Brain volume loss and late sequelae of head trauma in young people

Possible late impairments of cognition, memory and concentration in children, adolescents and young adults with a history of head trauma may be a consequence of the reduction in brain volume in these patients, according to researchers.

In a new study, published in the journal brain researchers from Imperial College London It’s from Great Ormond Street Hospitalboth in England, evaluated whether the cognitive, behavioral and emotional impairments observed after head injuries suffered by pediatric patients were more common in patients whose imaging exams revealed changes in brain volume after the trauma.

The Doctor. Niall Bourke, former member of the Division of Brain Sciences at Imperial College London and now affiliated with King’s Collegecommented: “We know that some children and adolescents with a history of head trauma may have learning or emotional difficulties [após o evento], but we still can’t predict who will have problems. This often means that the necessary support for children and adolescents who have these difficulties will take time to be offered.”

The authors commented that cases of head trauma are common in pediatrics, affecting between 42 and 280 per 100,000 children. Although these events often cause prolonged disability, it is “difficult to predict outcomes,” they noted.

While persistent cognitive, behavioral and psychiatric impairments are common, the “late effects of head trauma may end up being overlooked”, as changes that occur during the child development process can “blur the persistent effects” of brain injuries, including memory problems. , attention, executive function, and emotional control, the authors said. They warned that failure to recognize the late effects of pediatric head trauma “may limit children’s access to appropriate educational and health programs, exacerbating the late effects of the injury.”

Brain volume assessment

It is difficult to predict the late outcomes of a head injury in childhood or adolescence, the authors explained, and the presence or absence of focal brain injuries does not always explain the frequent and disabling cognitive, emotional, and behavioral impairments. The issue can be studied in the adult population through brain imaging tests, since the occurrence of head trauma in adults can cause progressive brain atrophy, something that can be clearly verified, and is associated with cognitive decline. However, as the brain of children and adolescents changes and grows rapidly as the organ develops, it is difficult to perform this type of imaging study in a younger population.

Seeking to contribute to deepening the understanding of the topic, the researchers studied a large group of children and young people to assess what happens to brain volume as people grow. “This allowed us to detect any differences in [relação às] children who have suffered a traumatic brain injury,” said Dr. Niall.

To understand the normal process of growth and development in different parts of the brain during childhood, adolescence and early adulthood, the study authors evaluated MRI scans of more than 1,200 healthy participants between the ages of 8 and 22. Then, individual estimates of regional gray and white matter volume were generated for 39 patients, mean age 13.5 years, who had suffered moderate to severe childhood head trauma (mean time since injury 14 months) comparing brain volumes in patients with 20 age-matched controls. To match the demographics, many of these controls were siblings or family members of the patient sample. Patients were individually classified as having low or normal brain volume for age, and neuropsychological and neuropsychiatric outcomes were assessed using standardized tests and parent/guardian assessments.

Low brain volume associated with cognitive and emotional problems

The authors reported that, in relation to head size, the gray matter regions decrease in volume during normal adolescent development, while the white matter tracts increase in volume. Healthy brain development was disrupted by head trauma, leading to reductions in brain gray and white matter volumes after correction for age. Those classified as having low brain volume, when compared with healthy controls, had “slower processing speed compared to healthy controls, emotional impairments, higher levels of apathy, increased anger, and learning difficulties,” the authors said. They pointed out that “the presence of focal brain injury and microbleeds were not associated with an increased risk of these clinical deficiencies.”

Study author Célia Demarchi, from the Department of Brain Sciences, Imperial College It’s from Great Ormond Street Hospital, said: “When children or young people suffer severe trauma to the skull, they often have imaging tests to look for brain injuries. Using the results of this research may allow us to start evaluating these scans for changes in the growth of different areas of the brain.”

Assessing individual brain volume by age provides more information that helps us understand the variation in clinical outcomes associated with pediatric head trauma, the authors said. “Combined with other clinical tools, age-specific volume estimates can help in the assessment of the clinical picture of a [pessoa com] injury, in order to improve the understanding of the case in question”.

Corresponding author, Professor David Sharp, Department of Brain Sciences, Imperial College, commented: “The effects of head injuries are complicated and vary from person to person. If we can get to a point where the accuracy analysis of the tests helps with routine clinical follow-up, this could help us identify why some children and youth are at risk for learning or behavioral impairment, and provide them with more [formas de] support or rehabilitation.”

“The issue is very important, because the difficulties faced by these young people can have lasting impacts on their education and subsequent opportunities in adult life”, he emphasized.

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