Abstract
Perinatal brain injury is a significant cause of adverse neurodevelopmental outcomes. The objective of this systematic review was to identify patterns of altered brain function, quantified using functional connectivity (FC) changes in resting-state fMRI (rs-fMRI) data, that were associated with motor and language outcomes in individuals with a history of perinatal brain injury. A systematic search using electronic databases was conducted to identify relevant studies. A total of 10 studies were included in the systematic review, representing 260 individuals with a history of perinatal brain injury. Motor and language outcomes were measured at time points ranging from 4 months to 29 years 1 month. Relations between FC and motor measures revealed increased intra-hemispheric FC, reduced inter-hemispheric FC and impaired lateralization of motor-related brain regions associated with motor outcomes. Altered FC within sensorimotor, visual, cerebellum and frontoparietal networks, and between sensorimotor, visual, auditory and higher-order networks, including cerebellum, frontoparietal, default-mode, salience, self-referential and attentional networks were also associated with motor outcomes. In studies assessing the relationship between rs-fMRI and language outcome, reduced intra-hemispheric FC, increased inter-hemispheric FC and right-hemisphere lateralization of language-related brain regions correlated with language outcomes. Evidence from this systematic review suggests a possible association between diaschisis and motor and language impairments in individuals after perinatal brain lesions. These findings support the need to explore the contributions of additional brain regions functionally connected but remote from the primary lesioned brain area for targeted treatments and appropriate intervention, though more studies with increased standardization across neuroimaging and neurodevelopmental assessments are needed.
Highlights
Perinatal brain injury (PBI) due to hypoxia-ischaemia, cerebral infarction, or haemorrhage are leading causes of severe motor deficits such as cerebral palsy, and language, visual and behavioural deficits [1,2]
Resting state functional magnetic resonance imaging may offer additional predictive utility by assessing the impact of perinatal brain lesions on functional connectivity in brain regions adjacent to and remote from the primary site of injury. rs-fMRI measures the temporal correlation of low frequency (
A recent rs-fMRI study in preterm-born infants with mild brain injury scanned at term-equivalent age (TEA) [44] showed decreased functional connectivity in both primary and higher-order resting-state network (RSN), and the findings from this review suggest these alterations remain compromised into adolescence, and are associated with later motor impairments
Summary
Perinatal brain injury (PBI) due to hypoxia-ischaemia, cerebral infarction, or haemorrhage are leading causes of severe motor deficits such as cerebral palsy, and language, visual and behavioural deficits [1,2]. These conditions are of different origin, they all disrupt the normal developmental trajectory of the brain, presenting considerable risk for motor and language development. Several studies have assessed the emergence of restingstate networks in term and preterm-born infants [13e16] and developmental trajectories of RSNs during typical development [16] These studies have established primary functional networks are established by term-equivalent age (TEA) in both term and pretermborn infants, followed by higher order networks, in parallel with structural brain development and the maturational sequence of cognitive, language and motor abilities [16]
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