Overview
This study will be a longitudinal multiple-visit observational study, done to identify possible bioindicators of recovery and repair of motor corticospinal pathways which may be targeted by future interventions in infants with perinatal stroke.
65 participants will be recruited and complete 1 visit at time point 1 (0-2 months), and 2 visits at each timepoints 2-5 with windows of +- 4 weeks (3-6 months, 12 months, 18 months and 24 months). Visits will consist of Magnetic Resonance Imaging (MRI) assessment during the child's natural sleep, Transcranial Magnetic Stimulation (TMS), and Motor Behavioral Assessments.
Description
Perinatal stroke has disabling consequences; 50-75% of individuals will develop life-long motor impairment, and 10-60% will also have cognitive deficits. These deficits lead to challenges in the school and home environments, with decreased likelihood of employment and independence and increased caregiver burden. Additionally, perinatal stroke is one of the primary causes of cerebral palsy (CP), a chronic and disabling neurological condition affecting motor function.
The first two years of life constitute a critical period of brain development and heightened neuroplasticity. There is now a consensus that, due to brain plasticity and rapid development, providing an early intervention may result in optimal recovery and lower costs of care. Unfortunately, researchers still have only limited understanding of how the brain develops after perinatal stroke and as a result CP diagnoses are typically not made until two years of age. There is an urgent need for very early diagnosis, prognosis and understanding of mechanisms in order to develop novel early interventions to improve outcomes in perinatal stroke with resultant CP.
Integrating study team's experience in studying and caring for this vulnerable infant stroke population, they propose to use non-invasive brain stimulation, neuroimaging, and behavioral assessments to analyze associations between development patterns, especially in the CST, and potential diagnosis of CP.
Specific aims of this study are:
- Aim 1. Map the presence and excitability of corticospinal pathways.
- Aim 2. Map the structural integrity and connectivity of corticospinal pathways.
- Aim 3. Compare motor outcomes from clinical behavioral assessments against corticospinal tract excitability and integrity.
- Aim 4. Identify the association between brain white-matter connectivity and general movements.
- Aim 5. Identify the association between corticospinal circuitry and general movements.
Protocol Amendment approved on 10/22/2021 removes TMS intervention and outcomes, adds a study time point at 0-2 months, and lowers the eligibility age to term.
Protocol Amendment approved on 12/21/2021 adds the TMS intervention back.
Eligibility
Inclusion Criteria:
- Infants with corrected gestational age between term age and 24 months of age at study enrollment
- Radiologically-confirmed acute unilateral or bilateral brain lesions, including perinatal stroke, neonatal hemorrhagic or thrombotic stroke, involving the motor cortex and/or subcortical structures, and intracranial hemorrhage, involving the motor cortex and/or subcortical white matter, or periventricular leukomalacia
- Diagnosis of hypoxic ischemic encephalopathy
- English-speaking parent/legal guardian (able to provide consent)
Exclusion Criteria:
- Other neurologic disorders unrelated to perinatal stroke
- Metabolic disorders
- Neoplasm
- Disorders of Cellular Migration and Proliferation
- Acquired Traumatic Brain Injury
- Received surgeries that may constrain current spontaneous movements
- Indwelling metal or incompatible medical devices, or other contraindications for MRI or TMS assessment
- Apneic episodes and syncope (known heart defects) for the safety of participants in the study
- Supplemental ventilation
- Uncontrolled seizure