Evidence is growing that brain damage in girls, which occurs during puberty, impairs cognitive function and the strength of the brain network
A head injury is an extremely dangerous medical condition. In severe cases, it can cause intracerebral bleeding, skull fractures and irreversible brain damage. In the mild cases, it can cause concussion (some decrease in the level of consciousness, confusion, vomiting and other clinical signs). The faster the treatment is given, the higher the chance of saving the damaged brain tissue.
Head injuries are very common in children of any age, and the main causes are falls and traffic accidents (in the car, while riding a bicycle or scooter or while walking). In such a situation, the developing brains of children are in greater danger than the brains of adults (for example, in MRI imaging you can see injuries such as tearing of axons, nerve fibers, which are sensitive to damage in children because the myelin sheath - the material that envelops and insulates them - has not yet fully developed) .
What is the question? How does sexual development affect the brain recovery of girls who have had a head injury?
The researchers Dr Abigail Livni- Ezer and Dr. Tamar Zilberg, focus on the question of how a head injury may affect the developing brain of girls and boys, at different stages of development. Dr. Livni-Ezer is a neuroscientist, head of the diagnostic brain imaging laboratory and director of clinical services for planning neurosurgical operations at the Sheba Medical Center, and a senior lecturer in the imaging department and the Segol School of Neuroscience at Tel Aviv University. Her research deals with understanding brain pathologies and diseases (such as traumatic head injuries, Alzheimer's, depression and pain), especially in the way the brain reorganizes in structure and clinical and cognitive function. These studies are carried out using advanced MRI imaging that examines the brain network and the connectivity that characterizes it. Dr. Zilberg is a rehabilitation psychologist and clinical neuropsychologist, therapist and researcher, senior lecturer in the field of clinical psychology at Bar-Ilan University and manages the unit for building evaluation and intervention programs in the children's rehabilitation department at Sheba (these programs deal with rehabilitation after a traumatic medical event, such as head injury, tumor and burns) . Her research deals with the psychological effects of medical trauma and crisis situations in children, focusing on personal and family coping, neuropsychological aspects and the development of effective multi-system therapeutic approaches. In the top row: connectivity in healthy brains, in the bottom row: connectivity in the brains of head-injured people. In the right column: connectivity in the brains of girls and women before menstruation, in the left column: connectivity in the brains of girls and women after menstruation.
The latest study by Dr. Livni-Ezer and Dr. Zilberg was born out of the thought that there is not enough reference in the medical world to the brain recovery of girls and boys from head trauma. "Recently we were at a medical conference in Toronto that dealt with head injuries among children and adults. There was a reference to the brain recovery of women, and from there the idea was born to study girls and girls as well. "Girls, girls and women go through unique and significant hormonal changes that must be taken into account, such as menstruating during sexual development, and this has an impact on brain rehabilitation and cognitive and behavioral function after a head injury," explains Dr. Zilberg.
According to Dr. Livni-Ezer, "Cognitive studies have shown that women of reproductive age are more sensitive to head trauma. Our hypothesis is probably because the fluctuations of female hormones during the month, such as estradiol and progesterone, affect brain areas with a high concentration of receptors for these hormones; The addition or withdrawal of hormones affects these areas of the brain and the communication between them and other brain areas, and thus the connectivity in the brain network can be damaged."
In their study, which won a grant from the National Science Foundation, the researchers sought to test the relationship between head injury, hormonal changes, brain changes and cognitive function. For this purpose, they recruited about 40 girls and women aged 18-9 (before or after menstruation) who had a head injury (mild to severe) and were treated in the emergency room or in the rehabilitation department at the Safra Children's Hospital at the Sheba Medical Center, under the direction of Dr. Jeanne Landa, the research partner). In addition, they recruited about 50 healthy girls of the same age (control group). They tested them at three time points: about two weeks-one month after the sabotage, after six months and after a year and a half. The tests included a hormonal blood test (for the level of female sex hormones), a questionnaire on sexual development (in which they were asked, for example, about receiving menstruation, height and weight in relation to others and initial signs of sex and breasts), and a brain MRI scan to examine the structural and functional brain connectivity.
In addition, the subjects underwent neuropsychiatric tests that focus on executive functions (higher cognitive functions, such as planning a sequence of actions to achieve a goal, focusing on a task and suppressing an impulse unrelated to it, which are used for concentration and thinking, planning and controlling actions). For example, they were asked to perform short tasks that test attention and concentration and the ability to delay a reaction (for example, they were required to concentrate on only one fish that appears in the center of the screen and indicate which direction it is facing and ignore many fish in the background that are facing in different directions). In addition, they were asked to answer a questionnaire related to emotional regulation, which may be undermined during hormonal changes (for example, to rate their degree of control over their emotions and the degree of their ability to relax before a stressful situation). The parents also filled out questionnaires about their daughters' emotional functioning and the consequences of the head injury.
The findings of the study show that the cognitive function of the affected girls, especially if they have already menstruated, is significantly lower than the function of those who have not yet menstruated and that of the healthy girls at the same stage of sexual maturity.
The research findings so far show that the cognitive function (as expressed in the assignments) of the affected girls, especially if they have already menstruated, is significantly lower than those who have not yet menstruated and that of the healthy girls at that stage of sexual maturity. In addition, changes in the strength of the brain network were observed in the simulations, depending on the stage of sexual development. For example, the connectivity of the brain network of girls who had already received their period was weaker and less effective following the damage, compared to the other girls. The reason for these results is apparently the stage of sexual maturity and the hormonal fluctuations that affect brain recovery.
"These findings indicate that sexual development is a factor that should be taken into account in the rehabilitation of girls and women who have suffered a head injury in order to reduce the risk of cognitive disorders in the long term, such as attention deficit disorder. For example, it is possible that a girl or a girl (before or after menstruation) who was injured in the head should receive treatment to balance the hormonal fluctuations in order to improve the brain and functional recovery. It is also known that a head injury also accelerates hormonal fluctuations and sexual maturation. Therefore, it is possible that a girl who has not yet had her period should receive hormonal treatment to delay it so that the brain can invest energy in recovery. These are medical interventions that can help to heal the brain, and raising awareness of them is the contribution of our research," says Dr. Zilberg. According to Dr. Livni-Ezer, "It is known that there are brain, hormonal and behavioral differences between the sexes and we hope that our research will lead to the development of personalized and gender medicine."
Life itself:
Tamar Zilberg (right), and Abigail Livni-Ezer (left)
Dr. Abigail Livni-Ezer, 45, married + three children (18, 15, 9), lives in Tel Aviv, used to be a dancer. In her spare time she is engaged in surfing (as a joint family hobby).
Dr. Tamar Zilberg, 48, married + three children (19, 16, 13), Lives in Moshav Mashgav-Dov. Loves trips and sports and loves to run, especially in Tel Aviv's night races.
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