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Zhang L, Abdeen N, Lang J. A novel center-based deep contrastive metric learning method for the detection of polymicrogyria in pediatric brain MRI. Comput Med Imaging Graph 2024; 114:102373. [PMID: 38522222 DOI: 10.1016/j.compmedimag.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Polymicrogyria (PMG) is a disorder of cortical organization mainly seen in children, which can be associated with seizures, developmental delay and motor weakness. PMG is typically diagnosed on magnetic resonance imaging (MRI) but some cases can be challenging to detect even for experienced radiologists. In this study, we create an open pediatric MRI dataset (PPMR) containing both PMG and control cases from the Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada. The differences between PMG and control MRIs are subtle and the true distribution of the features of the disease is unknown. This makes automatic detection of potential PMG cases in MRI difficult. To enable the automatic detection of potential PMG cases, we propose an anomaly detection method based on a novel center-based deep contrastive metric learning loss function (cDCM). Despite working with a small and imbalanced dataset our method achieves 88.07% recall at 71.86% precision. This will facilitate a computer-aided tool for radiologists to select potential PMG MRIs. To the best of our knowledge, our research is the first to apply machine learning techniques to identify PMG solely from MRI. Our code is available at: https://github.com/RichardChangCA/Deep-Contrastive-Metric-Learning-Method-to-Detect-Polymicrogyria-in-Pediatric-Brain-MRI. Our pediatric MRI dataset is available at: https://www.kaggle.com/datasets/lingfengzhang/pediatric-polymicrogyria-mri-dataset.
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Affiliation(s)
- Lingfeng Zhang
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, K1N 6N5, Canada.
| | - Nishard Abdeen
- Department of Radiology, University of Ottawa, Ottawa, K1N 6N5, Canada; Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada.
| | - Jochen Lang
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, K1N 6N5, Canada.
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2
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Cortes-Albornoz MC, Bedoya MA, Choi JJ, Jaimes C. MR insights into fetal brain development: what is normal and what is not. Pediatr Radiol 2024; 54:635-645. [PMID: 38416183 DOI: 10.1007/s00247-024-05890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Fetal brain development is a complex, rapid, and multi-dimensional process that can be documented with MRI. In the second and third trimesters, there are predictable developmental changes that must be recognized and differentiated from disease. This review delves into the key biological processes that drive fetal brain development, highlights normal developmental anatomy, and provides a framework to identify pathology. We will summarize the development of the cerebral hemispheres, sulci and gyri, extra-axial and ventricular cerebrospinal fluid, and corpus callosum and illustrate the most common abnormal findings in the clinical setting.
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Affiliation(s)
- Maria Camila Cortes-Albornoz
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jungwhan John Choi
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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3
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Costa FV, Zabegalov KN, Kolesnikova TO, de Abreu MS, Kotova MM, Petersen EV, Kalueff AV. Experimental models of human cortical malformations: from mammals to 'acortical' zebrafish. Neurosci Biobehav Rev 2023; 155:105429. [PMID: 37863278 DOI: 10.1016/j.neubiorev.2023.105429] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
Human neocortex controls and integrates cognition, emotions, perception and complex behaviors. Aberrant cortical development can be triggered by multiple genetic and environmental factors, causing cortical malformations. Animal models, especially rodents, are a valuable tool to probe molecular and physiological mechanisms of cortical malformations. Complementing rodent studies, the zebrafish (Danio rerio) is an important model organism in biomedicine. Although the zebrafish (like other fishes) lacks neocortex, here we argue that this species can still be used to model various aspects and brain phenomena related to human cortical malformations. We also discuss novel perspectives in this field, covering both advantages and limitations of using mammalian and zebrafish models in cortical malformation research. Summarizing mounting evidence, we also highlight the importance of translationally-relevant insights into the pathogenesis of cortical malformations from animal models, and discuss future strategies of research in the field.
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Affiliation(s)
- Fabiano V Costa
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | - Konstantin N Zabegalov
- Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | - Tatiana O Kolesnikova
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | | | - Maria M Kotova
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia
| | | | - Allan V Kalueff
- World-class Research Center "Center for Personalized Medicine", Almazov National Medical Research Center, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia; Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg, Russia; Laboratory of Preclinical Bioscreening, Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, Pesochny, Russia; Ural Federal University, Yekaterinburg, Russia; Neurobiology Program, Sirius University of Science and Technology, Sirius Federal Territory, Russia.
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4
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Karner E, Kasprian GJ, Farr A, Krampl-Bettelheim E. Polymicrogyria in a patient after twin-twin transfusion syndrome. BMJ Case Rep 2023; 16:e255510. [PMID: 37739446 PMCID: PMC10533711 DOI: 10.1136/bcr-2023-255510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
This case report presents a patient with a monochorionic twin pregnancy, development of twin-twin transfusion-syndrome (TTTS) and polymicrogyria (PMG) of one fetus. Due to TTTS grade 3, fetoscopic laser ablation was performed at gestational week 16+1. Sonographic follow-up showed a cortical malformation of the right parietal lobe in the former donor, which was identified as PMG by MRI scans. We describe the course of the pregnancy, as well as the clinical, especially neurological, development of the child over 3 years. This case report documents the power of neuroplasticity, leading to comparably good neurological outcome in an extensive, likely acquired cortical malformation. Further, it emphasises the importance of a thorough prenatal imaging characterisation of malformations of cortical development for optimal prenatal counselling of these cases.
