Dev Med Child Neurol. 2014 Apr;56(4):329-36. doi: 10.1111/dmcn.12387.
The aims of the study were to investigate (1) the impact of age at brain insult on functional outcome and (2) the influence of insult and environmental factors on cognitive and behavioural outcomes.
The study was a cross-sectional, retrospective observational study, involving 138 children (76 males, 62 females; mean age 13y 1mo, SD 1y 11mo, range 10–16y) with magnetic resonance imaging (MRI) evidence of focal brain insult sustained from the first trimester of pregnancy to adolescence. Children underwent MRI and intellectual, executive, behavioural, and social evaluation. Outcome predictors were insult (lesion location, laterality, and extent, history of seizures, age at insult) and environmental (social risk and family function) factors.
Focal insult before the age of 3 years was associated with poorer outcomes than insult after the age of 3 years across all domains. For IQ outcomes, insult characteristics and seizures were highly predictive. For executive and behavioural domains, family function and social risk had the greatest impact. Earlier age at insult predicted poorer social competence. INTERPRETATION Focal brain insult before age 3 years has devastating consequences for children's development. Findings suggest that greater emphasis should be placed on providing early intervention for children who sustain early focal brain insults.
本研究旨在调查（1）脑损伤时的年龄对功能结局的影响，以及（2）损伤和环境因素对认知和行为结局的影响。
本研究为一项横断面、回顾性观察研究，共纳入 138 名儿童（76 名男性，62 名女性；平均年龄 13 岁 1 个月，标准差 1 岁 11 个月，年龄范围 10-16 岁），这些儿童均有磁共振成像（MRI）证据表明其在妊娠早期至青春期期间存在局灶性脑损伤。儿童接受 MRI 检查和智力、执行功能、行为和社会评估。结局预测因素为损伤（病变位置、侧别、范围、癫痫发作史、损伤年龄）和环境（社会风险和家庭功能）因素。
3 岁前的局灶性损伤与 3 岁后损伤相比，在所有领域的结局均较差。在智商方面，损伤特征和癫痫发作具有高度预测性。在执行功能和行为领域，家庭功能和社会风险的影响最大。损伤年龄越早，社会能力越差。
3 岁前的局灶性脑损伤对儿童的发育有毁灭性的影响。研究结果表明，对于发生早期局灶性脑损伤的儿童，应更加重视早期干预。
