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Muscat CC, McCabe SA, Morgan AT, Scratch SE, MacKay MT, Lewis I, Beal DS. Neural mechanisms driving speech and language recovery following childhood stroke: a scoping review. Disabil Rehabil 2024:1-15. [PMID: 39218014 DOI: 10.1080/09638288.2024.2390053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This scoping review aimed to inform future research priorities by collating evidence on neural correlates of speech and language recovery following childhood stroke. METHODS Neuroimaging, motor speech, or language outcomes following childhood stroke (28 days to 18 years age) in the subacute to chronic community stages (care occurring after acute medical management, including inpatient and outpatient rehabilitation, and community-based programs) were identified and extracted from Medline, Embase, PsycInfo, and Clinical databases. RESULTS Of the 3990 studies screened, 11 met the inclusion criteria. Of the included articles, no papers formally assessed speech outcomes, 11 articles reported language outcomes through standardized testing, 11 utilized structural imaging (CT, MRI), and four reported functional neuroimaging outcomes (fMRI). INTERPRETATION This review revealed a rudimentary accounting of speech and language profiles in children post-stroke; limited by the use of varied and incomplete speech and language assessment batteries, inconsistent reporting of lesion locations associated with speech and language outcomes, a dearth of functional neuroimaging studies, and lack of information about speech and language function throughout the rehabilitation period, a time when the brain is most plastic and receptive to therapy. Future research should provide complete and accurate accounts of speech and language function and their neural correlates throughout rehabilitation and recovery to inform care, education, and employment planning.
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Affiliation(s)
- Christine C Muscat
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah A McCabe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Angela T Morgan
- University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mark T MacKay
- University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Iveta Lewis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Yang M, Liu Y, Yue Z, Yang G, Jiang X, Cai Y, Zhang Y, Yang X, Li D, Chen L. Transcranial photobiomodulation on the left inferior frontal gyrus enhances Mandarin Chinese L1 and L2 complex sentence processing performances. BRAIN AND LANGUAGE 2024; 256:105458. [PMID: 39197357 DOI: 10.1016/j.bandl.2024.105458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/09/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024]
Abstract
This study investigated the causal enhancing effect of transcranial photobiomodulation (tPBM) over the left inferior frontal gyrus (LIFG) on syntactically complex Mandarin Chinese first language (L1) and second language (L2) sentence processing performances. Two (L1 and L2) groups of participants (thirty per group) were recruited to receive the double-blind, sham-controlled tPBM intervention via LIFG, followed by the sentence processing, the verbal working memory (WM), and the visual WM tasks. Results revealed a consistent pattern for both groups: (a) tPBM enhanced sentence processing performance but not verbal WM for linear processing of unstructured sequences and visual WM performances; (b) Participants with lower sentence processing performances under sham tPBM benefited more from active tPBM. Taken together, the current study substantiated that tPBM enhanced L1 and L2 sentence processing, and would serve as a promising and cost-effective noninvasive brain stimulation (NIBS) tool for future applications on upregulating the human language faculty.
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Affiliation(s)
- Mingchuan Yang
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Yang Liu
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Zhaoqian Yue
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Guang Yang
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Xu Jiang
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Yimin Cai
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China
| | - Yuqi Zhang
- School of Chinese as a Second Language, Peking University, Beijing 100871, China
| | - Xiujie Yang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
| | - Dongwei Li
- Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University, Zhuhai 519087, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
| | - Luyao Chen
- Max Planck Partner Group, School of International Chinese Language Education, Beijing Normal University, Beijing 100875, China; Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Institute of Educational System Science, Beijing Normal University, Beijing 100875, China.
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3
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Heimgärtner M, Gschaidmeier A, Schnaufer L, Staudt M, Wilke M, Lidzba K. The long-term negative impact of childhood stroke on language. Front Pediatr 2024; 12:1338855. [PMID: 38774297 PMCID: PMC11106365 DOI: 10.3389/fped.2024.1338855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
Objectives This study aims to investigate the long-term language outcome in children with unilateral childhood stroke in comparison to those with perinatal strokes and typically developing individuals and to explore the impact of lesion-specific modifiers. Methods We examined nine patients with childhood stroke, acquired between 0;2 and 16;1 years (CHILD; 3 female, median = 13.5 years, 6 left-sided), 23 patients with perinatal strokes (PERI; 11 female, median = 12.5 years, 16 left-sided), and 33 age-matched typically developing individuals (CONTROL; 15 female, median = 12.33 years). The language outcome was assessed using age-appropriate tasks of the Potsdam Illinois Test of Psycholinguistic Abilities (P-ITPA) or the Peabody Picture Vocabulary Test (PPVT). For group comparisons, study-specific language z-scores were calculated. Non-verbal intelligence was assessed using the Test of Non-verbal Intelligence (TONI-4), language lateralization with functional MRI, and lesion size with MRI-based volumetry. Results All four patients with childhood stroke who initially presented with aphasic symptoms recovered from aphasia. Patients with childhood stroke showed significantly lower language scores than those in the control group, but their scores were similar to those of the patients with perinatal stroke, after adjusting for general intelligence (ANCOVA, language z-score CHILD = -0.30, PERI = -0.38, CONTROL = 0.42). Among the patients with childhood stroke, none of the possible modifying factors, including lesion side, correlated significantly with the language outcome. Conclusion Childhood stroke, regardless of the affected hemisphere, can lead to chronic language deficits, even though affected children show a "full recovery." The rehabilitation of children and adolescents with childhood stroke should address language abilities, even after the usually quick resolution of clear aphasic symptoms.
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Affiliation(s)
- Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, Tübingen, Germany
| | - Alisa Gschaidmeier
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
- Division of Neuropediatrics, Development and Rehabilitation, University Children’s Hospital Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, Tübingen, Germany
- Experimental Pediatric Neuroimaging, Children’s Hospital and Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, Tübingen, Germany
- Center for Pediatric Palliative Care, Dr von Hauner Children’s Hospital, University of Munich, Munich, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, Tübingen, Germany
- Experimental Pediatric Neuroimaging, Children’s Hospital and Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Karen Lidzba
- Division of Neuropediatrics, Development and Rehabilitation, University Children’s Hospital Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bogavac I, Jeličić L, Marisavljević M, Bošković Matić T, Subotić M. Arterial Presumed Perinatal Ischemic Stroke: A Mini Review and Case Report of Cognitive and Speech-Language Profiles in a 5-Year-Old Girl. CHILDREN (BASEL, SWITZERLAND) 2023; 11:33. [PMID: 38255347 PMCID: PMC10814911 DOI: 10.3390/children11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Arterial presumed perinatal ischemic stroke is a type of perinatal stroke that emerges due to late or delayed diagnostics of perinatal or neonatal arterial ischemic stroke. It is usually recognized before one year of life due to hemiparesis. This injury may lead to cognitive, behavioral, or motor symptoms, and life-long neurodevelopmental disabilities. In this case report, we describe a five-year-old girl with a history of arterial presumed perinatal ischemic stroke in the left hemisphere, which adversely affected her cognitive and language outcomes. The girl's cognitive development has been uneven, ranging from below average to average, and she had specific language acquisition deficits in comprehension, vocabulary, morphology, use of complex syntax, and narrative structure. The obtained results point to the specificity of each child whose development is influenced not only by the timing of the brain lesion and the degree of damage, but also by the child's neurobiological capacity. In addition, we provide an updated review of the literature that includes information on epidemiology, risk factors, diagnostics, clinical manifestations, outcomes, and potential therapies. The present article highlights the importance of early intervention and systematic monitoring of children with perinatal stroke with the aim of improving the child's development.
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Affiliation(s)
- Ivana Bogavac
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Ljiljana Jeličić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Maša Marisavljević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Tatjana Bošković Matić
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Clinic of Neurology, University Clinical Centre of Kragujevac, 34000 Kragujevac, Serbia
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (I.B.); (M.M.); (M.S.)