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Affiliation(s)
- Eva Karner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Wien, Austria
| | - Gregor J Kasprian
- Department of Radiology, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Wien, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Wien, Austria
| | - Elisabeth Krampl-Bettelheim
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Wien, Austria
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5
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Akula SK, Chen AY, Neil JE, Shao DD, Mo A, Hylton NK, DiTroia S, Ganesh VS, Smith RS, O’Kane K, Yeh RC, Marciano JH, Kirkham S, Kenny CJ, Song JHT, Al Saffar M, Millan F, Harris DJ, Murphy AV, Klemp KC, Braddock SR, Brand H, Wong I, Talkowski ME, O’Donnell-Luria A, Lai A, Hill RS, Mochida GH, Doan RN, Barkovich AJ, Yang E, Amrom D, Andermann E, Poduri A, Walsh CA. Exome Sequencing and the Identification of New Genes and Shared Mechanisms in Polymicrogyria. JAMA Neurol 2023; 80:980-988. [PMID: 37486637 PMCID: PMC10366952 DOI: 10.1001/jamaneurol.2023.2363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/23/2023] [Indexed: 07/25/2023]
Abstract
Importance Polymicrogyria is the most commonly diagnosed cortical malformation and is associated with neurodevelopmental sequelae including epilepsy, motor abnormalities, and cognitive deficits. Polymicrogyria frequently co-occurs with other brain malformations or as part of syndromic diseases. Past studies of polymicrogyria have defined heterogeneous genetic and nongenetic causes but have explained only a small fraction of cases. Objective To survey germline genetic causes of polymicrogyria in a large cohort and to consider novel polymicrogyria gene associations. Design, Setting, and Participants This genetic association study analyzed panel sequencing and exome sequencing of accrued DNA samples from a retrospective cohort of families with members with polymicrogyria. Samples were accrued over more than 20 years (1994 to 2020), and sequencing occurred in 2 stages: panel sequencing (June 2015 to January 2016) and whole-exome sequencing (September 2019 to March 2020). Individuals seen at multiple clinical sites for neurological complaints found to have polymicrogyria on neuroimaging, then referred to the research team by evaluating clinicians, were included in the study. Targeted next-generation sequencing and/or exome sequencing were performed on probands (and available parents and siblings) from 284 families with individuals who had isolated polymicrogyria or polymicrogyria as part of a clinical syndrome and no genetic diagnosis at time of referral from clinic, with sequencing from 275 families passing quality control. Main Outcomes and Measures The number of families in whom genetic sequencing yielded a molecular diagnosis that explained the polymicrogyria in the family. Secondarily, the relative frequency of different genetic causes of polymicrogyria and whether specific genetic causes were associated with co-occurring head size changes were also analyzed. Results In 32.7% (90 of 275) of polymicrogyria-affected families, genetic variants were identified that provided satisfactory molecular explanations. Known genes most frequently implicated by polymicrogyria-associated variants in this cohort were PIK3R2, TUBB2B, COL4A1, and SCN3A. Six candidate novel polymicrogyria genes were identified or confirmed: de novo missense variants in PANX1, QRICH1, and SCN2A and compound heterozygous variants in TMEM161B, KIF26A, and MAN2C1, each with consistent genotype-phenotype relationships in multiple families. Conclusions and Relevance This study's findings reveal a higher than previously recognized rate of identifiable genetic causes, specifically of channelopathies, in individuals with polymicrogyria and support the utility of exome sequencing for families affected with polymicrogyria.
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Affiliation(s)
- Shyam K. Akula
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
- Harvard-MIT MD/PhD Program, Harvard Medical School, Boston, Massachusetts
| | - Allen Y. Chen
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Jennifer E. Neil
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Diane D. Shao
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Alisa Mo
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Norma K. Hylton
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
- Harvard-MIT MD/PhD Program, Harvard Medical School, Boston, Massachusetts
| | - Stephanie DiTroia
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Vijay S. Ganesh
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Richard S. Smith
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Katherine O’Kane
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Rebecca C. Yeh
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Jack H. Marciano
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Samantha Kirkham
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Connor J. Kenny
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Janet H. T. Song
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Muna Al Saffar
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
- Department of Genetics and Genomics, United Arab Emirates University, United Arab Emirates
| | | | - David J. Harris
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Andrea V. Murphy
- Division of Medical Genetics, Our Lady of the Lake Health System, Baton Rouge, Louisiana
| | - Kara C. Klemp
- Division of Medical Genetics, Department of Pediatrics Saint Louis University School of Medicine, St Louis, Missouri
| | - Stephen R. Braddock
- Division of Medical Genetics, Department of Pediatrics Saint Louis University School of Medicine, St Louis, Missouri
| | - Harrison Brand
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Isaac Wong
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Michael E. Talkowski
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Anne O’Donnell-Luria
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Abbe Lai
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Robert Sean Hill
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Ganeshwaran H. Mochida
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Ryan N. Doan
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
| | - A. James Barkovich
- Benioff Children’s Hospital, Departments of Radiology, Pediatrics, Neurology, and Neurological Surgery, University of California, San Francisco, San Francisco
| | - Edward Yang
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Dina Amrom
- Neurogenetics Unit, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Neurology, Queen Fabiola Children’s University Hospital, Brussels, Belgium
- Pediatric Neurology Unit, Centre Hospitalier de Luxembourg, Grand-Duchy of Luxembourg
| | - Eva Andermann
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- Pediatric Neurology Unit, Centre Hospitalier de Luxembourg, Grand-Duchy of Luxembourg
- Epilepsy Research Group, Montreal Neurological Hospital and Institute, Quebec, Canada
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Annapurna Poduri
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Christopher A. Walsh
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, and Allen Discovery Center for Human Brain Evolution, Boston, Massachusetts
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts
- Harvard-MIT MD/PhD Program, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Center for Genomic Medicine, Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Zhang L, Zhao L, Liu D, Wu Z, Wang X, Liu T, Zhu D. Cortex2vector: anatomical embedding of cortical folding patterns. Cereb Cortex 2022; 33:5851-5862. [PMID: 36487182 PMCID: PMC10183757 DOI: 10.1093/cercor/bhac465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Current brain mapping methods highly depend on the regularity, or commonality, of anatomical structure, by forcing the same atlas to be matched to different brains. As a result, individualized structural information can be overlooked. Recently, we conceptualized a new type of cortical folding pattern called the 3-hinge gyrus (3HG), which is defined as the conjunction of gyri coming from three directions. Many studies have confirmed that 3HGs are not only widely existing on different brains, but also possess both common and individual patterns. In this work, we put further effort, based on the identified 3HGs, to establish the correspondences of individual 3HGs. We developed a learning-based embedding framework to encode individual cortical folding patterns into a group of anatomically meaningful embedding vectors (cortex2vector). Each 3HG can be represented as a combination of these embedding vectors via a set of individual specific combining coefficients. In this way, the regularity of folding pattern is encoded into the embedding vectors, while the individual variations are preserved by the multi-hop combination coefficients. Results show that the learned embeddings can simultaneously encode the commonality and individuality of cortical folding patterns, as well as robustly infer the complicated many-to-many anatomical correspondences among different brains.
