A Comprehensive Review of Neuroplasticity Following CNS Stroke in Pediatric Populations

Ashley S Membreno Lopez, Stephanie Johnson, Noa Wax, Amber Kalu, Camela S Barker, Cara Green, Megan Anderson, Kyla Whitten, Shiv Sudhakar, Noah Peltier, Mary Wood, Elaine Whitworth, Jasmine Benner, Wandy Cubilete, Jim Harper, Patrick Logue, Christopher L Edwards*

Abstract

Pediatric stroke, encompassing both cerebral and spinal cord infarctions, represents a unique neurological condition affecting the developing nervous system with profound implications for neuroplasticity and functional recovery. Unlike adult stroke, pediatric stroke occurs within the dynamic environment of neural maturation, creating distinct pathophysiological cascades and recovery patterns. This comprehensive review examines the molecular mechanisms underlying neuroplasticity following pediatric central nervous system stroke, with particular emphasis on the differential responses observed in brain versus spinal cord injuries. We analyze the complex interplay of genetic polymorphisms, epigenetic modifications, and social determinants that influence stroke susceptibility and recovery trajectories in pediatric populations. The review synthesizes current evidence regarding the temporal dynamics of neuroplastic reorganization, highlighting critical periods for intervention and the role of demographic factors including age, race, gender, and socioeconomic status in determining outcomes. We explore the cellular and molecular processes of sensorimotor reorganization, synaptic remodeling, and functional restoration, while examining evidence-based therapeutic approaches that harness neuroplasticity for optimal recovery. The rapid functional improvement observed in the 8-year-old patient with spinal stroke described herein exemplifies the remarkable capacity for pediatric neuroplastic adaptation, underscoring the urgent need for age-specific rehabilitation protocols that capitalize on the enhanced plasticity window inherent to the developing nervous system.