Brain Characteristics Noted Prior to and Following Cranial Orthotic Treatment

Michele DeGrazia; Banu Ahtam; Carolyn R Rogers-Vizena; Mark Proctor; Courtney Porter; Rutvi Vyas; Cynthia T Laurentys; Emily Bergling; Kara McLaughlin; Patricia Ellen Grant

doi:10.1177/2329048X20949769

Brain Characteristics Noted Prior to and Following Cranial Orthotic Treatment

Child Neurol Open. 2020 Aug 19:7:2329048X20949769. doi: 10.1177/2329048X20949769. eCollection 2020 Jan-Dec.

Authors

Michele DeGrazia^{1

2

3}, Banu Ahtam^{2

3

4}, Carolyn R Rogers-Vizena^{5

6}, Mark Proctor^{7

8}, Courtney Porter¹, Rutvi Vyas^{2

3

4}, Cynthia T Laurentys^{2

3

4}, Emily Bergling¹, Kara McLaughlin⁹, Patricia Ellen Grant^{2

3

4}

Affiliations

¹ Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA.
² Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
³ Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
⁴ Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA.
⁵ Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
⁶ Department of Surgery, Harvard Medical School, Boston, MA, USA.
⁷ Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA.
⁸ Department of Neurosurgery, Harvard Medical School, Boston, MA, USA.
⁹ Harvard School of Dental Medicine, Boston, MA, USA.

Abstract

Objective: This case report aims to assess a potential association between cranial asymmetry, brain deformation, and associated developmental delay.

Study design: Two infants born at ≥37 weeks pursuing cranial orthotic treatment for severe Deformational Plagiocephaly (DP) (cranial vault asymmetry index >8.75%) underwent developmental assessment using Mullen Scales of Early Learning (MSEL) and non-sedated brain structural and diffusion magnetic resonance imaging (MRI) prior to and following cranial orthotic treatment.

Results: In both infants with DP, tractography results revealed alterations in the white matter pathways of the brain. Both infants also had low to low/normal visual receptivity and fine motor skills. After cranial orthotic treatment, cranial asymmetry improved but did not completely resolve, tractography demonstrated a change toward normalized white matter pathways, and visual receptivity and fine motor skills improved.

Conclusions: These preliminary findings suggest a potential link between DP, altered brain structures, and developmental assessment. Further investigation with a larger sample is warranted.

Keywords: MRI; brain; developmental delay; diffusion tensor imaging; infant; neurodevelopment.