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Motor and cognitive outcome after specific early lesions of the brain - a systematic review
Tjitske Hielkema1,2, Mijna Hadders-Algra1
1University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
Insights
Severe early brain lesions in infants significantly increase the risk of cerebral palsy (CP) and intellectual disability. Cystic periventricular leukomalacia (cPVL) poses the highest risk, while outcomes vary by lesion type.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Neurology
Background:
- Severe early brain lesions, including cystic periventricular leukomalacia (cPVL) and preterm or term stroke, significantly impact infant neurodevelopmental outcomes.
- Understanding the prevalence of cerebral palsy (CP) and intellectual disability following these lesions is crucial for early intervention.
Purpose of the Study:
- To systematically review motor and cognitive outcomes in infants with severe early brain lesions.
- To evaluate the influence of lesion side, sex, and socioeconomic status on these outcomes.
Main Methods:
- A comprehensive literature search was conducted using PubMed and Embase databases.
- Included studies focused on infants with cPVL, preterm stroke, or term stroke, analyzing outcomes such as CP and intellectual disability.
Main Results:
- Median CP prevalence rates were 86% for cPVL, 71% for preterm stroke, and 29% for term stroke.
- Intellectual disability rates were 50% (cPVL), 27% (preterm stroke), and 33% (term stroke).
- Lesion type strongly correlated with CP type (bilateral for cPVL, unilateral for term stroke).
Conclusions:
- The risk for CP is highest following cPVL, moderate after preterm stroke, and lowest after term stroke.
- The risk of intellectual disability is generally lower than that of CP.
- Predicting individual outcomes remains challenging; advanced imaging may enhance developmental trajectory prediction.
Abstract:
The aim of this systematic review was to study motor and cognitive outcome in infants with severe early brain lesions and to evaluate effects of side of the lesion, sex, and social economic status on outcome. A literature search was performed using the databases Pubmed and Embase. Included studies involved infants with either cystic periventricular leukomalacia (cPVL), preterm, or term stroke (i.e. parenchymal lesion of the brain). Outcome was expressed as cerebral palsy (CP) and intellectual disability (mental retardation). Median prevalence rates of CP after cPVL, preterm, and term stroke were 86%, 71%, and 29% respectively; of intellectual disability 50%, 27%, and 33%. Most infants with cPVL developed bilateral CP, those with term stroke unilateral CP, whereas after preterm stroke bilateral and unilateral CP occurred equally often. Information on the effects of sex and social economic status on outcome after specific brain lesions was very limited. Our findings show that the risk for CP is high after cPVL, moderate after preterm stroke, and lowest after term stroke. The risk for intellectual disability after an early brain lesion is lower than that for CP. Predicting outcome at individual level remains difficult; new imaging techniques may improve predicting developmental trajectories.
