Age matters: A translational perspective on pediatric TBI from coma to concussion

Abstract

Traumatic brain injury is a major cause of acquired disability and death in children and adolescents worldwide. However, “children aren’t just little adults”, and the immature brain has both vulnerability and resiliency when faced with TBI. In particular, changes in synaptic plasticity and axonal connectivity can play important age-dependent roles in both the injury response and in recovery. Neuroplastic changes can affect risk for seizures and epilepsy, predispose to behavioral disturbances and alter the trajectory of learning and development. Moderate-severe TBI results in ongoing synaptic dysfunction and disconnection over time in a subset of children, possibly mediated by persistent inflammatory mechanisms. At the other end of the severity spectrum, mild TBI or concussion occurs much more commonly and is often recoverable, characterized by predominantly functional impairment rather than macrostructural damage. Nonetheless, mild TBI in the developing brain, often repeated in the setting of sport, raises questions of a recoverable injury transitioning to more lasting pathophysiology and persistent clinical impairments. This lecture will highlight the underlying neurobiology of all severities of TBI with particular attention to neurodevelopmental changes that can impact on potential treatment and recovery.