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Martin KC, Seydell-Greenwald A, Turkeltaub PE, Chambers CE, Giannetti M, Dromerick AW, Carpenter JL, Berl MM, Gaillard WD, Newport EL. One right can make a left: sentence processing in the right hemisphere after perinatal stroke. Cereb Cortex 2023; 33:11257-11268. [PMID: 37859521 PMCID: PMC10690853 DOI: 10.1093/cercor/bhad362] [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: 04/14/2023] [Revised: 09/08/2023] [Indexed: 10/21/2023] Open
Abstract
When brain regions that are critical for a cognitive function in adulthood are irreversibly damaged at birth, what patterns of plasticity support the successful development of that function in an alternative location? Here we investigate the consistency of language organization in the right hemisphere (RH) after a left hemisphere (LH) perinatal stroke. We analyzed fMRI data collected during an auditory sentence comprehension task on 14 people with large cortical LH perinatal arterial ischemic strokes (left hemisphere perinatal stroke (LHPS) participants) and 11 healthy sibling controls using a "top voxel" approach that allowed us to compare the same number of active voxels across each participant and in each hemisphere for controls. We found (1) LHPS participants consistently recruited the same RH areas that were a mirror-image of typical LH areas, and (2) the RH areas recruited in LHPS participants aligned better with the strongly activated LH areas of the typically developed brains of control participants (when flipped images were compared) than the weakly activated RH areas. Our findings suggest that the successful development of language processing in the RH after a LH perinatal stroke may in part depend on recruiting an arrangement of frontotemporal areas reflective of the typical dominant LH.
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Affiliation(s)
- Kelly C Martin
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
| | - Catherine E Chambers
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
| | - Margot Giannetti
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
| | - Alexander W Dromerick
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
| | - Jessica L Carpenter
- Division of Pediatric Neurology, Departments of Pediatrics and Neurology, University of Maryland School of Medicine, Baltimore MD 21201, United States
| | - Madison M Berl
- Children’s National Hospital and Center for Neuroscience, Washington, DC 20010, United States
| | - William D Gaillard
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- Children’s National Hospital and Center for Neuroscience, Washington, DC 20010, United States
| | - Elissa L Newport
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057, United States
- MedStar National Rehabilitation Hospital, Washington, DC 20010, United States
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6
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Kolk A, Saard M, Roštšinskaja A, Sepp K, Kööp C. Power of combined modern technology: Multitouch-multiuser tabletops and virtual reality platforms ( PowerVR) in social communication skills training for children with neurological disorders: A pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:187-196. [PMID: 35508442 DOI: 10.1080/21622965.2022.2066532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
New technologies such as multitouch-multiuser tabletops (MMT) and virtual reality (VR) provide modern neurorehabilitation options. The aim was to describe the structure of acquired social communication deficits in children with neurological disorders (ND) and implement a new PowerVR method- combined MMT/VR interfaces, into social neurorehabilitation. The study was designed based on the Structured Social Rehabilitation Model. Sixty children with ND aged 8-13 years participated: 28 with epilepsy, 10 with traumatic brain injury (TBI), 3 with tic disorders, 3 with stroke, 16 with other ND. A total of 16 patients (M = 10.5 years, SD = 1.8) completed trainings with pre- and post-intervention assessments. Forty-four patients participated in base-level assessment (M = 10.2 years, SD = 1.6). Two age-matched patients practiced in pairs on MMT and individually in VR. The most impaired components in patients were theory of mind (ToM) skills. A total of 64% of children presented behavioral problems related to executive dysfunctions. Patients lacked conflict resolution (median 38% out of 100%) and empathy skills (25%). After trainings, communication and cooperation, pragmatics, social attention, conflict resolution, and empathy skills improved. Patients' general verbal ToM and understanding false beliefs (p < .005) increased. Children's ability to start conversations improved; they experienced less bullying. Findings suggest that the combined technology-based intervention PowerVR offers increased power for multicomponent training of socio-emotional skills.
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Affiliation(s)
- Anneli Kolk
- Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital Children's Clinic, Tartu, Estonia
| | - Marianne Saard
- Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital Children's Clinic, Tartu, Estonia
| | - Alina Roštšinskaja
- Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Kirsi Sepp
- Tartu University Hospital Children's Clinic, Tartu, Estonia
| | - Christen Kööp
- Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Sullivan AW, Johnson MK, Boes AD, Tranel D. Implications of age at lesion onset for neuropsychological outcomes: A systematic review focusing on focal brain lesions. Cortex 2023; 163:92-122. [PMID: 37086580 PMCID: PMC10192019 DOI: 10.1016/j.cortex.2023.03.002] [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: 08/09/2022] [Revised: 02/10/2023] [Accepted: 03/19/2023] [Indexed: 04/24/2023]
Abstract
Theories of the relation between age at lesion onset and outcomes posit different views of the young brain: resilient and plastic (i.e., the so-called "Kennard Principle"), or vulnerable (i.e., the Early Vulnerability Hypothesis). There is support for both perspectives in previous research and questions about the "best" or "worst" times to sustain brain injury remain. Here, we present a systematic review investigating the influence of age at focal brain lesion onset on cognitive functioning. This systematic review identifies and qualitatively synthesizes empirical studies from 1985 to 2021 that investigated age at lesion onset as a variable of interest associated with neuropsychological outcomes. A total of 45 studies were identified from PubMed, PsycINFO, and CINAHL databases. Almost all studies indicated that brain injury earlier in the developmental period predicts worse cognitive outcomes when compared to onset either later in the developmental period or in adulthood. More specifically, the overwhelming majority of studies support an "earlier is worse" model for domains of intellect, processing speed, attention and working memory, visuospatial and perceptual skills, and learning and memory. Relatively more variability in outcomes exists for domains of language and executive functioning. Outcomes for all domains are influenced by various other age and injury variables (e.g., lesion size, lesion laterality, chronicity, a history of epilepsy). Continued interdisciplinary understanding and communication about the influence of age at lesion onset on neuropsychological outcomes will aid in promoting the best possible outcomes for patients.
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Affiliation(s)
- Alyssa W Sullivan
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Marcie K Johnson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Aaron D Boes
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA; Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA.
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8
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Visuospatial processing skills following unilateral arterial ischemic stroke in childhood. Eur J Paediatr Neurol 2023; 42:133-141. [PMID: 36645949 DOI: 10.1016/j.ejpn.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: 06/07/2022] [Revised: 10/06/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
Due to the rare occurrence of childhood stroke, its impact on later cognitive functioning remains unclear. While it is often assumed that children recover better than adults, recent studies suggest that childhood stroke can negatively affect a wide range of cognitive domains, such as attention, language, and processing speed, among others. We examined the effect of unilateral stroke on children's visuoconstructive ability and visual memory. Seventeen children with left- or right-sided arterial ischemic stroke were tested using subtests of the Hamburg-Wechsler Intelligenztest für Kinder and the Rey-Osterrieth Complex Figure (ROCF). The ROCF was evaluated both quantitatively and qualitatively with the help of two separate scoring methods. We found that lesion laterality and age at stroke impacted childhood stroke patients' ability to recall certain elements of the figure. Regarding lesion laterality, left-sided stroke patients had more difficulties recalling internal details than right-sided stroke patients. In terms of age, patients with stroke onset before the age of 5 years remembered fewer structural elements than patients with stroke onset after the age of 5 years did. Moreover, the qualitative scoring method better differentiated between individuals and between groups than the more commonly used quantitative method. The results of this study not only highlight the importance of a qualitative assessment of the ROCF but could also aid clinicians in testing stroke patients more accurately and tailoring subsequent therapy to the patient's individual needs.
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9
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Robb TJ, Tonks J, Spencer APC, Jary S, Whitfield CK, Thoresen M, Cowan FM, Chakkarapani E. Communication skills in children aged 6-8 years, without cerebral palsy cooled for neonatal hypoxic-ischemic encephalopathy. Sci Rep 2022; 12:17757. [PMID: 36272982 PMCID: PMC9588000 DOI: 10.1038/s41598-022-21723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/30/2022] [Indexed: 01/19/2023] Open
Abstract
We assessed communication skills of 48 children without cerebral palsy (CP) treated with therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) (cases) compared to 42 controls at early school-age and examined their association with white matter diffusion properties in both groups and 18-month Bayley-III developmental assessments in cases. Parents completed a Children's Communication Checklist (CCC-2) yielding a General Communication Composite (GCC), structural and pragmatic language scores and autistic-type behavior score. GCC ≤ 54 and thresholds of structural and pragmatic language score differences defined language impairment. Using tract-based spatial statistics (TBSS), fractional anisotropy (FA) was compared between 31 cases and 35 controls. Compared to controls, cases had lower GCC (p = 0.02), structural (p = 0.03) and pragmatic language score (p = 0.04) and higher language impairments (p = 0.03). GCC correlated with FA in the mid-body of the corpus callosum, the cingulum and the superior longitudinal fasciculus (p < 0.05) in cases. Bayley-III Language Composite correlated with GCC (r = 0.34, p = 0.017), structural (r = 0.34, p = 0.02) and pragmatic (r = 0.32, p = 0.03) language scores and autistic-type behaviors (r = 0.36, p = 0.01).
