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Kavčič A, Borko DK, Kodrič J, Georgiev D, Demšar J, Soltirovska-Šalamon A. EEG alpha band functional brain network correlates of cognitive performance in children after perinatal stroke. Neuroimage 2024; 297:120743. [PMID: 39067554 DOI: 10.1016/j.neuroimage.2024.120743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
Mechanisms underlying cognitive impairment after perinatal stroke could be explained through brain network alterations. With aim to explore this connection, we conducted a matched test-control study to find a correlation between functional brain network properties and cognitive functions in children after perinatal stroke. First, we analyzed resting-state functional connectomes in the alpha frequency band from a 64-channel resting state EEG in 24 children with a history of perinatal stroke (12 with neonatal arterial ischemic stroke and 12 with neonatal hemorrhagic stroke) and compared them to the functional connectomes of 24 healthy controls. Next, all participants underwent cognitive evaluation. We analyzed the differences in functional brain network properties and cognitive abilities between groups and studied the correlation between network characteristics and specific cognitive functions. Functional brain networks after perinatal stroke had lower modularity, higher clustering coefficient, higher interhemispheric strength, higher characteristic path length and higher small world index. Modularity correlated positively with the IQ and processing speed, while clustering coefficient correlated negatively with IQ. Graph metrics, reflecting network segregation (clustering coefficient and small world index) correlated positively with a tendency to impulsive decision making, which also correlated positively with graph metrics, reflecting stronger functional connectivity (characteristic path length and interhemispheric strength). Our study suggests that specific cognitive functions correlate with different brain network properties and that functional network characteristics after perinatal stroke reflect poorer cognitive functioning.
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Affiliation(s)
- Alja Kavčič
- Department for Neonatology, University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Daša Kocjančič Borko
- University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Jana Kodrič
- University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Dejan Georgiev
- Department for Neurology, University Medical Center Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; Faculty of Computer and Information Sciences, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
| | - Jure Demšar
- Faculty of Computer and Information Sciences, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia; Department of Psychology, Faculty of Arts, University of Ljubljana, Aškerčeva cesta 2, 1000 Ljubljana, Slovenia
| | - Aneta Soltirovska-Šalamon
- Department for Neonatology, University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
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Meghji S, Hilderley AJ, Murias K, Brooks BL, Andersen J, Fehlings D, Dlamini N, Kirton A, Carlson HL. Executive functioning, ADHD symptoms and resting state functional connectivity in children with perinatal stroke. Brain Imaging Behav 2024; 18:263-278. [PMID: 38038867 PMCID: PMC11156742 DOI: 10.1007/s11682-023-00827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
Perinatal stroke describes a group of focal, vascular brain injuries that occur early in development, often resulting in lifelong disability. Two types of perinatal stroke predominate, arterial ischemic stroke (AIS) and periventricular venous infarction (PVI). Though perinatal stroke is typically considered a motor disorder, other comorbidities commonly exist including attention-deficit hyperactivity disorder (ADHD) and deficits in executive function. Rates of ADHD symptoms are higher in children with perinatal stroke and deficits in executive function may also occur but underlying mechanisms are not known. We measured resting state functional connectivity in children with perinatal stroke using previously established dorsal attention, frontoparietal, and default mode network seeds. Associations with parental ratings of executive function and ADHD symptoms were examined. A total of 120 participants aged 6-19 years [AIS N = 31; PVI N = 30; Controls N = 59] were recruited. In comparison to typically developing peers, both the AIS and PVI groups showed lower intra- and inter-hemispheric functional connectivity values in the networks investigated. Group differences in between-network connectivity were also demonstrated, showing weaker anticorrelations between task-positive (frontoparietal and dorsal attention) and task-negative (default mode) networks in stroke groups compared to controls. Both within-network and between-network functional connectivity values were highly associated with parental reports of executive function and ADHD symptoms. These results suggest that differences in functional connectivity exist both within and between networks after perinatal stroke, the degree of which is associated with ADHD symptoms and executive function.
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Affiliation(s)
- Suraya Meghji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kara Murias
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Children's Stroke Program, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, 28 Oki Drive NW, Calgary, AB, Canada.
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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3
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Buccilli B. Exploring new horizons: Emerging therapeutic strategies for pediatric stroke. Exp Neurol 2024; 374:114701. [PMID: 38278205 DOI: 10.1016/j.expneurol.2024.114701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
Pediatric stroke presents unique challenges, and optimizing treatment strategies is essential for improving outcomes in this vulnerable population. This review aims to provide an overview of new, innovative, and potential treatments for pediatric stroke, with a primary objective to stimulate further research in this field. Our review highlights several promising approaches in the realm of pediatric stroke management, including but not limited to stem cell therapy and robotic rehabilitation. These innovative interventions offer new avenues for enhancing functional recovery, reducing long-term disability, and tailoring treatments to individual patient needs. The findings of this review underscore the importance of ongoing research and development of innovative treatments in pediatric stroke. These advancements hold significant clinical relevance, offering the potential to improve the lives of children affected by stroke by enhancing the precision, efficacy, and accessibility of therapeutic interventions. Embracing these innovations is essential in our pursuit of better outcomes and a brighter future for pediatric stroke care.
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Affiliation(s)
- Barbara Buccilli
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
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Sutter EN, Casey CP, Gillick BT. Single-pulse transcranial magnetic stimulation for assessment of motor development in infants with early brain injury. Expert Rev Med Devices 2024; 21:179-186. [PMID: 38166497 PMCID: PMC10947901 DOI: 10.1080/17434440.2023.2299310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Single-pulse transcranial magnetic stimulation (TMS) has many applications for pediatric clinical populations, including infants with perinatal brain injury. As a noninvasive neuromodulation tool, single-pulse TMS has been used safely in infants and children to assess corticospinal integrity and circuitry patterns. TMS may have important applications in early detection of atypical motor development or cerebral palsy. AREAS COVERED The authors identified and summarized relevant studies incorporating TMS in infants, including findings related to corticospinal development and circuitry, motor cortex localization and mapping, and safety. This special report also describes methodologies and safety considerations related to TMS assessment in infants, and discusses potential applications related to diagnosis of cerebral palsy and early intervention. EXPERT OPINION Single-pulse TMS has demonstrated safety and feasibility in infants with perinatal brain injury and may provide insight into neuromotor development and potential cerebral palsy diagnosis. Additional research in larger sample sizes will more fully evaluate the utility of TMS biomarkers in early diagnosis and intervention. Methodological challenges to performing TMS in infants and technical/equipment limitations require additional consideration and innovation toward clinical implementation. Future research may explore use of noninvasive neuromodulation techniques as an intervention in younger children with perinatal brain injury to improve motor outcomes.
