ICNC Abstracts, ICNC 2018

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Resting state cerebral glucose metabolism using [18]Fluoro-Deoxy-Glucose-Positron Emission Tomography (FDG-PET), Central Motor Conduction Times (CMCT) and Somatosensory Evoked Potentials (SEP) in children with dystonic cerebral palsy (CP)
Stavros Tsagkaris, Verity McClelland, Sinead Barkey, Maiju Kattelus, Lesley Baker, Sarah Perides, Daniel Lumsden, Margaret Kaminska, Hortensia Gimeno, Keyoumars Ashkan, Richard Selway, Alexander Hammers, Jean-Pierre Lin

Last modified: 2018-09-09

Abstract


Introduction: CP dystonia dominates referral to our Service. We assessed the clinical, neurophysiological and functional imaging characteristics to provide greater personalised prognostic information regarding suitability for DBS.

Methods: Data from 108 CP patients were analysed. CMCT and SEP were obtained using standard methodology. 106/108 FDG-PET-CT brain scans were quantitatively analysed using Statistical Parametric Mapping (SPM12), applying a visualization threshold of p=0.001.

Results: The cohort included 15(14%) cases of Kernicterus, 41(38%) pre-term and 52(48%) term births. The mean baseline dystonia severity score using the Burke-Fahn-Marsden Dystonia Rating Scale-motor (BFMDRS-M) was 87.4/120 (SD=19.9). DBS was performed in 54 (50%) cases. A 1-year follow-up (N=44) modest BFMDRS-M improvement trend was observed (Z=1.81, p=0.071). The kernicterus group had the least favourable DBS outcome and the pre-terms the most favourable (absolute change in mean BFMDRS-M=4.81, p=0.015). 14/77 (18%) cases had abnormal CMCT and 30/65 (46%) had abnormal SEP. SEP/CMCT did not relate significantly to outcome in this small group. PET imaging revealed a significant hypometabolism within the posterior putamen extending to the posterior globus pallidus of the CP-term patients, when compared to the other two CP groups. When compared to DYT1 cases (N=7), both term and pre-term CP cases had relative bilateral thalamic hypometabolism.

Discussion: CP is a common aetiology of dystonia. A significant proportion of children show neurophysiological abnormalities, particularly of sensory pathways. FDG-PET abnormalities imply an underlying functional defect, which may offer further insight into various distinct CP pathophysiologies. Multi-modal assessment may help with patient selection and prognostic counselling.


Keywords


Cerebral Palsy; dystonia; Deep Brain Stimulation; neurophysiology; FDG-PET

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