Interhemispheric temporal lobe connectivity predicts language impairment in adolescents born preterm

Plasticity of Interhemispheric Temporal Lobe White Matter Pathways Due to Early Disruption of Corpus Callosum Development in Spina Bifida

Spina bifida myelomeningocele (SBM) is commonly associated with anomalous development of the corpus callosum (CC) because of congenital partial hypogenesis and hydrocephalus-related hypoplasia. It represents a model disorder to examine the effects of early disruption of CC neurodevelopment and the plasticity of interhemispheric white matter connections. Diffusion tensor imaging was acquired on 76 individuals with SBM and 27 typically developing individuals, aged 8-36 years. Probabilistic tractography was used to isolate the interhemispheric connections between the posterior superior temporal lobes, which typically traverse the posterior third of the CC. Early disruption of CC development resulted in restructuring of interhemispheric connections through alternate commissures, particularly the anterior commissure (AC). These rerouted fibers were present in people with SBM and both CC hypoplasia and hypogenesis. In addition, microstructural integrity was reduced in the interhemispheric temporal tract in people with SBM, indexed by lower fractional anisotropy, axial diffusivity, and higher radial diffusivity. Interhemispheric temporal tract volume was positively correlated with total volume of the CC, such that more severe underdevelopment of the CC was associated with fewer connections between the posterior temporal lobes. Therefore, both the macrostructure and microstructure of this interhemispheric tract were reduced, presumably as a result of more extensive CC malformation. The current findings suggest that early disruption in CC development reroutes interhemispheric temporal fibers through both the AC and more anterior sections of the CC in support of persistent hypotheses that the AC may serve a compensatory function in atypical CC development.

Splenium development and early spoken language in human infants

The association between developmental trajectories of language-related white matter fiber pathways from 6 to 24 months of age and individual differences in language production at 24 months of age was investigated. The splenium of the corpus callosum, a fiber pathway projecting through the posterior hub of the default mode network to occipital visual areas, was examined as well as pathways implicated in language function in the mature brain, including the arcuate fasciculi, uncinate fasciculi, and inferior longitudinal fasciculi. The hypothesis that the development of neural circuitry supporting domain-general orienting skills would relate to later language performance was tested in a large sample of typically developing infants. The present study included 77 infants with diffusion weighted MRI scans at 6, 12 and 24 months and language assessment at 24 months. The rate of change in splenium development varied significantly as a function of language production, such that children with greater change in fractional anisotropy (FA) from 6 to 24 months produced more words at 24 months. Contrary to findings from older children and adults, significant associations between language production and FA in the arcuate, uncinate, or left inferior longitudinal fasciculi were not observed. The current study highlights the importance of tracing brain development trajectories from infancy to fully elucidate emerging brain-behavior associations while also emphasizing the role of the splenium as a key node in the structural network that supports the acquisition of spoken language.

The cerebral isthmus: fiber tract anatomy, functional significance, and surgical considerations

OBJECTIVE

The cerebral isthmus is the white matter area located between the periinsular sulcus and the lateral ventricle. Studies demonstrating the fiber tract and topographic anatomy of this entity are lacking in current neurosurgical literature. Hence, the authors' primary aim was to describe the microsurgical white matter anatomy of the cerebral isthmus by using the fiber dissection technique, and they discuss its functional significance. In addition, they sought to investigate its possible surgical utility in approaching lesions located in or adjacent to the lateral ventricle.

METHODS

This study was divided into 2 parts and included 30 formalin-fixed cerebral hemispheres, 5 of which were injected with colored silicone. In the first part, 15 uncolored specimens underwent the Klinger's procedure and were dissected in a lateromedial direction at the level of the superior, inferior, and anterior isthmuses, and 10 were used for coronal and axial cuts. In the second part, the injected specimens were used to investigate the surgical significance of the superior isthmus in accessing the frontal horn of the lateral ventricle.

RESULTS

The microsurgical anatomy of the anterior, superior, and inferior cerebral isthmuses was carefully studied and recorded both in terms of topographic and fiber tract anatomy. In addition, the potential role of the proximal part of the superior isthmus as an alternative safe surgical corridor to the anterior part of the lateral ventricle was investigated.

CONCLUSIONS

Using the fiber dissection technique along with coronal and axial cuts in cadaveric brain specimens remains a cornerstone in the acquisition of thorough anatomical knowledge of narrow white matter areas such as the cerebral isthmus. The surgical significance of the superior isthmus in approaching the frontal horn of the lateral ventricle is stressed, but further studies must be carried out to elucidate its role in ventricular surgery.

Diffusion tensor imaging for understanding brain development in early life

The human brain rapidly develops during the final weeks of gestation and in the first two years following birth. Diffusion tensor imaging (DTI) is a unique in vivo imaging technique that allows three-dimensional visualization of the white matter anatomy in the brain. It has been considered to be a valuable tool for studying brain development in early life. In this review, we first introduce the DTI technique. We then review DTI findings on white matter development at the fetal stage and in infancy as well as DTI applications for understanding neurocognitive development and brain abnormalities in preterm infants. Finally, we discuss limitations of DTI and potential valuable imaging techniques for studying white matter myelination.

Language comprehension in nonspeaking children with severe cerebral palsy: Neuroanatomical substrate?

BACKGROUND AND AIMS

To identify relations between brain abnormalities and spoken language comprehension, MRI characteristics of 80 nonspeaking children with severe CP were examined.