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Affiliation(s)
- Ellen N. Sutter
- Waisman Center, University of Wisconsin-Madison
- Department of Rehabilitation Medicine, University of Minnesota-Twin Cities
| | | | - Bernadette T. Gillick
- Waisman Center, University of Wisconsin-Madison
- Department of Pediatrics, University of Wisconsin-Madison
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Mallard C, Ferriero DM, Vexler ZS. Immune-Neurovascular Interactions in Experimental Perinatal and Childhood Arterial Ischemic Stroke. Stroke 2024; 55:506-518. [PMID: 38252757 DOI: 10.1161/strokeaha.123.043399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Emerging clinical and preclinical data have demonstrated that the pathophysiology of arterial ischemic stroke in the adult, neonates, and children share similar mechanisms that regulate brain damage but also have distinct molecular signatures and involved cellular pathways due to the maturational stage of the central nervous system and the immune system at the time of the insult. In this review, we discuss similarities and differences identified thus far in rodent models of 2 different diseases-neonatal (perinatal) and childhood arterial ischemic stroke. In particular, we review acquired knowledge of the role of resident and peripheral immune populations in modulating outcomes in models of perinatal and childhood arterial ischemic stroke and the most recent and relevant findings in relation to the immune-neurovascular crosstalk, and how the influence of inflammatory mediators is dependent on specific brain maturation stages. Finally, we discuss the current state of treatments geared toward age-appropriate therapies that signal via the immune-neurovascular interaction and consider sex differences to achieve successful translation.
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Affiliation(s)
- Carina Mallard
- Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden (C.M.)
| | - Donna M Ferriero
- Department of Pediatrics, UCSF, San Francisco, CA (D.M.F.)
- Department of Neurology, UCSF, Weill Institute for Neurosciences, San Francisco, CA (D.M.F., Z.S.V.)
| | - Zinaida S Vexler
- Department of Neurology, UCSF, Weill Institute for Neurosciences, San Francisco, CA (D.M.F., Z.S.V.)
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Kirton A, Jordan LC. Stroke in Children: Key Advances in the Field and the Next 20 Years. Stroke 2024; 55:182-185. [PMID: 38134252 DOI: 10.1161/strokeaha.123.044250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Canada (A.K.). Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
| | - Lori C Jordan
- Departments of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Canada (A.K.). Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Bruschettini M, Badura A, Romantsik O. Stem cell-based interventions for the treatment of stroke in newborn infants. Cochrane Database Syst Rev 2023; 11:CD015582. [PMID: 37994736 PMCID: PMC10666199 DOI: 10.1002/14651858.cd015582.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Perinatal stroke refers to a diverse but specific group of cerebrovascular diseases that occur between 20 weeks of fetal life and 28 days of postnatal life. Acute treatment options for perinatal stroke are limited supportive care, such as controlling hypoglycemia and seizures. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, or regenerate injured brain tissue. Preclinical findings have culminated in ongoing human neonatal studies. OBJECTIVES To evaluate the benefits and harms of stem cell-based interventions for the treatment of stroke in newborn infants compared to control (placebo or no treatment) or stem-cell based interventions of a different type or source. SEARCH METHODS We searched CENTRAL, PubMed, Embase, and three trials registries in February 2023. We planned to search the reference lists of included studies and relevant systematic reviews for studies not identified by the database searches. SELECTION CRITERIA We attempted to include randomized controlled trials, quasi-randomized controlled trials, and cluster trials that evaluated any of the following comparisons. • Stem cell-based interventions (any type) versus control (placebo or no treatment) • Mesenchymal stem/stromal cells (MSCs) of a specifictype (e.g. number of doses or passages) or source (e.g. autologous/allogeneic or bone marrow/cord) versus MSCs of another type or source • Stem cell-based interventions (other than MSCs) of a specific type (e.g. mononuclear cells, oligodendrocyte progenitor cells, neural stem cells, hematopoietic stem cells, or induced pluripotent stem cell-derived cells) or source (e.g. autologous/allogeneic or bone marrow/cord) versus stem cell-based interventions (other than MSCs) of another type or source • MSCs versus stem cell-based interventions other than MSCs We planned to include all types of transplantation regardless of cell source (bone marrow, cord blood, Wharton's jelly, placenta, adipose tissue, peripheral blood), type of graft (autologous or allogeneic), and dose. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause neonatal mortality, major neurodevelopmental disability, and immune rejection or any serious adverse event. Our secondary outcomes included all-cause mortality prior to first hospital discharge, seizures, adverse effects, and death or major neurodevelopmental disability at 18 to 24 months of age. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified no completed or ongoing randomized trials that met our inclusion criteria. We excluded three studies: two were phase 1 trials, and one included newborn infants with conditions other than stroke (i.e. cerebral ischemia and anemia). Among the three excluded studies, we identified the first phase 1 trial on the use of stem cells for neonatal stroke. It reported that a single intranasal application of bone marrow-derived MSCs in term neonates with a diagnosis of perinatal arterial ischemic stroke (PAIS) was feasible and apparently not associated with severe adverse events. However, the trial included only 10 infants, and follow-up was limited to three months. AUTHORS' CONCLUSIONS No evidence is currently available to evaluate the benefits and harms of stem cell-based interventions for treatment of stroke in newborn infants. We identified no ongoing studies. Future clinical trials should focus on standardizing the timing and method of cell delivery and cell processing to optimize the therapeutic potential of stem cell-based interventions and safety profiles. Phase 1 and large animal studies might provide the groundwork for future randomized trials. Outcome measures should include all-cause mortality, major neurodevelopmental disability and immune rejection, and any other serious adverse events.
