White matter and cerebellar involvement in alternating hemiplegia of childhood

  • Mariasavina Severino
  • Livia Pisciotta
  • Domenico Tortora
  • Benedetta Toselli
  • Michela Stagnaro
  • Ramona Cordani
  • Giovanni Morana
  • Anna Zicca
  • Svetlana Kotzeva
  • Clelia Zanaboni
  • Giovanni Montobbio
  • Andrea Rossi
  • Elisa De GrandisEmail author
  • the IBAHC Consortium
Original Communication



To determine whether brain volumetric and white matter microstructural changes are present and correlate with neurological impairment in subjects with alternating hemiplegia of childhood (AHC).


In this prospective single-center study, 12 AHC subjects (mean age 22.9 years) and 24 controls were studied with 3DT1-weighted MR imaging and high angular resolution diffusion imaging at 3T. Data obtained with voxel-based morphometry and tract-based spatial statistics were correlated with motor impairment using the International Cooperative Ataxia Rating Scale (ICARS) and Movement and Disability sub-scales of Burke-Fahn-Marsden Dystonia Rating Scale (BFMMS and BFMDS).


Compared to healthy controls, AHC subjects showed lower total brain volume (P < 0.001) and white matter volume (P = 0.002), with reduced clusters of white matter in frontal and parietal regions (P < 0.001). No significant regional differences were found in cortical or subcortical grey matter volumes. Lower cerebellar subvolumes correlated with worse ataxic symptoms and global motor impairment in AHC group (P < 0.001). Increased mean and radial diffusivity values were found in the corpus callosum, corticospinal tracts, superior and inferior longitudinal fasciculi, subcortical frontotemporal white matter, internal and external capsules, and optic radiations (P < 0.001). These diffusion scalar changes correlated with higher ICARS and BFMDS scores (P < 0.001).


AHC subjects showed prevalent white matter involvement, with reduced volume in several cerebral and cerebellar regions associated with widespread microstructural changes reflecting secondary myelin injury rather than axonal loss. Conversely, no specific pattern of grey matter atrophy emerged. Lower cerebellar volumes, correlating with severity of neurological manifestations, seems related to disrupted developmental rather than neurodegenerative processes.


Alternating hemiplegia of childhood Brain MRI Voxel-based morphometry Tract-based spatial statistics White matter 



Axial diffusivity


Alternating hemiplegia of childhood


Disability subscale of the Burke–Fahn–Marsden Dystonia Rating Scale


Movement subscale of the Burke–Fahn–Marsden Dystonia Rating Scale


Cerebrospinal fluid


Diffusion tensor imaging


Fractional anisotropy


General linear model


International Cooperative Ataxia Rating Scale


Mean diffusivity


Montreal neurological institute


Radial diffusivity


Tract-based spatial statistics


Voxel-based morphometry


White matter



We are grateful to the members of the Italian AHC Family Association AISEA for participating in this study. This work was supported by funds from “Ricerca Corrente sui Disordini Neurologici e Muscolari (Linea 5)” of the Italian Ministry of Health. The IBAHC Consortium: Members of the IBAHC (Italian Biobank and Clinical Registry for Alternating Hemiplegia) Consortium and Working Group: 1. Maria Teresa Bassi, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italia; 2. Claudio Zucca, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italia; 3. Edvige Veneselli, IRCCS Istituto Giannina Gaslini, University of Genoa, Genova, Italia; 4. Filippo Franchini, AISEA (associazione italiana sindrome dell’emiplegia alternante) Onlus, Milano, Italia; 5. Maria Rosaria Vavassori, IAHCRC (International Consortium for the Research on Alternating Hemiplegia of Childhood) Consortium; 6. Melania Giannotta, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia; 7. Giuseppe Gobbi, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia; 8. Tiziana Granata, IRCCS Foundation Neurological Institute Carlo Besta, Milano, Italia; 9. Nardo Nardocci, IRCCS Foundation Neurological Institute Carlo Besta, Milano, Italia; 10. Francesca Ragona, IRCCS Foundation Neurological Institute Carlo Besta, Milano, Italia; 11. Fiorella Gurrieri, Servizio di Genetica Medica, Fondazione Policlinico Universitario IRCCS Agostino Gemelli, Istituto di Medicina Genomica Università Cattolica del S. Cuore, Rome, Italia; 12. Giovanni Neri, Servizio di Genetica Medica, Fondazione Policlinico Universitario IRCCS Agostino Gemelli, Istituto di Medicina Genomica Università Cattolica del S. Cuore, Rome, Italia; 13. Francesco Danilo Tiziano, Servizio di Genetica Medica, Fondazione Policlinico Universitario IRCCS Agostino Gemelli, Istituto di Medicina Genomica Università Cattolica del S. Cuore, Rome, Italia; 14. Federico Vigevano, Alessandro Capuano, Bambino Gesù Children's Hospital, IRCCS, Rome, Italia; 15. Stefano Sartori, Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy

Author contributions

MS, LP, EDG, The IBAHC Consortium participants: conception and design of the study; MS, LP, EDG, DT, BT, GM, MS, RC, AZ, SK, CZ: acquisition and analysis of data; MS, LP, EDG, DT, BT, GM, MS, RC, AZ, SK, CZ, GM, AR: drafting a significant portion of the manuscript or figures.

Compliance with ethical standards

Conflicts of interest

The authors report no financial disclosure/conflict of interest concerning the research related to the manuscript.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.

Supplementary material

415_2020_9698_MOESM1_ESM.docx (47 kb)
Supplementary file1 (DOCX 46 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Neuroradiology UnitIRCCS Istituto Giannina GasliniGenovaItaly
  2. 2.Neuropsychiatry UnitIRCCS Istituto Giannina GasliniGenovaItaly
  3. 3.Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)Università di GenovaGenovaItaly
  4. 4.Department of Informatics, Bioengineering, Robotics and System EngineeringUniversità Degli Studi di GenovaGenovaItaly
  5. 5.Anesthesiology UnitIRCCS Istituto Giannina GasliniGenovaItaly

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