METHODS

MRI scans were analysed for patterns of brain abnormalities and scored for specific MRI measures: white matter (WM) areas; size of lateral ventricles, WM abnormality/reduction, cysts, subarachnoid space, corpus callosum thinning and grey matter (GM) areas; cortical GM abnormalities, thalamus, putamen, globus pallidus and nucleus caudatus and cerebellar abnormalities. Language comprehension was assessed with a new validated instrument (C-BiLLT).

RESULTS

MRI scans of 35 children were classified as a basal ganglia necrosis (BGN) pattern, with damage to central GM areas; in 60% of these children damage to WM areas was also found. MRI scans of 13 children were classified as periventricular leukomalacia (PVL) with little concomitant damage to central GM areas, 13 as malformations and 19 as miscellaneous. Language comprehension was best in children with BGN, followed by malformations and miscellaneous, and was poorest in PVL. Linear regression modelling per pattern group (malformations excluded), with MRI measures as independent variables, revealed that corpus callosum thinning in BGN and parieto-occipital WM reduction in PVL were the most important explanatory factors for poor language comprehension. No MRI measures explained outcomes in language comprehension in the miscellaneous group.

CONCLUSIONS

Comprehension of spoken language differs between MRI patterns of severe CP. In children with BGN and PVL differences in language comprehension performance is attributed to damage in the WM areas. Language comprehension was most affected in children with WM lesions in the subcortical and then periventricular areas, most characteristic for children with PVL.

White matter abnormalities and impaired attention abilities in children born very preterm

While attention impairments are commonly observed in very preterm (<32weeks' gestational age) children, neuroanatomical correlates of these difficulties are unclear. We aimed to determine whether the microstructural organization of key white matter tracts thought to be involved in attention (cingulum bundle, superior longitudinal fasciculi, reticular activating system, and corpus callosum) were altered in very preterm children compared with term-born controls. We also aimed to determine whether alterations in microstructural organization of these tracts were associated with attention functioning in very preterm children. One hundred and forty-nine very preterm children and 36 term-born controls underwent neuroimaging and assessment of their attention abilities at 7years. Constrained spherical deconvolution and probabilistic tractography was used to identify the key white matter tracts. Altered microstructural organization and reduced tract volume within reticular activating system and corpus callosum were found in the very preterm group compared with the control group. Diffusion and volume changes in the cingulum bundle, superior longitudinal fasciculi, reticular activating system, and corpus callosum were related to variations in attention functioning in the very preterm children. These findings emphasize that white matter tract integrity is associated with later attentional abilities in very preterm children.

Maturation of language networks in children: A systematic review of 22years of functional MRI

Understanding how language networks change during childhood is important for theories of cognitive development and for identifying the neural causes of language impairment. Despite this, there is currently little systematic evidence regarding the typical developmental trajectory for language from the field of neuroimaging. We reviewed functional MRI (fMRI) studies published between 1992 and 2014, and quantified the evidence for age-related changes in localisation and lateralisation of fMRI activation in the language network (excluding the cerebellum and subcortical regions). Although age-related changes differed according to task type and input modality, we identified four consistent findings concerning the typical maturation of the language system. First, activation in core semantic processing regions increases with age. Second, activation in lower-level sensory and motor regions increases with age as activation in higher-level control regions reduces. We suggest that this reflects increased automaticity of language processing as children become more proficient. Third, the posterior cingulate cortex and precuneus (regions associated with the default mode network) show increasing attenuation across childhood and adolescence. Finally, language lateralisation is established by approximately 5years of age. Small increases in leftward lateralisation are observed in frontal regions, but these are tightly linked to performance.

Spoken language comprehension of phrases, simple and compound-active sentences in non-speaking children with severe cerebral palsy

BACKGROUND

Children with severe cerebral palsy (CP) (i.e. 'non-speaking children with severely limited mobility') are restricted in many domains that are important to the acquisition of language.

AIMS

To investigate comprehension of spoken language on sentence type level in non-speaking children with severe CP.

METHODS & PROCEDURES

From an original sample of 87 non-speaking children with severe CP, 68 passed the pre-test (i.e. they matched at least five spoken words to the corresponding objects) of a specifically developed computer-based instrument for low motor language testing (C-BiLLT), admitting them to the actual C-BiLLT computer test. As a result, the present study included 68 children with severe CP (35 boys, 33 girls; mean age 6;11 years, SD 3;0 years; age range 1;9-11;11 years) who were investigated with the C-BiLLT for comprehension of different sentence types: phrases, simple active sentences (with one or two arguments) and compound sentences. The C-BiLLT provides norm data of typically developing (TD) children (1;6-6;6 years). Binomial logistic regression analyses were used to compare the percentage correct of each sentence type in children with severe CP with that in TD children (subdivided into age groups) and to compare percentage correct within the CP subtypes.

OUTCOMES & RESULTS

Sentence comprehension in non-speaking children with severe CP followed the developmental trajectory of TD children, but at a much slower rate; nevertheless, they were still developing up to at least age 12 years. Delays in sentence type comprehension increased with sentence complexity and showed a large variability between individual children and between subtypes of CP. Comprehension of simple and syntactically more complex sentences were significantly better in children with dyskinetic CP than in children with spastic CP. Of the children with dyskinetic CP, 10-13% showed comprehension of simple and compound sentences within the percentage correct of TD children, as opposed to none of the children with spastic CP.