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Affiliation(s)
- Lu Zhang
- Department of Computer Science and Engineering, The University of Texas at Arlington , Arlington, 76010, USA
| | - Lin Zhao
- Department of Computer Science, The University of Georgia , Athens, 30602, USA
| | | | - Zihao Wu
- Department of Computer Science, The University of Georgia , Athens, 30602, USA
| | - Xianqiao Wang
- College of Engineering, The University of Georgia , Athens, 30602, USA
| | - Tianming Liu
- Department of Computer Science, The University of Georgia , Athens, 30602, USA
| | - Dajiang Zhu
- Department of Computer Science and Engineering, The University of Texas at Arlington , Arlington, 76010, USA
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Dos Santos Heringer L, Rios Carvalho J, Teixeira Oliveira J, Texeira Silva B, de Souza Aguiar Dos Santos DM, Martinez Martinez Toledo AL, Borges Savoldi LM, Magalhães Portela D, Adriani Marques S, Campello Costa Lopes P, Blanco Martinez AM, Mendonça HR. Altered excitatory and inhibitory neocortical circuitry leads to increased convulsive severity after pentylenetetrazol injection in an animal model of schizencephaly, but not of microgyria. Epilepsia Open 2022; 7:462-473. [PMID: 35808864 PMCID: PMC9436300 DOI: 10.1002/epi4.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Malformations of the polymicrogyria spectrum can be mimicked in rodents through neonatal transcranial focal cortical freeze lesions. The animals presenting the malformations present both altered synaptic events and epileptiform activity in the vicinity of the microgyrus, but the comprehension of their contribution to increased predisposition or severity of seizures require further studies. METHODS In order to investigate these issues, we induced both microgyria and schizencephaly in 57 mice and evaluated: their convulsive susceptibility and severity after pentyleneterazol (PTZ) treatment, the quantification of their symmetric and asymmetric synapses, the morphology of their dendritic arbors, and the content of modulators of synaptogenesis, such as SPARC, gephyrin and GAP-43 within the adjacent visual cortex. RESULTS Our results have shown that only schizencephalic animals present increased convulsive severity. Nevertheless, both microgyric and schizencephalic cortices present increased synapse number and dendritic complexity of layer IV and layer V-located neurons. Specifically, the microgyric cortex presented reduced inhibitory synapses, while the schizencephalic cortex presented increased excitatory synapses. This altered synapse number is correlated with decreased content of both the anti-synaptogenic factor SPARC and the inhibitory postsynaptic organizer gephyrin in both malformed groups. Besides, GAP-43 content and dendritic spines number are enhanced exclusively in schizencephalic cortices. SIGNIFICANCE In conclusion, our study supports the hypothesis that the sum of synaptic alterations drives to convulsive aggravation in animals with schizencephaly, but not microgyria after PTZ treatment. These findings reveal that different malformations of cortical development should trigger epilepsy via different mechanisms, requiring further studies for development of specific therapeutic interventions.
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Affiliation(s)
- Luiza Dos Santos Heringer
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Julia Rios Carvalho
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | | | - Bruna Texeira Silva
- Laboratory of Neuroplasticity, Department of Neurobiology, Institute of Biology, Brazil, Niterói, - RJ
| | - Domethila Mariano de Souza Aguiar Dos Santos
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Anna Lecticia Martinez Martinez Toledo
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Laura Maria Borges Savoldi
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Debora Magalhães Portela
- Integrated Lab of Morphology, Institute of Biodiversity and Sustainability NUPEM, Brazil, Macaé, - RJ
| | - Suelen Adriani Marques
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | | | - Ana Maria Blanco Martinez
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ
| | - Henrique Rocha Mendonça
- Neurodegeneration and Repair Lab, Department of Pathology, Postgraduate Program in Anatomical Pathology, Faculty of Medicine, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil, Rio de Janeiro, - RJ.,Integrated Lab of Morphology, Institute of Biodiversity and Sustainability NUPEM, Brazil, Macaé, - RJ
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8
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Congenital Brain Malformations: An Integrated Diagnostic Approach. Semin Pediatr Neurol 2022; 42:100973. [PMID: 35868725 DOI: 10.1016/j.spen.2022.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Congenital brain malformations are abnormalities present at birth that can result from developmental disruptions at various embryonic or fetal stages. The clinical presentation is nonspecific and can include developmental delay, hypotonia, and/or epilepsy. An informed combination of imaging and genetic testing enables early and accurate diagnosis and management planning. In this article, we provide a streamlined approach to radiologic phenotyping and genetic evaluation of brain malformations. We will review the clinical workflow for brain imaging and genetic testing with up-to-date ontologies and literature references. The organization of this article introduces a streamlined approach for imaging-based etiologic classification into malformative, destructive, and migrational abnormalities. Specific radiologic ontologies are then discussed in detail, with correlation of key neuroimaging features to embryology and molecular pathogenesis.
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9
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Major brain malformations: corpus callosum dysgenesis, agenesis of septum pellucidum and polymicrogyria in patients with BCORL1-related disorders. J Hum Genet 2022; 67:95-101. [PMID: 34400773 DOI: 10.1038/s10038-021-00971-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE BCORL1, a transcriptional co-repressor, has a role in cortical migration, neuronal differentiation, maturation, and cerebellar development. We describe BCORL1 as a new genetic cause for major brain malformations. METHODS AND RESULTS We report three patients from two unrelated families with neonatal onset intractable epilepsy and profound global developmental delay. Brain MRI of two siblings from the first family depicted hypoplastic corpus callosum and septal agenesis (ASP) in the older brother and unilateral perisylvian polymicrogyria (PMG) in the younger one. MRI of the patient from the second family demonstrated complete agenesis of corpus callosum (CC). Whole Exome Sequencing revealed a novel hemizygous variant in NM_021946.5 (BCORL1):c.796C>T (p.Pro266Ser) in the two siblings from the first family and the NM_021946.5 (BCORL1): c.3376G>A; p.Asp1126Asn variant in the patient from the second family, both variants inherited from healthy mothers. We reviewed the patients' charts and MRIs and compared the phenotype to the other published BCORL1-related cases. Brain malformations have not been previously described in association with the BCORL1 phenotype. We discuss the potential influence of BCORL1 on brain development. CONCLUSIONS We suggest that BCORL1 variants present with a spectrum of neurodevelopmental disorders and can lead to major brain malformations originating at different stages of fetal development. We suggest adding BCORL1 to the genetic causes of PMG, ASP, and CC dysgenesis.
