Brain Control of Movements in Cerebral Palsy

INCLUSION CRITERIA: Children and adults 6 to 30 years of age. CEREBRAL PALSY PATIENTS: Patients previously diagnosed with spastic diplegia or spastic hemiplegia subtype of cerebral palsy. Lesions must be pre-, peri- or post-natal and acquired before 1 year of age. Lesions must be non-progressive. Patients must be able to voluntarily move their upper and lower limbs. Cognitive function: DQ over 50 or IQ over 50 as assessed by Gesell or with standardized tests (pre-school age), or through school testing (school age). Able to attend, at minimum, one-on-one tutoring or special education classes (to ensure cooperation with testing procedures). Able to ambulate either independently or with assistive mobility devices. HEALTHY SUBJECTS: Scores below 60 on Connor's (ADHD) checklist. Normal neurological history and examination. EXCLUSION CRITERIA: Any child who is pregnant. Adult women and girls between 12 and 17 years of age who have started their menstrual periods will be required to take a pregnancy test at the initial interview. If this is positive, they will not be allowed to take part in the study. At the initial phone screening we will inform both the parent/ guardian and the child that we will require this pregnancy test at the initial interview to determine eligibility and that we will inform both the child and her parents with the results of the test. CEREBRAL PALSY PATIENTS: Patients with subtypes of cerebral palsy that are not hemiplegia or diplegia. These include spastic quadriplegia (no difference in level of severity of motor deficit between arms and legs); spastic triplegia; mixed forms of cerebral palsy; athetoid or dystonic forms of cerebral palsy; unclassifiable forms of cerebral palsy. Hemiplegic cerebral palsy with greater than minimal motor deficits on the good hand. Spastic diplegia patients who have asymmetry of the motor deficit greater than 1 severity point between the two sides (e.g. left side mild, right side severe). Patients with DQ or IQ below 50 as assessed by Gesell or with standardized tests (pre-school age), or through school testing (school age). Uneducable patients by reason of severely impaired attention. Patients with seizures within the last 6 months. Patients with an underlying known genetic or chromosomal disorder. Patients with clearly identified familial or non-familial syndromes (without known chromosomal or genetic defect). Cerebral lesions acquired after 1 year of age. Patients with progressive or neurodegenerative disorders. Patient with spinal disorders in the absence of cerebral lesions. Patients with cerebral lesions caused by sickle cell disease or by emboli associated with congenital cardiac lesions. Patients with severe cognitive deficits who cannot follow simple verbal commands. Patients incapable of voluntary movement of either upper or lower limbs due to contractures. Patients who have had rhizotomy for upper extremity plasticity, who have had botulinum toxin within the last 3 months or have an intrathecal baclofen pump. Patients with severe postural abnormalities who cannot maintain supported sitting. HEALTHY SUBJECTS: Children or adults with any neurological and/or psychiatric disorder including attention deficit hyperactivity disorder or learning disorder. Subjects with any chronic medical disorders. Subjects taking regular medications, including medications for allergies, hormonal oral contraceptives, or over-the-counter medications. Healthy subjects born before 36 weeks gestation as estimated by dates, ultrasound or other methods (if a discrepancy exists, then the ultrasound estimation will be taken as definitive). Subjects with siblings who have developmental delay or abnormalities of the corpus callosum (these subjects have an increased chance of having asymptomatic abnormalities of the central nervous system). Subjects with albinism or a personal or family history of sensorineural hearing loss (these subjects have an increased incidence of incidental callosal abnormalities). EXCLUSIONARY CRITERIA FOR CLINICAL MRI STUDIES: Any subject with metal objects in the body such as pacemakers, aneurysm clips (metal clips on the wall of a large artery), metallic prostheses, cochlear implants, or shrapnel fragments). Any subject with permanent tattoos on the eyelids (ferromagnetic (iron oxide-based) tattoo pigments can interact with the static magnetic field of an MRI imager). Any subject that would require sedation for the scan. EXCLUSIONARY CRITERIA FOR TMS: Cerebral palsy patients on neuroactive medications (e.g. antiepileptics). Patients with hearing loss (greater than 15 dB at any individual frequency) in either ear (as evaluated in the Audiology Department, CC, NIH). Healthy children with a personal history of febrile seizures and with a family history of first degree relatives with seizures.