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Regional cerebral glucose metabolism in clinical subtypes of cerebral palsy
J F Kerrigan1, H T Chugani, M E Phelps
1Department of Neurology, University of California, Los Angeles School of Medicine 90024.
Insights
Positron emission tomography (PET) using 2-deoxy-2(18F)fluoro-D-glucose (FDG) revealed metabolic abnormalities in cerebral palsy subtypes. FDG-PET identified specific patterns beyond structural damage, suggesting potential for assessing learning handicaps.
Area of Science:
- Neuroscience
- Medical Imaging
- Pediatrics
Background:
- Cerebral palsy (CP) presents with diverse clinical subtypes.
- Understanding the functional brain impact in CP is crucial for diagnosis and management.
- Structural imaging (MRI/CT) may not fully capture metabolic dysfunction.
Purpose of the Study:
- To investigate glucose metabolism in different cerebral palsy subtypes using 2-deoxy-2(18F)fluoro-D-glucose (FDG) and positron emission tomography (PET).
- To correlate FDG-PET findings with structural imaging (MRI/CT).
- To explore the potential of FDG-PET in identifying learning handicaps and studying functional recovery in CP.
Main Methods:
- Studied 23 children with 4 CP subtypes (spastic quadriparesis, spastic diplegia, infantile hemiplegia, choreoathetosis).
- Utilized 2-deoxy-2(18F)fluoro-D-glucose (FDG) and positron emission tomography (PET) to assess glucose metabolism.
- Correlated FDG-PET findings with magnetic resonance imaging (MRI) or computed tomography (CT) scans.
Main Results:
- Metabolic abnormalities on FDG-PET generally corresponded to structural abnormalities but often extended beyond them.
- Spastic diplegia showed focal cortical hypometabolism without apparent structural issues.
- Choreoathetosis displayed normal cortical metabolism but thalamic and lenticular nuclei hypometabolism.
- Infantile hemiplegia revealed symmetric cerebellar metabolism, lacking crossed cerebellar hypometabolism (diaschisis), suggesting developmental plasticity.
Conclusions:
- FDG-PET provides insights into functional brain alterations in cerebral palsy subtypes beyond structural findings.
- The absence of crossed cerebellar hypometabolism in infantile hemiplegia suggests potential for metabolic recovery.
- FDG-PET may be valuable for identifying learning handicaps and studying functional recovery in pediatric cerebral palsy.
Abstract:
Twenty-three children with 4 clinical subtypes of cerebral palsy were studied using 2-deoxy-2(18F)fluoro-D-glucose (FDG) and positron emission tomography (PET). Subtypes included spastic quadriparesis (N = 6), spastic diplegia (N = 4), infantile hemiplegia (N = 8), and choreoathetosis (N = 5). FDG-PET images were correlated with magnetic resonance imaging or computed tomography. Although the location of glucose metabolic abnormalities corresponded, in general, to abnormalities of brain structure demonstrated by structural imaging studies, the distribution of metabolic impairment almost invariably extended beyond the region of anatomic involvement. The following observations in specific subtypes of cerebral palsy were determined with FDG-PET: (1) In spastic diplegic patients, PET revealed focal areas of cortical hypometabolism in the absence of apparent structural abnormality; (2) A relatively normal pattern of cortical metabolism was observed in most patients with choreoathetoid cerebral palsy, despite marked hypometabolism in the thalamus and lenticular nuclei; and (3) In patients with infantile hemiplegia, FDG-PET disclosed symmetric cerebellar glucose metabolism with absence of crossed cerebellar hypometabolism (diaschisis). This finding is contrary to the typical persistence of crossed cerebellar diaschisis in adult patients with acquired cerebral lesions and suggests metabolic recovery due to developmental plasticity. The possibility that FDG-PET may be clinically useful in identifying the cerebral palsy patient with potential learning handicap and in the study of functional recovery or sparing following brain injury should be explored further.