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10
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Kozłowska Z, Komasińska P, Steinborn B, Toboła-Wróbel K, Pietryga M, Szymankiewicz-Breborowicz M, Szczapa T, Bekiesińska-Figatowska M. Spontaneous Resolution of Congenital Dural Venous Sinus Ectasia Associated With Polymicrogyria-Case Report. Front Pediatr 2022; 10:822551. [PMID: 35295696 PMCID: PMC8918672 DOI: 10.3389/fped.2022.822551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Dural venous sinus ectasia belongs to a rare group of venous sinus malformations of unknown origin and uncertain prognosis. We report the first patient with idiopathic congenital ectasia of the confluence of sinuses with thrombosis associated with bilateral polymicrogyria. It may highlight the causative relation between ischemia within the central nervous system due to torcular herophili ectasia with thrombosis in early pregnancy and the development of cortical malformations in neonates. We also highlight the role of MR neuroimaging in the diagnosis of these entities.
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Affiliation(s)
- Zuzanna Kozłowska
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Paulina Komasińska
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kinga Toboła-Wróbel
- Department of Obstetrics and Women's Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Pietryga
- Department of Obstetrics and Women's Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Szymankiewicz-Breborowicz
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Szczapa
- Department of Newborns' Infectious Diseases, Chair of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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11
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NAS-optimized topology-preserving transfer learning for differentiating cortical folding patterns. Med Image Anal 2021; 77:102316. [PMID: 34979433 DOI: 10.1016/j.media.2021.102316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022]
Abstract
Increasing evidence suggests that cortical folding patterns of human cerebral cortex manifest overt structural and functional differences. However, for interpretability, few studies leverage advanced techniques (e.g., deep learning) to investigate the difference among cortical folds, resulting in more differences yet to be extensively explored. To this end, we proposed an effective topology-preserving transfer learning framework to differentiate cortical fMRI time series extracted from cortical folds. Our framework consists of three main parts: (1) Neural architecture search (NAS), which is used to devise a well-performing network structure based on an initialized hand-designed super-graph in an image dataset; (2) Topology-preserving transfer, which takes the model searched by NAS as the source network, keeping the topological connectivity in the network unchanged, while transforming all 2D operations including convolution and pooling into 1D, therefore resulting in a topology-preserving network, named TPNAS-Net; (3) Classification and correlation analysis, which involves using the TPNAS-Net to classify 1D cortical fMRI time series for each individual brain, and performing a group difference analysis between autism spectrum disorder (ASD) and healthy control (HC) and correlation analysis with clinical information (i.e., age). Extensive experiments on two ASD datasets obtain consistent results, demonstrating that the TPNAS-Net not only discriminates cortical folding patterns at high classification accuracy, but also captures subtle differences between ASD and HC (p-value = 0.042). In addition, we discover that there is a positive correlation between the classification accuracy and age in ASD (r = 0.39, p-value = 0.04). These findings together suggest that structural and functional differences in cortical folding patterns between ASD and HC may provide a potentially useful biomarker for the diagnosis of ASD.
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12
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Kachramanoglou C, Jan W, Jones B, Papachatzi E, Zombori L, Khan F, Gaur P, Basheer N, Randell P, Lyall H. Diagnostic analysis of baseline brain MRI features in infants with congenital cytomegalovirus infection: a simplified scoring system. Clin Radiol 2021; 76:942.e7-942.e14. [PMID: 34642043 DOI: 10.1016/j.crad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/10/2021] [Indexed: 01/16/2023]
Abstract
AIM To characterise the magnetic resonance imaging (MRI) features of infants with congenital cytomegalovirus (CMV) and categorise those into a simplified MRI scoring system. MATERIALS AND METHODS Three neuroradiologists reviewed the examinations of 71 infants retrospectively and scored for the presence of a white matter signal abnormality and structural lesion and each MRI was given a score of 0, 1, 2, or 3 for normal, structural abnormality alone, white matter abnormality alone, white matter abnormality plus structural lesion, respectively. Imaging features were outlines according to symptomatology. Chi-square and Spearman's rho were used to test relationships between MRI features and viral loads and MRI score/symptomatic disease respectively. Cohen's Kappa coefficient was used to assess interobserver agreement. RESULTS Of the 49 abnormal studies, 40% (n=20) were seen in asymptomatic infants. The commonest finding was white matter signal abnormality, followed by cyst formation and polymicrogyria (86%, n=42; 71%, n=35; and 33%, n=16, respectively). Cysts were significantly positively correlated with white matter abnormalities and polymicrogyria. On the MRI score, 31%, 10%, 15%, and 44% obtained a score of 0, 1, 2, and 3, respectively; the MRI score was positively correlated with log-transformed viral loads. Interobserver agreement for the presence of white matter signal abnormality, cyst formation, malformations of cortical development (MCD), and global MRI score was excellent (k = 0.82, 0.94, 0.96, and 0.86, respectively). CONCLUSION Baseline MRI provides information valuable for treatment decisions, especially in "asymptomatic" infants. The simplified scoring system is easier to use, incorporating solely the imaging findings that are anticipated to have an effect on clinical outcome.
