Does Injured Corticospinal Tract Recover after Rehabilitation Therapy in Patients with Hemiplegic Cerebral Palsy?

ABSTRACT

OBJECTIVE: To investigate whether injured corticospinal tract (CST) could recover after rehabilitative therapy in hemiplegic patients with cerebral palsy using diffusion tensor tractography (DTT) which is known to be useful in detecting microscopic white matter lesion in vivo. METHOD: Sixteen hemiplegic patients (mean age, 13.6 months) were enrolled. Diffuse tensor image (DTI) and gross motor functional measurement (GMFM) evaluation were performed before rehabilitative therapy and at follow-up. We measured the fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of CST in the affected and unaffected hemisphere. To evaluate asymmetry of affected and unaffected CST, asymmetry index of fractional anisotropy (AA) and asymmetry index of apparent diffusion coefficient (AD) were measured. RESULTS: The FA value of the affected CST was lower than that of the unaffected CST and the ADC value was higher than that of the unaffected CST in initial and follow up DTT (p<0.001). Compared with the result of initial DTT, the results of follow up DTT demonstrated that the FA value of both CST was increased (p=0.000). A significant increase in AA was showed in all patients (p=0.000) and the increase of AA had significant correlation with the increase of FA of affected CST, but not with the unaffected CST (r=0.537, p=0.032). CONCLUSION: DTT would be a powerful modality not only for diagnosis and prognosis of cerebral palsy, but also assessment of microstructural change of CST after rehabilitative therapy.