Articles, Issue 3/2022

Cerebral Reorganization in the Motor System in Patients with Hemiplegic Cerebral Palsy

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K. Gaberova, I. Pacheva, N. Sirakov, E. Timova, I. Ivanov


Abstract

Introduction: Motor deficiency is a mandatory symptom in patients with unilateral cerebral palsy. The identification of the factors causing varying degrees of this deficit has been the subject of a number of studies. Advances in neuroscience have made it possible to use in vivo methods for this purpose, determining both brain structure (morphometry) and functional reorganization at the cortical level.

Objective: To assess neuroplasticity in the motor system after a unilateral brain lesion that occurred in the early stages of human brain development and its dependence on the characteristics of the brain lesion.

Materials and methods: In the period 2017-2021, sMRI and fMRI with a motor paradigm for paretic (unified right) hand were performed in 44 patients with unilateral cerebral palsy with MACS 1-3 and IQ> 50 (mean age – 15 years 7 months, male- 24, female-20) and 42 healthy participants (mean age 16 years; male – 20, female – 22). The morphological characteristics of the lesion (size and type) were determined by morphometry. fMRI-analysis explored the cortical activation during motor paradigm in the control and patient group, the differences between the two groups and its dependence on the characteristics of the lesion.

Results: In the group of patients with unilateral cerebral palsy examined by us, six types of lesions were identified, the most common and with the largest volume being AIS. The cerebral reorganization of motor function in patients with unilateral cerebral palsy is diverse – ipsi-, bi- or contralateral to the affected hand in contrast to healthy controls, where it is only contralateral to the hand. In smaller and subcortical lesions, the ipsilesional (contralateral to the paretic hand) activation dominates.

Conclusion: unilateral cerebral palsy occurs as a result of various lesions. The cortical organization of motor function for the paretic upper limb in patients with unilateral cerebral palsy  is also diverse, depending on the morphological characteristics of the lesion – size and type.

Key words: hemiplegic cerebral palsy, morphometry, fMRI, neuroplasticity.

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Address for correspondence:

Department of Pediatrics and Medical Genetics, MU – Plovdiv
15A, “Vasil Aprilov”, Blvd.
4000, Plovdiv
Bulgaria
e-mail: katerina_gaberowa@yahoo.com