Brain plasticity and network reorganization in children with perinatal stroke: a functional magnetic resonance imaging study
Date
2022-10-03
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Abstract
Viimastel aastakümnetel on arstide, aga ka elanikkonna teadlikkus tõusnud, et insult võib esineda kogu elu jooksul, ka lastel. Eriti suur insuldi tõenäosus on vastsündinueas, umbes üks tuhande elussünni kohta. Insult vastsündinueas võib kaasa tuua elukestva motoorse, kognitiivse kahjustuse ning epilepsia, lisanduda võivad käitumishäired ja sotsiaalne puue. Vastsündinuea insult mõjutab väga pika aja jooksul lisaks lastele ka nende lähedasi, tuues kaasa stressi ja depressiooni kogu perele, ning koormab majanduslikult tervet ühiskonda.
Vastsündinuea insuldi järgne ajukahjustus on olenevalt tekkemehhanismist ja suurusest erinev, ka laste areng ja oskused on sellest tulenevalt erinevad. Õnneks on laste aju arenev ja plastiline ning suudab vähemalt osa ajukahjustustest võrreldes täiskasvanutega paremini kompenseerida. Kuna insult on harvaesinev ja kahjustus varieeruv, on teadmised vastsündinuea insuldi kohta piiratud.
Uurimistöö eesmärk oli uurida vastsündinuea insuldiga laste aju võimet võrreldes tervete lastega kahjustust erinevate kahjustuse tüüpide ja ulatuste puhul kompenseerida. Me kasutasime erinevaid magnetresonantstomograafilisi (MRT) uuringuid koos pilditöötlusega, et leida tunnuseid, mille abil oleks võimalik juba esimestel eluaastatel ennustada insuldiga laste kognitiivseid ja motoorseid võimeid ja paremini planeerida taastusravi.
Uuringu tulemused näitasid vastsündinuea insuldiga laste motoorsete ja kognitiivsete võimete ning aju ümberorganiseerumise seost kahjustuse ulatuse ja tüübiga. Muutused insuldiga vastsündinu ajus aitavad kompenseerida ja vähendada kahjustuse mõju, kuid ei suuda täielikult tagada eakohast arengut.
Uuringus saadud teadmisi aju plastilisuse ja ümberorganiseerumisvõime kohta on võimalik rakendada lisaks insuldihaigetele ka teiste ajukahjustusega (nt trauma, ajukasvaja või epilepsia) laste puhul. Need teadmised täiendavad vastsündinuea insuldi laste radioloogilistest uuringutest saadavat teavet, rõhutades nende vajalikkust.
Stroke can occur during the entire lifetime and is probably underdiagnosed in children. In perinatal period the risk of stroke is especially high, about 1:1000 live births. Perinatal stroke may lead to various motor and cognitive impairments and epilepsy. Perinatal stroke causes lifelong physical, mental and emotional disabilities and social burden not only to children, but also to their families along with an economic burden to the society. Perinatal stroke is a heterogonous condition, with different brain lesions depending on the vascular type of stroke leading to different outcomes. Children’s brain is plastic and able to reorganize and at least partly compensate for damage after stroke. However, the knowledge of perinatal stroke is still limited due to the low prevalence and inherent heterogeneity of damage. The aim of the study was to investigate brain’s ability to reorganize in different vascular types of perinatal stroke compared to healthy controls and to evaluate how it affects the motor, cognitive and language outcomes. Various radiological markers for predicting motor, cognitive and language outcome in children with perinatal stroke were identified using functional magnetic resonance imaging and volumetric image analysis. The study showed that motor, cognitive and language outcomes in children with perinatal stroke correlates with vascular type and extent of stroke lesion. The brain’s plasticity and reorganization abilities were shown to only minimize the negative effect of large stroke lesions, but not to ensure entirely normal outcome. The knowledge of brain plasticity and reorganization in perinatal stroke children can be generalized to cases involving other focal brain damages, like trauma, tumors and epilepsy. The study accentuates the importance of radiological investigation of children with perinatal stroke and enhances the value of radiological evaluation.
Stroke can occur during the entire lifetime and is probably underdiagnosed in children. In perinatal period the risk of stroke is especially high, about 1:1000 live births. Perinatal stroke may lead to various motor and cognitive impairments and epilepsy. Perinatal stroke causes lifelong physical, mental and emotional disabilities and social burden not only to children, but also to their families along with an economic burden to the society. Perinatal stroke is a heterogonous condition, with different brain lesions depending on the vascular type of stroke leading to different outcomes. Children’s brain is plastic and able to reorganize and at least partly compensate for damage after stroke. However, the knowledge of perinatal stroke is still limited due to the low prevalence and inherent heterogeneity of damage. The aim of the study was to investigate brain’s ability to reorganize in different vascular types of perinatal stroke compared to healthy controls and to evaluate how it affects the motor, cognitive and language outcomes. Various radiological markers for predicting motor, cognitive and language outcome in children with perinatal stroke were identified using functional magnetic resonance imaging and volumetric image analysis. The study showed that motor, cognitive and language outcomes in children with perinatal stroke correlates with vascular type and extent of stroke lesion. The brain’s plasticity and reorganization abilities were shown to only minimize the negative effect of large stroke lesions, but not to ensure entirely normal outcome. The knowledge of brain plasticity and reorganization in perinatal stroke children can be generalized to cases involving other focal brain damages, like trauma, tumors and epilepsy. The study accentuates the importance of radiological investigation of children with perinatal stroke and enhances the value of radiological evaluation.
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Keywords
stroke, child neurology, perinatology, brain plasticity, magnetic resonance imaging, motor development, cognitive development