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Affiliation(s)
- Thomas J Robb
- St Michael's Hospital, Level D Neonatal Neuroscience, University Hospitals Bristol and Weston NHS Trust, Bristol, BS2 8EG, UK
| | - James Tonks
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
- Haven Clinical Psychology Practice, Cornwall, UK
| | - Arthur P C Spencer
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Sally Jary
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | | | - Marianne Thoresen
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Frances M Cowan
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Ela Chakkarapani
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK.
- St Michael's Hospital, Level D Neonatal Neuroscience, University Hospitals Bristol and Weston NHS Trust, Bristol, BS2 8EG, UK.
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10
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Martin KC, Seydell-Greenwald A, Berl MM, Gaillard WD, Turkeltaub PE, Newport EL. A Weak Shadow of Early Life Language Processing Persists in the Right Hemisphere of the Mature Brain. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:364-385. [PMID: 35686116 PMCID: PMC9169899 DOI: 10.1162/nol_a_00069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Studies of language organization show a striking change in cerebral dominance for language over development: We begin life with a left hemisphere (LH) bias for language processing, which is weaker than that in adults and which can be overcome if there is a LH injury. Over development this LH bias becomes stronger and can no longer be reversed. Prior work has shown that this change results from a significant reduction in the magnitude of language activation in right hemisphere (RH) regions in adults compared to children. Here we investigate whether the spatial distribution of language activation, albeit weaker in magnitude, still persists in homotopic RH regions of the mature brain. Children aged 4-13 (n = 39) and young adults (n = 14) completed an auditory sentence comprehension fMRI (functional magnetic resonance imaging) task. To equate neural activity across the hemispheres, we applied fixed cutoffs for the number of active voxels that would be included in each hemisphere for each participant. To evaluate homotopicity, we generated left-right flipped versions of each activation map, calculated spatial overlap between the LH and RH activity in frontal and temporal regions, and tested for mean differences in the spatial overlap values between the age groups. We found that, in children as well as in adults, there was indeed a spatially intact shadow of language activity in the right frontal and temporal regions homotopic to the LH language regions. After a LH stroke in adulthood, recovering early-life activation in these regions might assist in enhancing recovery of language abilities.
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Affiliation(s)
- Kelly C. Martin
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Madison M. Berl
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - William D. Gaillard
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - Peter E. Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Elissa L. Newport
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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11
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Gschaidmeier A, Heimgärtner M, Schnaufer L, Driever PH, Wilke M, Lidzba K, Staudt M. Cognitive development after perinatal unilateral infarctions: No evidence for preferential sparing of verbal functions. Eur J Paediatr Neurol 2022; 37:8-11. [PMID: 34999444 DOI: 10.1016/j.ejpn.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Even children with extensive perinatal left-sided lesions have been reported to show normal language functions based on right-hemispheric language reorganization. This reorganization can lead to deficits in originary right hemispheric functions ("crowding hypothesis"). In a previous study, however, we identified epilepsy (even when well-controlled), and not language reorganization, as the major risk factor for impaired nonverbal functions. Here, we asked whether verbal and nonverbal functions develop differently, and whether they share the same risk factors. METHODS We investigated 23 patients (11f, Md = 12.56 years) with perinatal strokes (16 left-sided, 8 with epilepsy), and 23 healthy age-matched controls (8 f, Md = 12.42years). Language functions were assessed using the Potsdam Illinois Test of Psycholinguistic Abilities, nonverbal intelligence with the Test of Nonverbal Intelligence, language lateralization with functional MRI, and lesion size with MRI-based volumetry. RESULTS We found no systematic difference between verbal and nonverbal skills in our patients or controls [median difference Z(PITPA)-Z(TONI): patients = -0.03, controls = -0.06]. Accordingly, verbal and nonverbal functions were strongly correlated in patients (r = 0.80) and in controls (r = 0.74). Language ability correlated significantly with epilepsy. Furthermore, in patients with epilepsies, verbal skills were significantly lower than in controls. CONCLUSION In our cohort, we found no evidence for a differential effect of perinatal strokes on the development of verbal versus nonverbal functions, and, specifically, no evidence for a preferential sparing of verbal functions. Epilepsy, even when well-controlled, was confirmed as a single key risk factor for verbal functions.
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Affiliation(s)
- Alisa Gschaidmeier
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Germany.
| | - Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Pablo Hernáiz Driever
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Germany
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12
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Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
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13
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Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:397-414. [PMID: 35034751 PMCID: PMC10149040 DOI: 10.1016/b978-0-12-819410-2.00021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The language system is perhaps the most unique feature of the human brain's cognitive architecture. It has long been a quest of cognitive neuroscience to understand the neural components that contribute to the hierarchical pattern processing and advanced rule learning required for language. The most important goal of this research is to understand how language becomes impaired when these neural components malfunction or are lost to stroke, and ultimately how we might recover language abilities under these circumstances. Additionally, understanding how the language system develops and how it can reorganize in the face of brain injury or dysfunction could help us to understand brain plasticity in cognitive networks more broadly. In this chapter we will discuss the earliest features of language organization in infants, and how deviations in typical development can-but in some cases, do not-lead to disordered language. We will then survey findings from adult stroke and aphasia research on the potential for recovering language processing in both the remaining left hemisphere tissue and in the non-dominant right hemisphere. Altogether, we hope to present a clear picture of what is known about the capacity for plastic change in the neurobiology of the human language system.
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Affiliation(s)
- Kelly C Martin
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - W Tyler Ketchabaw
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - Peter E Turkeltaub
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, United States.
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14
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Sporns PB, Fullerton HJ, Lee S, Kirton A, Wildgruber M. Current treatment for childhood arterial ischaemic stroke. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:825-836. [PMID: 34331864 DOI: 10.1016/s2352-4642(21)00167-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Paediatric arterial ischaemic stroke is an important cause of neurological morbidity in children, with consequences including motor disorders, intellectual impairment, and epilepsy. The causes of paediatric arterial ischaemic stroke are unique compared with those associated with stroke in adulthood. The past decade has seen substantial advances in paediatric stroke research and clinical care, but many unanswered questions and controversies remain. Shortage of prospective evidence for the use of recanalisation therapies in patients with paediatric stroke has resulted in little standardisation of disease management. Substantial time delays in diagnosis and treatment continue to challenge best possible care. In this Review, we highlight on some of the most pressing and productive aspects of research in the treatment of arterial ischaemic stroke in children, including epidemiology and cause, rehabilitation, secondary stroke prevention, and treatment updates focusing on advances in hyperacute therapies such as intravenous thrombolysis, mechanical thrombectomy, and critical care. Finally, we provide a future perspective for improving outcomes and quality of life for affected children and their families.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Weill Institute of Neurosciences, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
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15
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Vojcek E, Jermendy A, Laszlo AM, Graf R, Rudas G, Berenyi M, Seri I. The role of brain territorial involvement and infection/inflammation in the long-term outcome of neonates with arterial ischemic stroke: A population-based cohort study. Early Hum Dev 2021; 158:105393. [PMID: 34034089 DOI: 10.1016/j.earlhumdev.2021.105393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neonatal arterial ischemic stroke (NAIS) carries the risk of significant long-term neurodevelopmental burden on survivors. AIMS To assess the long-term neurodevelopmental outcome of term neonates diagnosed with NAIS and investigate the associations among brain territorial involvement on MRI, clinical risk factors and neurodevelopmental outcomes. STUDY DESIGN Population-based cohort study. SUBJECTS Seventy-nine term neonates with NAIS confirmed by MRI born between 2007 and 2017. OUTCOME MEASURES Long-term neurodevelopmental outcome assessed using the Bayley Scales of Infant Development-II, the Brunet-Lézine test and the Binet Intelligence scales-V. RESULTS Follow-up was available in 70 (89%) of the subjects enrolled, at a median age of 60 months [IQR: 35-84]. Normal neurodevelopmental outcome was found in 43% of the patients. In a multivariable model, infants with main MCA stroke had an increased risk for overall adverse outcome (OR: 9.1, 95% CI: 1.7-48.0) and a particularly high risk for cerebral palsy (OR: 55.9, 95% CI: 7.8-399.2). The involvement of the corticospinal tract without extensive stroke also increased the risk for cerebral palsy/fine motor impairment (OR: 13.5, 95% CI: 2.4-76.3). Multiple strokes were associated with epilepsy (OR: 9.5, 95% CI: 1.0-88.9) and behavioral problems (OR: 4.4, 95% CI: 1.1-17.5) and inflammation/infection was associated with cerebral palsy (OR: 9.8, 95% CI: 1.4-66.9), cognitive impairment (OR: 9.2, 95% CI: 1.8-47.8) and epilepsy (OR: 10.3, 95% CI: 1.6-67.9). CONCLUSIONS Main MCA stroke, involvement of the corticospinal tract, multiple strokes and inflammation/infection were independent predictors of adverse outcome, suggesting that the interplay of stroke territorial involvement and clinical risk factors influence the outcome of NAIS.
