Severe perinatal asphyxia can lead to injury and dysfunction of the basal ganglia. Post insult administration of insulin-like growth factor-1 is neuroprotective, particularly in the striatum. Insulin-like growth factor-1 is also known to be a neuromodulator of several types of striatal neurons. The striatum comprises various phenotypic neurons with a complex neurochemical anatomy and physiology. In the present study, we examined the specificity of neuronal rescue with insulin-like growth factor-1 on different striatal neurons. Bilateral brain injury was induced in near term fetal sheep by 30min of reversible carotid artery occlusion. A single dose of 3μg of insulin-like growth factor-1 was infused over 1h into the lateral ventricle 90min following ischemia. The histological and immunohistochemical outcome were examined after 4 days recovery using paraffin tissue preparations. Insulin-like growth factor-1 treatment (n=11) significantly reduced the percentage of neuronal loss in the striatum compared with the vehicle treated group (n=10, 28.3±5.1% vs 55.5±17.3%, P<0.005). Immunohistochemical studies showed that ischemia resulted in a significant loss of calbindin-28kd, choline acetyltransferase, parvalbumin, glutamate acid decarboxylase, neuronal nitric oxide synthase and neuropeptide Y immunopositive neurons, compared with sham controls. Insulin-like growth factor-1 markedly prevented the loss of calbindin-28kd (n=7, P<0.05), choline acetyltransferase (n=7, P<0.05), neuropeptide Y (n=7, P<0.05), neuronal nitric oxide synthase (n=8, P<0.05) and glutamate acid decarboxylase (n=9, P<0.05) immunopositive neurons, but failed to protect parvalbumin (n=6) immunopositive neurons. The present study indicates that the therapeutic effect of insulin-like growth factor-1 in the basal ganglia is selectively associated with cholinergic and some phenotypic GABAergic neurons. These data suggest a potential role for insulin-like growth factor-1 in preventing cerebral palsy due to perinatal asphyxia.