What are static brain injuries?
http://www.cnsfoundation.org/site/News2?page=NewsArticle&id=7727

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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