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Affiliation(s)
- Eszter Vojcek
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Saint John Hospital and North-Buda Unified Hospitals, Budapest, Hungary.
| | - Agnes Jermendy
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Anna M Laszlo
- Institute of Mathematics and Base Sciences, Szent István University, Budapest, Hungary
| | - Rozsa Graf
- Department of Rehabilitation, Szent János Hospital and North Buda United Hospitals, Budapest, Hungary
| | - Gabor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Marianne Berenyi
- Department of Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Istvan Seri
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary; Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, United States
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16
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Bartha‐Doering L, Gleiss A, Knaus S, Schmook MT, Seidl R. Influence of socioeconomic status on cognitive outcome after childhood arterial ischemic stroke. Dev Med Child Neurol 2021; 63:465-471. [PMID: 33336807 PMCID: PMC7986130 DOI: 10.1111/dmcn.14779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
AIM To determine whether socioeconomic status (SES) is a stronger predictor for cognitive outcome after childhood arterial ischemic stroke compared to clinical factors. METHOD We investigated perceptual reasoning, executive functions, language, memory, and attention in 18 children and adolescents (12 males, six females, median age at testing 13y 4mo, range 7y-17y 5mo) after arterial ischemic stroke; collected sociodemographic information (education of parents, household income); and used clinical information (initial lesion volume, residual lesion volume, age at stroke, time since stroke). Linear regression models were used to investigate the potential influence of SES and clinical parameters on cognitive abilities. RESULTS SES had a moderate effect on all cognitive outcome parameters except attention by explaining 41.9%, 37.9%, 38.0%, and 22.5% of variability in perceptual reasoning, executive functions, language, and memory respectively. Initial lesion volume was the only clinical parameter that showed moderate importance on cognitive outcome (33.1% and 25.6% of the variability in perceptual reasoning and memory respectively). Overall, SES was a stronger predictor of cognitive outcome than clinical factors. INTERPRETATION Future paediatric studies aiming at clinical predictors of cognitive outcome should control their analyses for SES in their study participants. The findings of the present study further point to the need for more attention to the treatment of children with low SES. WHAT THIS PAPER ADDS Socioeconomic status (SES) explains up to 42% of variance in cognitive outcome after childhood arterial ischemic stroke. SES is a stronger predictor of outcome than clinical factors.
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Affiliation(s)
- Lisa Bartha‐Doering
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
| | - Andreas Gleiss
- Centre for Medical Statistics, Informatics, and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Sarah Knaus
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
| | - Maria Theresa Schmook
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Rainer Seidl
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria,Comprehensive Centre for PediatricsMedical University of ViennaViennaAustria
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17
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François C, Garcia-Alix A, Bosch L, Rodriguez-Fornells A. Signatures of brain plasticity supporting language recovery after perinatal arterial ischemic stroke. BRAIN AND LANGUAGE 2021; 212:104880. [PMID: 33220646 DOI: 10.1016/j.bandl.2020.104880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
Brain imaging methods such as functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) have already been used to decipher the functional and structural brain changes occurring during normal language development. However, little is known about the differentiation of the language network after an early lesion. While in adults, stroke over the left hemisphere generally induces post-stroke aphasia, it is not always the case when a stroke occurs in the perinatal period, thus revealing a remarkable plastic power of the language network during early development. In particular, the role of perilesional tissues, as opposed to undamaged brain areas in the functional recovery of language functions after an early insult, remains unclear. In this review article, we provide an overview of the extant literature using functional and structural neuroimaging data revealing the signatures of brain plasticity underlying near-normal language development.
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Affiliation(s)
| | - Alfredo Garcia-Alix
- Service of Genetic and Molecular Medicine, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; NeNe Foundation, Madrid, Spain
| | - Laura Bosch
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain
| | - Antoni Rodriguez-Fornells
- Cognition and Brain Plasticity Group, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
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18
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Does the Occurrence of Particular Symptoms and Outcomes of Arterial Ischemic Stroke Depend on Sex in Pediatric Patients?-A Pilot Study. Brain Sci 2020; 10:brainsci10110881. [PMID: 33233638 PMCID: PMC7699743 DOI: 10.3390/brainsci10110881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
Arterial ischemic stroke (AIS) in childhood is reported to occur more frequently in boys, which may lead to the assumption that the prevalence of post-stroke deficits is sex related. The present study aimed to evaluate sex-related differences in functional outcomes (hemiparesis, seizures, aphasia, and motor disturbances other than hemiparesis) in pediatric patients with AIS. A total of 89 children (52 boys and 37 girls; mean age at stroke onset: 8.4 ± 5.6 years) were evaluated retrospectively based on data from medical records. The patients were divided into subgroups according to age (i.e., infants and toddlers, children, and adolescents), stroke subtype (i.e., lacunar anterior circulation infarct (LACI), total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI)) and stroke location (i.e., anterior stroke, posterior stroke). Significant differences in the prevalence of stroke subtypes between girls and boys were observed (p = 0.034). POCI stroke were found to be more frequent in boys than in girls (OR = 8.57 95%CI 1.05–70.23, p = 0.023). Males predominated in the total group and in all analyzed age subgroups. The proportions of boys within the subgroups according to stroke subtype were extremely high for the POCI and TACI stroke subgroups. On the other hand, girls predominated in the LACI stroke subgroup. Frequency of central type facial nerve palsy and other symptoms of AIS were found to significantly differ between male subgroups according to stroke subtype (p = 0.050 and p < 0.001, respectively), as well as between children with anterior stroke and those with posterior stroke (p = 0.059 and p < 0.001, respectively). Post-stroke seizures appeared significantly more commonly in girls with TACI and POCI stroke than in girls with LACI and PACI stroke (p = 0.022). In turn, the prevalence of post-stroke hemiparesis differed between stroke subtypes in boys (p = 0.026). In conclusion, sex may have an impact in predisposing to a certain type of AIS in the patient. Post-stroke seizure may be related to stroke subtype in girls and hemiparesis in boys. However, further studies are needed to confirm the results.
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19
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Imaging Developmental and Interventional Plasticity Following Perinatal Stroke. Can J Neurol Sci 2020; 48:157-171. [DOI: 10.1017/cjn.2020.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT:Perinatal stroke occurs around the time of birth and leads to lifelong neurological disabilities including hemiparetic cerebral palsy. Magnetic resonance imaging (MRI) has revolutionized our understanding of developmental neuroplasticity following early injury, quantifying volumetric, structural, functional, and metabolic compensatory changes after perinatal stroke. Such techniques can also be used to investigate how the brain responds to treatment (interventional neuroplasticity). Here, we review the current state of knowledge of how established and emerging neuroimaging modalities are informing neuroplasticity models in children with perinatal stroke. Specifically, we review structural imaging characterizing lesion characteristics and volumetrics, diffusion tensor imaging investigating white matter tracts and networks, task-based functional MRI for localizing function, resting state functional imaging for characterizing functional connectomes, and spectroscopy examining neurometabolic changes. Key challenges and exciting avenues for future investigations are also considered.