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Affiliation(s)
- C Kachramanoglou
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK.
| | - W Jan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - B Jones
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - E Papachatzi
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - L Zombori
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - F Khan
- Neuroradiology Department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - P Gaur
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - N Basheer
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - P Randell
- North West London Pathology, London, UK
| | - H Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
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13
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Sanfelici R, Ruef A, Antonucci LA, Penzel N, Sotiras A, Dong MS, Urquijo-Castro M, Wenzel J, Kambeitz-Ilankovic L, Hettwer MD, Ruhrmann S, Chisholm K, Riecher-Rössler A, Falkai P, Pantelis C, Salokangas RKR, Lencer R, Bertolino A, Kambeitz J, Meisenzahl E, Borgwardt S, Brambilla P, Wood SJ, Upthegrove R, Schultze-Lutter F, Koutsouleris N, Dwyer DB. Novel Gyrification Networks Reveal Links with Psychiatric Risk Factors in Early Illness. Cereb Cortex 2021; 32:1625-1636. [PMID: 34519351 DOI: 10.1093/cercor/bhab288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Adult gyrification provides a window into coordinated early neurodevelopment when disruptions predispose individuals to psychiatric illness. We hypothesized that the echoes of such disruptions should be observed within structural gyrification networks in early psychiatric illness that would demonstrate associations with developmentally relevant variables rather than specific psychiatric symptoms. We employed a new data-driven method (Orthogonal Projective Non-Negative Matrix Factorization) to delineate novel gyrification-based networks of structural covariance in 308 healthy controls. Gyrification within the networks was then compared to 713 patients with recent onset psychosis or depression, and at clinical high-risk. Associations with diagnosis, symptoms, cognition, and functioning were investigated using linear models. Results demonstrated 18 novel gyrification networks in controls as verified by internal and external validation. Gyrification was reduced in patients in temporal-insular, lateral occipital, and lateral fronto-parietal networks (pFDR < 0.01) and was not moderated by illness group. Higher gyrification was associated with better cognitive performance and lifetime role functioning, but not with symptoms. The findings demonstrated that gyrification can be parsed into novel brain networks that highlight generalized illness effects linked to developmental vulnerability. When combined, our study widens the window into the etiology of psychiatric risk and its expression in adulthood.
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Affiliation(s)
- Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max Planck School of Cognition, Leipzig, 04103, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, 70124, Italy
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Aristeidis Sotiras
- Department of Radiology and Institute of Informatics, Washington University in St. Luis, st. Luis, MO63110, USA
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Maria Urquijo-Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Psychology, Aston University, Birmingham, B4 7ET, UK
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max-Planck Institute of Psychiatry, Munich, 80804, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centrem University of Melbourne & Melbourne Health, Melbourne, 3053, Australia
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, 48149, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, 23538, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, 70124, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, 40629, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, 23538, Germany.,Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, 4002, Switzerland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano, 20122, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, 3052, Australia.,Orygen, Melbourne, 3052, Australia.,School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.,Early Intervention Service, Birmingham Women's and Children's NHS foundation Trust, Birmingham, B4 6NH, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, 40629, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surubaya, 60286, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, 3000, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany.,Max-Planck Institute of Psychiatry, Munich, 80804, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, 80336, Germany
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14
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Lerman-Sagie T, Pogledic I, Leibovitz Z, Malinger G. A practical approach to prenatal diagnosis of malformations of cortical development. Eur J Paediatr Neurol 2021; 34:50-61. [PMID: 34390998 DOI: 10.1016/j.ejpn.2021.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/27/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
Malformations of cortical development (MCD) can frequently be diagnosed at multi-disciplinary Fetal Neurology clinics with the aid of multiplanar neurosonography and MRI. The patients are usually referred following prenatal sonographic screening that raises the suspicion of a possible underlying MCD. These indirect findings include, but are not limited to, ventriculomegaly (lateral ventricles larger than 10 mm), asymmetric ventricles, commissural anomalies, absent cavum septum pellucidum, cerebellar vermian and/or hemispheric anomalies, abnormal head circumference (microcephaly or macrocephaly), multiple CNS malformations, and associated systemic defects. The aim of this paper is to suggest a practical approach to prenatal diagnosis of malformations of cortical development utilizing dedicated neurosonography and MRI, based on the current literature and our own experience. We suggest that an MCD should be suspected in utero when the following intracranial imaging signs are present: abnormal development of the Sylvian fissure; delayed achievement of cortical milestones, premature appearance of sulcation; irregular ventricular borders, abnormal cortical thickness (thick, thin); abnormal shape and orientation of the sulci and gyri; irregular, abnormal, asymmetric, and enlarged hemisphere; simplified cortex; non continuous cortex or cleft; and intraparenchymal echogenic nodules. Following the putative diagnosis of fetal MCD by neurosonography and MRI, when appropriate and possible (depending on gestational age), the imaging diagnosis is supplemented by genetic studies (CMA and trio whole exome sequencing). In some instances, no further studies are required during pregnancy due to the clear dire prognosis and then the genetic evaluation can be deferred after delivery or termination of pregnancy (in countries where allowed).
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Affiliation(s)
- Tally Lerman-Sagie
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Pediatric Neurology Unit, Center for Rare Diseases-Magen, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ivana Pogledic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Zvi Leibovitz
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel; Technion Faculty of Medicine, Haifa, Israel
| | - Gustavo Malinger
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Fetal Neurology Multidisciplinary Clinic, Division of Ultrasound in Obstetrics & Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
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15
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Wang Z, Martin B, Weickenmeier J, Garikipati K. An inverse modelling study on the local volume changes during early morphoelastic growth of the fetal human brain. BRAIN MULTIPHYSICS 2021; 2:100023. [PMID: 34109320 PMCID: PMC8186493 DOI: 10.1016/j.brain.2021.100023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We take a data-driven approach to deducing the local volume changes accompanying early development of the fetal human brain. Our approach uses fetal brain atlas MRI data for the geometric changes in representative cases. Using a nonlinear continuum mechanics model of morphoelastic growth, we invert the deformation obtained from MRI registration to arrive at a field for the growth deformation gradient tensor. Our field inversion uses a combination of direct and adjoint methods for computing gradients of the objective function while constraining the optimization by the physics of morphoelastic growth. We thus infer a growth deformation gradient field that obeys the laws of morphoelastic growth. The errors between the MRI data and the forward displacement solution driven by the inverted growth deformation gradient field are found to be smaller than the reference displacement by well over an order of magnitude, and can be driven even lower. The results thus reproduce the three-dimensional growth during the early development of the fetal brain with controllable error. Our findings confirm that early growth is dominated by in plane cortical expansion rather than thickness increase.
