Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability for children and adolescents in the U.S. and other developed and developing countries. Injury to the immature brain varies greatly from that of the mature, adult brain due to numerous developmental, pre-injury, and injury-related factors that work together to influence the trajectory of recovery during the course of typical brain development. Substantial damage to brain structure often underlies subsequent functional limitations that persist for years following pediatric TBI. Advances in neuroimaging have established an important role in the acute management of pediatric TBI, and magnetic resonance imaging (MRI) techniques have a particular relevance for the sequential assessment of long-term consequences from injuries sustained to the developing brain. The present paper will discuss the various factors that influence recovery and review the findings from the present neuroimaging literature to assess altered development and long-term outcome following pediatric TBI. Four MR-based neuroimaging modalities have been used to examine recovery from pediatric TBI longitudinally: (1) T1-weighted structural MRI is sensitive to morphological changes in gray matter volume and cortical thickness, (2) diffusion-weighted MRI is sensitive to changes in the microstructural integrity of white matter, (3) MR spectroscopy provides a sensitive assessment of metabolic and neurochemical alterations in the brain, and (4) functional MRI provides insight into the functional changes that occur as a result of structural damage and typical developmental processes. As reviewed in this paper, 13 cohorts have contributed to only 20 studies published to date using neuroimaging to examine longitudinal changes after TBI in pediatric patients. The results of these studies demonstrate considerable heterogeneity in post-injury outcome; however, the existing literature consistently shows that alterations in brain structure, function, and metabolism can persist for an extended period of time post-injury. With larger sample sizes and multi-site cooperation, future studies will be able to further examine potential moderators of outcome, such as the developmental, pre-injury, and injury-related factors discussed in the present review.
Highlights
Recent estimates suggest that a child under the age of 14 sustains a traumatic brain injury (TBI) every 60 s in the United States [1]
The TBI-Slow group was shown to have lower levels of Cho globally and lower levels of N-acetyl aspartate (NAA) in the corpus callosum, relative to the TBINormal group. These findings suggest that the acute metabolic abnormalities, reflective of initial neuronal loss and impaired oligodendrocyte/myelin function, do not recover over time in those with functional impairments evidenced by slower inter-hemispheric transfer time (IHTT); the lower levels of Cho longitudinally in this group suggest a lack of ongoing membrane repair
Following an in-depth discussion of conflicting models in the literature for the role of the anterior cingulate cortex after pediatric moderate-to-severe traumatic brain injury (msTBI), the authors suggest that, based on the results of their study, the anterior cingulate cortex may play a compensatory role in recovery from pediatric TBI, where it is recruited when the executive system is overloaded during participation in a difficult task or when structural disconnection has occurred
Summary
Recent estimates suggest that a child under the age of 14 sustains a traumatic brain injury (TBI) every 60 s in the United States [1]. Understanding the ways in which developmental, injury-related, and pre-injury factors may impact neuroplasticity in the developing brain may be key to explaining more of this variance Following this discussion, we will briefly review the findings from longitudinal studies employing MR-based neuroimaging modalities to increase our current understanding of altered development and long-term outcome following pediatric TBI. We identified 19 research articles that met the following four inclusion criteria: (a) the studies involved children or adolescents who sustained a TBI prior to the age of 19; (b) MRI-based methods were employed to measure brain structure and/or function; (c) changes in brain structure and/or function were assessed over at least two separate points in time (i.e., longitudinal studies). Three analysis methods were used across the six studies: four studies utilized semior fully automatic ROI region-of-interest (ROI) approaches to measure longitudinal changes in gray matter density [105,106,107,108], one study measured volumetric change longitudinally
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