CONCLUSION & IMPLICATIONS

In non-speaking children with severe CP sentence comprehension is delayed rather than deviant. Results indicate the importance of following comprehension skills across all age groups, even beyond age 12 years. Moreover, the subtype of CP should be considered when establishing an educational programme for sentence comprehension, and augmentative and alternative communication support. In addition, educational programmes for children with severe CP should take into account the linguistic hierarchy of sentence comprehension when focusing on the input and understanding of spoken language comprehension.

Epilepsy, cognitive deficits and neuroanatomy in males with ZDHHC9 mutations

OBJECTIVE

Systematic investigation of individuals with intellectual disability after genetic diagnosis can illuminate specific phenotypes and mechanisms relevant to common neurodevelopmental disorders. We report the neurological, cognitive and neuroanatomical characteristics of nine males from three families with loss-of-function mutations in ZDHHC9 (OMIM #300799).

METHODS

All known cases of X-linked intellectual disability (XLID) due to ZDHHC9 mutation in the United Kingdom were invited to participate in a study of neurocognitive and neuroimaging phenotypes.

RESULTS

Seven out of nine males with ZDHHC9 mutations had been diagnosed with epilepsy, exceeding epilepsy risk in XLID comparison subjects (P = 0.01). Seizure histories and EEG features amongst ZDHHC9 mutation cases shared characteristics with rolandic epilepsy (RE). Specific cognitive deficits differentiated males with ZDHHC9 mutations from XLID comparison subjects and converged with reported linguistic and nonlinguistic deficits in idiopathic RE: impaired oromotor control, reduced verbal fluency, and impaired inhibitory control on visual attention tasks. Consistent neuroanatomical abnormalities included thalamic and striatal volume reductions and hypoplasia of the corpus callosum.

INTERPRETATION

Mutations in ZDHHC9 are associated with susceptibility to focal seizures and specific cognitive impairments intersecting with the RE spectrum. Neurocognitive deficits are accompanied by consistent abnormalities of subcortical structures and inter-hemispheric connectivity. The biochemical, cellular and network-level mechanisms responsible for the ZDHHC9-associated neurocognitive phenotype may be relevant to cognitive outcomes in RE.

Extensive and interrelated subcortical white and gray matter alterations in preterm-born adults

Preterm birth is a leading cause for impaired neurocognitive development with an increased risk for persistent cognitive deficits in adulthood. In newborns, preterm birth is associated with interrelated white matter (WM) alterations and deep gray matter (GM) loss; however, little is known about the persistence and relevance of these subcortical brain changes. We tested the hypothesis that the pattern of correspondent subcortical WM and GM changes is present in preterm-born adults and has a brain-injury-like nature, i.e., it predicts lowered general cognitive performance. Eighty-five preterm-born and 69 matched term-born adults were assessed by diffusion- and T1-weighted MRI and cognitive testing. Main outcome measures were fractional anisotropy of water diffusion for WM property, GM volume for GM property, and full-scale IQ for cognitive performance. In preterm-born adults, reduced fractional anisotropy was widely distributed ranging from cerebellum to brainstem to hemispheres. GM volume was reduced in the thalamus, striatum, temporal cortices, and increased in the cingulate cortices. Fractional anisotropy reductions were specifically associated with GM loss in thalamus and striatum, with correlation patterns for both regions extensively overlapping in the WM of brainstem and hemispheres. For overlap regions, fractional anisotropy was positively related with both gestational age and full-scale IQ. Results provide evidence for extensive, interrelated, and adverse WM and GM subcortical changes in preterm-born adults. Data suggest persistent brain-injury-like changes of subcortical-cortical connectivity after preterm delivery.

Anterior commissural white matter fiber abnormalities in first-episode psychosis: a tractography study

BACKGROUND

The Anterior Commissure (AC) is an important interhemispheric pathway that connects contralateral temporal lobes and orbitofrontal areas. The role of the AC is not yet well understood, although abnormalities in this white matter tract have been reported in patients diagnosed with chronic schizophrenia. However, it is not known whether changes in the AC are present at earlier stages of the disease.

METHODS

Diffusion Magnetic Resonance Images (dMRI) were acquired from 17 First Episode Schizophrenia Patients (FESZ) and 20 healthy controls. The AC was reconstructed using a streamline tractography approach. DMRI measures, including Fractional Anisotropy (FA), Trace, Axial Diffusivity (AD) and Radial Diffusivity (RD) were computed in order to assess microstructural changes in the AC.

RESULTS

FA was reduced, while trace and RD showed increases in FESZ. AD did not show differences between groups.

CONCLUSION

The observed changes in these dMRI measures, namely reductions in FA and increases in trace and RD, without changes in AD, likely point to myelin abnormalities of this white matter tract, and provide evidence of white matter pathology extant in the early phases of schizophrenia.

Reduced language connectivity in pediatric epilepsy

OBJECTIVE

Functional connectivity (FC) among language regions is decreased in adults with epilepsy compared to controls, but less is known about FC in children with epilepsy. We sought to determine if language FC is reduced in pediatric epilepsy, and examined clinical factors that associate with language FC in this population.

METHODS

We assessed FC during an age-adjusted language task in children with left-hemisphere focal epilepsy (n = 19) compared to controls (n = 19). Time series data were extracted for three left regions of interest (ROIS) and their right homologues: inferior frontal gyrus (IFG), middle frontal gyrus (MFG), and Wernicke's area (WA) using SPM8. Associations between FC and factors such as cognitive performance, language dominance, and epilepsy duration were assessed.

