What Research Is Being Done? Investigators from many arenas of medicine and health are using their expertise to help improve treatment and prevention of cerebral palsy. Much of their work is supported through the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Child Health and Human Development, other agencies within the Federal Government, nonprofit groups such as the United Cerebral Palsy Research Foundation, and private institutions. The ultimate hope for overcoming cerebral palsy lies with prevention. In order to prevent cerebral palsy, however, scientists must first understand the complex process of normal brain development and what can make this process go awry. Between early pregnancy and the first months of life, one cell divides to form first a handful of cells, and then hundreds, millions, and, eventually, billions of cells. Some of these cells specialize to become brain cells. These brain cells specialize into different types and migrate to their appropriate site in the brain. They send out branches to form crucial connections with other brain cells. Ultimately, the most complex entity known to us is created: a human brain with its billions of interconnected neurons. Mounting evidence is pointing investigators toward this intricate process in the womb for clues about cerebral palsy. For example, a group of researchers has recently observed that more than one-third of children who have cerebral palsy also have missing enamel on certain teeth. This tooth defect can be traced to problems in the early months of fetal development, suggesting that a disruption at this period in development might be linked both to this tooth defect and to cerebral palsy. As a result of this and other research, many scientists now believe that a significant number of children develop cerebral palsy because of mishaps early in brain development. They are examining how brain cells specialize, how they know where to migrate, how they form the right connections -- and they are looking for preventable factors that can disrupt this process before or after birth. Scientists are also scrutinizing other events -- such as bleeding in the brain, seizures, and breathing and circulation problems -- that threaten the brain of the newborn baby. Through this research, they hope to learn how these hazards can damage the newborn's brain and to develop new methods for prevention. Some newborn infants, for example, have life-threatening problems with breathing and blood circulation. A recently introduced treatment to help these infants is extracorporeal membrane oxygenation, in which blood is routed from the patient to a special machine that takes over the lungs' task of removing carbon dioxide and adding oxygen. Although this technique can dramatically help many such infants, some scientists have observed that a substantial fraction of treated children later experience long-term neurological problems, including developmental delay and cerebral palsy. Investigators are studying infants through pregnancy, delivery, birth, and infancy, and are tracking those who undergo this treatment. By observing them at all stages of development, scientists can learn whether their problems developed before birth, result from the same breathing problems that made them candidates for the treatment, or spring from errors in the treatment itself. Once this is determined, they may be able to correct any existing problems or develop new treatment methods to prevent brain damage. Other scientists are exploring how brain insults like hypoxic-ischemic encephalopathy (brain damage from a shortage of oxygen or blood flow), bleeding in the brain, and seizures can cause the abnormal release of brain chemicals and trigger brain damage. For example, research has shown that bleeding in the brain unleashes dangerously high amounts of a brain chemical called glutamate. While glutamate is normally used in the brain for communication, too much glutamate overstimulates the brain's cells and causes a cycle of destruction. Scientists are now looking closely at glutamate to detect how its release harms brain tissue and spreads the damage from stroke. By learning how such brain chemicals that normally help us function can hurt the brain, scientists may be equipped to develop new drugs that block their harmful effects. In related research, some investigators are already conducting studies to learn if certain drugs can help prevent neonatal stroke. Several of these drugs seem promising because they appear to reduce the excess production of potentially dangerous chemicals in the brain and may help control brain blood flow and volume. Earlier research has linked sudden changes in blood flow and volume to stroke in the newborn.

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