Multi-modal neuroimaging in children with congenital hemiplegia to assess functional and anatomical reorganization in relation to hand function

项目摘要 脑性瘫痪(CP)是儿童早期最常见的肢体残疾，导致严重的运动和 感官损伤。约30%的脑性瘫痪儿童有先天性偏瘫，由脑室周围引起 白质损伤(PV-WMI)，损害一只手的使用，扰乱双手协调。 先天性偏瘫对每个儿童的生活都有深远的影响，因此对公众来说非常重要 健康。脑组织的改变通常发生在PV-WMI之后，根据时间，位置， 以及损伤的程度，以及涉及的功能系统。了解这些变化是至关重要的 用于开发新的或改进的神经康复策略。此R21应用程序是 旨在识别与手功能相关的异常功能和解剖脑重组 年幼的儿童(18-24个月)由于单侧PV-WMI而患有先天性偏瘫，使用一种创新的多 模式神经成像方法。多模式神经成像研究在CP儿童中很少见，而且几乎 在患有CP的幼儿中不存在。通过利用儿科领域的最新进展 脑磁图(MEG)和扩散磁共振成像(MRI)为基础的多张量束成像(MTT)，我们建议 建立一种新颖的儿童脑磁图引导的四甲基偶氮唑盐技术以确定脑功能与结构的关系 在患有先天性偏瘫的幼儿中。对于儿科MEG，我们将使用BabyMEG系统，儿科MEG 专为0至3岁儿童设计的具有独特功能的MEG系统，在波士顿上市 儿童医院。我们推测单侧PV患儿偏瘫手部的运动指令。 WMI在对侧大脑半球产生，而感觉反馈在对侧大脑半球处理 半球。为了验证我们的假设，我们计划：(I)用儿科脑磁图确定大脑皮质的功能图谱。 食指主动运动时的初级运动皮质(M1)，以及初级躯体感觉 食指被动运动和拇指触觉刺激时的皮质(S1)， 和小指；(Ii)确定皮质脊髓运动和丘脑皮质感觉束的完整性 我们的脑磁图引导的四甲基偶氮唑蓝技术；以及(Iii)关联M1和S1激活图中的功能变化， 与手运动有关的皮质脊髓运动和丘脑皮质感觉束的结构变化 通过辅助手评估测试来评估性能。我们的研究将提供详细的见解 损伤后手部感觉运动功能重组的神经可塑性机制 发育中的人脑。我们的研究将直接影响患有癌症的儿童的生活质量 先天性偏瘫以及其他形式的脑性瘫痪，因为它有可能：(I)通知发育 根据个别患者的测量制定神经康复策略，(Ii)促进发展 针对特定大脑网络的促进可塑性干预，以及(Iii)确定最佳治疗参数 以及哪些患者群体将从这种治疗中受益。

Project Summary Cerebral palsy (CP) is the most common physical disability in early childhood causing serious motor and sensory impairments. About 30% of children with CP have congenital hemiplegia, resulting from periventricular white matter injury (PV-WMI), which impairs the use of one hand and disrupts bimanual co-ordination. Congenital hemiplegia has a profound effect on each child’s life and, thus, is of great importance to public health. Changes in brain organization often occur following PV-WMI varies depending on the timing, location, and extent of the injury, as well as the functional system involved. Understanding these changes is essential for the development of novel or improved neurological rehabilitation strategies. This R21 application is designed to identify abnormal functional and anatomical brain reorganization associated with hand function in young children (18-24 months) with congenital hemiplegia due to unilateral PV-WMI using an innovative multi- modal neuroimaging approach. Multi-modal neuroimaging studies are rare in children with CP, and are nearly non-existent in young children with CP. By capitalizing on recent advances in pediatric magnetoencephalography (MEG) and diffusion MRI based multi-tensor tractography (MTT), we propose to develop an innovative pediatric MEG-guided MTT technique to determine the brain function-structure relations in young children with congenital hemiplegia. For pediatric MEG, we will use the BabyMEG system, a pediatric MEG system with unique features designed specifically for children 0 to 3 years, which is available at Boston Children’s Hospital. We hypothesize that motor commands of the paretic hand in children with unilateral PV- WMI are generated in the contralesional hemisphere, while sensory feedback is processed in the ipsilesional hemisphere. To test our hypothesis, we plan to: (i) determine with pediatric MEG the functional maps of the primary motor cortex (M1) during active movements of the index finger, and of the primary somatosensory cortex (S1) during passive movements of the index finger and during tactile stimulation of the thumb, middle, and little fingers; (ii) determine the integrity of the corticospinal motor and thalamocortical sensory tracts using our MEG-guided MTT technique; and (iii) correlate the functional changes in the activation maps of M1 and S1, and the structural changes in the corticospinal motor and thalamocortical sensory tracts, with the hand motor performance assessed with the Assisting Hand Assessment test. Our study will provide detailed insights into the neuroplastic mechanisms involved in the reorganization of hand sensorimotor function following lesions to the developing human brain. Our research will have direct impact on the quality of life of children with congenital hemiplegia, as well as other forms of CP, because it has the potential to: (i) inform the development of neurorehabilitation strategies tailored to individual patients’ measurements, (ii) facilitate the development of plasticity-promoting interventions for specific brain networks, and (iii) determine optimal therapy parameters and which patient populations will benefit from such treatments.