CEREBRAL REORGANIZATION AS A RESPONSE TO NEONATAL BRACHIAL PLEXUS PALSY (NBPP): A SYSTEMATIC REVIEW

Purpose: NBPP is a closed nerve traction lesion to the fragile brachial plexus during child delivery. As a result, the plasticity of both peripheral and central nervous system (CNS) is challenged to achieve optimal upper limb recovery. While extensive research focused on peripheral consequences, less attention has been given to the CNS response. The aim of this review is to provide an overview of CNS changes and corresponding brain imaging techniques, allowing us to highlight brain regions involved in central reorganization in children with NBPP. Methods: These key links are necessary to understand how these regions reprogram following peripheral nerve lesion in the newborn so early treatment interventions can be adjusted and fine-tuned. This review was established following the PRISMA guidelines. Three databases were systematically searched and relevant studies were identified by two independent reviewers according to predetermined eligibility criteria. Methodological quality was assessed with the CASP checklist and the GRADE approach. Results: Ten studies were included and anatomical brain changes (n=5) were distinguished from functional alterations in brain activation patterns (n=7). Two authors investigated both. The primary imaging method was MRI. The anatomical studies reported either reduced volumes or no significant changes in structures of the brain as a result of NBPP. Changes in brain activation were observed in associative motor areas, primary sensorimotor areas and corpus callosum, mainly due to difficulties in refinement, planning effort and efficiency in neural processing. Conclusion: The results indicate that NBPP also affects the development of the neonatal brain due to the disturbance of afferent input and perturbation of the sensorimotor interplay. Research exploring actual, unrestricted movements, e.g. with fNIRS, should be encouraged as well as a longitudinal follow-up design to determine in which window these changes arise. Hence, early therapy strategies and interventions can be fine-tuned by also engaging the identified areas.