Neuro-cognitive Outcome After Early Focal Brain Damage

描述（由申请人提供）：通过研究在大脑发育的关键时期遭受大脑损伤的儿童，可以了解到大量关于发育中的人类神经系统的可塑性。对发育中的大脑的损害可能对认知产生与对完全发育的大脑的损害非常不同的影响。本研究的重点是评估癫痫发作和癫痫样脑活动对早期局灶性脑损伤（FL）儿童认知功能的作用。这项研究提出，通过研究在出生前或出生时因中风或出血而遭受早期单侧脑损伤的儿童，探索发育中的人类大脑的可塑性和重组问题。该项目的具体目标是：1）确定癫痫发作和癫痫样脑活动对早期局灶性脑损伤儿童认知结果的影响; 2）确定FL人群中癫痫样脑电图（EEG）异常是否随时间推移而稳定，或随时间推移而变差或变好，以及EEG随时间推移的变化是否与认知功能的变化相关; 3）确定该人群可塑性的程度和限度，以及癫痫发作或癫痫样脑波活动在限制可塑性中的作用。 三组年龄在8岁至12岁之间，因中风或出血而在出生前或围生期大脑中动脉分布处发生单侧脑损伤的儿童，以及匹配的对照组，将接受神经心理学、行为和适应功能评估，包括智力、语言、视觉空间技能、注意力、记忆力、学业成绩和执行功能测试。受试者还将进行EEG以评估癫痫样异常对认知功能的影响，并进行脑部MRI扫描以确定病变的体积和位置。3个FL组将包括20名有癫痫发作史的儿童，20名无癫痫发作但有癫痫样EEG异常的儿童，以及20名无癫痫发作且EEG正常的儿童。 这些研究的结果应该提供了一个更好的理解癫痫发作和癫痫样脑活动对大脑发育过程中认知功能的作用，以及在发育中的人类大脑的可塑性的潜在限制。这些发现可以进一步作为基础，为因早期脑损伤而有认知功能障碍风险的儿童设计更有效的干预措施。

DESCRIPTION (provided by applicant): A great deal can be learned about plasticity in the developing human nervous system by studying children who incur brain insults during critical periods of brain development. Damage to the developing brain may have a very different impact on cognition than would damage to the fully developed brain. The focus of this study will be to evaluate the role of seizures and of epileptiform brain activity on cognitive function in children with early focal brain damage (FL). The study proposes to explore issues of plasticity and reorganization in the developing human brain by studying children who suffered very early unilateral brain damage from stroke or hemorrhage, incurred prior to or at birth. The specific aims of the project are 1) to determine the impact of seizures and of epileptiform brain activity on cognitive outcome in children with early focal brain damage; 2) to determine whether epileptiform electroencephalographic (EEG) abnormalities in the FL population are stable over time, or get worse or better with time, and whether changes in the EEG over time correlate with changes in cognitive function; 3) to identify the extent and limits of plasticity in this population, and the role of seizures or epileptiform brainwave activity in limiting plasticity. Three groups of children between the ages of 8 and 12 years with pre- or peri-natal unilateral brain lesions in the middle cerebral artery distribution from stroke or hemorrhage, and matched controls, will receive neuropsychological, behavioral, and adaptive function assessments, including tests of intelligence, language, visual spatial skills, attention, memory, academic achievement, and executive function. Subjects will also have EEGs to assess the effects of epileptiform abnormalities on cognitive function, and brain MRI scans to determine the volume and location of the lesions. The 3 FL groups will consist of 20 children with a history of seizures, 20 children without seizures but with epileptiform EEG abnormalities, and 20 children with no seizures and normal EEGs. The results of these investigations should provide a better understanding of the role of seizures and epileptiform brain activity on cognitive function during brain development, as well as potential limitations on plasticity in the developing human brain. The findings may further serve as a basis from which to design more effective interventions for children at risk for cognitive dysfunction because of early brain damage.