第十八屆 [利用穿顱磁刺激合併腦部影像及整體動作評估法預測有腦部出血之新生兒的未來動作發展：個案報告]

[利用穿顱磁刺激合併腦部影像及整體動作評估法預測有腦部出血之新生兒的未來動作發展：個案報告]

Predicting Motor Outcomes in Infants with Brain Hemorrhage using Transcranial Magnetic Stimulation with Brain Imaging and the General Movements Assessment: Two Case Reports

陳昭縈^1,*、陳默²、James W. Stinear³、Jed T. Elison⁴、Samuel T. Nemanich¹、Colleen Peyton⁵、Bryon A. Mueller⁶、Michael K. Georgieff⁷、Raghavendra Rao⁷、Kyle D. Rudser⁸、Bernadette T. Gillick¹

Chao-Ying Chen^1,*   Mo Chen²   James W. Stinear³   Jed T. Elison⁴   Samuel T. Nemanich¹    Colleen Peyton⁵   Bryon A. Mueller⁶   Michael K. Georgieff⁷   Raghavendra Rao⁷   Kyle D. Rudser⁸   Bernadette T. Gillick¹

¹明尼蘇達大學復健醫學系、²明尼蘇達大學醫學工程所、 ³奧克蘭大學運動醫學學系、⁴ 明尼蘇達大學兒童發展所、⁵芝加哥大學醫院復健治療部門、⁶明尼蘇達大學精神病學系、⁷明尼蘇達大學兒科學系 ⁸ 明尼蘇達大學臨床與轉譯科學所

¹Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA, ²Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA, ³Department of Exercise Sciences, University of Auckland, New Zealand, ⁴Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA, ⁵Department of Therapy Services, University of Chicago Medicine, Chicago, Illinois, USA, ⁶Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA, ⁷Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA, ⁸Clinical and Translational Science Institute, University of Minneapolis, Minnesota, USA

Background and Purpose: Early prediction of Cerebral Palsy (CP) in high-risk infants is critical for timely intervention. In clinic, neuroimaging techniques and motor assessment scales contribute to the prediction of CP. Examining neurophysiological outcomes may also help to identify the characteristics of future motor impairments of CP. However, the accuracy of prognosis prediction within the first few months after birth still needs improvement. The purpose of this project is to explore the feasibility and the value of integrating Transcranial Magnetic Stimulation (TMS) together with brain imaging results and the General Movements Assessment (GMA) to predict motor outcomes in infants with perinatal brain hemorrhage.

Methods: Two case reports are presented. The medical records including clinical MRI and cranial ultrasound, performed at the hospital, were used to confirm and describe brain injuries in the two infant participants. Both infants received an additional MRI scan using a non-sedative protocol at 3-5 months corrected age at the research center. The obtained anatomical T1-image was then projected onto a frameless stereotactic neuronavigation system to guide TMS assessment for corticospinal excitability examination. TMS was performed using a 70-mm figure-of-eight head coil and the corticospinal excitability was assessed by detecting the electromyography (EMG) activities of wrist flexors in Case 2. A 3 to 5-minute video was recorded for the GMA used to predict the risk of CP in each infant.

Results: In Case 1, the combination of neuroimaging and GMA showed an elevated risk of neurodevelopmental impairment not necessarily related to CP. The same analysis showed Case 2 to be at high-risk of CP and the additional TMS assessment revealed potential asymmetry of corticospinal excitability between hemispheres, which may impact the infant’s motor development. At the follow-up clinic after participating in the study, a routine observation for potential visual impairment in Case 1 was suggested; Case 2 was noted to show signs of CP and started receiving Physical Therapy immediately.

Conclusion: A combined battery of neuroimaging, neuroexcitability, and movement assessments is feasible and provides valuable information to identify infants who are at high-risk of motor impairments and the early needs of intervention. Although a larger sample to include infants who are at different risk levels of motor impairments including CP is needed to confirm the prediction accuracy of aforementioned assessments, our pilot findings are intended to aid future longitudinal and interventional studies with larger sample sizes to enhance the developmental outcomes in high-risk infant populations.

Keywords: Infant, Cerebral Palsy, Transcranial Magnetic Stimulation, Magnetic Resonance Imaging, General Movements Assessment, Motor Impairments