'My kid is in there,' UT Health San Antonio imaging studies confirm

July 31, 2017

Highlights:Children who are resuscitated after drowning can survive as prisoners inside their own bodies, awake but paralyzed. Drowning deprives the brain of oxygen, which can cause a form of anoxic brain injury (ABI). Unable to move or speak, 10 children with ABI studied at UT Health San Antonio exhibited variations of locked-in syndrome, a rare condition in adults and thought to be even rarer in children. This work suggests that pediatric drowning may be one of the most common causes of locked-in syndrome.

Injury is localized, not diffuse

The scientists are from the Research Imaging Institute at The University of Texas Health Science Center, now called UT Health San Antonio. They studied brain images of the 10 children and reported July 31 in Human Brain Mapping that the pattern of ABI seen in childhood drowning is not widespread as was previously believed. Instead it is largely confined to a small but crucially important motor pathway supplied by a specific set of small arteries deep inside the brain.

Focal stroke

The injury is a focal stroke that, in the future, might be treated when children are first admitted to the hospital. That's if neuroprotective agents now being tested in animals are moved into human trials, said Peter T. Fox, M.D., professor in the Joe R. & Teresa Lozano Long School of Medicine at UT Health San Antonio and director of the Research Imaging Institute. Dr. Fox is senior author of the new paper and two other recent studies that report anatomical and functional effects on the brains of young children resuscitated after drowning.

Preservation of networks

"In the imaging studies we see preservation of visual, auditory, tactile and cognitive networks, and predictably, we also see damage to motor pathways and networks," Dr. Fox said.

The Research Imaging Institute developed a Neural Network-Based Behavioral Scoring System©, which is a score sheet for families and caregivers to submit their impressions of the awareness and cognition that their children display. Some of the children are able to communicate via eye movements. Others are not able to do so.

Family impressions

"In locked-in syndrome, the patients' families are typically the first to report return of consciousness," Dr. Fox said. "They are around their children all the time and they remember the child's personalities and preferences from before the injury."

The brain system that's most associated with awareness is called the default-mode network. The team found a strong correlation between social behaviors and preservation of this network, Dr. Fox said.

Machinery for awareness

"Even in the most severely affected of the children, we have evidence that at least the machinery for awareness of themselves and others remains functioning," he said.

"Does it mean that they're fully conscious? Well, we can see that the machinery is still intact."

Relief to parents

The finding is exciting and a relief to parents like Liz Tullis, whose son, Conrad, suffered ABI from drowning and was resuscitated. She founded the Conrad Smiles Fund, which has supported the research, and is a co-author on the three papers.

"Some parents, like Liz, are quite convinced that their kid is in there, thinking," Dr. Fox said. "Perhaps clinicians are telling them that their child is not aware, and they want another opinion. They came to be a part of the study for another opinion."

In future, treatment in hospital envisioned

If this new observation -- that ABI from childhood drowning can cause a focal stroke in the motor pathways -- becomes widely known among clinicians, and if treatments that are effective in animal models can be translated to humans, children could be treated immediately after hospital admission and much function could be saved, Dr. Fox said.

"This is a new syndrome," he said. "It's not taught in medical school. This is all new neuroscience."

Hope for parents

"When Conrad survived his accident, I was not given much hope or guidance; in fact I was encouraged to institutionalize Conrad," Tullis said. "Other families were encouraged to withdraw care. Because ABI is believed to be 'generalized' brain damage, the prevailing medical prognosis is grim and any treatment or recovery is considered too difficult if not impossible.

"The results of this study are groundbreaking," she continued. "Simply publicizing the results of Dr. Fox's research will have a huge impact on families. The fact that these children are 'in there' has never been communicated to the medical community and will improve the support we receive. The fact that this study can lead to more advancements in the understanding and treatment of ABI provides additional hope to fuel the fire of our love and dedication to our children."

The team has published its research findings in clinical journals so that this will have an impact on care delivery, Dr. Fox said.

Maximizing intellectual stimulation

Thirteen years after his accident, Conrad Tullis is 15 and a high school sophomore in San Antonio. Parents like Liz Tullis provide "environmental enrichment" opportunities for their locked-in children.

"If you believe that your kid is aware, then you want him to be stimulated, and have the opportunity to develop his own knowledge base and develop his own personality and intellect," Dr. Fox said. "This research can guide care toward brain systems that are preserved, and it can encourage families to provide an enriched environment."
-end-
Acknowledgments

Support for this project is from the National Institutes of Health (National Center for Advancing Translational Sciences and National Institute for Mental Health) and the Kronkosky Charitable Foundation. The Nonfatal Drowning Registry (nonfataldrowningregistry.org) assisted with participant recruitment. The Conrad Smiles Fund publicized this study and provided funding for travel and logistical support. Miracle Flights (miracleflights.org) supported airfare costs. The authors thank Thomas Vanasse, Research Imaging Institute, UT Health San Antonio, for his guidance in data analysis, and all participants and families for their time and involvement in this study.

Authors are Mariam Ishaque, Ph.D., (lead author), Research Imaging Institute, UT Health San Antonio; Janessa Manning, Ph.D., Wayne State University, Detroit, Mich.; Mary Woolsey, Research Imaging Institute; Crystal Franklin, Research Imaging Institute; Elizabeth Tullis, Research Imaging Institute; Christian Beckmann, Ph.D., Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands; and Peter Fox, M.D., Research Imaging Institute, UT Health San Antonio, South Texas Veterans Health Care System and Shenzhen University, Shenzhen, China.

Read more news from UT Health San Antonio:

Strengthening military caregivers is new program's goal

For current news from the UT Health Science Center San Antonio, now called UT Health San Antonio™, please visit our online newsroom, like us on Facebook or follow us on Twitter.

The University of Texas Health Science Center at San Antonio, with missions of teaching, research and healing, is one of the country's leading health sciences universities and is now called UT Health San Antonio™. UT Health's schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 33,000 alumni who are advancing their fields throughout the world. With seven campuses in San Antonio and Laredo, UT Health has a FY 2017 revenue operating budget of $806.6 million and is the primary driver of its community's $37 billion biomedical and health care industry. For more information on the many ways "We make lives better®," visit http://www.uthscsa.edu.

University of Texas Health Science Center at San Antonio

Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.