The clinical outcomes of deep gray matter injury in children with cerebral palsy in relation with brain magnetic resonance imaging.
Severe HIE MRI pattern flags global impairment risk in CP, while kernicterus pattern flags mixed outcomes including hearing loss.
01Research in Context
What this study did
Doctors looked at brain MRI scans of children with cerebral palsy. They wanted to see which injury patterns predict future problems.
The team grouped the scans into two main patterns: severe HIE and kernicterus. Then they tracked how each child moved, thought, and talked.
What they found
Kids with the severe HIE pattern had big trouble in almost every area. They scored low on motor, cognitive, and language tests.
Children with the kernicterus pattern had mixed results. Some did fairly well, others had hearing loss or learning gaps.
How this fits with other research
Park et al. (2013) also studied what drives daily skills in CP. They found gross motor function is the direct path. Young et al. add MRI pictures that warn us when gross motor is likely to stay poor.
Tseng et al. (2011) showed motor severity and prosocial behavior predict daily capacity. The MRI patterns in Young et al. give an earlier red flag for that same motor severity.
Huang et al. (2013) pinpointed motor severity, IQ, and classroom supports as keys to school success. Young et al. tell us which kids will probably need all three supports before they even enter school.
Why it matters
You can read the MRI report at intake. If you see "severe HIE pattern," plan for full-scale support across motor, language, and cognitive goals. If you see "kernicterus pattern," add hearing screens and be ready for uneven skill profiles. This single image sharpens your whole treatment roadmap.
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02At a glance
03Original abstract
UNLABELLED: 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.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.04.010