RESULTS

Children with epilepsy showed decreased interhemispheric connectivity compared to controls, particularly between core left language regions (IFG, WA) and their right hemisphere homologues, as well as decreased intrahemispheric right frontal FC. Increased intrahemispheric FC between left IFG and left WA was a positive predictor of language skills overall, and naming ability in particular. FC of language areas was not affected by language dominance, as the effects remained only when examining participants with left language dominance. Overall FC did not differ according to duration of epilepsy or age of onset.

SIGNIFICANCE

FC during a language task is reduced in children, similar to findings in adults. In specific, children with left focal epilepsy demonstrated decreased interhemispheric FC in temporal and frontal language connections and decreased intrahemispheric right frontal FC. These differences were present near the onset of epilepsy. Greater FC between left language centers is related to better language ability. Our results highlight that connectivity of language areas has a developmental pattern and is related to cognitive ability.

Corpus callosum and motor development in healthy term infants

BACKGROUND

Corpus callosum atrophy has been associated with cognitive and motor deficits in elderly people. However, the role of the corpus callosum in infant development is unclear. The aim of this study was to assess the impact of corpus callosum size on motor development in infants.

METHODS

We investigated cerebral ultrasonograms performed on healthy infants aged 4 to 6 months. The correlation between the development of rolling over and corpus callosum size was calculated for determining odds ratios. Covariates, including gestational age, sex, age in months, and head circumference were tested using logistic regression.

RESULTS

We investigated 244 cerebral ultrasonograms performed on term infants from 2009 to 2011. The percentage of rolling over development in the examined infants increased with age (47.8%, 78.4%, and 97.5% at ages 4, 5, and 6 months, respectively). There was no significant difference in the development of rolling over between male (67.9%) and female (73.6%) children or among different gestational age groups. After the other covariates in the logistic model were adjusted, only age and corpus callosum size (length and thickness) were significantly associated with the development of rolling over: 3.86 times the odds (confidence interval, 2.1 to 7.0) for age in months, 1.14 times the odds (confidence interval, 1.0 to 1.3) for corpus callosum length, and 3.92 times the odds (confidence interval, 1.6 to 9.6) for corpus callosum thickness.

CONCLUSIONS

Corpus callosum size is positively associated with the development of rolling over in healthy term infants, independent of the gestational age, sex, age, and head circumference.

[The hearing function in the premature infants]

The present review of the literature is focused on the morphological and functional aspects of antenatal ontogenesis of the hearing system with special reference to the peculiar features of its formation during the post-natal period in the premature infants. In this context, the results of the objective psychoacoustic investigation s are considered (including those obtained by such methods as threshold audiometry, verbal and non-verbal tests, evaluation of central auditory processing of the sound information). Also presented are the results of the objective methods of hearing investigations (acoustic impedancometry, registration of optoacoustic emission and auditory evoked potentials). The underdevelopment of the hearing system in the premature infants manifests itself as the specific functional features of all its components. Their parameters are presented with reference to dynamics of their formation. In addition, the problem of central auditory processing of the disorders that are very likely to be present in the premature infants are discussed.

Adaptive mechanisms of developing brain: cerebral lateralization in the prematurely-born

Preterm birth results in alterations in neural connectivity, but the impact of prematurity on the functional organization of the developing brain has yet to be explored. To test the hypothesis that preterm birth alters cortical organization during the late second and third trimesters of gestation, we interrogated cerebral lateralization at rest in 26 very preterm subjects (birth weight 500-1500g) with no evidence of brain injury and 25 healthy term control subjects at term equivalent age. Employing an unbiased voxel-based measure of functional connectivity, these data demonstrated that cerebral lateralization is impaired in the prematurely-born. At term equivalent age, preterm neonates showed significantly less lateralization in regions subserving both receptive and expressive language, left Brodmann (BA) areas insula-BA22-BA21 and L BA45-BA47 (p<0.05 corrected for multiple comparisons for both). Exploratory region of interest analyses demonstrated significantly less inter-hemispheric connectivity from L BA22 to R BA22 in preterm infants compared to term controls (p<0.005) and from R BA22 to its homolog (p<0.005). L BA22, Wernicke's area, was more strongly connected to R BA39, foreshadowing neural networks for language in preterm subjects at school age, adolescence and young adulthood. For these very preterm neonates born at less than 30weeks' PMA, the degree of prematurity had no influence on lateralization in these differential regions.

Temporal lobe impairment in West syndrome: event-related potential evidence

Objective

This study investigates auditory processing in infants with West syndrome (WS) using event-related potentials (ERPs).

Methods

ERPs were measured in 25 infants with mainly symptomatic WS (age range = 3–10 months) and 26 healthy term infants (age range = 3–9 months) using an auditory novelty oddball paradigm. The ERP recordings were made during wakefulness and repeated in stage II sleep.

Results

The obligatory components (P150, N250, P350) and novelty response components (P300, Nc) were recordable during both sleep and wakefulness in patients and controls. All ERP latencies decreased with age in controls but not in the WS group (age × group interaction, F = 22.3, p < 0.0001). These ERP latency alterations were not affected by pharmacological treatment for WS.

Interpretation

This study demonstrated a persistently altered ERP signature in patients with a recent history of infantile spasms. The prolongation of auditory obligatory and novelty ERPs in WS patients indicates a severe failure of temporal lobe maturation during infancy. It remains to be investigated whether this predicts long-term cognitive impairments characteristic for this epileptic encephalopathy.