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Affiliation(s)
- Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anna Badura
- Department of Neonatology, University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Olga Romantsik
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Giraud A, Stephens CM, Fluss J, Kossorotoff M, Walsh BH, Chabrier S. Long-term developmental condition following neonatal arterial ischemic stroke: A systematic review. Arch Pediatr 2023; 30:600-606. [PMID: 37805299 DOI: 10.1016/j.arcped.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Neonatal arterial ischemic stroke (NAIS) is the most frequent subtype of perinatal stroke. Its elusive pathophysiology, its abrupt and unexpected occurrence, and the uncertainty of the post-NAIS developmental condition may lead to parental emotional distress and psychological difficulties. The aim of this study was to summarize the current data on long-term developmental conditions following NAIS to support parental information given within the neonatal unit. METHODS This systematic review included clinical studies of term infants with NAIS, who had a developmental assessment at ≥5 years of age. Studies were identified from the Medline and Embase databases on June 1, 2022. The Joanna Briggs Institute (JBI) appraisal tool was used to assess the risk of bias. Results were synthesized using a narrative approach. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to report this work. RESULTS Three cohort studies enrolling 205 children assessed from 5 to 7 years after NAIS were included. Most of the children presented long-term developmental conditions allowing them to be integrated into a regular school program, to participate in physical activities, and to have a good quality of life. Global intellectual deficiency and moderate-to-severe cerebral palsy occurred in less than 10% of the children. CONCLUSION Physicians should not overestimate the incidence of moderate-to-severe developmental outcome following NAIS when discussing the prognosis with parents. A parental information sheet about NAIS and its long-term developmental conditions is provided.
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Affiliation(s)
- Antoine Giraud
- Service de Réanimation Néonatale, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France; INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France; Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.
| | - Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Joel Fluss
- Paediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Manoëlle Kossorotoff
- Centre National de Référence de l'AVC de l'Enfant, Service de Neurologie Pédiatrique, APHP - Hôpital Necker Enfants Malades, Paris, France
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Stéphane Chabrier
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France; Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
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Giraud A, Garel P, Walsh BH, Chabrier S. From Early Motor Ability to Global Cognitive Development 7 Years after Neonatal Arterial Ischemic Stroke. Dev Neurosci 2023; 46:149-152. [PMID: 37647866 DOI: 10.1159/000533816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
The developmental condition of children after neonatal arterial ischemic stroke (NAIS) is characterized by cognitive and motor impairments. We hypothesized that independent walking age would be a predictor of later global cognitive functioning in this population. Sixty-one children with an available independent walking age and full-scale intelligence quotient (IQ) score 7 years after NAIS were included in this study. Full-scale IQ was assessed using the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV). Independent walking age was negatively correlated with full-scale IQ score at 7 years of age (Pearson correlation coefficient of -0.27; 95% confidence interval from -0.48 to -0.01; p < 0.05). Early motor function is correlated with later global cognitive functioning in children after NAIS. Assessing and promoting early motor ability is essential in this population.
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Affiliation(s)
- Antoine Giraud
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Réanimation Néonatale, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Pauline Garel
- Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Stéphane Chabrier
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Centre National de Référence de l'AVC de l'Enfant, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
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Kavčič A, Demšar J, Georgiev D, Meglič NP, Šalamon AS. EEG functional connectivity after perinatal stroke. Cereb Cortex 2023; 33:9927-9935. [PMID: 37415237 DOI: 10.1093/cercor/bhad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
Impaired cognitive functioning after perinatal stroke has been associated with long-term functional brain network changes. We explored brain functional connectivity using a 64-channel resting-state electroencephalogram in 12 participants, aged 5-14 years with a history of unilateral perinatal arterial ischemic or haemorrhagic stroke. A control group of 16 neurologically healthy subjects was also included-each test subject was compared with multiple control subjects, matched by sex and age. Functional connectomes from the alpha frequency band were calculated for each subject and the differences in network graph metrics between the 2 groups were analyzed. Our results suggest that the functional brain networks of children with perinatal stroke show evidence of disruption even years after the insult and that the scale of changes appears to be influenced by the lesion volume. The networks remain more segregated and show a higher synchronization at both whole-brain and intrahemispheric level. Total interhemispheric strength was higher in children with perinatal stroke compared with healthy controls.
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Affiliation(s)
- Alja Kavčič
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Jure Demšar
- Faculty of Computer and Information Sciences, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Aškerčeva 2, 1000 Ljubljana, Slovenia
| | - Dejan Georgiev
- Faculty of Computer and Information Sciences, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Nuška Pečarič Meglič
- Department of Neuroradiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Aneta Soltirovska Šalamon
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Giraud A, Dinomais M, Garel P, Chevin M, Thébault G, Renaud C, Presles É, Raia-Barjat T, Sébire G, Chabrier S. Perinatal inflammation exposure and developmental outcomes 7 years after neonatal arterial ischaemic stroke. Dev Med Child Neurol 2023; 65:1073-1080. [PMID: 36700522 DOI: 10.1111/dmcn.15522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
AIM To test the association between perinatal inflammation exposure and Full-Scale IQ (FSIQ) score 7 years after neonatal arterial ischaemic stroke (NAIS). METHOD We conducted a cross-sectional ancillary study nested in a multicentric longitudinal French cohort of infants born at term with NAIS between November 2003 and October 2006. Seventy-three children were included (45 males, 28 females). The a priori defined primary outcome measure was the FSIQ score assessed with the Wechsler Intelligence Scale for Children, Fourth Edition at 7 years of age. RESULTS Seventeen (23%) of the included children were exposed to perinatal inflammation. Exposure to perinatal inflammation was independently associated with an increase of FSIQ score (coefficient 13.4, 95% confidence interval 1.3-25.4; p = 0.03). Children exposed to perinatal inflammation had a higher median cerebral volume, a lower median lesion volume, and less extensive lesion distributions compared to non-exposed children. INTERPRETATION We propose the existence of two NAIS categories: arteritis-associated NAIS in children exposed to perinatal inflammation and embolism-associated NAIS in children non-exposed to perinatal inflammation. Identifying these two NAIS categories would open the possibility for specific curative strategies: anti-inflammatory strategy in arteritis-associated NAIS and recanalization strategy in embolism-associated NAIS.
