Abstract
Objective Schizencephaly is a rare congenital malformation that causes motor impairment. To determine the treatment strategy, each domain of the motor functions should be appropriately evaluated. We correlated a color map of diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) with the hand function test (HFT) to identify the type of hand function that each test (DTI and TMS) reflects. Further, we attempted to demonstrate the motor neuron organization in schizencephaly. Method This retrospective study was conducted on 12 patients with schizencephaly. TMS was conducted in the first dorsal interosseous (FDI), biceps (BB), and deltoid muscles of the upper extremity, and contralateral MEP (cMEP) and ipsilateral MEP (iMEP) were recorded. The HFT included the grip strength, box and block (B&B), and 9-hole peg test. The schizencephalic cleft was confirmed using magnetic resonance imaging, and the corticospinal tract (CST) was identified using the color map of DTI. The symmetry indices for the peduncle and CST at pons level were calculated as the ratios of the cross-sectional area of the less-affected side and that of the more-affected side. Result In the more-affected hemisphere TMS, no iMEP was obtained. In the less-affected hemisphere TMS, the iMEP response was detected in 9 patients and cMEP in all patients, which was similar to the pattern observed in unilateral lesion. Paretic hand grip strength was strongly correlated with the presence of iMEP (p = 0.044). The symmetry index of the color map of DTI was significantly correlated with the B&B (p = 0.008, R2 = 0.416), whereas the symmetry index of the peduncle was not correlated with all HFTs. Conclusion In patients with schizencephaly, the iMEP response rate is correlated with the hand function related to strength, while the symmetricity of the CST by the color map of DTI is correlated with the hand function associated with dexterity. Additionally, we suggest the possible motor organization pattern of schizencephaly following interhemispheric competition.
Highlights
Is a congenital cerebral malformation characterized by the presence of one or more cerebral mantle clefts extending from the pial surface to the lateral ventricles and spanning the pial and ependymal surfaces of one or both cerebral hemispheres, delineated by the gray matter [1]
To confirm the function of ipsilateral CST (iCST) without contralateral corticospinal tract (CST) interference, we investigated the correlation between ipsilateral motor evoked potentials (MEP) (iMEP) evocation status and hand function in patients who did not show contralateral MEP (cMEP) corresponding to the paretic hand
The MEPs of the 12 patients with schizencephaly were obtained, and the iMEP and cMEP parameters were collected for each muscle
Summary
Is a congenital cerebral malformation characterized by the presence of one or more cerebral mantle clefts extending from the pial surface to the lateral ventricles and spanning the pial and ependymal surfaces of one or both cerebral hemispheres, delineated by the gray matter [1]. Is associated with several clinical features of varying severity, including developmental delay, intellectual disability, epilepsy, and motor deficits [2, 3]. Is one of the several brain lesions that lead to CP [5] but has distinct structural and temporal. BioMed Research International features compared to other brain lesions. Schizencephaly is a brain damage at an earlier stage than other lesions leading to CP and is not a 3rd trimester lesion, such as periventricular leukomalacia and stroke, but is a 2nd trimester lesion that has the highest plasticity [6]. Based on the abundant plasticity, the physiological manifestations in response to the brain damage can be better observed
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