Hitting a moving target: Basic mechanisms of recovery from acquired developmental brain injury.
Acquired brain injuries represent a major cause of disability in the pediatric population. Understanding responses to developmental acquired brain injuries requires knowledge of the neurobiology of normal development, age-at-injury effects and experience-dependent neuroplasticity. In the developing brain, full recovery cannot be considered as a return to the premorbid baseline, since ongoing maturation means that cerebral functioning in normal individuals will continue to advance. Thus, the recovering immature brain has to 'hit a moving target' to achieve full functional recovery, defined as parity with age-matched uninjured peers. This review will discuss the consequences of developmental injuries such as focal lesions, diffuse hypoxia and traumatic brain injury (TBI). Underlying cellular and physiological mechanisms relevant to age-at-injury effects will be described in considerable detail, including but not limited to alterations in neurotransmission, connectivity/network functioning, the extracellular matrix, response to oxidative stress and changes in cerebral metabolism. Finally, mechanisms of experience-dependent plasticity will be reviewed in conjunction with their effects on neural repair and recovery.
Giza
Christopher C
CC
Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. cgiza@mednet.ucla.edu
Kolb
Bryan
B
Harris
Neil G
NG
Asarnow
Robert F
RF
Prins
Mayumi L
ML
D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001930:Brain Injuries / Q000534:rehabilitation*; D002545:Brain Ischemia / Q000534:rehabilitation*; D002560:Cerebrovascular Circulation; D002648:Child; D002657:Child Development; D006801:Humans; D009415:Nerve Net / Q000473:pathology / Q000503:physiopathology; D009474:Neurons / Q000473:pathology; D018384:Oxidative Stress; D020127:Recovery of Function