Perinatal Stroke: Understanding Brain Reorganization

Summary

The incidence of perinatal stroke is relatively common, as high as 1 in 2,300 births, but little is known about the resulting changes in the brain that eventually manifest as cerebral palsy (CP). Motor signs that indicate the infant is beginning to develop CP often do not become evident for several months after the diagnosis of perinatal stroke which delays therapy. The main purpose of this study is to examine early brain reorganization in infants 3-12 months of age corrected for prematurity with perinatal stroke using magnetic resonance imaging (MRI) and non-invasive transcranial magnetic stimulation (TMS). In addition, the association between the brain reorganization and motor outcomes of these infant participants will be identified.

In this study, the MRI scans will include diffusion tensor imaging (DTI) - an established method used to investigate the integrity of pathways in the brain that control limb movement. Infants will be scanned during nature sleeping after feeding. The real scanning time will be less than 38 minutes. TMS is a painless, non-surgical brain stimulation device which uses principles of electromagnetic induction to excite cortical tissue from outside the skull. Using TMS as a device to modulate and examine cortical excitability in children with hemiparetic CP and in adults has been conducted previously.

In this infant study, we will assess cortical excitability from the motor cortex of both the ipsilesional and contralesional hemispheres under the guidance of a frameless stereotactic neuronavigation system. Additionally, the investigators will assess infants' movement quality using an age-appropriate standardized movement assessment. This will allow the investigators to examine the relationship between measures of motor pathway integrity and early signs of potential motor impairment. We will longitudinally follow enrolled infants, and complete repeat assessments at 12- and 24-months corrected age to assess how infants develop over time after perinatal stroke. The remote follow-up will occur at 5 years or less.

Conditions

• Stroke
• Hemiparesis

Interventions

DEVICE

Magnetic Resonance Imaging

Anatomical and Diffusion Tensor Imaging Analysis.

DEVICE

Transcranial Magnetic Stimulation

Assessment of brain (cortical) excitability

BEHAVIORAL

General Movement Assessment

Spontaneous movement assessment of infant while lying in unperturbed state.

Sponsors & Collaborators

• Cerebral Palsy Alliance

  collaborator OTHER

• American Academy of Cerebral Palsy and Developmental Medicine

  collaborator OTHER

• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

  collaborator NIH

• University of Minnesota

  lead OTHER

Principal Investigators

• Bernadette T Gillick, PhD, MSPT, PT · University of Minnesota

Eligibility

Min Age

3 Months

Max Age

5 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2016-05-01

Primary Completion

2021-07-31

Completion

2022-07-31

Countries

• United States

Study Locations