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Affiliation(s)
- Antoine Giraud
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Mickaël Dinomais
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Pauline Garel
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Mathilde Chevin
- Child Neurology Division, Department of Paediatrics, McGill University, QC, Canada
| | - Guillaume Thébault
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Paul Coste Floret, France
| | - Cyrille Renaud
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Émilie Presles
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Sébire
- Child Neurology Division, Department of Paediatrics, McGill University, QC, Canada
| | - Stéphane Chabrier
- INSERM, U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- Centre National de Référence de l'AVC de l'Enfant, Médecine Physique et Réadaptation Pédiatrique, INSERM CIC1408, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
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13
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Shinde K, Craig BT, Hassett J, Dlamini N, Brooks BL, Kirton A, Carlson HL. Alterations in cortical morphometry of the contralesional hemisphere in children, adolescents, and young adults with perinatal stroke. Sci Rep 2023; 13:11391. [PMID: 37452141 PMCID: PMC10349116 DOI: 10.1038/s41598-023-38185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Perinatal stroke causes most hemiparetic cerebral palsy and cognitive dysfunction may co-occur. Compensatory developmental changes in the intact contralesional hemisphere may mediate residual function and represent targets for neuromodulation. We used morphometry to explore cortical thickness, grey matter volume, gyrification, and sulcal depth of the contralesional hemisphere in children, adolescents, and young adults after perinatal stroke and explored associations with motor, attention, and executive function. Participants aged 6-20 years (N = 109, 63% male) with unilateral perinatal stroke underwent T1-weighted imaging. Participants had arterial ischemic stroke (AIS; n = 36), periventricular venous infarction (PVI; n = 37) or were controls (n = 36). Morphometry was performed using the Computational Anatomy Toolbox (CAT12). Group differences and associations with motor and executive function (in a smaller subsample) were assessed. Group comparisons revealed areas of lower cortical thickness in contralesional hemispheres in both AIS and PVI and greater gyrification in AIS compared to controls. Areas of greater grey matter volume and sulcal depth were also seen for AIS. The PVI group showed lower grey matter volume in cingulate cortex and less volume in precuneus relative to controls. No associations were found between morphometry metrics, motor, attention, and executive function. Cortical structure of the intact contralesional hemisphere is altered after perinatal stroke. Alterations in contralesional cortical morphometry shown in perinatal stroke may be associated with different mechanisms of damage or timing of early injury. Further investigations with larger samples are required to more thoroughly explore associations with motor and cognitive function.
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Affiliation(s)
- Karan Shinde
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Brandon T Craig
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jordan Hassett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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14
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Fukuzaki Y, Faustino J, Lecuyer M, Rayasam A, Vexler ZS. Global sphingosine-1-phosphate receptor 2 deficiency attenuates neuroinflammation and ischemic-reperfusion injury after neonatal stroke. iScience 2023; 26:106340. [PMID: 37009213 PMCID: PMC10064246 DOI: 10.1016/j.isci.2023.106340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/31/2022] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
Arterial ischemic stroke is common in neonates-1 per 2,300-5,000 births-and therapeutic targets remain insufficiently defined. Sphingosine-1-phosphate receptor 2 (S1PR2), a major regulator of the CNS and immune systems, is injurious in adult stroke. Here, we assessed whether S1PR2 contributes to stroke induced by 3 h transient middle cerebral artery occlusion (tMCAO) in S1PR2 heterozygous (HET), knockout (KO), and wild type (WT) postnatal day 9 pups. HET and WT of both sexes displayed functional deficits in Open Field test whereas injured KO at 24 h reperfusion performed similarly to naives. S1PR2 deficiency protected neurons, attenuated infiltration of inflammatory monocytes, and altered vessel-microglia interactions without reducing increased cytokine levels in injured regions at 72 h. Pharmacologic inhibition of S1PR2 after tMCAO by JTE-013 attenuated injury 72 h after tMCAO. Importantly, the lack of S1PR2 alleviated anxiety and brain atrophy during chronic injury. Altogether, we identify S1PR2 as a potential new target for mitigating neonatal stroke.
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Affiliation(s)
- Yumi Fukuzaki
- Department of Neurology, University California San Francisco, Weill Institute for Neurosciences, San Francisco, CA 94158-0663, USA
| | - Joel Faustino
- Department of Neurology, University California San Francisco, Weill Institute for Neurosciences, San Francisco, CA 94158-0663, USA
| | - Matthieu Lecuyer
- Department of Neurology, University California San Francisco, Weill Institute for Neurosciences, San Francisco, CA 94158-0663, USA
| | - Aditya Rayasam
- Department of Neurology, University California San Francisco, Weill Institute for Neurosciences, San Francisco, CA 94158-0663, USA
| | - Zinaida S. Vexler
- Department of Neurology, University California San Francisco, Weill Institute for Neurosciences, San Francisco, CA 94158-0663, USA
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15
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Felling RJ, Jordan LC, Mrakotsky C, deVeber G, Peterson RK, Mineyko A, Feldman SJ, Shapiro K, Lo W, Beslow LA. Roadmap for the Assessment and Management of Outcomes in Pediatric Stroke. Pediatr Neurol 2023; 141:93-100. [PMID: 36805967 DOI: 10.1016/j.pediatrneurol.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Neurological morbidity is common after pediatric stroke, with moderate to severe deficits that can significantly impact education and social function. Care and recovery occur in phases distinguished by the time interval after stroke onset. These phases include the hyperacute and acute periods in which the focus is on cerebral reperfusion and prevention of neurological deterioration, followed by the subacute and chronic phases in which the focus is on secondary stroke prevention and mitigation of disability through rehabilitation, adaptation, and reintegration into the community. In this article, a multidisciplinary group of pediatric stroke experts review the stages of recovery after pediatric stroke with an emphasis on critical assessment time points. Our goal is to encourage increased standardization of outcome assessment to facilitate future clinical trials comparing various treatment and intervention options and advance optimized care for children with stroke.