TMEM106B influences volume of left-sided temporal lobe and interhemispheric structures in the general population

BACKGROUND

Frontotemporal lobar degeneration is a neurodegenerative disease characterized by brain atrophy of the frontal and anterior temporal lobes. The associated frontotemporal dementia syndromes are clinically heterogeneous, and the pattern of affected cortical regions varies among subtypes. The TMEM106B rs1990622 polymorphism is associated with frontotemporal lobar degeneration, but little is known about how it affects the brain.

METHODS

We investigated the rs1990622 polymorphism in relation to regional brain volumes to identify potential structures through which TMEM106B confers risk for frontotemporal lobar degeneration. In 4413 nondemented and stroke-free participants from the population-based Rotterdam Study, 150 cortical brain structures and 6 commissural regions were segmented from magnetic resonance imaging.

RESULTS

A distinct pattern of association was found between rs1990622 and gray matter volume of left-sided temporal brain regions important for language processing, including the superior temporal gyrus (β=-88.8 μL per risk allele, p=7.64×10(-5)), which contains Wernicke's area. The risk allele was also associated with a smaller anterior commissure cross-sectional area (β=-.167 mm2 per risk allele, p=4.90×10(-5)) and posterior part of the corpus callosum (β=-15.3 μL per risk allele, p=1.23×10(-5)), both of which contain temporal lobe commissural tracts.

CONCLUSIONS

The asymmetric, predominantly left-sided involvement suggests an effect of TMEM106B on functions lateralized to the dominant hemisphere, such as language. These results show that, in nondemented persons, TMEM106B influences the volume of temporal brain regions that are important for language processing.

Neural compensation in adulthood following very preterm birth demonstrated during a visual paired associates learning task

Very preterm birth (VPT; < 33 weeks of gestation) is associated with an increased risk of learning disability, which contributes to more VPT-born children repeating grades and underachieving in school. Learning problems associated with VPT birth may be caused by pathophysiological alterations in neurodevelopment resulting from perinatal brain insult; however, adaptive neuroplastic processes may subsequently occur in the developing preterm brain which ameliorate, to an extent, the potential sequelae of altered neurophysiology. Here, we used functional magnetic resonance imaging (fMRI) to compare neuronal activation in 24 VPT individuals and 22 controls (CT) in young adulthood during a learning task consisting of the encoding and subsequent recognition of repeated visual paired associates. Structural MRI data were also collected and analysed in order to explore possible structure-function associations. Whilst the two groups did not differ in their learning ability, as demonstrated by their capacity to recognize previously-seen and previously-unseen visual pairs, between-group differences in linear patterns of Blood Oxygenation Level Dependant (BOLD) activity were observed across the four repeated blocks of the task for both the encoding and recognition conditions, suggesting that the way learning takes place differs between the two groups. During encoding, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the cerebellum, the anterior cingulate gyrus, the midbrain/substantia nigra, medial temporal (including parahippocampal) gyrus and inferior and superior frontal gyri. During the recognition condition, significant between-group differences in patterns of BOLD activity were seen in clusters centred on the claustrum and the posterior cerebellum. Structural analysis revealed smaller grey matter volume in right middle temporal gyrus in VPT individuals compared to controls, however volume in this region was not significantly associated with functional activation. These results demonstrate that although cognitive task performance between VPT individuals and controls may be comparable on certain measures, differences in BOLD signal may also be evident, some of which could represent compensatory neural processes following VPT-related brain insult.

Preterm birth and structural brain alterations in early adulthood

Alterations in cortical development and impaired neurodevelopmental outcomes have been described following very preterm (VPT) birth in childhood and adolescence, but only a few studies to date have investigated grey matter (GM) and white matter (WM) maturation in VPT samples in early adult life. Using voxel-based morphometry (VBM) we studied regional GM and WM volumes in 68 VPT-born individuals (mean gestational age 30 weeks) and 43 term-born controls aged 19–20 years, and their association with cognitive outcomes (Hayling Sentence Completion Test, Controlled Oral Word Association Test, Visual Reproduction test of the Wechsler Memory Scale-Revised) and gestational age. Structural MRI data were obtained with a 1.5 Tesla system and analysed using the VBM8 toolbox in SPM8 with a customized study-specific template. Similarly to results obtained at adolescent assessment, VPT young adults compared to controls demonstrated reduced GM volume in temporal, frontal, insular and occipital areas, thalamus, caudate nucleus and putamen. Increases in GM volume were noted in medial/anterior frontal gyrus. Smaller subcortical WM volume in the VPT group was observed in temporal, parietal and frontal regions, and in a cluster centred on posterior corpus callosum/thalamus/fornix. Larger subcortical WM volume was found predominantly in posterior brain regions, in areas beneath the parahippocampal and occipital gyri and in cerebellum. Gestational age was associated with GM and WM volumes in areas where VPT individuals demonstrated GM and WM volumetric alterations, especially in temporal, parietal and occipital regions. VPT participants scored lower than controls on measures of IQ, executive function and non-verbal memory. When investigating GM and WM alterations and cognitive outcome scores, subcortical WM volume in an area beneath the left inferior frontal gyrus accounted for 14% of the variance of full-scale IQ (F = 12.9, p < 0.0001). WM volume in posterior corpus callosum/thalamus/fornix and GM volume in temporal gyri bilaterally, accounted for 21% of the variance of executive function (F = 9.9, p < 0.0001) and WM in the posterior corpus callosum/thalamus/fornix alone accounted for 17% of the variance of total non-verbal memory scores (F = 9.9, p < 0.0001). These results reveal that VPT birth continues to be associated with altered structural brain anatomy in early adult life, although it remains to be ascertained whether these changes reflect neurodevelopmental delays or long lasting structural alterations due to prematurity. GM and WM alterations correlate with length of gestation and mediate cognitive outcome.

