Maturation of central motor nervous system and development of its impairment

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Magnetic stimulation of the motor cortex (MEP) and somatosensory evoked potential (SSEP) was used to examine the central conduction time in children with cerebral palsy. Twenty-two children with cerebral palsy (14 males and 8 females), aged between 4 to 12 years, were studied. Thirteen patients had spastic diplegia, 5 spastic quadriplegia and 4 hemiplegia, respectively. All subjects were studied in the fully awake state. Informed consent was obtained from subjects and parents. A standardized examination procedure was used with the children lying supine as relaxd as possible, with electrodes attached to the abductor pollicis brevis (APB) muscle over the thenar eminence and the abductor hallucis (AH) bilaterally. Stimulation was performed using a Nihon Koden SMN-1100 magnetic stimulator with an 8 shaped stimulator coil. MEP was recorded from APB in all patients with spastic diplegia. The mean latency of MEP,i.e.36.1 msec, from APB was longer than the latency in normal controls (20.5 msec). MEP from AH was recorded by stimulation to Cz in a patient with spastic diplegia, and 8 of the 13 patients with spastic diplegia showed responses in AH according to stimulation to the cortex of hand motor area. Patients with spastic diplegia who had responses in AH was able to walk. In one of the 5 patients with spastic quadriplegia MEP in APB was recorded, and there was no response in lower extremities. Other patients with spastic quadriplegia showed no response by magnetic stimulation. In patients with hemiplegia MEP was gained by stimulation to the healthy side of the head. SSEP did not show any specific changes in patients with CP.All of subjects did not show seizure or any other side effect. MEP studies may be useful to examine the function of patients with cerebral palsy.