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20
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Lidzba K, Bürki SE, Staudt M. Predicting Language Outcome After Left Hemispherotomy: A Systematic Literature Review. Neurol Clin Pract 2020; 11:158-166. [PMID: 33842069 DOI: 10.1212/cpj.0000000000000852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/28/2020] [Indexed: 01/11/2023]
Abstract
Objective Hemidecortication is a therapeutic option in patients with drug-resistant structural epilepsy. If surgery is performed early enough in left-hemispheric pathology, the plasticity of the developing brain may enable the right hemisphere to take over language-if this has not occurred before surgery. A systematic overview of potential predictors of language outcome after left hemidecortication in children is warranted. Methods In a systematic literature review, we analyzed 58 studies on language lateralization after congenital or postneonatally acquired left-hemispheric pathology, and on language outcome after left-sided hemidisconnection, such as hemispherotomy. Single-subject data were pooled to determine the distribution of lateralization across etiologies in congenital lesions and across age groups in acute postneonatal lesions. A hierarchical linear regression assessed the influence of age at surgery, lesion type, age at seizure onset, and presurgery language function on language outcome after left hemidecortication. Results In acute postneonatal lesions, younger age at injury was significantly associated with right-sided language lateralization (Cramér V = 0.458; p = 0.039). In patients with hemidecortication, age at surgery was not significantly associated with language outcome (Cramér V = -0.056; p = 0.584). Presurgical language function was the most powerful predictor for postsurgical language outcome (F 4,47 = 7.35, p < 0.0001), with good presurgical language bearing the risk of postsurgical deterioration. In congenital pathology, right-sided language lateralization was most frequent in pre-/perinatal stroke (Cramér V = 0.357; p < 0.0001). Conclusions We propose a presurgical decision algorithm with age, presurgical language function, language lateralization, and left-hemispheric structural pathology as decision points regarding surgery.
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Affiliation(s)
- Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland
| | - Sarah E Bürki
- Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine (KL, MS), University Children's Hospital Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation (MS), Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Pediatric Neurology (KL), Inselspital University Children's Hospital, University of Bern, Switzerland; and Department of Neuropediatrics (SEB), University Children's Hospital Zurich, Switzerland
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21
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Enhancing Stroke Recovery Across the Life Span With Noninvasive Neurostimulation. J Clin Neurophysiol 2020; 37:150-163. [DOI: 10.1097/wnp.0000000000000543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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22
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Asaridou SS, Demir-Lira ÖE, Goldin-Meadow S, Levine SC, Small SL. Language development and brain reorganization in a child born without the left hemisphere. Cortex 2020; 127:290-312. [PMID: 32259667 DOI: 10.1016/j.cortex.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 11/08/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022]
Abstract
We present a case of a 14-year-old girl born without the left hemisphere due to prenatal left internal carotid occlusion. We combined longitudinal language and cognitive assessments with functional and structural neuroimaging data to situate the case within age-matched, typically developing children. Despite having had a delay in getting language off the ground during the preschool years, our case performed within the normal range on a variety of standardized language tests, and exceptionally well on phonology and word reading, during the elementary and middle school years. Moreover, her spatial, number, and reasoning skills also fell in the average to above-average range based on assessments during these time periods. Functional MRI data revealed activation in right fronto-temporal areas when listening to short stories, resembling the bilateral activation patterns in age-matched typically developing children. Diffusion MRI data showed significantly larger dorsal white matter association tracts (the direct and anterior segments of the arcuate fasciculus) connecting areas active during language processing in her remaining right hemisphere, compared to either hemisphere in control children. We hypothesize that these changes in functional and structural brain organization are the result of compensatory brain plasticity, manifesting in unusually large right dorsal tracts, and exceptional performance in phonology, speech repetition, and decoding. More specifically, we posit that our case's large white matter connections might have played a compensatory role by providing fast and reliable transfer of information between cortical areas for language in the right hemisphere.
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Affiliation(s)
- Salomi S Asaridou
- University of California, Irvine, Department of Neurology, Biological Sciences III, Irvine, CA, USA.
| | - Ö Ece Demir-Lira
- The University of Iowa, Department of Psychological and Brain Sciences, DeLTA Center, Iowa Neuroscience Institute, Iowa City, IA, USA
| | - Susan Goldin-Meadow
- Department of Psychology, Center for Gesture, Sign and Language, University of Chicago, Chicago, IL, USA
| | - Susan C Levine
- University of Chicago, Department of Psychology, Chicago, IL, USA
| | - Steven L Small
- University of California, Irvine, Department of Neurology, Biological Sciences III, Irvine, CA, USA
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23
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From Broca and Wernicke to the Neuromodulation Era: Insights of Brain Language Networks for Neurorehabilitation. Behav Neurol 2019; 2019:9894571. [PMID: 31428210 PMCID: PMC6679886 DOI: 10.1155/2019/9894571] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022] Open
Abstract
Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain "understands," "speaks," and "writes," and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks ("streams"), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.
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Carlson HL, Sugden C, Brooks BL, Kirton A. Functional connectivity of language networks after perinatal stroke. Neuroimage Clin 2019; 23:101861. [PMID: 31141787 PMCID: PMC6536856 DOI: 10.1016/j.nicl.2019.101861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 02/06/2023]
Abstract
Successful language acquisition during development is imperative for lifelong function. Complex language networks develop throughout childhood. Perinatal stroke may cause significant language disabilities but function can also be remarkably normal. Studying such very early brain injury populations may inform developmental plasticity models of language networks. We examined functional connectivity (FC) of language networks in children with arterial and venous perinatal stroke and typically developing controls (TDC) in a population-based, controlled, cohort study. Resting state functional MRI was performed at 3 T (TR/TE = 2000/30 ms, 150 volumes, 3.6mm3 voxels). Seed-based analyses used bilateral inferior frontal and superior temporal gyri. A subset of stroke participants completed clinical language testing. Sixty-six children participated (median age: 12.85±3.8y, range 6-19; arterial N = 17; venous N = 15; TDC N = 34]. Children with left hemisphere strokes had comparable FC in their right hemispheres compared to TDC. Inter- and intra-hemispheric connectivity strengths were similar between TDC and PVI but lower for AIS. Reduced FC was associated with poorer language comprehension. Language networks can be estimated using resting-state fMRI in children with perinatal stroke. Altered connectivity may occur in both hemispheres, is more pronounced with arterial lesions, and is associated with clinical function. Our results have implications for therapeutic language interventions after early stroke.
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Affiliation(s)
- Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
| | - Cole Sugden
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Neuropsychology Service, Alberta Children's Hospital, Calgary, AB, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, 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; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Peterson RK, McDonald KP, Vincent M, Williams TS, Dlamini N, Westmacott R. Characterizing language outcomes following childhood basal ganglia stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:14-25. [PMID: 31006275 DOI: 10.1080/21622965.2019.1590202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.
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Affiliation(s)
- Rachel K Peterson
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Megan Vincent
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Northam GB, Morgan AT, Fitzsimmons S, Baldeweg T, Liégeois FJ. Corticobulbar Tract Injury, Oromotor Impairment and Language Plasticity in Adolescents Born Preterm. Front Hum Neurosci 2019; 13:45. [PMID: 30837853 PMCID: PMC6389783 DOI: 10.3389/fnhum.2019.00045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
Children born preterm are at risk of impairments in oromotor control, with implications for early feeding and speech development. In this study, we aimed to identify (a) neuroanatomical markers of persistent oromotor deficits using diffusion-weighted imaging (DWI) tractography and (b) evidence of compensatory neuroplasticity using functional MRI (fMRI) during a language production task. In a cross-sectional study of 36 adolescents born very preterm (<33 weeks' gestation) we identified persistent difficulties in oromotor control in 31% of cases, but no clinical diagnoses of speech-sound disorder (e.g., dysarthria, dyspraxia). We used DWI-tractography to examine the microstructure (fractional anisotropy, FA) of the corticospinal and corticobulbar tracts. Compared to the unimpaired group, the oromotor-impaired group showed (i) reduced FA within the dorsal portion of the left corticobulbar tract (containing fibres associated with movements of the lips, tongue, and larynx) and (ii) greater recruitment of right hemisphere language regions on fMRI. We conclude that, despite the development of apparently normal everyday speech, early injury to the corticobulbar tract leads to persistent subclinical problems with voluntary control of the face, lips, jaw, and tongue. Furthermore, we speculate that early speech problems may be ameliorated by cerebral plasticity - in particular, recruitment of right hemisphere language areas.