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Preterm birth is associated with brain alterations in early adulthood

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Preterm birth affects maturation of both white and grey matter

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Volume alterations are observed in temporal, frontal, parietal and occipital areas

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Regional alterations mediate the effects of preterm birth on cognitive functioning

Anterior Commissure Involvement in Humanherpes Virus 6 Encephalitis

The anterior commissure is an evolutionarily conserved nerve bundle that connects the right and left hemispheres, playing pivotal neurological roles in visual, linguistic, and olfactory functions. The authors herein describe a 16-month-old boy with high fever, lethargy, and recurrent seizures. Polymerase chain reaction (PCR) examination detected human herpesvirus 6 (HHV-6) in both the cerebrospinal fluid and the pharyngeal swabs, leading to the diagnosis of HHV-6 encephalitis. Brain magnetic resonance imaging (MRI) 4 days after disease onset distinctly revealed anterior commissure involvement on diffusion-weighted images and apparent diffusion coefficient maps, suggesting that this lesion was cytotoxic edema. After treatment with 30 mg/kg/d methylprednisolone for 3 days, the anterior commissure involvement on MRI was completely diminished. This is the first MRI report rarely showing anterior commissure involvement in encephalitis, suggesting that this lesion might be caused by direct invasion of HHV-6 or transient axonal swelling associated with inferior temporal lobe damage.

Vulnerability of the ventral language network in children with focal epilepsy

Croft et al. present fMRI and functional connectivity analyses of the language network in children with epilepsy and healthy controls. In both groups, the network is organised into dorsal and ventral systems. Activation of the ventral network is reduced in children with epilepsy, in association with poorer language function.

Children with focal epilepsy are at increased risk of language impairment, yet the neural substrate of this dysfunction is not yet known. Using functional magnetic resonance imaging we investigated the impact of focal epilepsy on the developing language system using measures of network topology (spatial organization of activation) and synchrony (functional connectivity). We studied healthy children (n = 48, 4–12 years, 24 females) and children with focal epilepsy (n = 21, 5–12 years, nine females) with left hemisphere language dominance. Participants performed an age-adjusted auditory description decision task during functional magnetic resonance imaging, to identify perisylvian language regions. Mean signal change was extracted from eight left perisylvian regions of interest and compared between groups. Paired region of interest functional connectivity analysis was performed on time course data from the same regions, to investigate left network synchrony. Two principal component analyses were performed to extract (i) patterns of activation (using mean signal change data); and (ii) patterns of synchronized regions (using functional connectivity data). For both principal component analyses two components (networks) were extracted, which mapped onto the functional anatomy of dorsal and ventral language systems. Associations among network variables, age, epilepsy-related factors and verbal ability were assessed. Activated networks were affected by age and epilepsy [F(2,60) = 3.74, P = 0.03]: post hoc analyses showed, for healthy children, activation in both ventral and dorsal networks decreased with age (P = 0.02). Regardless of age and task performance, children with epilepsy showed reduced activation of the ventral network (P < 0.001). They also showed a trend for increased activation of the dorsal network (P = 0.08) associated with improved task performance (r = 0.62, P = 0.008). Crucially, decreased activation of the ventral network in patients predicted poorer language outcome ( = 0.47, P = 0.002). This suggests childhood onset epilepsy preferentially alters maturation of the ventral language system, and this is related to poorer language ability.

An inability to learn to read caused by shaken baby syndrome

We report a 12-year-old boy who suffered from shaken baby syndrome at the age of 4 months and has been unable to learn to read even high-frequency, three-letter words, despite slow but accurate letter naming. He had a right homonymous hemianopia and evidence of impaired higher visual function, but not at a severe enough level to account for his inability to read. Speech production and reception of language were impaired for his age but at least of an order of magnitude better than his reading performance. MRI scanning revealed focal damage to the dorsal and ventral reading pathways. This case challenges the Kennard principle, a widely accepted assumption which claims that the earlier a brain injury occurs, the better the recovery. It also adds to the growing literature suggesting that early damage to multiple parts of the language learning network can result in relatively selective impairments later in life.

New imaging approaches to evaluate newborn brain injury and their role in predicting developmental disorders

PURPOSE OF REVIEW

This review highlights recent work using advanced imaging approaches that have improved our understanding of the underlying neural mechanisms associated with disrupted brain development or demonstrated the potential of MRI to provide objective biomarkers of cerebral injury that relate to subsequent neurodevelopmental performance.

RECENT FINDINGS

Preterm birth impacts on the development of thalamocortical connections to inferior frontal and medial temporal cortex, and cingulate gyri. Impairments to cortical development in these regions are evident in early adulthood and associated with lower intelligence quotient scores. Disruptions to microstructural development of cortical gray matter are prevalent in survivors of preterm birth and related to immaturity at birth, postnatal growth and neurodevelopmental performance. Brain dysmaturation is also evident in infants with congenital heart disease and is detectable prior to surgery, highlighting the influence of adverse conditions on in-utero brain development. In infants with hypoxic-ischemic encephalopathy who have undergone therapeutic hypothermia, quantitative magnetic resonance measures in the neonatal period are related to performance at 2 years.

