Motor Deficits Mask Functional Integrity in Pediatric Anoxic Brain Injury with Nonfatal Drowning

OBJECTIVE: The objective of this study is to evaluate the neurological and functional consequences of pediatric anoxic brain injury (ABI) from nonfatal drowning using resting-state functional MRI (rs-fMRI). BACKGROUND: Drowning is a leading cause of death and unintentional injury in young children. Anoxic brain injury can result from nonfatal drowning, causing severe neurological morbidity. The substantial motor deficits associated with anoxic injury and the lack of reliable cognitive evaluations make the assessment of functional status and long-term prognostication extremely challenging in children with ABI. This results in difficult clinical management decisions. A novel, more potent imaging protocol is needed for improved clinical assessment in this disorder. It is hypothesized that resting-state fMRI will provide an objective, accurate assessment of neural-system integrity in children with ABI. DESIGN/METHODS: 11 children with drowning-related ABI and 11 age- and gender-matched neurotypical controls (4-12 years) were scanned during mildly sedated sleep; resting-state fMRI blood oxygen level dependent (BOLD) data were acquired. Independent components analysis (ICA) was implemented at group and per-subject levels to investigate the integrity of resting-state networks (RSNs). ABI patient RSNs were compared to a normal template of networks created from control group data. Extensive functional evaluations were conducted and a systematic behavioral evaluation form and scoring system were developed to correlate imaging and behavioral measures. RESULTS: Compromise of motor RSNs (basal ganglia, cerebellum) and prominent preservation of sensory (visual, auditory, sensorimotor) and higher-order (default mode, executive function) RSNs were consistently observed. Imaging findings corroborated parentsu0027 reports of physical and residual functional abilities, as assessed through behavioral evaluation forms. CONCLUSIONS: Our observations suggest that motor deficits underlie the inability to communicate and convey relatively intact cognitive, perceptual, and emotive capabilities in pediatric post-drowning ABI, depicting a locked-in-type syndrome. Further, resting-state fMRI can be a potent clinical assessment tool in this disorder. Disclosure: Dr. Ishaque has nothing to disclose. Dr. Manning has nothing to disclose. Dr. Franklin has nothing to disclose. Dr. Woolsey has nothing to disclose. Dr. Fox has nothing to disclose. Language: en