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Affiliation(s)
- Z. Wang
- Mechanical Engineering, University of Michigan, United States
| | - B. Martin
- Computer Science and Engineering, University of Michigan, United States
| | - J. Weickenmeier
- Mechanical Engineering, Stevens Institute of Technology, United States
| | - K. Garikipati
- Mechanical Engineering, Mathematics and Michigan Institute for Computational Discovery & Engineering, University of Michigan, United States
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16
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Abstract
The characteristically folded surface of the human brain is critical for brain function and allows for higher cognitive abilities. Recent mostly computational research advances have shown that mechanical instabilities play a crucial role during early brain development and cortical folding. However, it is difficult to investigate such mechanisms in vivo. To experimentally gain deeper insights into the physical mechanisms that underlie the development of brain shape, we use a setup of swelling polymers. We investigate the influence of cortical thickness and the stiffness ratio between cortex and subcortex on the resulting surface pattern by taking the initially smooth fetal brain geometry at week 22 into consideration. The gel specimens possess a two-layered structure accounting for gray and white matter tissue and yield complex surface morphologies that well resemble patterns in the human brain. The results are in good agreement with analytical predictions. Through the variation of cortical thickness and stiffness, it is possible to reproduce cortical malformations such as polymicrogyria and lissencephaly. The results suggest that wrinkling with subsequent transition into folding is the driving instability mechanism during brain development. In addition, the experiments provide valuable insights towards the distinction between wrinkling and creasing instabilities. Taken together, the presented swelling experiments impressively demonstrate the purely physical aspects of brain shape and constitute a valuable tool to advance our understanding of human brain development.
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Affiliation(s)
- Alexander Greiner
- Institute of Applied Mechanics, Department of Mechanical Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91058 Erlangen, Germany.
| | - Stefan Kaessmair
- Institute of Applied Mechanics, Department of Mechanical Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91058 Erlangen, Germany.
| | - Silvia Budday
- Institute of Applied Mechanics, Department of Mechanical Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91058 Erlangen, Germany.
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17
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Ravi K, Paidas MJ, Saad A, Jayakumar AR. Astrocytes in rare neurological conditions: Morphological and functional considerations. J Comp Neurol 2021; 529:2676-2705. [PMID: 33496339 DOI: 10.1002/cne.25118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023]
Abstract
Astrocytes are a population of central nervous system (CNS) cells with distinctive morphological and functional characteristics that differ within specific areas of the brain and are widely distributed throughout the CNS. There are mainly two types of astrocytes, protoplasmic and fibrous, which differ in morphologic appearance and location. Astrocytes are important cells of the CNS that not only provide structural support, but also modulate synaptic activity, regulate neuroinflammatory responses, maintain the blood-brain barrier, and supply energy to neurons. As a result, astrocytic disruption can lead to widespread detrimental effects and can contribute to the pathophysiology of several neurological conditions. The characteristics of astrocytes in more common neuropathologies such as Alzheimer's and Parkinson's disease have significantly been described and continue to be widely studied. However, there still exist numerous rare neurological conditions in which astrocytic involvement is unknown and needs to be explored. Accordingly, this review will summarize functional and morphological changes of astrocytes in various rare neurological conditions based on current knowledge thus far and highlight remaining neuropathologies where astrocytic involvement has yet to be investigated.
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Affiliation(s)
- Karthik Ravi
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Ali Saad
- Pathology and Laboratory Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Arumugam R Jayakumar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami School of Medicine, Miami, Florida, USA.,South Florida VA Foundation for Research and Education Inc, Miami, Florida, USA.,General Medical Research Neuropathology Section, R&D Service, Veterans Affairs Medical Centre, Miami, Florida, USA
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18
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Assadsangabi R, Ozturk A, Kantamneni T, Azizi N, Asaikar SM, Hacein-Bey L. Neuroimaging of Childhood Epilepsy: Focal versus Generalized Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractNeuroimaging plays an increasingly crucial role in delineating the pathophysiology, and guiding the evaluation, management and monitoring of epilepsy. Imaging contributes to adequately categorizing seizure/epilepsy types in complex clinical situations by demonstrating anatomical and functional changes associated with seizure activity. This article reviews the current status of multimodality neuroimaging in the pediatric population, including focal lesions which may result in focal epileptic findings, focal structural abnormalities that may manifest as generalized epileptiform discharges, and generalized epilepsy without evidence of detectable focal abnormalities.
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Affiliation(s)
- Reza Assadsangabi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Arzu Ozturk
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Trishna Kantamneni
- Department of Neurology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Nazarin Azizi
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Shailesh M. Asaikar
- Child & Adolescent Neurology Consultants, Sacramento, California, United States
| | - Lotfi Hacein-Bey
- Department of Neuroradiology, Radiology, University of California Davis School of Medicine, Sacramento, California, United States
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19
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Scholl T, Gruber VE, Samueli S, Lehner R, Kasprian G, Czech T, Reinten RJ, Hoogendijk L, Hainfellner JA, Aronica E, Mühlebner A, Feucht M. Neurite Outgrowth Inhibitor (NogoA) Is Upregulated in White Matter Lesions of Complex Cortical Malformations. J Neuropathol Exp Neurol 2021; 80:274-282. [PMID: 33517425 DOI: 10.1093/jnen/nlaa159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Complex cortical malformations (CCMs), such as hemimegalencephaly and polymicrogyria, are associated with drug-resistant epilepsy and developmental impairment. They share certain neuropathological characteristics including mammalian target of rapamycin (mTOR) activation and an atypical number of white matter neurons. To get a better understanding of the pathobiology of the lesion architecture, we investigated the role of neurite outgrowth inhibitor A (NogoA), a known regulator of neuronal migration. Epilepsy surgery specimens from 16 CCM patients were analyzed and compared with sections of focal cortical dysplasia IIB (FCD IIB, n = 22), tuberous sclerosis complex (TSC, n = 8) as well as healthy controls (n = 15). Immunohistochemistry was used to characterize NogoA, myelination, and mTOR signaling. Digital slides were evaluated automatically with ImageJ. NogoA staining showed a significantly higher expression within the white matter of CCM and FCD IIB, whereas cortical tubers presented levels similar to controls. Further analysis of possible associations of NogoA with other factors revealed a positive correlation with mTOR and seizure frequency. To identify the main expressing NogoA cell type, double staining revealed dysmorphic neuronal white matter cells. Increased NogoA expression is associated with profound inhibition of neuritic sprouting and therefore contributes to a decrease in neuronal network complexity in CCM patients.
