Implications of Plasticity
One must consider the effect of normal developmental activities of the immature brain on the mechanisms of developing damage after TBI. Apoptotic death of neurons is a part of plasticity and normal brain development.
Does this result in the developing brain being more susceptible to activating the apoptotic cascade than the adult brain (15,19,34)? If so, this could help to explain the poorer prognosis for functional outcome for those injured at a very young age (34). In one animal study of posttrauma apoptosis, for a specific developmental age, the areas that had the highest density of programmed cell death were also noted to have high numbers of apoptotic cells in general (15). It may also be possible that excitatory neurotransmitter release could result in excessive stimulation of some pathways and stimulate the development of abnormal connections or that decreased excitatory activity could decrease connections (34). This implies that the relatively high plasticity of the developing brain could actually have a negative impact on the overall outcome after diffuse TBI and be at least partially responsible for the poorer outcomes seen in those injured at a very young age.
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