title: Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome.
abstract: BACKGROUND
  Recovery after arterial ischaemic stroke is known to largely depend on the plastic properties of the brain. The present study examines changes in the network topography of the developing brain after stroke. Effects of brain damage are best assessed by examining entire networks rather than single sites of structural lesions. Relating these changes to post-stroke neuropsychological variables and motor abilities will improve understanding of functional plasticity after stroke. Inclusion of healthy controls will provide additional insight into children's normal brain development. Resting state functional magnetic resonance imaging is a valid approach to topographically investigate the reorganisation of functional networks after a brain lesion. Transcranial magnetic stimulation provides complementary output information. This study will investigate functional reorganisation after paediatric arterial ischaemic stroke by means of resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a cross-sectional plus longitudinal study design. The general aim of this study is to better understand neuroplasticity of the developing brain after stroke in order to develop more efficacious therapy and to improve the post-stroke functional outcome.
  
  
  METHODS
  The cross-sectional part of the study will investigate the functional cerebral networks of 35 children with chronic arterial ischaemic stroke (time of the lesion >2 years). In the longitudinal part, 15 children with acute arterial ischaemic stroke (shortly after the acute phase of the stroke) will be included and investigations will be performed 3 times within the subsequent 9 months. We will also recruit 50 healthy controls, matched for age and sex. The neuroimaging and neurophysiological data will be correlated with neuropsychological and neurological variables.
  
  
  CONCLUSIONS
  This study is the first to combine resting state functional magnetic resonance imaging and transcranial magnetic stimulation in a paediatric population diagnosed with arterial ischaemic stroke. Thus, this study has the potential to uniquely contribute to the understanding of neuronal plasticity in the brains of healthy children and those with acute or chronic brain injury. It is expected that the results will lead to the development of optimal interventions after arterial ischaemic stroke.
authors.affiliation: Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern, Switzerland. Salome.Kornfeld@insel.ch.|Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland. Salome.Kornfeld@insel.ch.
authors.forename: Salome
authors.initials: S
authors.lastname: Kornfeld
authors.affiliation: Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern, Switzerland. Juan.Delgado@insel.ch.|Graduate School for Health Sciences, University of Bern, Bern, Switzerland. Juan.Delgado@insel.ch.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Delgado Rodríguez
authors.affiliation: Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern, Switzerland. Regula.Everts@insel.ch.|Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland. Regula.Everts@insel.ch.
authors.forename: Regula
authors.initials: R
authors.lastname: Everts
authors.affiliation: Neurocenter of Southern Switzerland, Lugano, Switzerland. Alain.Kaelin@eoc.ch.
authors.forename: Alain
authors.initials: A
authors.lastname: Kaelin-Lang
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital, Bern, Switzerland. Roland.Wiest@insel.ch.
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital, Bern, Switzerland. Christian.Weisstanner@insel.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Weisstanner
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital, Bern, Switzerland. Pasquale.Mordasini@insel.ch.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.affiliation: Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern, Switzerland. Maja.Steinlin@insel.ch.|Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland. Maja.Steinlin@insel.ch.
authors.forename: Maja
authors.initials: M
authors.lastname: Steinlin
authors.affiliation: Division of Neuropaediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern, Switzerland. Sebastian.Grunt@insel.ch.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Grunt
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000150:complications; D001931:Brain Mapping / Q000379:methods*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D009415:Nerve Net / Q000503:physiopathology*; D009473:Neuronal Plasticity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D012107:Research Design; D020521:Stroke / Q000209:etiology / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation