Eye-Hand Coordination in Children With Spastic Diplegia

INCLUSION CRITERIA FOR SPECIFIC AIM #1: Children 12 to 14 years of age will be eligible for the study as neuromotor function in healthy children is close to adult levels at this age. Diplegic children must have been born before 36 weeks gestation with a birth weight appropriate for their gestational age. Clinical examination for these children must show bilateral spasticity with more severe involvement of the legs than of the arms. Healthy subjects must be free from all neurologic and psychiatric disorders with normal scores on the Connor's attention deficit hyperactivity disorder (ADHD) checklist and the Child Behavior Check List (CBCL). Neurological history and examination must be normal. EXCLUSION CRITERIA FOR SPECIFIC AIM #1: Patients with sapstic diplegia who were born at term will be excluded from the study as these form a separate diagnostic cohort. Children with a history of a severe (grade III or IV) intraventricular hemorrhage, or periventricular hemorrhagic infarction will be excluded. Diplegic children who have a genetic or congenital disorder (such as congenital cytomegalovirus or rubella infection) will be excluded. Children with obviously asymmetric findings (hemiplegia) or quadriplegia (arms and legs affected equally) will also be excluded. Healthy children will be excluded from the study if they have ADHD, obsessive compulsive symptoms, tics or any other neurologic or psychiatric disorders. Subjects who have siblings with an undiagnosed cause of developmental delay or abnormalities of the corpus callosum will be excluded from the study. Subjects with albinism or a personal or family history of sensorineural hearing loss have an increased incidence of incidental callosal abnormalities and for this reason will be excluded. Diplegic subjects with a personal history of seizures and any subject with a family history of first degree relatives with seizures will be excluded from the transcranial magnetic stimulation portion of the study. INCLUSION CRITERIA FOR SPECIFIC AIM #2: Spastic diplegia patients and age matched healthy controls aged 7-14 years of age will be recruited using the same methods outlined in Specific Aim #1. Data from eligible 13-year-old patients and healthy controls studied in Specific Aim #1 will be included in the data analysis of this specific aim. Spastic diplegia patients will be matched on the extent and severity of periventricular leucomalacia (PVL) on their clinical MRIs. We will study the group of patients with pathology extending from occipital to frontal regions, as this appears to be most common in diplegic children. Healthy subjects must be free from all neurologic and psychiatric disorders with normal scores on the Connor's attention deficit hyperactivity disorder (ADHD) checklist and the Child Behavior Check List (CBCL). Neurological history and examination must be normal. EXCLUSION CRITERIA FOR SPECIFIC AIM #2: These will be the same as those outlined in Specific Aim #1 for both spastic diplegia patients and healthy controls. In addition, diplegic children with MRI lesions other than PVL (porencephaly, schizencephaly) will be excluded.