Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk...

Area of Science:

• Neuroscience
• Developmental Pediatrics
• Biomedical Engineering

Background:

• The corticoreticular tract (CRT) plays a role in motor control, including walking and postural stability.
• Gait dysfunction and trunk instability are common in pediatric patients with developmental delays.
• Diffusion tensor tractography (DTT) is a neuroimaging technique used to visualize white matter tracts.

Purpose of the Study:

• To investigate the relationship between the corticoreticular tract (CRT) and gait dysfunction, specifically trunk instability, in pediatric patients.
• To compare CRT integrity in patients with bilateral versus unilateral trunk instability and typically developed children.
• To assess the correlation between CRT status and functional motor assessments.

Main Methods:

• Recruited 30 pediatric patients with delayed development (15 with bilateral trunk instability - Group A, 15 with unilateral trunk instability - Group B) and 15 typically developed (TD) children.
• Utilized diffusion tensor tractography (DTT) to measure fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract.
• Assessed functional status using the Growth Motor Function Classification System and Functional Ambulation Category scales.

Main Results:

• Corticospinal tract integrity did not differ significantly across groups.
• Both CRTs were disrupted in Group A (bilateral instability).
• CRT disruption occurred in hemispheres contralateral to clinical manifestations in Group B (unilateral instability).
• Fractional anisotropy and fiber numbers were decreased in both CRTs in Group A compared to TD.
• Decreases in fractional anisotropy and fiber numbers were more pronounced on the ipsilateral side in Group B compared to the contralateral side, relative to TD.
• CRT status showed strong correlations with functional evaluation data and clinical manifestations, unlike corticospinal tract status.

Conclusions:

• Corticoreticular tract (CRT) integrity is clinically significant for gait function and trunk stability in pediatric patients.
• Diffusion tensor tractography (DTT) is a valuable tool for assessing CRT status in pediatric patients with gait dysfunction.
• Findings highlight the CRT's critical role in pediatric motor control, differentiating its involvement in bilateral versus unilateral trunk instability.