Brain lesion extent, growth, and body composition in children with cerebral palsy
Stina Oftedal1, Simona Fiori2, Kristie L Bell3
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Health, Medicine and Behavioral Science, The University of Queensland, Brisbane, Queensland, Australia.
Insights
In children with cerebral palsy (CP), a larger brain lesion extent correlates with reduced height, weight, and head circumference. Body composition, however, was not significantly associated with lesion severity.
Area of Science:
- Neurology
- Pediatrics
- Medical Imaging
Background:
- Cerebral palsy (CP) is a group of disorders affecting movement and posture, often resulting from brain damage before, during, or shortly after birth.
- Growth and body composition are crucial aspects of health and development in children with CP, but their relationship with brain lesion extent is not fully understood.
Purpose of the Study:
- To investigate the association between the extent of brain lesions, measured by structural magnetic resonance imaging (MRI), and growth parameters (height, weight, head circumference) and body composition (Fat Mass Index, Fat-Free Mass Index) in children with CP.
Main Methods:
- A prospective, population-based cohort study included 124 children with CP (aged 18 months to 13 years).
- Brain lesion extent was assessed using validated semi-quantitative MRI scales.
- Growth z-scores (height, weight, head circumference) and body composition indices (FMI, FFMI) were calculated and analyzed using mixed-effects linear regression.
Main Results:
- A greater extent of brain lesions, particularly in the global, basal ganglia/brainstem, corpus callosum, and hemispheric regions, was significantly associated with lower height z-scores (HTZ).
- Increased global and corpus callosum lesion scores were linked to lower weight z-scores (WTZ).
- A greater hemispheric lesion score was associated with a lower head circumference z-score (HDZ), while lesion extent did not correlate with FMI or FFMI.
Conclusions:
- The extent of brain lesions in children with CP is significantly associated with reduced growth (height, weight, head circumference).
- Body composition (FMI, FFMI) was not found to be associated with the severity of brain lesions in this cohort.
- These findings highlight the impact of brain injury on physical development in children with CP and suggest that growth monitoring is essential.
Aim:
To investigate the relationship between growth, body composition, and the extent of brain lesion measured using structural magnetic resonance imaging (MRI) in children with cerebral palsy (CP).
Method:
This prospective population-based cohort study recorded 359 assessments from 124 children with CP aged 18 months to 13 years (38% female, Gross Motor Function Classification System [GMFCS] levels I = 50, II = 24, III = 17, IV = 12, and V = 21). A neurologist assessed the extent of the brain lesion using a validated semi-quantitative scale (global, basal ganglia/brainstem, hemispheric and corpus callosum scores). Height (HTZ), weight (WTZ), and head circumference (HDZ) z-scores were calculated. The Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) were determined using a deuterium dilution technique, bioelectrical impedance or dual-energy X-ray absorptiometry, and height. Data were analysed using mixed-effects linear regression.
Results:
Greater global (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.02), basal ganglia/brainstem (β = -0.06, 95% CI = -0.11 to -0.02), corpus callosum (β = -0.27, 95% CI = -0.27 to -0.12), and hemispheric (β = -0.08, 95% CI = -0.12 to -0.04) scores were associated with lower HTZ. Greater global (β = -0.03,95% CI = -0.06 to -0.01) and corpus callosum (β = -0.23, 95% CI = -0.40 to -0.06) scores were associated with lower WTZ. A greater hemispheric score (β = -0.06, 95% CI = -0.119 to -0.001) was associated with lower HDZ. Semi-quantitative MRI scores were not associated with FMI or FFMI.
Interpretation:
Greater extent of the brain lesion was significantly associated with lower HDZ, HTZ, and WTZ but not body composition in children with CP aged 18 months to 13 years.
