Perinatal Stroke: Longitudinal Assessment of Infant Brain Organization and Recovery through Neuroexcitability, Neuroimaging and Motor Development

项目摘要 围产期中风可导致运动障碍，是脑性瘫痪(CP)的主要原因之一 在童年后期被诊断出来。因为第一年的快速发展和高度的神经可塑性 对于生命来说，早一点而不是晚一点提供干预被认为提供了最好的康复机会 围产期中风。然而，缺乏早期干预的证据，主要是因为缺乏数据 关于人类围产期中风后的大脑组织、连通性和由此导致的运动发育。 因此，在这项拟议的研究中，我们的目标是对婴儿进行多模式、非侵入性评估 生命头两年的大脑和行为发育，以确定可能的康复生物指标 和修复，这可能是未来干预的目标。我们的研究设计结合了纵向 围产期卒中后两年的非脑组织兴奋性和组织性评估 除了神经成像和适合年龄的行为评估外，还有侵入性脑刺激。我们会 从当地和地区新生儿重症监护病房招募50名围产期中风婴儿，在4岁时进行评估 时间指向24个月龄。大脑兴奋性和连接性的测量将与运动相关 发展和可能的CP诊断，以研究随着时间的推移恢复的轨迹和模式。如果孩子 已被诊断为脑瘫，一名训练有素的调查员还将分配粗大运动功能分类 量表水平和迷你手动能力分类量表水平，以预测运动功能和护理计划。 最终，确定本研究中发现的结构/功能关系将允许开发量身定制的 早期干预，基于大脑发育的个体模式，旨在改善终身运动 围产期卒中所致脑性瘫痪婴儿的功能及对其他疾病的早期干预进展 相关的神经学诊断。

PROJECT ABSTRACT Perinatal stroke can result in motor impairments, and is one of the major causes of cerebral palsy (CP) diagnosis later in childhood. Because of the rapid development and heightened neuroplasticity in the first years of life, intervention provided earlier rather than later is thought to offer the best chance of recovery following perinatal stroke. However, the evidence for early interventions is lacking, mainly due to the paucity of data regarding brain organization, connectivity and resulting motor development after perinatal stroke in humans. Therefore, in this proposed study, our objective is to perform a multimodal, non-invasive assessment of infant brain and behavioral development over the first two years of life to identify possible bioindicators of recovery and repair which may be targeted by future interventions. Our study design incorporates longitudinal assessment over the first two years of life after perinatal stroke of brain excitability and organization using non- invasive brain stimulation, in addition to neuroimaging and age-appropriate behavioral assessments. We will recruit 50 infants with perinatal stroke from local and regional neonatal intensive care units for assessment at 4 time points up to 24 months of age. Measures of brain excitability and connectivity will be correlated with motor development and possible CP diagnosis to study the trajectory and patterns of recovery over time. If the child has been diagnosed with CP, a trained investigator will also assign a Gross Motor Functional Classification Scale level and a mini-Manual Ability Classification Scale level to predict motor function and plan for care. Ultimately, identifying structure/function relationships discovered in this study will allow development of tailored early interventions, based on individual patterns of brain development, designed to improve life-long motor function in infants with CP due to perinatal stroke, as well as development of early interventions for other related neurologic diagnoses.