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Hitting a moving target: Basic mechanisms of recovery from acquired developmental brain injury
Christopher C Giza1, Bryan Kolb, Neil G Harris
1Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. cgiza@mednet.ucla.edu
Insights
Pediatric acquired brain injuries (ABIs) require understanding neurodevelopment and plasticity for recovery. Full recovery means matching peers, a complex challenge for the developing brain.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Biology
Background:
- Acquired brain injuries (ABIs) are a significant cause of disability in children.
- Recovery in the developing brain is complex due to ongoing maturation, making the 'target' for recovery a moving one.
- Understanding neurodevelopment, age-at-injury effects, and neuroplasticity is crucial for pediatric ABI recovery.
Purpose of the Study:
- To review the consequences of developmental acquired brain injuries in the pediatric population.
- To detail the cellular and physiological mechanisms underlying age-at-injury effects.
- To examine experience-dependent plasticity's role in neural repair and recovery.
Main Methods:
- Literature review focusing on developmental acquired brain injuries.
- Detailed discussion of cellular and physiological mechanisms.
- Analysis of experience-dependent plasticity in neural repair.
Main Results:
- Developmental ABIs include focal lesions, diffuse hypoxia, and traumatic brain injury (TBI).
- Age-at-injury effects involve alterations in neurotransmission, network connectivity, extracellular matrix, oxidative stress response, and metabolism.
- Experience-dependent plasticity mechanisms influence neural repair and recovery outcomes.
Conclusions:
- Full functional recovery in pediatric ABIs is defined as achieving parity with age-matched peers.
- The immature brain must overcome the challenge of a continuously developing baseline for recovery.
- Mechanisms of plasticity are key to optimizing neural repair and functional recovery after pediatric brain injury.
Abstract:
Acquired brain injuries represent a major cause of disability in the pediatric population. Understanding responses to developmental acquired brain injuries requires knowledge of the neurobiology of normal development, age-at-injury effects and experience-dependent neuroplasticity. In the developing brain, full recovery cannot be considered as a return to the premorbid baseline, since ongoing maturation means that cerebral functioning in normal individuals will continue to advance. Thus, the recovering immature brain has to 'hit a moving target' to achieve full functional recovery, defined as parity with age-matched uninjured peers. This review will discuss the consequences of developmental injuries such as focal lesions, diffuse hypoxia and traumatic brain injury (TBI). Underlying cellular and physiological mechanisms relevant to age-at-injury effects will be described in considerable detail, including but not limited to alterations in neurotransmission, connectivity/network functioning, the extracellular matrix, response to oxidative stress and changes in cerebral metabolism. Finally, mechanisms of experience-dependent plasticity will be reviewed in conjunction with their effects on neural repair and recovery.
