Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome

Abstract

BackgroundRecovery after arterial ischaemic stroke is known to largely depend on the plastic properties of the brain. The present study examines changes in the network topography of the developing brain after stroke. Effects of brain damage are best assessed by examining entire networks rather than single sites of structural lesions. Relating these changes to post-stroke neuropsychological variables and motor abilities will improve understanding of functional plasticity after stroke. Inclusion of healthy controls will provide additional insight into children’s normal brain development. Resting state functional magnetic resonance imaging is a valid approach to topographically investigate the reorganisation of functional networks after a brain lesion. Transcranial magnetic stimulation provides complementary output information.This study will investigate functional reorganisation after paediatric arterial ischaemic stroke by means of resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a cross-sectional plus longitudinal study design. The general aim of this study is to better understand neuroplasticity of the developing brain after stroke in order to develop more efficacious therapy and to improve the post-stroke functional outcome.MethodsThe cross-sectional part of the study will investigate the functional cerebral networks of 35 children with chronic arterial ischaemic stroke (time of the lesion >2 years). In the longitudinal part, 15 children with acute arterial ischaemic stroke (shortly after the acute phase of the stroke) will be included and investigations will be performed 3 times within the subsequent 9 months. We will also recruit 50 healthy controls, matched for age and sex. The neuroimaging and neurophysiological data will be correlated with neuropsychological and neurological variables.DiscussionThis study is the first to combine resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a paediatric population diagnosed with arterial ischaemic stroke. Thus, this study has the potential to uniquely contribute to the understanding of neuronal plasticity in the brains of healthy children and those with acute or chronic brain injury. It is expected that the results will lead to the development of optimal interventions after arterial ischaemic stroke.

Neuroplasticity and Epilepsy Surgery in Brain Eloquent Areas: Case Report

“…We consider that the improvement found between 1 month presurgery and 2 months post-surgery in our patient indicates the implementation of the incipient functional areas of language developed by neuroplasticity in the right hemisphere over the years, similar to previous observations in patients with long-standing lesions in eloquent areas ( 23 , 24 ).…”

Resting-state connectivity and executive functions after pediatric arterial ischemic stroke

“…All participants were part of a clinical study investigating cortical reorganization after pediatric stroke, the HERO (Hemispheric Reorganization)-Study ( Kornfeld et al, 2015 ). Children and adolescents who had an AIS before the age of 16 years were recruited from the population-based Swiss Neuropaediatric Stroke Registry (SNPSR) ( Steinlin et al, 2005 , Studer et al, 2014 ).…”

“…Comprehensive neuropsychological tests were used to assess cognitive performance. Details of cognitive assessment have been described in the study protocol ( Kornfeld et al, 2015 ). All participants were assessed according to the methods described in the study protocol.…”

Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop

“…92,93 Studies of network reorganization in children after stroke are few. 94,95 However, studies using fMRI to evaluate hand function in children with remote stroke by Domi et al 96 demonstrated a high correlation between motor deficit and greater asymmetry in fMRI activations. Differences in sensorimotor reorganization after ischemic injury may impact neuroplasticity and response to rehabilitative interventions.…”