Persistence of layer IV in the primary motor cortex (area 4) of children with cerebral palsy.

The normal development of the human primary motor cortex is characterized by a cytoarchitectonic transformation from the fetal, six-layered cortex to the adult, five-layered agranular cortex. The present study examines whether this transformation also occurs in children with cerebral palsy. Nissl-stained, serial sections through the left precentral gyrus of 14 children (age: 3-13 years) with cerebral palsy and from a control group without any clinically manifested disturbances of the motor system were analyzed. The widths of cortical layers, the laminar distributions of area 1 fractions occupied by cell bodies and neuropil, and the numerical densities and mean sizes of cell bodies were measured. In 5 cases of cerebral palsy, an inner granular layer (IV) persisted up to ages between 3 and 9 years. Layer IV was absent in other cases and in the controls. The persistence of layer IV was closely related to severe impairments of posture: all children with persistent layer IV were unable to maintain an upright posture. Cytoarchitectonic differences to controls were also found in other layers. Layer V, the major source of the pyramidal tract, was more narrow in children with cerebral palsy. The ratio between average cell body size for layers III and V was changed in the group of cerebral palsy. Thus, severe impairment of posture can be associated with disturbed cytoarchitectonic development of the motor cortex.