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Affiliation(s)
- Theresa Scholl
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Victoria-Elisabeth Gruber
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sharon Samueli
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Lehner
- Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Roy J Reinten
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisette Hoogendijk
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eleonora Aronica
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - Angelika Mühlebner
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martha Feucht
- From the Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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20
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Wang Z, Martin B, Weickenmeier J, Garikipati K. An inverse modelling study on the local volume changes during early morphoelastic growth of the fetal human brain. BRAIN MULTIPHYSICS 2021; 2. [PMID: 34109320 DOI: 10.1016/j.brain.2021.100023an] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
We take a data-driven approach to deducing the local volume changes accompanying early development of the fetal human brain. Our approach uses fetal brain atlas MRI data for the geometric changes in representative cases. Using a nonlinear continuum mechanics model of morphoelastic growth, we invert the deformation obtained from MRI registration to arrive at a field for the growth deformation gradient tensor. Our field inversion uses a combination of direct and adjoint methods for computing gradients of the objective function while constraining the optimization by the physics of morphoelastic growth. We thus infer a growth deformation gradient field that obeys the laws of morphoelastic growth. The errors between the MRI data and the forward displacement solution driven by the inverted growth deformation gradient field are found to be smaller than the reference displacement by well over an order of magnitude, and can be driven even lower. The results thus reproduce the three-dimensional growth during the early development of the fetal brain with controllable error. Our findings confirm that early growth is dominated by in plane cortical expansion rather than thickness increase.
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Affiliation(s)
- Z Wang
- Mechanical Engineering, University of Michigan, United States
| | - B Martin
- Computer Science and Engineering, University of Michigan, United States
| | - J Weickenmeier
- Mechanical Engineering, Stevens Institute of Technology, United States
| | - K Garikipati
- Mechanical Engineering, Mathematics and Michigan Institute for Computational Discovery & Engineering, University of Michigan, United States
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21
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Kobow K, Jabari S, Pieper T, Kudernatsch M, Polster T, Woermann FG, Kalbhenn T, Hamer H, Rössler K, Mühlebner A, Spliet WGM, Feucht M, Hou Y, Stichel D, Korshunov A, Sahm F, Coras R, Blümcke I, von Deimling A. Mosaic trisomy of chromosome 1q in human brain tissue associates with unilateral polymicrogyria, very early-onset focal epilepsy, and severe developmental delay. Acta Neuropathol 2020; 140:881-891. [PMID: 32979071 PMCID: PMC7666281 DOI: 10.1007/s00401-020-02228-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Polymicrogyria (PMG) is a developmental cortical malformation characterized by an excess of small and frustrane gyration and abnormal cortical lamination. PMG frequently associates with seizures. The molecular pathomechanisms underlying PMG development are not yet understood. About 40 genes have been associated with PMG, and small copy number variations have also been described in selected patients. We recently provided evidence that epilepsy-associated structural brain lesions can be classified based on genomic DNA methylation patterns. Here, we analyzed 26 PMG patients employing array-based DNA methylation profiling on formalin-fixed paraffin-embedded material. A series of 62 well-characterized non-PMG cortical malformations (focal cortical dysplasia type 2a/b and hemimegalencephaly), temporal lobe epilepsy, and non-epilepsy autopsy controls was used as reference cohort. Unsupervised dimensionality reduction and hierarchical cluster analysis of DNA methylation profiles showed that PMG formed a distinct DNA methylation class. Copy number profiling from DNA methylation data identified a uniform duplication spanning the entire long arm of chromosome 1 in 7 out of 26 PMG patients, which was verified by additional fluorescence in situ hybridization analysis. In respective cases, about 50% of nuclei in the center of the PMG lesion were 1q triploid. No chromosomal imbalance was seen in adjacent, architecturally normal-appearing tissue indicating mosaicism. Clinically, PMG 1q patients presented with a unilateral frontal or hemispheric PMG without hemimegalencephaly, a severe form of intractable epilepsy with seizure onset in the first months of life, and severe developmental delay. Our results show that PMG can be classified among other structural brain lesions according to their DNA methylation profile. One subset of PMG with distinct clinical features exhibits a duplication of chromosomal arm 1q.
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Affiliation(s)
- Katja Kobow
- Department of Neuropathology, Institute of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Samir Jabari
- Department of Neuropathology, Institute of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tom Pieper
- Department of Neurology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Department of Neurosurgery and Epilepsy Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
- Research Institute "Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Tilman Polster
- Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | | | - Thilo Kalbhenn
- Department of Neurosurgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Angelika Mühlebner
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Affiliated Partner of the ERN EpiCARE, Medical University Vienna, Vienna, Austria
| | - Yanghao Hou
- Department of Neuropathology, Universitätsklinikum Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Universitätsklinikum Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, Universitätsklinikum Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Universitätsklinikum Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roland Coras
- Department of Neuropathology, Institute of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, Institute of Neuropathology, Affiliated Partner of the ERN EpiCARE, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Universitätsklinikum Heidelberg, and, CCU Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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22
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Andelman-Gur MM, Leventer RJ, Hujirat M, Ganos C, Yosovich K, Carmi N, Lev D, Nissenkorn A, Dobyns WB, Bhatia K, Lerman-Sagie T, Blumkin L. Bilateral polymicrogyria associated with dystonia: A new neurogenetic syndrome? Am J Med Genet A 2020; 182:2207-2213. [PMID: 33001581 DOI: 10.1002/ajmg.a.61795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/15/2020] [Accepted: 06/23/2020] [Indexed: 11/07/2022]
Abstract
The clinical presentation of bilateral perisylvian polymicrogyria (PMG) is highly variable, including oromotor dysfunction, epilepsy, intellectual disability, and pyramidal signs. Extrapyramidal features are extremely rare. We present four apparently unrelated patients with a unique association of PMG with dystonia. The clinical, genetic, and radiologic features are described and possible mechanisms of dystonia are discussed. All patients were female and two were born to consanguineous families. All presented with early childhood onset dystonia. Other neurologic symptoms and signs classically seen in bilateral perisylvian PMG were observed, including oromotor dysfunction and speech abnormalities ranging from dysarthria to anarthria (4/4), pyramidal signs (3/4), hypotonia (3/4), postnatal microcephaly (1/4), and seizures (1/4). Neuroimaging showed a unique pattern of bilateral PMG with an infolded cortex originating primarily from the perisylvian region in three out of four patients. Whole exome sequencing was performed in two out of four patients and did not reveal pathogenic variants in known genes for cortical malformations or movement disorders. The dystonia seen in our patients is not described in bilateral PMG and suggests an underlying mechanism of impaired connectivity within the motor network or compromised cortical inhibition. The association of bilateral PMG with dystonia in our patients may represent a new neurogenetic disorder.
