Abstract
Introduction: Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability. However, the neural basis of these problems and how repetitive transcranial magnetic stimulation (rTMS) can make potential impacts on the disrupted structural brain network in BSCP remain unclear. This study was aimed to explore the topological characteristics of the structural brain network in BSCP following the treatment of rTMS.Methods: Fourteen children with BSCP underwent 4 weeks of TMS and 15 matched healthy children (HC) were enrolled. Diffusion tensor imaging (DTI) data were acquired from children with bilateral spastic cerebral palsy before treatment (CP1), children with bilateral spastic cerebral palsy following treatment (CP2) and HC. The graph theory analysis was applied to construct the structural brain network. Then nodal clustering coefficient (Ci) and shortest path length (Li) were measured and compared among groups.Results: Brain regions with significant group differences in Ci were located in the left precental gyrus, middle frontal gyrus, calcarine fissure, cuneus, lingual gyrus, postcentral gyrus, inferior parietal gyri, angular gyrus, precuneus, paracentral lobule and the right inferior frontal gyrus (triangular part), insula, posterior cingulate gyrus, precuneus, paracentral lobule, pallidum. In addition, significant differences were detected in the Li of the left precental gyrus, lingual gyrus, superior occipital gyrus, middle occipital gyrus, superior parietal gyrus, precuneus and the right median cingulate gyrus, posterior cingulate gyrus, hippocampus, putamen, thalamus. Post hoc t-test revealed that the CP2 group exhibited increased Ci in the right inferior frontal gyrus, pallidum and decreased Li in the right putamen, thalamus when compared with the CP1 group.Conclusion: Significant differences of node-level metrics were found in various brain regions of BSCP, which indicated a disruption in structural brain connectivity in BSCP. The alterations of the structural brain network provided a basis for understanding of the pathophysiological mechanisms of motor and cognitive impairments in BSCP. Moreover, the right inferior frontal gyrus, putamen, thalamus could potentially be biomarkers for predicting the efficacy of TMS.
Highlights
Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability
Nodal Clustering Coefficient in CP1 vs. healthy children (HC) Between-group comparisons revealed that the CP1 group had a significantly decreased coefficient of the node (Ci) in the left middle frontal gyrus, calcarine fissure, cuneus, inferior parietal gyrus, angular gyrus, precuneus and the right inferior frontal gyrus, posterior cingulate gyrus, precuneus, pallidum when compared with the HC group
Nodal Path Length in CP1 vs. HC The results showed that the CP1 group exhibited significantly increased Li in the lingual gyrus, superior occipital gyrus, middle occipital gyrus, fusiform gyrus, angular gyrus, precuneus and the right median cingulated gyrus, posterior cingulate gyrus, hippocampus, putamen, thalamus when compared with the HC group
Summary
Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability. Cerebral palsy (CP) is considered as an early childhoodonset neurodevelopmental disorder, which is characterized by motor and postural dysfunction often accompanied by cognitive impairments [1, 2]. The emerging magnetic resonance imaging (MRI) technique, especially diffusion tensor imaging (DTI), provides a non-invasive tool to explore white matter changes of CP and has recently advance our current understanding of the pathogenesis of CP [7,8,9]. The abnormal structure of basal ganglia and thalamus were found in CP children by the method of MRI, which were considered to be related to the motor and postural dysfunction of CP [17, 18]. Widespread abnormalities were found in the cerebral cortex and subcortical structures of CP children
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