Plasticity in the developing brain: intellectual, language and academic functions in children with ischaemic perinatal stroke
Plasticity in the developing brain: intellectual, language and academic functions in children with ischaemic perinatal stroke
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DOI：
10.1093/brain/awn176
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发表时间：
2008-11-01
期刊：
影响因子：
14.5
通讯作者：
Trauner, Doris A.
中科院分区：
文献类型：
--
作者：
Ballantyne, Angela O.;Spilkin, Amy M.;Trauner, Doris A.
发育中的大脑具有很大的可塑性。许多研究人员已经证明，单侧围产期中风后的儿童的智力和语言能力可能处于正常范围。然而，有人质疑这些技能是否可以随着大脑的成熟而保持在相同的水平。本研究旨在检查围产期卒中儿童发育过程中智力、学业和语言功能的稳定性，并解决先前研究中提出的不一致之处。参与者包括 29 名患有单侧缺血性围产期卒中的学龄前至学龄儿童和 24 名对照儿童。在两个时间点进行智力和认知能力的纵向测试。研究 1 在测试间隔期间使用相同的测试版本检查了智商、学术技能和语言功能。研究 2 在较长的测试间隔（学前至学龄）内检查了智商，并使用了不同的测试版本。这项研究得出了重要的新发现。没有证据表明围产期单侧脑损伤的儿童认知功能会随着时间的推移而下降。这些结果表明，早期局灶性损伤后，发育中的大脑具有足够的持续可塑性，从而导致认知功能随着时间的推移保持稳定。此外，癫痫发作的存在限制了可塑性，因此癫痫发作组不仅智力和语言测量的表现显着降低（研究 1），而且认知发展的过程也显着改变（如研究 2 所示）。这项研究提供的信息支持发育中大脑功能可塑性的概念；文献中对早期缺血性围产期卒中儿童的预后进行了急需的澄清；提供证据表明癫痫发作限制了发育过程中的可塑性；并避免了先前研究中的许多混淆。更好地了解缺血性围产期卒中儿童随时间的变化情况尤为重要，因为有关该人群预后的信息相互矛盾。看来，当大脑发育的早期受到损害时，大脑功能重组会随着时间的推移维持稳定的发育速度。
The developing brain has the capacity for a great deal of plasticity. A number of investigators have demonstrated that intellectual and language skills may be in the normal range in children following unilateral perinatal stroke. Questions have been raised, however, about whether these skills can be maintained at the same level as the brain matures. This study aimed to examine the stability of intellectual, academic and language functioning during development in children with perinatal stroke, and to resolve the inconsistencies raised in previous studies. Participants were 29 pre-school to school-age children with documented unilateral ischaemic perinatal stroke and 24 controls. Longitudinal testing of intellectual and cognitive abilities was conducted at two time points. Study 1 examined IQ, academic skills and language functions using the same test version over the testretest interval. Study 2 examined IQ over a longer testretest interval (pre-school to school-age), and utilized different test versions. This study has resulted in important new findings. There is no evidence of decline in cognitive function over time in children with perinatal unilateral brain damage. These results indicate that there is sufficient ongoing plasticity in the developing brain following early focal damage to result in the stability of cognitive functions over time. Also, the presence of seizures limits plasticity such that there is not only significantly lower performance on intellectual and language measures in the seizure group (Study 1), but the course of cognitive development is significantly altered (as shown in Study 2). This study provides information to support the notion of functional plasticity in the developing brain; yields much-needed clarification in the literature of prognosis in children with early ischaemic perinatal stroke; provides evidence that seizures limit plasticity during development; and avoids many of the confounds in prior studies. A greater understanding of how children with ischaemic perinatal stroke fare over time is particularly important, as there has been conflicting information regarding prognosis for this population. It appears that when damage is sustained very early in brain development, cerebral functional reorganization acts to sustain a stable rate of development over time.