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Affiliation(s)
- Ryan J Felling
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine Mrakotsky
- Departments of Psychiatry & Neurology, Center for Neuropsychology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabrielle deVeber
- Child Health Evaluative Sciences Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Rachel K Peterson
- Neuropsychology Department, Kennedy Krieger Institute, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Samantha J Feldman
- Neurosciences and Mental Health Research Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Kevin Shapiro
- Cortica Healthcare, Westlake Village, California; Division of Neurology, Children's Hospital Lost Angeles, Los Angeles, California
| | - Warren Lo
- Departments of Pediatrics and Neurology, The Ohio State University Nationwide Children's Hospital, Columbus, Ohio
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Jadavji Z, Kirton A, Metzler MJ, Zewdie E. BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study. Front Hum Neurosci 2023; 17:1006242. [PMID: 37007682 PMCID: PMC10063823 DOI: 10.3389/fnhum.2023.1006242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundPerinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain computer interface- activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.MethodsThirteen participants (mean age = 12.2 years, 31% female) were recruited from a population-based cohort. Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6–18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded. Participants attended two BCI sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants’ imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.ResultsNo serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 min with 33 min of stimulation delivered. Mean classification accuracies were (M = 78.78%, SD = 9.97) for training and (M = 73.48, SD = 12.41) for rehabilitation. Mean Cohen’s Kappa across rehabilitation trials was M = 0.43, SD = 0.29, range = 0.019–1.00, suggesting BCI competency.ConclusionBrain computer interface-FES was well -tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.
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Affiliation(s)
- Zeanna Jadavji
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Megan J. Metzler
- Department of Clinical Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Ephrem Zewdie
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- *Correspondence: Ephrem Zewdie,
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17
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Bruschettini M, Badura A, Romantsik O. Stem cell‐based interventions for the treatment of stroke in newborn infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD015582. [PMCID: PMC9933426 DOI: 10.1002/14651858.cd015582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of stem cell‐based interventions for the treatment of stroke in newborn infants compared to control (placebo or no treatment) or stem‐cell based interventions of a different type or source.
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Affiliation(s)
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, PaediatricsLund University, Skåne University HospitalLundSweden,Cochrane SwedenLund University, Skåne University HospitalLundSweden
| | | | - Olga Romantsik
- Department of Clinical Sciences Lund, PaediatricsLund University, Skåne University HospitalLundSweden
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18
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Kuo HC, Ferre CL, Chin KY, Friel KM, Gordon AM. Mirror movements and brain pathology in children with unilateral cerebral palsy. Dev Med Child Neurol 2023; 65:264-273. [PMID: 35751166 DOI: 10.1111/dmcn.15322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/04/2023]
Abstract
AIM We systematically examined the relationship between mirror movements and brain lesion type, corticospinal tract (CST) organization, and hand function to determine the relevance between mirror movements, brain lesion, the CST pattern, and hand function in children with unilateral cerebral palsy (CP). METHOD Forty-eight children (mean age 9y 9mo [SD 3y 3mo], range 6-18y; 30 males, 18 females) with unilateral CP participated. Mirror movements, brain lesion type, CST pattern identified by transcranial magnetic stimulation, and clinical outcomes were evaluated. Children performed four unilateral tasks: hand opening/closing, finger opposition, individuation, and finger 'walking'. Mirror movements induced in the contralateral hand were scored using standardized criteria (scores 0-4 using the Woods and Teuber scale). RESULTS We found that children with periventricular lesion may have stronger mirror movement scores induced in either hand than those with middle cerebral artery lesion (more affected hand: p=0.02; less affected hand: p<0.01). The highest mirror movement score a child exhibits across the tested tasks (i.e. scores of 3-4 using the Woods and Teuber scoring criteria) may potentially be an indicator of an ipsilateral CST connectivity pattern (p=0.03). Significant correlations were observed between higher mirror movement scores when performing hand opening/closing as well as finger walking and better unimanual dexterity (Spearman's rank correlation coefficient rs =0.44, p=0.002; rs =0.46, p=0.002 respectively). INTERPRETATION Brain lesions may be predictive of the strength of mirror movements in either hand in children with unilateral CP. Our findings warrant further studies to extensively investigate the relationship between mirror movements and the underlying brain pathology. WHAT THIS PAPER ADDS Brain lesion type may be predictive of mirror movement scores induced in either hand in children with unilateral cerebral palsy. The highest mirror movement score a child exhibits across the tested tasks may indicate corticospinal tract connectivity pattern in children with unilateral cerebral palsy.
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Affiliation(s)
- Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, CA, USA
| | - Claudio L Ferre
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Department of Occupational Therapy, Boston University, Boston, MA, USA
| | - Karen Y Chin
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | | | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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19
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Mrakotsky C, Williams TS, Shapiro KA, Westmacott R. Rehabilitation in Pediatric Stroke: Cognition and Behavior. Semin Pediatr Neurol 2022; 44:100998. [PMID: 36456041 DOI: 10.1016/j.spen.2022.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Pediatric stroke is associated with a range of maladaptive cognitive and behavioral outcomes that often require targeted intervention. Despite increasing research on neuropsychological outcomes over the past decade, evidence for effective therapies and interventions for the most commonly reported cognitive and behavioral challenges is still limited. The most widely prescribed interventions address more overt deficits in sensorimotor and speech/language functions, yet interventions for higher-order cognitive, linguistic and behavioral deficits are notably less defined. Moreover, concepts of rehabilitation in adult stroke cannot be easily translated directly to pediatric populations because the effect of stroke and recovery in the developing brain takes a very different course than in the mature brain. In pediatric stroke, neuropsychological deficits often emerge gradually over time necessitating a long-term approach to intervention. Furthermore, family and school context often play a much larger role. The goal of this review is to describe cognitive and behavioral interventions for perinatal and childhood stroke, as motor rehabilitation is covered elsewhere in this issue. We also discuss cognitive aspects of current rehabilitative therapies and technology. Acknowledging the current limited state of stroke-specific rehabilitation research in children, findings from pediatric acquired brain injury intervention and use of transdiagnostic approaches lend important insights. Because there is limited support for single domain (cognitive) trainings and translation of research rehabilitation programs to clinical practice can be challenging, the value of holistic multidisciplinary approaches to improve everyday function in children and adolescents following stroke is emphasized.
