Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability

The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- ing trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed （TD） children were recruited. Fifteen patients with gait dysfunction （bilateral trunk instability） were included in the group A, and the other 15 patients with gait dysfunction （unilateral trunk instability） were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical mani- festations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

Efficacy of oral magnesium therapy in the treatment of chronic constipation in spastic cerebral palsy children:a randomized controlled trial

Background Constipation is a common problem in children with spastic cerebral palsy(sCP)with a prevalence that reaches 75%.We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care.Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP.Methods A prospective,double-blinded randomized control trial was carried out involving 100 children aged 2-12 years with sCP(level Ⅲ-Ⅴ of the Gross Motor Functional Classification system)and chronic constipation.They were followed up in the Pediatric neurology clinic,Children's hospital,Ain Shams University,May 2017-January 2019.The intervention group(O-Mg)received oral magnesium sulfate 1 mL/kg/day daily for 1 month compared to the placebo.Outcome measures were constipation improvement and decrease in bowel evacuation time after 1 month.Results Initially,weekly bowel movements,constipation scores and stool consistency were comparable in both groups.After 1 month of regular administration of oral magnesium sulfate,the constipation score,stool frequency and consistency improved compared to the placebo group(P<0.001).Effective safe treatment was achieved in 31(68%)and 4(9.5%)patients in the O-Mg and placebo groups,respectively(RR,2.95;95%CI 2.0-4.5)(P<0.001).Painful bowel evacuation attempts spent by mothers decreased from 25(55.6%)of the cases initially to 10(22%)cases after one month in the O-Mg group(P=0.001).In contrast,in the placebo group,the decrease went from 21(50%)cases initially to 18(42.9%)after 1 month and was not significant(P=0.5).Conclusions Oral magnesium sulfate seems effective in alleviating chronic constipation and pain experience in children with sCP.Consequently,saving maternal time spent in daily bowel evacuation attempts.