Neuropediatrics 2006; 37 - CS2_4_2
DOI: 10.1055/s-2006-945549

ADVANCES OF NEUROIMAGING: STRUCTURE AND FUNCTION

I Krägeloh-Mann 1
  • 1Department of Paediatric and Developmental Neurology, University Children's Hospital, Tübingen, Germany

Objectives: Cerebral palsy (CP) is one of the commonest forms of severe childhood disability. Recent evidence from neuroimaging suggests that CP, in the majority of cases, is due to brain lesions acquired during different periods of early brain development. CP – as a well defined form of early lesional encephalopathy – offers an ideal model to study brain plasticity, e.g. functional consequences of early brain lesions as well as compensatory mechanisms.

Methods: We have studied patients with CP due to lesions of different timing during early development neurologically, neuropsychologically and by means of MRI, fMRI and TMS as well as MEG.

Results: In children with unilateral spastic CP, abnormal fast conducting cortico-spinal projections from the healthy hemisphere can exert the primary motor control, when, due to large lesions, motor tracts are disrupted. Such ipsilateral projections are not seen in the adult brain after stroke. Thus they constitute a specific compensatory mechanism of the young brain although their functional role seems to decrease already during late gestation. This limited compensatory potential within the motor system contrasts with the good compensation of language function after early left hemispheric lesions which is, however, on the expense of right hemispheric functions.

In conclusion, evidence for superior brain plasticity in the developing brain is well established for language function after left sided lesions, we could, however, support the concept of crowding in the healthy hemisphere. There is only some evidence for higher plasticity in the motor system – maintenance of ipsilateral tracts seems to play a certain, but incomplete functional role after unilateral lesions in early and mid gestation.

References: Staudt M, Grodd W, Gerloff Ch, Erb M, Stitz J, Krägeloh-Mann I. Two types of ipsilateral reorganization in congenital hemiparesis: a TMS and fMRI study. Brain 2002; 125:2222–2237.

Staudt M, Gerloff Ch, Grodd W, Holthausen H, Niemann G, Krägeloh-Mann I. Reorganization in congenital hemiparesis acquired at different gestational ages. Annals of Neurology 56:854–863

Lidzba, K, Staudt, M, Wilke, M, Krägeloh-Mann, I Visuospatial deficits in patients with early left-hemispheric lesions and functional reorganization of language: Consequence of lesion or reorganization? Neuropsychologia, accepted