SUMMARY

Advanced MRI approaches offer the opportunity to assess objectively brain structure and function, and a number of studies, spanning different patient groups, demonstrate their utility as early biomarkers of altered neurological outcome.

Growing up after extremely preterm birth: lifespan mental health outcomes

There is growing interest in the long-term mental health sequelae of extremely preterm birth. In this paper we review literature relating to mental health outcomes across the lifespan. Studies conducted in the preschool years, school age and adolescence, and adulthood show continuity in outcomes and point to an increased risk for inattention, socio-communicative problems and emotional difficulties in individuals born extremely preterm. Both behavioural and neuroimaging studies also provide evidence of a neurodevelopmental origin for mental health disorders in this population. Here we summarise contemporary evidence and highlight key methodological considerations for carrying out and interpreting studies in this field.

Preterm birth affects the developmental synergy between cortical folding and cortical connectivity observed on multimodal MRI

The survival rates of infants born prematurely have improved as a result of advances in neonatal care, although there remains an increased risk of subsequent disability. Accurate measurement of the shape and appearance of the very preterm brain at term-equivalent age may guide the development of predictive biomarkers of neurological outcome. We demonstrate in 92 preterm infants (born at an average gestational age of 27.0±2.7weeks) scanned at term equivalent age (scanned at 40.4±1.74weeks) that the cortical sulcation ratio varies spatially over the cortical surface at term equivalent age and correlates significantly with gestational age at birth (r=0.49,p<0.0001). In the underlying white matter, fractional anisotropy of local white matter regions correlated significantly with gestational age at birth at term equivalent age (for the genu of the corpus callosum r=0.26,p=0.02 and for the splenium r=0.52,p<0.001) and in addition the fractional anisotropy in these local regions varies according to location. Finally, we demonstrate that connectivity measurements from tractography correlate significantly and specifically with the sulcation ratio of the overlying cortical surface at term equivalent age in a subgroup of 20 infants (r={0.67,0.61,0.86}, p={0.004,0.01,0.00002}) for tract systems emanating from the left and right corticospinal tracts and the corpus callosum respectively). Combined, these results suggest a close relationship between the cortical surface phenotype and underlying white matter structure assessed by diffusion weighted MRI. The spatial surface pattern may allow inference on the connectivity and developmental trajectory of the underlying white matter complementary to diffusion imaging and this result may guide the development of biomarkers of functional outcome.

Pediatric traumatic brain injury: language outcomes and their relationship to the arcuate fasciculus

Pediatric traumatic brain injury (TBI) may result in long-lasting language impairments alongside dysarthria, a motor-speech disorder. Whether this co-morbidity is due to the functional links between speech and language networks, or to widespread damage affecting both motor and language tracts, remains unknown. Here we investigated language function and diffusion metrics (using diffusion-weighted tractography) within the arcuate fasciculus, the uncinate fasciculus, and the corpus callosum in 32 young people after TBI (approximately half with dysarthria) and age-matched healthy controls (n=17). Only participants with dysarthria showed impairments in language, affecting sentence formulation and semantic association. In the whole TBI group, sentence formulation was best predicted by combined corpus callosum and left arcuate volumes, suggesting this "dual blow" seriously reduces the potential for functional reorganisation. Word comprehension was predicted by fractional anisotropy in the right arcuate. The co-morbidity between dysarthria and language deficits therefore seems to be the consequence of multiple tract damage.

Specific impairment of functional connectivity between language regions in former early preterms

Very preterm (PT) birth (≤32 weeks of gestation) carries a high risk for an adverse neurodevelopmental outcome. In recent years, the importance of neurocognitive deficits in the language domain has been increasingly recognized, which can be well-characterized using neuropsychological testing and noninvasive imaging approaches. We compared former early PT born children and adolescents (PT, n = 29, 20M) and typically developing children (TD, n = 19, 7M), using conventional fMRI group analyses as well as functional connectivity analyses. We found only small regions with significantly different group activation (PT > TD) but significantly stronger connectivity between superior temporal lobe (STL) language regions in TD participants. There were also significant differences in local and global network efficiency (TD > PT). Surprisingly, there was a stronger connectivity of STL regions with non-STL regions both intrahemispherically and interhemispherically in PT participants, suggesting the coexistence of reduced and increased connectivity in the language network of former PTs. Very similar results were obtained when using task-based versus resting state functional connectivity approaches. Finally, lateralization of functional connectivity correlated with verbal comprehension abilities, suggesting that a more bilateral language comprehension representation is associated with better performance. Our results underline the importance of interhemispheric crosstalk for language comprehension.