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Affiliation(s)
- Christine Mrakotsky
- Departments of Neurology & Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Tricia S Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin A Shapiro
- Cortica Healthcare, Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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20
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He Y, Ying J, Tang J, Zhou R, Qu H, Qu Y, Mu D. Neonatal Arterial Ischaemic Stroke: Advances in Pathologic Neural Death, Diagnosis, Treatment, and Prognosis. Curr Neuropharmacol 2022; 20:2248-2266. [PMID: 35193484 PMCID: PMC9890291 DOI: 10.2174/1570159x20666220222144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022] Open
Abstract
Neonatal arterial ischaemic stroke (NAIS) is caused by focal arterial occlusion and often leads to severe neurological sequelae. Neural deaths after NAIS mainly include necrosis, apoptosis, necroptosis, autophagy, ferroptosis, and pyroptosis. These neural deaths are mainly caused by upstream stimulations, including excitotoxicity, oxidative stress, inflammation, and death receptor pathways. The current clinical approaches to managing NAIS mainly focus on supportive treatments, including seizure control and anticoagulation. In recent years, research on the pathology, early diagnosis, and potential therapeutic targets of NAIS has progressed. In this review, we summarise the latest progress of research on the pathology, diagnosis, treatment, and prognosis of NAIS and highlight newly potential diagnostic and treatment approaches.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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21
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Pandey S, Joutsa J, Mehanna R, Shukla AW, Rodriguez‐Porcel F, Espay AJ. Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders. Mov Disord 2022; 37:1996-2007. [DOI: 10.1002/mds.29218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Institute of Postgraduate Medical Education and Research New Delhi India
- Department of Neurology, Amrita Hospital, Mata Amritanandamayi Marg Sector 88, Faridabad Delhi National Capital Region India
| | - Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Neurocenter Turku University Hospital Turku Finland
| | - Raja Mehanna
- UT Move, Department of Neurology University of Texas Health Science Center at Houston‐McGovern Medical School Houston Texas USA
| | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases University of Florida Gainesville Florida USA
| | | | - Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders University of Cincinnati Academic Health Center Cincinnati Ohio USA
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22
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Nakazawa K. Brain Reorganization and Neural Plasticity in Elite Athletes With Physical Impairments. Exerc Sport Sci Rev 2022; 50:118-127. [PMID: 35175230 PMCID: PMC9197146 DOI: 10.1249/jes.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/21/2022]
Abstract
Use-dependent and impairment-specific brain plasticity are hypothesized to interact and enhance neural reorganization in the central nervous system (CNS) of athletes with physical impairments. Paralympic brain studies are helpful in achieving a fundamental understanding of the underlying neural mechanism related to CNS reorganization after physical therapy or athletic training. Information learned from these individuals also provides new insights into sports- and rehabilitation-related neuroscience.
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23
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Kuo HC, Zewdie E, Giuffre A, Gan LS, Carlson HL, Wrightson J, Kirton A. Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis. Hum Brain Mapp 2022; 43:3745-3758. [PMID: 35451540 PMCID: PMC9294290 DOI: 10.1002/hbm.25881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Brain stimulation combined with intensive therapy may improve hand function in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). However, response to therapy varies and underlying neuroplasticity mechanisms remain unclear. Here, we aimed to characterize robotic motor mapping outcomes in children with UCP. Twenty‐nine children with perinatal stroke and UCP (median age 11 ± 2 years) were compared to 24 typically developing controls (TDC). Robotic, neuronavigated transcranial magnetic stimulation was employed to define bilateral motor maps including area, volume, and peak motor evoked potential (MEP). Map outcomes were compared to the primary clinical outcome of the Jebsen–Taylor Test of Hand Function (JTT). Maps were reliably obtained in the contralesional motor cortex (24/29) but challenging in the lesioned hemisphere (5/29). Within the contralesional M1 of participants with UCP, area and peak MEP amplitude of the unaffected map were larger than the affected map. When comparing bilateral maps within the contralesional M1 in children with UCP to that of TDC, only peak MEP amplitudes were different, being smaller for the affected hand as compared to TDC. We observed correlations between the unaffected map when stimulating the contralesional M1 and function of the unaffected hand. Robotic motor mapping can characterize motor cortex neurophysiology in children with perinatal stroke. Map area and peak MEP amplitude may represent discrete biomarkers of developmental plasticity in the contralesional M1. Correlations between map metrics and hand function suggest clinical relevance and utility in studies of interventional plasticity.
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Affiliation(s)
- Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, California, USA
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrianna Giuffre
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Wrightson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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24
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Hurd C, Livingstone D, Brunton K, Smith A, Gorassini M, Watt MJ, Andersen J, Kirton A, Yang JF. Early, Intensive, Lower Extremity Rehabilitation Shows Preliminary Efficacy After Perinatal Stroke: Results of a Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:360-370. [PMID: 35427191 PMCID: PMC9127938 DOI: 10.1177/15459683221090931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. Objective To determine the feasibility and potential efficacy of ELEVATE—Engaging the Lower Extremity Via Active Therapy Early—on gross motor function. Methods We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. Results Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registration This study was registered at ClinicalTrials.gov (NCT01773369).
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Affiliation(s)
- Caitlin Hurd
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Donna Livingstone
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Kelly Brunton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Allison Smith
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Monica Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Man-Joe Watt
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jaynie F. Yang
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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25
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Craig BT, Kinney-Lang E, Hilderley AJ, Carlson HL, Kirton A. Structural connectivity of the sensorimotor network within the non-lesioned hemisphere of children with perinatal stroke. Sci Rep 2022; 12:3866. [PMID: 35264665 PMCID: PMC8907195 DOI: 10.1038/s41598-022-07863-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Perinatal stroke occurs early in life and often leads to a permanent, disabling weakness to one side of the body. To test the hypothesis that non-lesioned hemisphere sensorimotor network structural connectivity in children with perinatal stroke is different from controls, we used diffusion imaging and graph theory to explore structural topology between these populations. Children underwent diffusion and anatomical 3T MRI. Whole-brain tractography was constrained using a brain atlas creating an adjacency matrix containing connectivity values. Graph theory metrics including betweenness centrality, clustering coefficient, and both neighbourhood and hierarchical complexity of sensorimotor nodes were compared to controls. Relationships between these connectivity metrics and validated sensorimotor assessments were explored. Eighty-five participants included 27 with venous stroke (mean age = 11.5 ± 3.7 years), 26 with arterial stroke (mean age = 12.7 ± 4.0 years), and 32 controls (mean age = 13.3 ± 3.6 years). Non-lesioned primary motor (M1), somatosensory (S1) and supplementary motor (SMA) areas demonstrated lower betweenness centrality and higher clustering coefficient in stroke groups. Clustering coefficient of M1, S1, and SMA were inversely associated with clinical motor function. Hemispheric betweenness centrality and clustering coefficient were higher in stroke groups compared to controls. Hierarchical and average neighbourhood complexity across the hemisphere were lower in stroke groups. Developmental plasticity alters the connectivity of key nodes within the sensorimotor network of the non-lesioned hemisphere following perinatal stroke and contributes to clinical disability.