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Affiliation(s)
- Gemma B. Northam
- Great Ormond Street Hospital for Children NHS Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Angela T. Morgan
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Sophie Fitzsimmons
- Great Ormond Street Hospital for Children NHS Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Torsten Baldeweg
- Great Ormond Street Hospital for Children NHS Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Frédérique J. Liégeois
- Great Ormond Street Hospital for Children NHS Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Gaberova K, Pacheva I, Timova E, Petkova A, Velkova K, Ivanov I. An Individualized Approach to Neuroplasticity After Early Unilateral Brain Damage. Front Psychiatry 2019; 10:747. [PMID: 31798467 PMCID: PMC6878729 DOI: 10.3389/fpsyt.2019.00747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Reorganization after early lesions in the developing brain has been an object of extensive scientific work, but even growing data from translational neuroscience studies in the last 20 years does not provide unified factors for prediction of type of reorganization and rehabilitation potential of patients with unilateral cerebral palsy (UCP) due to pre/perinatal insult. Aim: To analyze the type of motor, language, and sensory brain reorganization in patients with right-sided cerebral palsy due to pre/perinatal isolated left-sided brain lesions taking into consideration the type (cortico-subcortical or periventricular) and extent (gray and white matter damage) of the lesion, etiology, comorbidity, and other postnatal factors that could have played a role in the complex process of brain plasticity. Material and Methods: Eight patients with unilateral right cerebral palsy were included in the study. The individual data from fMRI of primary sensory, motor, and language representation were analyzed and compared with respective comprehensive etiological, clinical, and morphological data. Patients were examined clinically and psychologically, and investigated by structural and functional 3T GE scanner. A correlation between the type and extent of the lesion (involvement of cortical and subcortical structures), timing of lesion, type of reorganization (laterality index), and clinical and psychological outcome was done. Results: Significant interindividual diversity was found in the patient group predominantly in the patterns of motor reorganization. Patients with small periventricular lesions have ipsilesional representation of primary motor, sensory, and word generation function. Patients with lesions involving left cortico-subcortical regions show various models of reorganization in all three modalities (ipsilesional, contralesional, and bilateral) and different clinical outcome that seem to be impossible for prediction. However, patients with UCP who demonstrate ipsilesional motor cortical activation have better motor functional capacity. Conclusion: The type and size of the pre/perinatal lesion in left hemisphere could affect the natural potential of the young brain for reorganization and therefore the clinical outcome. Much larger sample and additional correlation with morphological data (volumetry, morphometry, tractography) is needed for determination of possible risk or protective factors that could play a role in the complex process of brain plasticity.
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Affiliation(s)
- Katerina Gaberova
- Department of Pediatrics, University Hospital "St.George", Plovdiv, Bulgaria.,Complex of Translational Neuroscience, Medical University - Plovdiv, Plovdiv, Bulgaria
| | - Iliyana Pacheva
- Department of Pediatrics, University Hospital "St.George", Plovdiv, Bulgaria.,Complex of Translational Neuroscience, Medical University - Plovdiv, Plovdiv, Bulgaria.,Department of Pediatrics and Medical Genetics, Medical University - Plovdiv, Plovdiv, Bulgaria
| | - Elena Timova
- Department of Pediatrics, University Hospital "St.George", Plovdiv, Bulgaria
| | - Anelia Petkova
- Department of Pediatrics, University Hospital "St.George", Plovdiv, Bulgaria
| | - Kichka Velkova
- Complex of Translational Neuroscience, Medical University - Plovdiv, Plovdiv, Bulgaria.,Department of Medical imaging, Medical University - Plovdiv, Plovdiv, Bulgaria
| | - Ivan Ivanov
- Department of Pediatrics, University Hospital "St.George", Plovdiv, Bulgaria.,Complex of Translational Neuroscience, Medical University - Plovdiv, Plovdiv, Bulgaria.,Department of Pediatrics and Medical Genetics, Medical University - Plovdiv, Plovdiv, Bulgaria
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Atypical language representation is unfavorable for language abilities following childhood stroke. Eur J Paediatr Neurol 2019; 23:102-116. [PMID: 30314763 PMCID: PMC6339521 DOI: 10.1016/j.ejpn.2018.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/29/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022]
Abstract
Brain plasticity has often been quoted as a reason for the more favorable outcome in childhood stroke compared to adult stroke. We investigated the relationship between language abilities and language localization in childhood stroke. Seventeen children and adolescents with left- or right-sided ischemic stroke and 18 healthy controls were tested with a comprehensive neurolinguistic test battery, and the individual neural representation of language was measured with an fMRI language paradigm. Overall, 12 of 17 stroke patients showed language abilities below average, and five patients exhibited impaired language performance. fMRI revealed increased activity in right hemisphere areas homotopic to left hemisphere language regions. In sum, seven stroke patients revealed atypical, i.e. bilateral or right lateralized language representation. Typical left hemispheric language lateralization was associated with better performance in naming and word fluency, whereas increased involvement of right homologues was accompanied by worse language outcome. In contrast, lesion lateralization or lesion volume did not correlate with language outcome or atypical language lateralization. Thus, atypical language lateralization is unfavorable for language outcome, and right homologues do not have the same cognitive capacity, even in young children.
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Abstract
Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event.
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Lõo S, Ilves P, Männamaa M, Laugesaar R, Loorits D, Tomberg T, Kolk A, Talvik I, Talvik T, Haataja L. Long-term neurodevelopmental outcome after perinatal arterial ischemic stroke and periventricular venous infarction. Eur J Paediatr Neurol 2018; 22:1006-1015. [PMID: 30249407 DOI: 10.1016/j.ejpn.2018.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/04/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up data after different vascular types of ischemic perinatal stroke is sparse. Our aim was to study neurodevelopmental outcomes following neonatal and presumed perinatal ischemic middle cerebral artery territory stroke (arterial ischemic stroke, AIS) and periventricular venous infarction (PVI). METHODS A prospective consecutive cohort of 40 term-born children with perinatal stroke (21 AIS, 19 PVI) was identified through the Estonian Paediatric Stroke Database. While 48% of the children with AIS were diagnosed during the neonatal period, all the children with PVI had presumed perinatal stroke. Outcomes based on the Paediatric Stroke Outcome Measure (PSOM) and Kaufman Assessment Battery for Children - Second Edition (K-ABC-II), in relation to extent and laterality of stroke, were defined. RESULTS At a median age of 7 years 6 months (range 3.6-13y), there was a trend towards worse neurodevelopmental outcome in participants with AIS when compared to PVI (mean total PSOM scores 3.1 and 2.2, respectively; p = 0.06). Combined deficits of motor, language and cognitive/behavioural functions were significantly more common among children with AIS (90%) when compared to children with PVI (53%, p = 0.007). General cognitive ability (by K-ABC-II) was significantly lower in the AIS subgroup (mean 79.6; 95% CI 72.3-87.0), but children with PVI (91.6; 95% CI 85.5-97.8) also had poorer performance than the age-equivalent normative mean. Large extent of stroke was associated with poorer neurodevelopmental outcome and lower cognitive performance in children following AIS but not in PVI. CONCLUSION In this national cohort, poor long-term neurodevelopmental outcome after perinatal ischemic stroke was seen irrespective of the vascular type or time of diagnosis of stroke. However, the spectrum of neurological deficits is different after perinatal AIS and PVI, with combined deficits more common among children following AIS.
