Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

Aim
To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings of children with cerebral palsy (CP) that can be used in CP registers.

Method
The classification system was based on pathogenic patterns occurring in different periods of brain development. The MRI classification system (MRICS) consists of five main groups: maldevelopments, predominant white matter injury, predominant grey matter injury, miscellaneous, and normal findings. A detailed manual for the descriptions of these patterns was developed, including test cases (www.scpenetwork.eu/en/my-scpe/rtm/neuroimaging/cp-neuroimaging/). A literature review was performed and MRICS was compared with other classification systems. An exercise was carried out to check applicability and interrater reliability. Professionals working with children with CP or in CP registers were invited to participate in the exercise and chose to classify either 18 MRIs or MRI reports of children with CP.

Results
Classification systems in the literature were compatible with MRICS and harmonization possible. Interrater reliability was found to be good overall (k=0.69; 0.54–0.82) among the 41 participants and very good (k=0.81; 0.74–0.92) using the classification based on imaging reports.

Interpretation
Surveillance of Cerebral Palsy in Europe (SCPE) proposes the MRICS as a reliable tool. Together with its manual it is simple to apply for CP registers.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.13166

MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations.

• If the clinical history or findings on neuroimaging do not determine a specific structural abnormality or if there are additional and atypical features in the history or clinical examination, metabolic and genetic testing should be considered (Level C, Class III and IV). • Detection of a brain malformation in a child with CP warrants consideration of an underlying genetic or metabolic etiology (Level C, Class III and IV evidence). This is a summary of the American Academy of Neurology (AAN) and the Child Neurology Society (CNS) guideline evaluating the value and utility of investigative tests used to evaluate children diagnosed as having Cerebral Palsy (CP). Additionally, this parameter reviewed evidence pertaining to the frequency of other correlated health issues in children with CP, such as epilepsy, mental retardation, and ophthalmologic and hearing impairments. There is insufficient evidence to recommend the best sequence of tests to determine the etiology of CP. Taking into account diagnostic yield and potential ability to treat, the AAN developed the following consensus-based evaluation algorithm.

Practice Parameter: Diagnostic assessment of the child with cerebral palsy

Assessment of the structural brain network reveals altered connectivity in children with unilateral cerebral palsy due to periventricular white matter lesions

Aim
This study aimed to systematically map the severity of mirror movements in both hands in a prospective cohort of children with unilateral cerebral palsy, and to explore the relationship with hand function and brain lesion type.

Method
Seventy-eight children were included (41 males, 37 females; age 9y 4mo, SD 3y 1mo, range 5–15y). Mirror movements were scored during three repetitive tasks following Woods and Teuber criteria. Strength, tone, Melbourne Assessment, Jebsen–Taylor test, and Assisting Hand Assessment were evaluated. Lesions were classified into malformations (n=5), periventricular (n=43), cortico–subcortical (n=22), and postnatally acquired lesions (n=8).

Results
Significantly more mirror movements were observed in the non-paretic versus the paretic hand (p≤0.003). Higher mirror movement scores in the non-paretic hand significantly correlated with lower distal strength and lower scores on unimanual and bimanual assessments (r=0.29–0.41). In the paretic hand, significant differences were found between lesion types (p=0.03).

Interpretation
The occurrence of mirror movements in the non-paretic hand seems related to hand function while mirror movements in the paretic hand seem more related to the lesion timing, whereby children with earlier lesions present with more mirror movements.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.12977

Do mirror movements relate to hand function and timing of the brain lesion in children with unilateral cerebral palsy

Aim

To describe the development of a novel rating scale for classification of brain structural magnetic resonance imaging (MRI) in children with cerebral palsy (CP) and to assess its interrater and intrarater reliability.



Method

The scale consists of three sections. Section 1 contains descriptive information about the patient and MRI. Section 2 contains the graphical template of brain hemispheres onto which the lesion is transposed. Section 3 contains the scoring system for the quantitative analysis of the lesion characteristics, grouped into different global scores and subscores that assess separately side, regions, and depth. A larger interrater and intrarater reliability study was performed in 34 children with CP (22 males, 12 females; mean age at scan of 9y 5mo [SD 3y 3mo], range 4y–16y 11mo; Gross Motor Function Classification System level I, [n=22], II [n=10], and level III [n=2]).



Results

Very high interrater and intrarater reliability of the total score was found with indices above 0.87. Reliability coefficients of the lobar and hemispheric subscores ranged between 0.53 and 0.95. Global scores for hemispheres, basal ganglia, brain stem, and corpus callosum showed reliability coefficients above 0.65.



Interpretation

This study presents the first visual, semi-quantitative scale for classification of brain structural MRI in children with CP. The high degree of reliability of the scale supports its potential application for investigating the relationship between brain structure and function and examining treatment response according to brain lesion severity in children with CP.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.12457

Katrjin Klingels

Papers

Reliability of a novel, semi-quantitative scale for classification of structural brain magnetic resonance imaging in children with cerebral palsy.