Helping children affected by disability and infections

Stroke in newborns: predicting the effect on language skills

First published on 21 October 2008

Updated on 13 November 2014

What did the project achieve?

“Our work will help babies who suffer a stroke around the time of birth,” says Dr Frances Cowan of Imperial College London.

Estimates suggest that around 350 newborn babies have a stroke each year in the UK.1,2 They may be left with permanent brain damage, which can lead to long-term problems during childhood and into adulthood, including speech and language difficulties.

“Our findings mean parents can learn more about how their babies’ language skills might be affected during childhood,” says Dr Cowan. It can be devastating for parents when babies suffer a stroke. Knowing what to expect in the future can be incredibly helpful.

“Our work will help children get the most appropriate support as early as possible, such as speech and language therapy, and extra educational assistance” continues Dr Cowan. Language skills are important for many things in life – including a child’s progress at school, self-esteem and relationships with peers.

“We have also improved understanding of how the brain overcomes damage to areas involved in language,” says Dr Cowan. “This will help when counselling parents after babies suffer a stroke and will be valuable in other situations too, for example if children need brain surgery, or have brain tumours, head injuries or epilepsy.”

References

1. Schulzke S et al. Incidence and diagnosis of unilateral arterial cerebral infarction in newborn infants. J Perinat Med 2005; 33:170-5, abstract http://www.ncbi.nlm.nih.gov/pubmed/15843270 Website accessed 13 October 2014.

2. Office for National Statistics. Annual Mid-year Population Estimates, 2013. http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk--... Website accessed 13 October 2014.

This research was completed on 14 December 2011

Estimates suggest at least one baby in every 2,300 born at full-term suffers a stroke.1 Some go on to have problems understanding and using language whereas others do not, and researchers are investigating why. This work could make it easier to predict which babies will have difficulties so they can get the most appropriate help as soon as possible. It may also boost understanding of how the brain manages to overcome damage caused by stroke.

What's the problem and who does it affect?

Strokes in babies

Estimates suggest that each year in the UK almost 300 babies suffer a stroke that affects the brain tissue in an area supplied by one of the major brain arteries.1-3 These strokes often happen unexpectedly in apparently well babies after seemingly normal pregnancies. They are most likely to occur around the time of birth.

Sadly, some babies go on to develop long-term problems. About 30% have difficulties moving the arm and leg on one side of their body, difficulties which can be predicted accurately using magnetic resonance brain scans.4,5

Strokes can also lead to many other complications – seizures and problems with vision, language, behaviour or temperament, for example. While it is possible to predict how a stroke will affect a baby’s control of their movement, it’s not so easy to predict exactly how each baby will be affected by these other complications as they grow and develop.

This project is focusing on problems children can face with speech and communication, problems that do not necessarily become apparent until they become older and have to deal with more complex language.

Children who had a stroke around the time of birth are often able to attend mainstream school. Their difficulties are always not directly obvious and can easily be underestimated by outsiders. They do not always get the help that they need. Children can be very sensitive about their problems, their differences from their peers can make them self-conscious, and their limitations can cause frustration.

What is the project trying to achieve?

Looking deep inside their brain

When a baby suffers a stroke, part of their brain can be permanently damaged. The researchers are aiming to identify which areas of the brain are damaged in babies who develop language difficulties in childhood.

Sometimes, the brain reorganises itself to compensate for the injury caused by a stroke. A healthy, unharmed area of the brain may take on the functions that would more commonly take place in the damaged tissue. The researchers are studying the effects of this phenomenon on children’s language skills.

Around 100 children are due to take part in the study. About half suffered a stroke around the time of birth, the others are healthy controls.

The researchers are assessing the nature, location and size of the children’s brain injuries using state-of-the-art MRI scans. These scans are obtained using diffusion-weighted imaging and functional MRI. Diffusion-weighted imaging can detect injuries that may not be readily visible on conventional MRI scans and functional MRI can show which parts of the brain are being used for different functions.