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Affiliation(s)
- Silva Lõo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Pediatrics, University of Tartu, Tartu, Estonia.
| | - Pilvi Ilves
- Department of Radiology, University of Tartu, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Mairi Männamaa
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- Department of Pediatrics, University of Tartu, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Inga Talvik
- Department of Neurology and Rehabilitation, Tallinn Children's Hospital, Tallinn, Estonia
| | - Tiina Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Leena Haataja
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Gaberova K, Pacheva I, Ivanov I. Task-related fMRI in hemiplegic cerebral palsy-A systematic review. J Eval Clin Pract 2018; 24:839-850. [PMID: 29700896 DOI: 10.1111/jep.12929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE Functional magnetic resonance imaging (fMRI) is used widely to study reorganization after early brain injuries. Unilateral cerebral palsy (UCP) is an appealing model for studying brain plasticity by fMRI. AIM To summarize the results of task-related fMRI studies in UCP in order to get better understanding of the mechanism of neuroplasticity of the developing brain and its reorganization potential and better translation of this knowledge to clinical practice. METHODS A systematic search was conducted on the PubMed database by keywords: "cerebral palsy", "congenital hemiparesis", "unilateral", "Magnetic resonance imaging" , "fMRI", "reorganization", and "plasticity" The exclusion criteria were as follows: case reports; reviews; studies exploring non-UCP patients; and studies with results of rehabilitation. RESULTS We found 7 articles investigated sensory tasks; 9 studies-motor tasks; 12 studies-speech tasks. Ipsilesional reorganization is dominant in sensory tasks (in 74/77 patients), contralesional-in only 3/77. In motor tasks, bilateral activation is found in 64/83, only contralesional-in 11/83, and only ipsilesional-8/83. Speech perception is bilateral in 35/51, only or dominantly ipsilesional (left-sided) in 8/51, and dominantly contralesional (right-sided) in 8/51. Speech production is only or dominantly contralesional (right-sided) in 88/130, bilateral-26/130, and only or dominantly ipsilesional (left-sided)-in 16/130. DISCUSSION The sensory system is the most "rigid" to reorganization probably due to absence of ipsilateral (contralesional) primary somatosensory representation. The motor system is more "flexible" due to ipsilateral (contralesional) motor pathways. The speech perception and production show greater flexibility resulting in more bilateral or contralateral activation. CONCLUSIONS The models of reorganization are variable, depending on the development and function of each neural system and the extent and timing of the damage. The plasticity patterns may guide therapeutic intervention and prognostics, thus proving the fruitiness of the translational approach in neurosciences.
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Affiliation(s)
- Katerina Gaberova
- Department of Pediatrics, St. George University Hospital, Plovdiv, Bulgaria
| | - Iliyana Pacheva
- Department of Pediatrics, St. George University Hospital, Plovdiv, Bulgaria
- Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Bulgaria
| | - Ivan Ivanov
- Department of Pediatrics, St. George University Hospital, Plovdiv, Bulgaria
- Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Bulgaria
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Lidzba K, de Haan B, Wilke M, Krägeloh-Mann I, Staudt M. Lesion characteristics driving right-hemispheric language reorganization in congenital left-hemispheric brain damage. BRAIN AND LANGUAGE 2017; 173:1-9. [PMID: 28549234 DOI: 10.1016/j.bandl.2017.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 04/19/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Pre- or perinatally acquired ("congenital") left-hemispheric brain lesions can be compensated for by reorganizing language into homotopic brain regions in the right hemisphere. Language comprehension may be hemispherically dissociated from language production. We investigated the lesion characteristics driving inter-hemispheric reorganization of language comprehension and language production in 19 patients (7-32years; eight females) with congenital left-hemispheric brain lesions (periventricular lesions [n=11] and middle cerebral artery infarctions [n=8]) by fMRI. 16/17 patients demonstrated reorganized language production, while 7/19 patients had reorganized language comprehension. Lesions to the insular cortex and the temporo-parietal junction (predominantly supramarginal gyrus) were significantly more common in patients in whom both, language production and comprehension were reorganized. These areas belong to the dorsal stream of the language network, participating in the auditory-motor integration of language. Our data suggest that the integrity of this stream might be crucial for a normal left-lateralized language development.
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Affiliation(s)
- Karen Lidzba
- University Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany; Experimental Pediatric Neuroimaging Group, Department of Pediatric Neurology and Developmental Medicine & Department of Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Bianca de Haan
- Center of Neurology, Division of Neuropsychology, Hertie-Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Marko Wilke
- University Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany; Experimental Pediatric Neuroimaging Group, Department of Pediatric Neurology and Developmental Medicine & Department of Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Ingeborg Krägeloh-Mann
- University Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Martin Staudt
- University Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, University of Tübingen, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Centre for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany
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Lidzba K, Küpper H, Kluger G, Staudt M. The time window for successful right-hemispheric language reorganization in children. Eur J Paediatr Neurol 2017. [PMID: 28648758 DOI: 10.1016/j.ejpn.2017.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM To identify, in a retrospective, observational study, the time window during which successful right-hemispheric language reorganization is possible after left-hemispheric brain damage. METHOD 25 patients (10 females; age 6-41 years; ≥12 months after insult; age at insult 0;3-15;11 years) with acute, language-relevant left-hemispheric insults acquired during childhood and adolescence completed questionnaires for self-assessment of language problems. 12 patients of those reporting no (n = 8) or only moderate (n = 4) language problems participated in language fMRI. RESULTS Language outcome of lesions occurring before 5 years of age (n = 7) was always favorable, and language was right-lateralized (2 patients: age at lesion < 2 years) or bilateral (3 patients: age at lesion 2-5 years). Following lesions occurring after 5 years of age, language outcome was often unfavorable (11/18 patients: moderate or severe problems), and of the 7 patients without problems, none showed right-hemispheric reorganization (fMRI available in 4). INTERPRETATION The combination of normal language outcome and right-hemispheric language reorganization after a left-hemispheric lesion sustained after the neonatal period is extremely rare. Functionally sufficient right-hemispheric language was documented in only two patients with lesions acquired before two years of age.
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Affiliation(s)
- Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Hanna Küpper
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Gerhard Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany; Institute of Rehabilitation, Transition and Palliation of Children with Neurological Illnesses, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany
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Murphy CFB, Stavrinos G, Chong K, Sirimanna T, Bamiou DE. Auditory Processing after Early Left Hemisphere Injury: A Case Report. Front Neurol 2017; 8:226. [PMID: 28596753 PMCID: PMC5442171 DOI: 10.3389/fneur.2017.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/09/2017] [Indexed: 12/28/2022] Open
Abstract
Few studies have addressed the long-term outcomes of early brain injury, especially after hemorrhagic stroke. This is the first study to report a case of acquired auditory processing disorder in a 10-year-old child who had a severe left hemorrhagic cerebral infarction at 13 months of age, compromising nearly all of the left temporal lobe. This case, therefore, is an excellent and rare opportunity to investigate the presence of neural plasticity of central auditory system in a developing brain followed severe brain damage. After assuring normal functioning of the peripheral auditory system, a series of behavioral auditory processing tests was applied in dichotic and monaural listening conditions and with verbal and non-verbal stimuli. For all verbal dichotic tasks (dichotic digits, competing words, and sentences tests), good performance on the left ear, especially for Dichotic digits test (100%), and zero performance on the right ear were observed. For monaural low-redundancy tests, the patient also exhibited good performance for auditory figure-ground and time-compressed sentences tests in the left ear. In the right ear, a very poor performance was observed, but slightly better than the same in Dichotic tasks. Impaired performance was also observed in the LiSN test in terms of spatial advantage and, for the Pitch Pattern Sequence test, the only non-verbal test applied, the patient had performance within the normal range in both ears. These results are interpreted taking into consideration the anatomical location of stroke lesion and also the influence of hemispheric specialization for language on auditory processing performance.
