Exploring structural connectomes in children with unilateral cerebral palsy using graph theory

Area of Science:

• Neuroscience
• Medical Imaging
• Pediatrics

Background:

• Spastic unilateral cerebral palsy (uCP) affects motor function due to brain lesions.
• Understanding the relationship between brain structure and function in uCP is crucial for targeted interventions.

Purpose of the Study:

• To investigate structural brain connectomes in children with uCP using graph theory.
• To explore the association between brain connectivity patterns and sensory-motor function in uCP.
• To compare connectivity between different lesion types and corticospinal tract (CST) wiring patterns.

Main Methods:

• Structural MRI (diffusion-weighted, T1-weighted, T2-FLAIR) and transcranial magnetic stimulation (TMS) were used in 46 children with uCP.
• Structural connectomes were constructed using Virtual Brain Grafting and diffusion MRI tractography.
• Graph theory metrics analyzed whole-brain and sensory-motor network connectivity, compared between lesion types (PWM vs. CDGM) and CST-wiring patterns.

Main Results:

• Children with cortical and deep gray matter (CDGM) lesions exhibited hyperconnectivity (higher clustering coefficient, characteristic path length, local efficiency; lower global efficiency) compared to periventricular white matter (PWM) lesions.
• No significant differences in connectivity were found between CST-wiring groups.
• Elastic-net regression models effectively predicted sensory-motor function (R² = 0.40–0.87), with CST-wiring pattern being the strongest predictor for motor function.

Conclusions:

• Structural connectomics offers valuable insights into disease severity and brain development in pediatric uCP.
• Brain hyperconnectivity in CDGM lesions suggests altered network organization impacting function.
• CST-wiring patterns are critical determinants of motor function in uCP, highlighting potential therapeutic targets.