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The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging

Authors
 Ja Young Choi  ;  Yoon Seong Choi  ;  Dong-wook Rha  ;  Eun Sook Park 
Citation
 RESEARCH IN DEVELOPMENTAL DISABILITIES, Vol.55 : 218-225, 2016 
Journal Title
 RESEARCH IN DEVELOPMENTAL DISABILITIES 
ISSN
 0891-4222 
Issue Date
2016
MeSH
Adolescent ; Cerebral Palsy/diagnostic imaging* ; Cerebral Palsy/epidemiology ; Cerebral Palsy/physiopathology ; Child ; Child, Preschool ; Cognition ; Communication ; Developmental Disabilities/diagnostic imaging* ; Developmental Disabilities/epidemiology ; Developmental Disabilities/physiopathology ; Epilepsy/diagnostic imaging ; Epilepsy/epidemiology ; Female ; Gray Matter/diagnostic imaging* ; Gray Matter/physiopathology ; Humans ; Hypoxia-Ischemia, Brain/diagnostic imaging* ; Hypoxia-Ischemia, Brain/epidemiology ; Hypoxia-Ischemia, Brain/physiopathology ; Infant ; Intellectual Disability/diagnostic imaging ; Intellectual Disability/epidemiology ; Kernicterus/diagnostic imaging* ; Kernicterus/epidemiology ; Kernicterus/physiopathology ; Magnetic Resonance Imaging ; Male ; Motor Skills ; Retrospective Studies ; Risk Factors ; Severity of Illness Index
Keywords
Cerebral palsy ; Clinical outcome ; Deep gray matter ; Magnetic resonance imaging
Abstract
In the present study we investigated the nature and extent of clinical outcomes using various classifications and analyzed the relationship between brain magnetic resonance imaging (MRI) findings and the extent of clinical outcomes in children with cerebral palsy (CP) with deep gray matter injury. The deep gray matter injuries of 69 children were classified into hypoxic ischemic encephalopathy (HIE) and kernicterus patterns. HIE patterns were divided into four groups (I-IV) based on severity. Functional classification was investigated using the gross motor function classification system-expanded and revised, manual ability classification system, communication function classification system, and tests of cognitive function, and other associated problems. The severity of HIE pattern on brain MRI was strongly correlated with the severity of clinical outcomes in these various domains. Children with a kernicterus pattern showed a wide range of clinical outcomes in these areas. Children with severe HIE are at high risk of intellectual disability (ID) or epilepsy and children with a kernicterus pattern are at risk of hearing impairment and/or ID. Grading severity of HIE pattern on brain MRI is useful for predicting overall outcomes. The clinical outcomes of children with a kernicterus pattern range widely from mild to severe. WHAT THIS PAPER ADDS: Delineation of the clinical outcomes of children with deep gray matter injury, which are a common abnormal brain MRI finding in children with CP, is necessary. The present study provides clinical outcomes for various domains in children with deep gray matter injury on brain MRI. The deep gray matter injuries were divided into two major groups; HIE and kernicterus patterns. Our study showed that severity of HIE pattern on brain MRI was strongly associated with the severity of impairments in gross motor function, manual ability, communication function, and cognition. These findings suggest that severity of HIE pattern can be useful for predicting the severity of impairments. Conversely, children with a kernicterus pattern showed a wide range of clinical outcomes in various domains. Children with severe HIE pattern are at high risk of ID or epilepsy and children with kernicterus pattern are at risk of hearing impairment or ID. The strength of our study was the assessment of clinical outcomes after 3 years of age using standardized classification systems in various domains in children with deep gray matter injury.
Full Text
http://www.sciencedirect.com/science/article/pii/S0891422216300804
DOI
10.1016/j.ridd.2016.04.010
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Dong Wook(나동욱) ORCID logo https://orcid.org/0000-0002-7153-4937
Park, Eun Sook(박은숙) ORCID logo https://orcid.org/0000-0002-9144-3063
Choi, Yoon Seong(최윤성)
Choi, Ja Young(최자영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151759
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