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Published on: November 19, 2012
Neurocognitive outcomes for acute global acquired brain injury in children
1aDepartment of Child Health, University Hospital Southampton, Southampton bDevelopmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London cClinical and Experimental Sciences, University of Southampton, Southampton, UK.
Insights
Children with acute brain injuries face significant long-term cognitive challenges, especially in processing speed and IQ. Research now highlights these persistent effects, impacting development and recovery.
Area of Science:
- Pediatric neurology
- Neuroscience
- Developmental psychology
Background:
- Acute global brain injury in children, from traumatic brain injury (TBI) or nontraumatic coma, incurs substantial costs.
- Historically, research on long-term cognitive and behavioral outcomes in pediatric TBI has been limited.
Purpose of the Study:
- To review current understanding of long-term cognitive and behavioral outcomes in children following acute global brain injury.
- To synthesize findings from recent studies, including follow-up, population-based, and meta-analyses.
Main Methods:
- Review of recent long-term follow-up studies, population-based studies, and meta-analyses concerning pediatric TBI and coma.
- Analysis of cognitive outcomes (processing speed, working memory, IQ, attention) and diagnostic/prognostic utility of MRI.
Main Results:
- Severe TBI in children is associated with significant cognitive deficits, particularly in processing speed, working memory, and IQ.
- Children surviving cardiac arrest often show reduced IQ; meningitis survivors typically have normal IQ, though lower than controls.
- Advances in encephalitis research include recognizing autoimmune and demyelinating causes; MRI shows diagnostic and potential prognostic value.
Conclusions:
- Long-term cognitive deficits are a significant consequence of acute global brain injury in children.
- Cognitive and MRI endpoints are crucial for evaluating interventions in clinical trials due to long follow-up times.
Purpose Of Review:
In children, acute global brain injury from traumatic brain injury (TBI) and nontraumatic coma has a substantial cost to the child, the family, and the society. There have historically been relatively few studies looking at long-term cognition and behavioural outcomes.
Recent Findings:
Long-term follow-up studies, population-based studies, and meta-analyses are now available for TBI in children as well as adults and suggest that there is a significant cognitive cost, particularly for processing speed, working memory, and intelligence quotient (IQ) in severe TBI. Poor attention is often a premorbid deficit. Children surviving a cardiac arrest typically have a reduction in IQ. The available data for meningitis suggest that IQ is within the normal range at follow-up in most but is lower than that of matched controls. For encephalitis, the main advances have been in the recognition of additional mechanisms for postinfectious causes, including autoimmune disorders and demyelination. MRI assists with diagnosis, particularly in infectious causes, and there is some evidence that it may be useful for prognosis, particularly in TBI.
Summary:
For the essential randomized control trials of acute treatment and rehabilitation, cognitive or MRI endpoints may become feasible as otherwise the time frame for follow-up is too long for the implementation of change.