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Affiliation(s)
| | | | - Kling Chong
- Radiology Department, Great Ormond Street Hospital, London, UK
| | - Tony Sirimanna
- Audiological Medicine Department, Great Ormond Street Hospital, London, UK
| | - Doris-Eva Bamiou
- The Ear Institute, University College London, London, UK.,Audiological Medicine Department, Great Ormond Street Hospital, London, UK
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Language Representation Following Left MCA Stroke in Children and Adults: An fMRI Study. Can J Neurol Sci 2017; 44:483-497. [PMID: 28468691 DOI: 10.1017/cjn.2017.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this case series, functional magnetic resonance imaging was used to examine brain networks that mediate different aspects of language function in 4 young adults (17-22 years) with a history of left middle cerebral artery (MCA) stroke in childhood (40 years of age). Although it is widely believed that altered lateralization patterns are more likely to occur following early brain injuries compared with later brain injuries, the presumed plasticity of the young brain has been challenged in recent years, particularly in the domain of language. METHODS We explored this issue by contrasting the brain activation patterns of individuals with childhood left MCA stroke and adult left MCA stroke while performing two language tasks: verb generation and picture-word matching. Importantly, both groups showed significant recovery of language function, based on standard clinical indicators. RESULTS Controls showed left lateralized activation for both tasks, although much more pronounced for verb generation. Adult stroke patients also showed left lateralization for both tasks, though somewhat weaker than controls. Childhood stroke patients exhibited significantly weaker lateralization than the adult group for verb generation, but there was no significant group difference for picture-word matching. CONCLUSIONS These preliminary findings suggest that successful reorganization of language function is more likely to involve bilateral recruitment following left MCA stroke in childhood than in adulthood. Of importance, although childhood stroke patients had primarily subcortical lesions, there were substantial alterations in cortical activation patterns.
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Domi T, Vossough A, Stence NV, Felling RJ, Leung J, Krishnan P, Watson CG, Grant PE, Kassner A. The Potential for Advanced Magnetic Resonance Neuroimaging Techniques in Pediatric Stroke Research. Pediatr Neurol 2017; 69:24-36. [PMID: 28237248 DOI: 10.1016/j.pediatrneurol.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This article was written to provide clinicians and researchers with an overview of a number of advanced neuroimaging techniques in an effort to promote increased utility and the design of future studies using advanced neuroimaging in childhood stroke. The current capabilities of advanced magnetic resonance imaging techniques provide the opportunity to build on our knowledge of the consequences of stroke on the developing brain. These capabilities include providing information about the physiology, metabolism, structure, and function of the brain that are not routinely evaluated in the clinical setting. METHODS During the Proceedings of the Stroke Imaging Laboratory for Children Workshop in Toronto in June 2015, a subgroup of clinicians and imaging researchers discussed how the application of advanced neuroimaging techniques could further our understanding of the mechanisms of stroke injury and repair in the pediatric population. This subgroup was established based on their interest and commitment to design collaborative, advanced neuroimaging studies in the pediatric stroke population. RESULTS In working toward this goal, we first sought to describe here the magnetic resonance imaging techniques that are currently available for use, and how they have been applied in other stroke populations (e.g., adult and perinatal stroke). CONCLUSIONS With the continued improvement in advanced neuroimaging techniques, including shorter acquisition times, there is an opportunity to apply these techniques to their full potential in the research setting and learn more about the effects of stroke in the developing brain.
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Affiliation(s)
- Trish Domi
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas V Stence
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan J Felling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jackie Leung
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher G Watson
- Department of Computational Neuroscience, Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - P Ellen Grant
- Division of Newborn Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Kassner
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Saliba E, Debillon T, Auvin S, Baud O, Biran V, Chabernaud JL, Chabrier S, Cneude F, Cordier AG, Darmency-Stamboul V, Diependaele JF, Debillon T, Dinomais M, Durand C, Ego A, Favrais G, Gruel Y, Hertz-Pannier L, Husson B, Marret S, N’Guyen The Tich S, Perez T, Saliba E, Valentin JB, Vuillerot C. Accidents vasculaires cérébraux ischémiques artériels néonatals : synthèse des recommandations. Arch Pediatr 2017; 24:180-188. [DOI: 10.1016/j.arcped.2016.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/25/2016] [Accepted: 11/22/2016] [Indexed: 12/01/2022]
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Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke. Neural Plast 2016; 2016:2306406. [PMID: 28074160 PMCID: PMC5198182 DOI: 10.1155/2016/2306406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 01/08/2023] Open
Abstract
Perinatal stroke is a leading cause of congenital hemiparesis and neurocognitive deficits in children. Dysfunctions in the large-scale resting-state functional networks may underlie cognitive and behavioral disability in these children. We studied resting-state functional connectivity in patients with perinatal stroke collected from the Estonian Pediatric Stroke Database. Neurodevelopment of children was assessed by the Pediatric Stroke Outcome Measurement and the Kaufman Assessment Battery. The study included 36 children (age range 7.6–17.9 years): 10 with periventricular venous infarction (PVI), 7 with arterial ischemic stroke (AIS), and 19 controls. There were no differences in severity of hemiparesis between the PVI and AIS groups. A significant increase in default mode network connectivity (FDR 0.1) and lower cognitive functions (p < 0.05) were found in children with AIS compared to the controls and the PVI group. The children with PVI had no significant differences in the resting-state networks compared to the controls and their cognitive functions were normal. Our findings demonstrate impairment in cognitive functions and neural network profile in hemiparetic children with AIS compared to children with PVI and controls. Changes in the resting-state networks found in children with AIS could possibly serve as the underlying derangements of cognitive brain functions in these children.
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Awake surgery for hemispheric low-grade gliomas: oncological, functional and methodological differences between pediatric and adult populations. Childs Nerv Syst 2016; 32:1861-74. [PMID: 27659829 DOI: 10.1007/s00381-016-3069-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Brain mapping through a direct cortical and subcortical electrical stimulation during an awake craniotomy has gained an increasing popularity as a powerful tool to prevent neurological deficit while increasing extent of resection of hemispheric diffuse low-grade gliomas in adults. However, few case reports or very limited series of awake surgery in children are currently available in the literature. METHODS In this paper, we review the oncological and functional differences between pediatric and adult populations, and the methodological specificities that may limit the use of awake mapping in pediatric low-grade glioma surgery. RESULTS This could be explained by the fact that pediatric low-grade gliomas have a different epidemiology and biologic behavior in comparison to adults, with pilocytic astrocytomas (WHO grade I glioma) as the most frequent histotype, and with WHO grade II gliomas less prone to anaplastic transformation than their adult counterparts. In addition, aside from the issue of poor collaboration of younger children under 10 years of age, some anatomical and functional peculiarities of children developing brain (cortical and subcortical myelination, maturation of neural networks and of specialized cortical areas) can influence direct electrical stimulation methodology and sensitivity, limiting its use in children. CONCLUSIONS Therefore, even though awake procedure with cortical and axonal stimulation mapping can be adapted in a specific subgroup of children with a diffuse glioma from the age of 10 years, only few pediatric patients are nonetheless candidates for awake brain surgery.
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Ilves P, Laugesaar R, Loorits D, Kolk A, Tomberg T, Lõo S, Talvik I, Kahre T, Talvik T. Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings. J Child Neurol 2016; 31:621-8. [PMID: 26446909 DOI: 10.1177/0883073815609149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/22/2015] [Indexed: 12/28/2022]
Abstract
It is unknown why some infants with perinatal stroke present clinical symptoms late during infancy and will be identified as infants with presumed perinatal stroke. The risk factors and clinical and radiological data of 42 infants with presumed perinatal stroke (69% with periventricular venous infarction and 31% with arterial ischemic stroke) from the Estonian Pediatric Stroke Database were reviewed. Children with presumed perinatal stroke were born at term in 95% of the cases and had had no risk factors during pregnancy in 43% of the cases. Children with periventricular venous infarction were born significantly more often (82%) vaginally (P = .0213) compared to children with arterial stroke (42%); nor did they require resuscitation (P = .0212) or had any neurological symptoms after birth (P = .0249). Periventricular venous infarction is the most common type of lesion among infants with the presumed perinatal stroke. Data suggest that the disease is of prenatal origin.
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Affiliation(s)
- Pilvi Ilves
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia Department of Radiology, University of Tartu, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Silva Lõo
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Inga Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiina Kahre
- Department of Genetics, United Laboratories of Tartu University Hospital, Tartu, Estonia
| | - Tiina Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
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