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，是脑性瘫痪的主要原因之一 在儿童时期诊断。因为在最初几年里， 在生命的最后阶段，早期而不是晚期提供的干预被认为提供了最好的康复机会， 围产期中风然而，早期干预的证据缺乏，主要是由于缺乏数据 关于人类围产期中风后的大脑组织、连接和由此产生的运动发育。 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。 大脑和行为发育在生命的头两年，以确定可能的生物指标的恢复 和修复，这可能是未来干预的目标。我们的研究设计包括纵向 评估在出生后的头两年的生活后，脑兴奋性和组织使用非- 侵入性脑刺激，以及神经影像学和适合年龄的行为评估。我们将 从当地和地区新生儿重症监护室招募50名围产期卒中婴儿， 时间点长达24个月的年龄。大脑兴奋性和连通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CP，经过培训的研究者还将分配粗大运动功能分类 量表水平和小型手动能力分类量表水平，以预测运动功能和护理计划。 最终，识别本研究中发现的结构/功能关系将允许开发定制的 早期干预，基于大脑发育的个人模式，旨在改善终身运动 由于围产期卒中导致的CP婴儿的功能，以及其他早期干预措施的发展 相关神经学诊断。

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.