They are assessing the children’s language skills – their speech, vocabulary, grammar and reading, for example – as well as other factors, such as their behaviour, hearing, intelligence and socioeconomic status, using a comprehensive range of tests and questionnaires.
 

What are the researchers' credentials?

Project Leader Dr T Baldeweg MD
Project team
  • Dr Gemma Northam MSc
  • Dr F Cowan MRCPCH PhD
LocationDepartment of Paediatrics and Imaging Sciences, Imperial College, London in conjunction with UCL Institute of Child Health, University College, London.
Duration2 years
Grant awarded21 July 2008
Start date15 June 2009
End date14 December 2011
Grant amount£100,698.00
Grant codeSP4363

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Dr Frances Cowan, Senior Lecturer at Imperial College, and the team at the Hammersmith Hospital have been taking very detailed images of babies’ brains using an MRI scanner for many years now. This has allowed them to diagnose strokes early and follow the progress of children as they grow.

Dr Cowan is one of the leading researchers in her field. She has published high-quality papers in some of the best paediatric and neuroimaging journals. With earlier funding from Action Medical Research, Dr Cowan along with others at the Hammersmith has developed a way to use MRI scans to predict whether babies are likely to suffer movement problems on one side of their body after a stroke, and how severe those problems will be.4,5 She has also followed up children into school age to assess their learning abilities, and how those abilities are affected by having movement problems or later fits.6

Dr Cowan has linked up with Dr Torsten Baldeweg, who is an expert in using state-of-the-art MRI scans to show which parts of the brain are active when processing language. Dr Baldeweg has been studying, also funded by a grant from AMR, the language development in children born very preterm, with and without stroke-like lesions. His team is using brain scans to look for any injuries in the children’s brains that affect their language skills and how the brain sometimes compensates for this damage.

Who stands to benefit from this research and how?

Anticipating and ameliorating language problems

It is devastating for parents to hear their baby has suffered a stroke. Researchers hope this new research will make it easier to predict whether a baby will have difficulties with language as they grow and develop, as well as how severe their problems may be. This research could also help explain why some babies and children make good progress after suffering a stroke, while others have greater difficulties with communication.

A clear diagnosis, with information about what to expect in the future, could be incredibly reassuring for parents. More importantly, it could ensure children get the most appropriate assessments and help with their language skills, such as speech therapy and trying other ways to aid communication, as early as possible.

Currently, many children get little help, partly because the impact of their stroke on their language skills can be underestimated. Yet language skills are of vital importance, not least to a child’s educational progress, self esteem and peer relations.

Researchers believe their work may prove relevant to many other children as well – to premature babies or older children who suffer a stroke, and possibly to some children with other types of brain injury, such as some tumours and head injuries, and to children with epilepsy or those who need brain surgery.

References

  1. Nelson K, Lynch JK. Stroke in newborn infants. Lancet Neurol 2004;3:150-8.
  2. Office for National Statistics. Health Statistics Quarterly 35 (Autumn 2007), Table 2.1
  3. The Information Centre, Community Health Statistics. NHS Maternity Statistics, England: 2003-04, 2004-05, 2005-06
  4. Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S, Papadimitriou M, Azzopardi D, Bydder G, Dubowitz L. Early prognostic indicators in infants with neonatal cerebral infarction: a clinical, EEG and MRI study.  Pediatrics 1999;103:39-46.
  5. Mercuri E, Barnett A, Rutherford M, Guzzetta A, Haataja L, Cioni G, Cowan F, Dubowitz L. Neonatal cerebral infarction and neuromotor outcome at school age. Pediatrics 2004;113:95-100.
  6. Ricci D, Mercuri E, Barnett AL, Rathbone R,  Haataja L,  Rutherford M,  Dubowitz LS, Cowan F. Cognitive outcome at early school age in term-born children with perinatally acquired middle cerebral artery territory infarction. Stroke 2008 Feb;39(2):403-10.