Abstract
Childhood arterial ischemic stroke is a severe disorder that can cause lasting cognitive impairments, particularly in executive functions. Although early research assumed an improved outcome in childhood stroke patients compared to adults, more recent studies indicate similar rates of disabilities and cognitive impairment, with widespread brain network disruptions underlying these deficits. Here, we used resting-state fMRI to study alterations in functional brain dynamics and their association with cognitive outcome in children and adolescents after childhood stroke. We used co-activation pattern analysis to characterize five recurring brain states and their temporal properties in a cohort of 16 patients and 17 age-matched controls. We found that in pediatric stroke patients, a specific brain state characterizing the frontoparietal network was more prevalent and more frequently involved in state transitions. This was paralleled by lower occurrence rates of a brain state related to default mode network deactivation. Moreover, our analysis showed that these dynamics relate more to the extent to which the lesion impacts functional networks than to lesion size alone. Taken together, our findings suggest that disrupted brain dynamics following childhood stroke relate to cognitive performance and that the location of a focal lesion can have wide-ranging implications on brain state dynamics.