Abstract
This study examined whether lesions to the cerebellum obtained in early childhood are better compensated than lesions in middle childhood or adolescence. Since cerebellar lesions might affect motor as well a cognitive performance, posture, upper limb and working memory function were assessed in 22 patients after resection of a cerebellar tumour (age at surgery 1-17 years, minimum 3 years post-surgery). Working memory was only impaired in those patients who had received chemo- or radiation therapy. Postural sway was enhanced in 64% of the patients during dynamic posturography conditions, which relied heavily on vestibular input for equilibrium control. Upper limb function was generally less impaired, but 54% of the patients revealed prolonged deceleration times in an arm pointing task, which probably does not reflect a genuine cerebellar deficit but rather the patients' adopted strategy to avoid overshooting. Age at surgery, time since surgery or lesion volume were poor predictors of motor or cognitive recovery. Brain imaging analysis revealed that lesions of all eight patients with abnormal posture who did not receive chemo- and/or radiation therapy included the fastigial and interposed nuclei (NF and NI). In patients with normal posture, NI and NF were spared. In 11 out of 12 patients with abnormal deceleration time, the region with the highest overlap included the NI and NF and dorsomedial portions of the dentate nuclei in 10 out of 12 patients. We conclude that cerebellar damage inflicted at a young age is not necessarily better compensated. The lesion site is critical for motor recovery, and lesions affecting the deep cerebellar nuclei are not fully compensated at any developmental age in humans. Brain
Original language | English (US) |
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Pages (from-to) | 1428-1441 |
Number of pages | 14 |
Journal | Brain |
Volume | 128 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2005 |
Bibliographical note
Funding Information:We wish to thank the many patients who invested considerable time to be part of this study, all other participants for their support, and Beate Brol and Hans-Georg Elles for helping with the experimental set-up and the data collection. This research was supported by a grant from the Deutsche Forschungsgemeinschaft TI 239/5-1 to D.T. and by a sabbatical awarded to J.K. from the University of Minnesota.
Keywords
- Ataxia
- Cerebellum
- Development
- Human
- Motor control