Team discovers marker that may help to identify youths at risk of poor outcomes and prevent cognitive decline

March 16, 2017
Team discovers marker that may help to identify youths at risk of poor outcomes and prevent cognitive decline
In these images of children’s brains, red correlates with slower brain signaling speeds, while green and blue indicate normal brain signaling. Credit: UCLA

A new biological marker may help doctors identify children at risk of poor outcomes after a traumatic brain injury, UCLA scientists report in a preliminary study.

The discovery, published in the online issue of the medical journal Neurology, will allow researchers to zero in on ways to prevent progressive cognitive decline seen in roughly half of with moderate to severe traumatic brain injuries.

"It's really very hopeful. It means there's something we can do about this," said Robert Asarnow, the study's senior author and the Della Martin Professor of Psychiatry in the UCLA Department of Psychiatry and Biobehavioral Sciences. "If we understand which kids are showing this neurodegeneration and why, then it's possible to start using existing treatments to forestall this process or identify new ones to forestall this process."

The study involved 21 children with moderate to severe traumatic brain injuries who were treated in hospital intensive care units in Los Angeles County. Causes of injuries included auto-pedestrian accidents, motor vehicle accidents, and falls from bikes, scooters and skateboards. The children, ages eight to 18, were assessed twice—two to five months after injury, and again at 13 to 19 months post-injury. The results were compared with children of the same age who had not had a .

Traumatic brain injury is the leading cause of disability and death in children and adolescents in the United States, according to the Centers for Disease Control and Prevention. Researchers at UCLA and elsewhere have observed that after children sustain a moderate to severe , they typically follow one of two trajectories—either steady gains toward normal, pre-injury functioning, or progressive, widespread cognitive decline.

Researchers, however, have been unable to predict, early on, the outcomes. The likelihood of poor outcomes is not immediately apparent; in fact, studies have shown that brain damage visible on a CT scan does not accurately predict a patient's potential for full recovery. It's only later, often after the child returns to school, that parents start noticing the child is falling behind or has problems with attention, learning or depression.

Credit: UCLA Health

"While the severity of the injury certainly plays a role in this, there's still a lot of uncertainty—you frequently have two patients with similar injuries who have different recoveries," said Emily Dennis of the University of Southern California and first author of the study.

To detect which individuals might be at risk for ongoing cognitive decline, a team of researchers from different medical specialties used special MRIs and electroencephalograms, or EEGs, to measure the speed of brain signals passing from one hemisphere of the brain to another, a measure of brain function. Previous studies have shown that both children and adults have slow signal transfer times right after a traumatic brain injury.

In the first assessment, the children wore headphones and watched a movie while the MRI scanner assessed the integrity of the brain's , which connects different brain regions to support cognitive functions. The children also took tests of attention and memory skills.

After the first assessment, UCLA researchers found half of the children had brain signaling speeds within normal range, an indication of healthy white matter. The other half had significantly slower signaling, compared with healthy children, an indication of white matter disorganization or disruption.

At 13 to 19 months after their injuries, the children who had normal signaling at the first assessment still compared favorably with healthy peers. In contrast, the children with slower signaling showed progressive decline in white matter organization and loss of white matter volume.

Researchers suspect a prolonged, inflammatory process may be the culprit, causing ongoing damage to the still-maturing brain. Anti-inflammatory agents might alter this course, Asarnow said. But these agents may have some adverse effects.

"You don't want to give these drugs unless you have a pretty good assurance that they would work," Asarnow said. "We don't have enough evidence right now to make that leap."

The study was small and the results need to be confirmed in larger studies, the researchers noted.

Explore further: Treating childhood traumatic brain injury early to avoid lifelong cognitive deficits

More information: Emily L. Dennis et al. Diverging white matter trajectories in children after traumatic brain injury, Neurology (2017). DOI: 10.1212/WNL.0000000000003808

Related Stories

Treating childhood traumatic brain injury early to avoid lifelong cognitive deficits

March 15, 2017
Children with delayed visual perception as a result of serious head injuries may end up with structural changes in their brains that interrupt normal development, a new Keck School of Medicine of USC study shows.

Even mild traumatic brain injury may cause brain damage

July 16, 2014
Even mild traumatic brain injury may cause brain damage and thinking and memory problems, according to a study published in the July 16, 2014, online issue of Neurology, the medical journal of the American Academy of Neurology.

Mapping brain in preemies may predict later disability

January 18, 2017
Scanning a premature infant's brain shortly after birth to map the location and volume of lesions, small areas of injury in the brain's white matter, may help doctors better predict whether the baby will have disabilities ...

Studies uncover long-term effects of traumatic brain injury

February 10, 2017
Doctors are beginning to get answers to the question that every parent whose child has had a traumatic brain injury (TBI) wants to know: What will my child be like 10 years from now?

Study could lead to better treatment for child brain injuries

June 26, 2014
(Medical Xpress)—The discovery of a new link between post-traumatic stress disorder (PTSD), pain and children with traumatic brain injuries could lead to better treatment methods, according to a new study.

Damage to key brain region important in predicting cognitive function after pediatric TBI

July 14, 2015
Disruptions in a key brain region can explain the varied outcomes after a traumatic brain injury (TBI) in children and adolescents, according to research published July 15 in The Journal of Neuroscience. Post-injury outcomes ...

Recommended for you

How a seahorse-shaped brain structure may help us recognize others

December 8, 2017
How do we recognize others? How do we know friend from foe, threat from reward? How does the brain compute the multitude of cues telling us that Susan is not Erica even though they look alike? The complexity of social interactions—human ...

Brain networks that help babies learn to walk ID'd

December 8, 2017
Scientists have identified brain networks involved in a baby's learning to walk—a discovery that eventually may help predict whether infants are at risk for autism.

Why we can't always stop what we've started

December 7, 2017
When we try to stop a body movement at the last second, perhaps to keep ourselves from stepping on what we just realized was ice, we can't always do it—and Johns Hopkins University neuroscientists have figured out why.

Mutations in neurons accumulate as we age: The process may explain normal cognitive decline and neurodegeneration

December 7, 2017
Scientists have wondered whether somatic (non-inherited) mutations play a role in aging and brain degeneration, but until recently there was no good technology to test this idea. A study published online today in Science, ...

Researchers launch atlas of developing human brain

December 7, 2017
The human brain has been called the most complex object in the cosmos, with 86 billion intricately interconnected neurons and an equivalent number of supportive glial cells. One of science's greatest mysteries is how an organ ...

How we learn: Mastering the features around you rather than learning about individual objects

December 7, 2017
A Dartmouth-led study on how we learn finds that humans tend to rely on learning about the features of an object, rather than on the individual object itself.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.