What are static brain injuries? http://www.cnsfound
Donald Marion, MD, MSc
Science Officer
Static brain injuries can be broadly defined as injuries that occur at a particular point in time, and result in damage to relatively well-defined locations in the brain. Such a designation is perhaps most useful in distinguishing static injuries from the progressive pediatric brain diseases such as brain tumors, some of the glycogen storage diseases, or Rett Syndrome. Some of the most common static injuries are traumatic brain injury, perinatal hypoxic/ischemic encephalopathy, and pediatric stroke. It is estimated that as many as 20,000 children per year are hospitalized with moderate to severe traumatic brain injury. The incidence of severe perinatal hypoxic/ischemic encephalopathy is 2-4 cases/1000 live births, and it is most common in premature and low birth-weight infants. Stroke in children is certainly uncommon compared to the incidence in the elderly, but it can occur following the rupture of malformed blood vessels , or arteriovenous malformations. In other
cases, occlusion of a major cerebral artery can occur from blood clots dislodged from the heart in children with congenital heart disease, or sluggish blood flow in the case of sickle cell disease, and cause infarction or death of a portion of the brain receiving it's blood supply from that artery. Stroke has been estimated to occur in 2.5/100,000 children/year. Other less common causes of static brain injury include infections of the brain (encephalitis of meningitis), carbon monoxide poisoning, or radiation necrosis.
The extent of brain damage and clinical manifestations of the disease are related to the cause of the static injury. For example, hypoxic/ischemic encephalopathy, and some cases of severe traumatic brain injury, will damage large areas of the brain in both hemispheres. Such diffuse injuries are likely to result in severe cognitive, behavioral, and motor disabilities. But brain injury caused by stroke tends to be localized, more likely to result in specific motor deficits, and less likely to cause cognitive impairment. Each of these diseases is associated with typical MRI findings. Perinatal hypoxic/ischemic encephalopathy, particularly if severe, results in cystic and diffuse white-matter injury that is termed periventricular leukomalacia, or PVL. Stroke causes a discreet area of the brain to appear either dead or severely damaged, with very well defined margins.
While static brain injuries tend not to cause gradually progressive deterioration in the child's neurologic or general health, there clearly is symptomatic progression, or progression of behavioral and cognitive deficits, in many of these kids as they grow older. In fact, very disabling symptoms may not even appear early after the injury. In many cases behavioral problems are magnified in children with static injuries as they progress through adolescence and the early teens. Several years ago a pair of neurologists (Scott and Jankovic) from Baylor College of Medicine published a study of 53 subjects with static brain injuries and showed that, among those injured before age 2, the mean time delay from injury to onset of dystonia was 25.5 years.
Current treatment of children with static brain injuries is primarily focused on physical and cognitive rehabilitation. Children with a diminished level of consciousness or with attention deficit problems may also benefit from pharmacotherapy. But these are symptomatic treatments and do little or nothing to alter the long-term course of the disease. CNS is very excited about the possibility that stem cell therapy will soon be shown to result in at least partial repair of the damaged brain, and thereby treat the underlying cause of the functional disabilities in these children. Laboratory studies, including those conducted by Dr. Evan Snyder at the Burnham Institute in California, clearly demonstrate the feasibility of stem cell transplants and the ability of these cells to repair damaged neural systems. And many of the problems that limited progress in the past, such as rejection or differentiation of stem cells into cells other than neurons, have recently been overcome.
In February of next year, CNS, together with Texas Children's Hospital, will host a 2 day Static Brain Injury Workshop. During that meeting some of the nations leading stem cell biologists will convene to define the current most pressing research questions regarding the successful treatment of children with static brain injuries. We anticipate that the group will identify the few remaining impediments to the successful translation of a large amount of laboratory work into clinical trials in children with hypoxic/ischemic encephalopathy, traumatic brain injury, and stroke.
References:
Scott BL and Jankovic J: Delayed-onset progressive movement disorders after static brain lesions. Neurology 46:68-74, 1996
Hoon AH: Neuroimaging in Cerebral Palsy: Patterns of Brain Dysgenesis and Injury. J Child Neurol 2005;12:936—939
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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