand manipulation. A homogeneous sample of 16 UCP children, aged 9 to 14 years, was enrolled in the study. Motor assessment included the characterization of the specific pattern of hand manipulation, by means of unimanual and bimanual measures (Kinematic Hand Classification, KHC; Manual Ability Classification System, MACS; House Functional Classification System, HFCS; Melbourne Unilateral Upper Limb Assessment, MUUL; Assisting Hand Assessment, AHA). The MRI morphological study included multiple methods: (a) qualitative lesion classification, (b) semi-quantitative classification (sq-MRI), (c) voxel-based morphometry comparing UCP and typically developed children (VBM-DARTEL), and (d) quantitative brain tissue segmentation (q-BTS). In addition, functional MRI was used to assess spared functional activations and cluster lateralization in the ipsilesional and contralesional hemispheres of UCP children during the execution of simple movements and grasping actions with the more affected hand. Lesions most frequently involved the periventricular white matter, corpus callosum, posterior limb of the internal capsule, thalamus, basal ganglia and brainstem. VMB-DARTEL analysis allowed to detect mainly white matter lesions. Both sq-MRI classification and q-BTS identified lesions of thalamus, brainstem, and basal ganglia. In particular, UCP patients with synergic hand pattern showed larger involvement of subcortical structures, as compared to those with semi-functional hand. Furthermore, sparing of gray matter in basal ganglia and thalamus was positively correlated with MUUL and AHA scores. Concerning whi