Asymmetry of planum temporale constrains interhemispheric language plasticity in children with focal epilepsy

Reorganization of eloquent cortex enables rescue of language functions in patients who sustain brain injury. Individuals with left-sided, early-onset focal epilepsy often show atypical (i.e. bilateral or right-sided) language dominance. Surprisingly, many patients fail to show such interhemispheric shift of language despite having major epileptogenic lesions in close proximity to eloquent cortex. Although a number of epilepsy-related factors may promote interhemispheric plasticity, it has remained unexplored if neuroanatomical asymmetries linked to human language dominance modify the likelihood of atypical lateralization. Here we examined the asymmetry of the planum temporale, one of the most striking asymmetries in the human brain, in relation to language lateralization in children with left-sided focal epilepsy. Language functional magnetic resonance imaging was performed in 51 children with focal epilepsy and left-sided lesions and 36 healthy control subjects. We examined the association of language laterality with a range of potential clinical predictors and the asymmetry of the length of the planum temporale. Using voxel-based methods, we sought to determine the effect of lesion location (in the affected left hemisphere) and grey matter density (in the unaffected right hemisphere) on language laterality. Atypical language lateralization was observed in 19 patients (38%) and in four controls (11%). Language laterality was increasingly right-sided in patients who showed atypical handedness, a left perisylvian ictal electroencephalographic focus, and a lesion in left anterior superior temporal or inferior frontal regions. Most striking was the relationship between rightward asymmetry of the planum temporale and atypical language (R = 0.70, P < 0.0001); patients with a longer planum temporale in the right (unaffected) hemisphere were more likely to have atypical language dominance. Voxel-based regression analysis confirmed that increased grey matter density in the right temporo-parietal junction was correlated with right hemisphere lateralization of language. The length of the planum temporale in the right hemisphere was the main predictor of language lateralization in the epilepsy group, accounting for 48% of variance, with handedness accounting for only a further 5%. There was no correlation between language lateralization and planum temporale asymmetry in the control group. We conclude that asymmetry of the planum temporale may be unrelated to language lateralization in healthy individuals, but the size of the right, contra-lesional planum temporale region may reflect a ‘reserve capacity’ for interhemispheric language reorganization in the presence of a seizure focus and lesions within left perisylvian regions.

Diffusion magnetic resonance imaging in preterm brain injury

INTRODUCTION

White matter injury and abnormal maturation are thought to be major contributors to the neurodevelopmental disabilities observed in children and adolescents who were born preterm. Early detection of abnormal white matter maturation is important in the design of preventive, protective, and rehabilitative strategies for the management of the preterm infant. Diffusion-weighted magnetic resonance imaging (d-MRI) has become a valuable tool in assessing white matter maturation and injury in survivors of preterm birth. In this review, we aim to (1) describe the basic concepts of d-MRI; (2) evaluate the methods that are currently used to analyse d-MRI; (3) discuss neuroimaging correlates of preterm brain injury observed at term corrected age; during infancy, adolescence and in early adulthood; and (4) explore the relationship between d-MRI measures and subsequent neurodevelopmental performance.

METHODS

References for this review were identified through searches of PubMed and Google Scholar before March 2013.

RESULTS

The impact of premature birth on cerebral white matter can be observed from term-equivalent age through to adulthood. Disruptions to white matter development, identified by d-MRI, are related to diminished performance in functional domains including motor performance, cognition and behaviour in early childhood and in later life.

CONCLUSION

d-MRI is an effective tool for investigating preterm white matter injury. With advances in image acquisition and analysis approaches, d-MRI has the potential to be a biomarker of subsequent outcome and to evaluate efficacy of clinical interventions in this population.

Interhemispheric functional connectivity following prenatal or perinatal brain injury predicts receptive language outcome

Early brain injury alters both structural and functional connectivity between the cerebral hemispheres. Despite increasing knowledge on the individual hemispheric contributions to recovery from such injury, we know very little about how their interactions affect this process. In the present study, we related interhemispheric structural and functional connectivity to receptive language outcome following early left hemisphere stroke. We used functional magnetic resonance imaging to study 14 people with neonatal brain injury, and 25 age-matched controls during passive story comprehension. With respect to structural connectivity, we found that increased volume of the corpus callosum predicted good receptive language outcome, but that this is not specific to people with injury. In contrast, we found that increased posterior superior temporal gyrus interhemispheric functional connectivity during story comprehension predicted better receptive language performance in people with early brain injury, but worse performance in typical controls. This suggests that interhemispheric functional connectivity is one potential compensatory mechanism following early injury. Further, this pattern of results suggests refinement of the prevailing notion that better language outcome following early left hemisphere injury relies on the contribution of the contralesional hemisphere (i.e., the "right-hemisphere-take-over" theory). This pattern of results was also regionally specific; connectivity of the angular gyrus predicted poorer performance in both groups, independent of brain injury. These results present a complex picture of recovery, and in some cases, such recovery relies on increased cooperation between the injured hemisphere and homologous regions in the contralesional hemisphere, but in other cases, the opposite appears to hold.

Building Spinal and Brain Commissures: Axon Guidance at the Midline

Commissural circuits are brain and spinal cord connections which interconnect the two sides of the central nervous system (CNS). They play essential roles in brain and spinal cord processing, ensuring left-right coordination and synchronization of information and commands. During the formation of neuronal circuits, all commissural neurons of the central nervous system must accomplish a common task, which is to project their axon onto the other side of the nervous system, across the midline that delineates the two halves of the CNS. How this task is accomplished has been the topic of extensive studies over the last past 20 years and remains one of the best models to investigate axon guidance mechanisms. In the first part of this review, I will introduce the commissural circuits, their general role in the physiology of the nervous system, and their recognized or suspected pathogenic properties in human diseases. In the second part of the review, I will concentrate on two commissural circuits, the spinal commissures and the corpus callosum, to detail the cellular and molecular mechanisms governing their formation, mostly during their navigation at the midline.