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Injury and recovery in the developing brain: evidence from functional MRI studies of prematurely born children

Nature Clinical Practice Neurology volume 3, pages 558–571 (2007)Cite this article

Abstract

Functional MRI (fMRI) might provide important insights into emerging data that suggest that recovery from injury can occur in the brains of children born prematurely. Strategies employing auditory stimulation demonstrate blood-oxygen-level-dependent (BOLD) activation in preterm infants as young as 33 weeks' gestational age, and reliable BOLD signal in response to visual stimulation occurs at term-equivalent age. Strategies based on fMRI are particularly suited to the study of language and memory, and emerging data are likely to provide insights into perplexing reports that have demonstrated improving cognitive scores but persistent volumetric and microstructural changes in frontotemporal language systems in the prematurely born. Even when sex, gestational age and early medical and environmental interventions are taken into account, fMRI data from several investigators suggest the engagement of alternative neural networks for language and memory in the developing preterm brain.

Key Points

  • Functional MRI (fMRI) might provide insight into the neurobiological mechanisms supporting recovery from injury in prematurely born individuals

  • fMRI can detect activation to auditory stimuli in preterm neonates as early as 33 weeks' postmenstrual age; blood-oxygen-level-dependent signal to visual stimulation can be reliably detected in preterm infants at term-equivalent age

  • fMRI investigations of language suggest the engagement of alternative compensatory neural systems in preterm children at school age and beyond

  • Gestational age, sex and structural and microstructural cerebral changes must be considered when evaluating fMRI tasks in the prematurely born population

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Figure 1: Blood-oxygen-level-dependent group difference maps (preterm minus term) at 12 years of age in a category language task for males (top row) and females (bottom row).
Figure 2: Ventricular size mismatch across groups can provide erroneous evidence for functional differences.
Figure 3: Group difference maps (preterm minus term control study participants) at 12 years of age during a semantic task.

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Acknowledgements

The authors wish to thank Drs Deborah Hirtz, Betty Vohr, Walter Allan, Kenneth Pugh, Robin Schafer and Allan Reiss for scientific advice; they also thank Ms Cheryl Lacadie, Karol Katz and Karen Schneider for scientific and technical support. The authors' work was supported by NIH/NINDS grants NS27116, NS35476, NS038467, NS047605 and NS051622.

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  1. LR Ment is a Professor of Pediatrics and Neurology and Associate Dean for Admissions at the Yale University School of Medicine, and RT Constable is a Professor of Diagnostic Radiology, Biomedical Engineering and Neurosurgery at the Yale University School of Medicine and Co-Director of the Yale Magnetic Resonance Research Center, New Haven, CT, USA.,

    Laura R Ment & R Todd Constable

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Correspondence to Laura R Ment.

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Ment, L., Constable, R. Injury and recovery in the developing brain: evidence from functional MRI studies of prematurely born children. Nat Rev Neurol 3, 558–571 (2007). https://doi.org/10.1038/ncpneuro0616

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