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Affiliation(s)
- Brandon T Craig
- Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eli Kinney-Lang
- Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alicia J Hilderley
- Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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26
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Huggins JE, Krusienski D, Vansteensel MJ, Valeriani D, Thelen A, Stavisky S, Norton JJS, Nijholt A, Müller-Putz G, Kosmyna N, Korczowski L, Kapeller C, Herff C, Halder S, Guger C, Grosse-Wentrup M, Gaunt R, Dusang AN, Clisson P, Chavarriaga R, Anderson CW, Allison BZ, Aksenova T, Aarnoutse E. Workshops of the Eighth International Brain-Computer Interface Meeting: BCIs: The Next Frontier. BRAIN-COMPUTER INTERFACES 2022; 9:69-101. [PMID: 36908334 PMCID: PMC9997957 DOI: 10.1080/2326263x.2021.2009654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/15/2021] [Indexed: 12/11/2022]
Abstract
The Eighth International Brain-Computer Interface (BCI) Meeting was held June 7-9th, 2021 in a virtual format. The conference continued the BCI Meeting series' interactive nature with 21 workshops covering topics in BCI (also called brain-machine interface) research. As in the past, workshops covered the breadth of topics in BCI. Some workshops provided detailed examinations of specific methods, hardware, or processes. Others focused on specific BCI applications or user groups. Several workshops continued consensus building efforts designed to create BCI standards and increase the ease of comparisons between studies and the potential for meta-analysis and large multi-site clinical trials. Ethical and translational considerations were both the primary topic for some workshops or an important secondary consideration for others. The range of BCI applications continues to expand, with more workshops focusing on approaches that can extend beyond the needs of those with physical impairments. This paper summarizes each workshop, provides background information and references for further study, presents an overview of the discussion topics, and describes the conclusion, challenges, or initiatives that resulted from the interactions and discussion at the workshop.
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Affiliation(s)
- Jane E Huggins
- Department of Physical Medicine and Rehabilitation, Department of Biomedical Engineering, Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan, United States 325 East Eisenhower, Room 3017; Ann Arbor, Michigan 48108-5744, 734-936-7177
| | - Dean Krusienski
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23219
| | - Mariska J Vansteensel
- UMC Utrecht Brain Center, Dept of Neurosurgery, University Medical Center Utrecht, The Netherlands
| | | | - Antonia Thelen
- eemagine Medical Imaging Solutions GmbH, Berlin, Germany
| | | | - James J S Norton
- National Center for Adaptive Neurotechnologies, US Department of Veterans Affairs, 113 Holland Ave, Albany, NY 12208
| | - Anton Nijholt
- Faculty EEMCS, University of Twente, Enschede, The Netherlands
| | - Gernot Müller-Putz
- Institute of Neural Engineering, GrazBCI Lab, Graz University of Technology, Stremayrgasse 16/4, 8010 Graz, Austria
| | - Nataliya Kosmyna
- Massachusetts Institute of Technology (MIT), Media Lab, E14-548, Cambridge, MA 02139, Unites States
| | | | | | - Christian Herff
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Christoph Guger
- g.tec medical engineering GmbH/Guger Technologies OG, Austria, Sierningstrasse 14, 4521 Schiedlberg, Austria, +43725122240-0
| | - Moritz Grosse-Wentrup
- Research Group Neuroinformatics, Faculty of Computer Science, Vienna Cognitive Science Hub, Data Science @ Uni Vienna University of Vienna
| | - Robert Gaunt
- Rehab Neural Engineering Labs, Department of Physical Medicine and Rehabilitation, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA, 3520 5th Ave, Suite 300, Pittsburgh, PA 15213, 412-383-1426
| | - Aliceson Nicole Dusang
- Department of Electrical and Computer Engineering, School of Engineering, Brown University, Carney Institute for Brain Science, Brown University, Providence, RI
- Department of Veterans Affairs Medical Center, Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Providence, RI
- Center for Neurotechnology and Neurorecovery, Neurology, Massachusetts General Hospital, Boston, MA
| | | | - Ricardo Chavarriaga
- IEEE Standards Association Industry Connections group on neurotechnologies for brain-machine interface, Center for Artificial Intelligence, School of Engineering, ZHAW-Zurich University of Applied Sciences, Switzerland, Switzerland
| | - Charles W Anderson
- Department of Computer Science, Molecular, Cellular and Integrative Neurosience Program, Colorado State University, Fort Collins, CO 80523
| | - Brendan Z Allison
- Dept. of Cognitive Science, Mail Code 0515, University of California at San Diego, La Jolla, United States, 619-534-9754
| | - Tetiana Aksenova
- University Grenoble Alpes, CEA, LETI, Clinatec, Grenoble 38000, France
| | - Erik Aarnoutse
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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27
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Hassett J, Carlson H, Babwani A, Kirton A. Bihemispheric developmental alterations in basal ganglia volumes following unilateral perinatal stroke. NEUROIMAGE: CLINICAL 2022; 35:103143. [PMID: 36002972 PMCID: PMC9421529 DOI: 10.1016/j.nicl.2022.103143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Basal ganglia segmentation appears reliable in children with perinatal stroke. Alterations from perinatal stroke to basal ganglia development may be bihemispheric. Stroke type may dictate nucleus-specific differences in basal ganglia development. Putamen volume is associated with motor function in children with perinatal stroke.
