Motor Evoked Potentials as Potential Biomarkers of Early Atypical Corticospinal Tract Development in Infants with Perinatal Stroke

Jesse L Kowalski, Samuel T Nemanich, Tanjila Nawshin, Mo Chen, Colleen Peyton, Elizabeth Zorn, Marie Hickey, Raghavendra Rao, Michael Georgieff, Kyle Rudser, Bernadette T Gillick, Jesse L Kowalski, Samuel T Nemanich, Tanjila Nawshin, Mo Chen, Colleen Peyton, Elizabeth Zorn, Marie Hickey, Raghavendra Rao, Michael Georgieff, Kyle Rudser, Bernadette T Gillick

Abstract

Diagnosis of cerebral palsy (CP) after perinatal stroke is often delayed beyond infancy, a period of rapid neuromotor development with heightened potential for rehabilitation. This study sought to assess whether the presence or absence of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) could be an early biomarker of atypical development within the first year of life. In 10 infants with perinatal stroke, motor outcome was assessed with a standardized movement assessment. Single-pulse TMS was utilized to assess presence of MEPs. Younger infants (3-6 months CA, n = 5, 4/5 (80%)) were more likely to present with an MEP from the more-affected hemisphere (MAH) compared to older infants (7-12 months CA, n = 5, 0/5, (0%)) (p = 0.048). Atypical movement was demonstrated in the majority of infants with an absent MEP from the MAH (5/6, 83%) compared to those with a present MEP (1/4, 25%) (p = 0.191). We found that age influences the ability to elicit an MEP from the MAH, and motor outcome may be related to MAH MEP absence. Assessment of MEPs in conjunction with current practice of neuroimaging and motor assessments could promote early detection and intervention in infants at risk of CP.

Keywords: cerebral palsy; infant; non-invasive brain stimulation; pediatrics; perinatal stroke; transcranial magnetic stimulation.

Conflict of interest statement

Colleen Peyton is a member of the Prechtl General Movements Trust Speaker’s Bureau. All other authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Example of transcranial magnetic stimulation assessment of motor evoked potentials (MEPs) from the more-affected hemisphere (MAH). Presence of MEPs (+MEP) was defined by presence of at least one MEP in either the contralateral (black line), ipsilateral (blue line), or both wrist flexors. MEP absence (−MEP) was defined by lack of MEP presence in the wrist flexor of either arm.
Figure 2
Figure 2
Surface electromyography (EMG) recording from the contralateral (black line) and ipsilateral (blue line) wrist flexors in a 12-month-old infant with unilateral perinatal stroke. (A) Motor evoked potential (MEP) in the contralateral wrist flexor elicited by transcranial magnetic stimulation (TMS) of the less-affected hemisphere. (B) EMG signal displaying absence of MEP in either wrist flexor after TMS of the more-affected hemisphere. Both traces A and B were recorded at a TMS intensity of 85% of maximum stimulator output.

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