Introduction Perinatal stroke affects millions of children and results in lifelong disability. Two forms prevail: arterial ischemic stroke (AIS), and periventricular venous infarction (PVI). With such focal damage early in life, neural structures may reorganize during development to determine clinical function, particularly in the contralesional hemisphere. Such processes are increasingly understood in the motor system, however, the role of the basal ganglia, a group of subcortical nuclei that are critical to movement, behaviour, and learning, remain relatively unexplored. Perinatal strokes that directly damage the basal ganglia have been associated with worse motor outcomes, but how developmental plasticity affects bilateral basal ganglia structure is unknown. We hypothesized that children with perinatal stroke have alterations in bilateral basal ganglia volumes, the degree of which correlates with clinical motor function. Methods Children with AIS or PVI, and controls, aged 6–19 years, were recruited from a population-based cohort. MRIs were acquired on a 3 T GE MR750w scanner. High-resolution T1-weighted images (166 slices, 1 mm isotropic voxels) underwent manual segmentations of bilateral caudate and putamen. Extracted volumes were corrected for total intracranial volume. A structure volume ratio quantified hemispheric asymmetry of caudate and putamen (non-dominant/dominant hemisphere structure volume) with ratios closer to 1 reflecting a greater degree of symmetry between structures. Participants were additionally dichotomized by volume ratios into two groups, those with values above the group mean (0.8) and those below. Motor function was assessed using the Assisting Hand Assessment (AHA) and the Box and Blocks test in affected (BBTA) and unaffected (BBTU) hands. Group differences in volumes were explored using Kruskal-Wallis tests, and interhemispheric differences using Wilcoxon. Partial Spearman correlations explored associations between volumes and motor function (factoring out age, and whole-brain white matter volume, a proxy for lesion extent). Results In the dominant (non-lesioned) hemisphere, volumes were larger in AIS compared to PVI for both the caudate (p < 0.05) and putamen (p < 0.01) but comparable between stroke groups and controls. Non-dominant (lesioned) hemisphere volumes were larger for controls than AIS for the putamen (p < 0.05), and for the caudate in PVI (p = 0.001). Interhemispheric differences showed greater dominant hemisphere volumes for the putamen in controls (p < 0.01), for both the caudate (p < 0.01) and putamen (p < 0.001) in AIS, and for the caudate (p = 0.01) in PVI. Motor scores did not differ between AIS and PVI thus groups were combined to increase statistical power. Better motor scores were associated with larger non-dominant putamen volumes (BBTA: r = 0.40, p = 0.011), and larger putamen volume ratios (BBTA: r = 0.52, p < 0.001, AHA: r = 0.43, p < 0.01). For those with relatively symmetrical putamen volume ratios (ratio > group mean of 0.8), age was positively correlated with BBTA (r = 0.54, p < 0.01) and BBTU (r = 0.69, p < 0.001). For those with more asymmetrical putamen volume ratios, associations with motor function and age were not seen (BBTA: r = 0.21, p = 0.40, BBTU: r = 0.37, p = 0.13). Conclusion Specific perinatal stroke lesions affect different elements of basal ganglia development. PVI primarily affected the caudate, while AIS primarily affected the putamen. Putamen volumes in the lesioned hemisphere are associated with clinical motor function. The basal ganglia should be included in evolving models of developmental plasticity after perinatal stroke.
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Affiliation(s)
- Jordan Hassett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Ali Babwani
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada.
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28
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Giuffre A, Zewdie E, Wrightson JG, Cole L, Carlson HL, Kuo HC, Babwani A, Kirton A. Effects of Transcranial Direct Current Stimulation and High-Definition Transcranial Direct Current Stimulation Enhanced Motor Learning on Robotic Transcranial Magnetic Stimulation Motor Maps in Children. Front Hum Neurosci 2021; 15:747840. [PMID: 34690726 PMCID: PMC8526891 DOI: 10.3389/fnhum.2021.747840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Conventional transcranial direct current stimulation (tDCS) and high-definition tDCS (HD-tDCS) may improve motor learning in children. Mechanisms are not understood. Neuronavigated robotic transcranial magnetic stimulation (TMS) can produce individualised maps of primary motor cortex (M1) topography. We aimed to determine the effects of tDCS- and HD-tDCS-enhanced motor learning on motor maps. Methods: Typically developing children aged 12-18 years were randomised to right M1 anodal tDCS, HD-tDCS, or Sham during training of their left-hand on the Purdue Pegboard Task (PPT) over 5 days. Bilateral motor mapping was performed at baseline (pre), day 5 (post), and 6-weeks retention time (RT). Primary muscle was the first dorsal interosseous (FDI) with secondary muscles of abductor pollicis brevis (APB) and adductor digiti minimi (ADM). Primary mapping outcomes were volume (mm2/mV) and area (mm2). Secondary outcomes were centre of gravity (COG, mm) and hotspot magnitude (mV). Linear mixed-effects modelling was employed to investigate effects of time and stimulation type (tDCS, HD-tDCS, Sham) on motor map characteristics. Results: Twenty-four right-handed participants (median age 15.5 years, 52% female) completed the study with no serious adverse events or dropouts. Quality maps could not be obtained in two participants. No effect of time or group were observed on map area or volume. LFDI COG (mm) differed in the medial-lateral plane (x-axis) between tDCS and Sham (p = 0.038) from pre-to-post mapping sessions. Shifts in map COG were also observed for secondary left-hand muscles. Map metrics did not correlate with behavioural changes. Conclusion: Robotic TMS mapping can safely assess motor cortex neurophysiology in children undergoing motor learning and neuromodulation interventions. Large effects on map area and volume were not observed while changes in COG may occur. Larger controlled studies are required to understand the role of motor maps in interventional neuroplasticity in children.
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Affiliation(s)
- Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James G Wrightson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauran Cole
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hsing-Ching Kuo
- Department of Physical Medicine & Rehabilitation, University of California, Davis, Sacramento, CA, United States
| | - Ali Babwani
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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29
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Wilson JL, Dowling M, Fullerton HJ. Stroke in Children. Stroke 2021; 52:3388-3390. [PMID: 34470487 DOI: 10.1161/strokeaha.121.033967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jenny L Wilson
- Pediatric Neurology, Oregon Health & Science University, Portland (J.L.W.)
| | - Michael Dowling
- Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas (M.D.)
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, University of California, San Francisco (H.J.F.)
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