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Affiliation(s)
| | - Richard J Leventer
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | | | - Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
- Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Keren Yosovich
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
- Molecular Genetics Laboratory, Wolfson Medical Center, Holon, Israel
| | - Nirit Carmi
- Child Development Center, Maccabi Health Services, Bnei Brak, Israel
| | - Dorit Lev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Rina Mor Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - Andreea Nissenkorn
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - William B Dobyns
- Departments of Pediatrics and Neurology, University of Washington, Seattle, Washington, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Tally Lerman-Sagie
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - Lubov Blumkin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
- Pediatric Movement Disorders Service, Wolfson Medical Center, Holon, Israel
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23
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Severino M, Geraldo AF, Utz N, Tortora D, Pogledic I, Klonowski W, Triulzi F, Arrigoni F, Mankad K, Leventer RJ, Mancini GMS, Barkovich JA, Lequin MH, Rossi A. Definitions and classification of malformations of cortical development: practical guidelines. Brain 2020; 143:2874-2894. [PMID: 32779696 PMCID: PMC7586092 DOI: 10.1093/brain/awaa174] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Malformations of cortical development are a group of rare disorders commonly manifesting with developmental delay, cerebral palsy or seizures. The neurological outcome is extremely variable depending on the type, extent and severity of the malformation and the involved genetic pathways of brain development. Neuroimaging plays an essential role in the diagnosis of these malformations, but several issues regarding malformations of cortical development definitions and classification remain unclear. The purpose of this consensus statement is to provide standardized malformations of cortical development terminology and classification for neuroradiological pattern interpretation. A committee of international experts in paediatric neuroradiology prepared systematic literature reviews and formulated neuroimaging recommendations in collaboration with geneticists, paediatric neurologists and pathologists during consensus meetings in the context of the European Network Neuro-MIG initiative on Brain Malformations (https://www.neuro-mig.org/). Malformations of cortical development neuroimaging features and practical recommendations are provided to aid both expert and non-expert radiologists and neurologists who may encounter patients with malformations of cortical development in their practice, with the aim of improving malformations of cortical development diagnosis and imaging interpretation worldwide.
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Affiliation(s)
| | - Ana Filipa Geraldo
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Neuroradiology Unit, Imaging Department, Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - Norbert Utz
- Department of Pediatric Radiology, HELIOS Klinikum Krefeld, Germany
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ivana Pogledic
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wlodzimierz Klonowski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Poland
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi Milano, Italy
| | - Filippo Arrigoni
- Department of Neuroimaging Lab, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Richard J Leventer
- Department of Neurology Royal Children’s Hospital, Murdoch Children’s Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - James A Barkovich
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Maarten H Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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24
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Liu Y, Zhou W, Hong B, Zhao T, Xu C, Ruan J, Bai J, Wang S. Multiple Stereoelectroencephalography-Guided Radiofrequency Thermocoagulations for Polymicrogyria With Startle Seizures: A Case Report. Front Neurol 2019; 10:1095. [PMID: 31681156 PMCID: PMC6813566 DOI: 10.3389/fneur.2019.01095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
The best results of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) were observed in epilepsies with more limited lesions, but this procedure is rarely used in a wide range of brain malformation. We report a rare case of polymicrogyria (PMG) combined with drug-resistant startle seizures. Presurgical monitoring was performed using SEEG owing to the large lesion and complexity of PMG. According to the intracranial electrode results, the seizure onset was extensive, with the onset starting earlier in the cingulate sulcus and insular pole than in other sites of the other electrodes. Multi-point and multi-step SEEG-guided RF-TC was used for diffuse lesion and functional protection. RF-TC was first applied to the cingulate sulcus and insular pole, and our patient was rendered free from startle seizures after 2 weeks. Two weeks of observation helped us to observe the efficacy of RF-TC and the changes of SEEG, so as to make the next TC scheme. The patient still had spontaneous seizures after the first treatment. RF-TC was then applied to other sites involved earlier. Finally, the patient reached Engel class IIa for a follow-up period of 1 year. There were no additional startle seizures, and important functional areas were protected.
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Affiliation(s)
- Yi'Ou Liu
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Wenjing Zhou
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Bo Hong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tong Zhao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chengwei Xu
- Inner Mongolia People's Hospital, Inner Mongolia Autonomous Region, Hohhot, China
| | - Jing Ruan
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Jianjun Bai
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Siyu Wang
- Tsinghua University Yuquan Hospital, Beijing, China
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25
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Minocha S, Herr W. Cortical and Commissural Defects Upon HCF-1 Loss in Nkx2.1-Derived Embryonic Neurons and Glia. Dev Neurobiol 2019; 79:578-595. [PMID: 31207118 PMCID: PMC6771735 DOI: 10.1002/dneu.22704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022]
Abstract
Formation of the cerebral cortex and commissures involves a complex developmental process defined by multiple molecular mechanisms governing proliferation of neuronal and glial precursors, neuronal and glial migration, and patterning events. Failure in any of these processes can lead to malformations. Here, we study the role of HCF-1 in these processes. HCF-1 is a conserved metazoan transcriptional co-regulator long implicated in cell proliferation and more recently in human metabolic disorders and mental retardation. Loss of HCF-1 in a subset of ventral telencephalic Nkx2.1-positive progenitors leads to reduced numbers of GABAergic interneurons and glia, owing not to decreased proliferation but rather to increased apoptosis before cell migration. The loss of these cells leads to development of severe commissural and cortical defects in early postnatal mouse brains. These defects include mild and severe structural defects of the corpus callosum and anterior commissure, respectively, and increased folding of the cortex resembling polymicrogyria. Hence, in addition to its well-established role in cell proliferation, HCF-1 is important for organ development, here the brain.
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Affiliation(s)
- Shilpi Minocha
- Center for Integrative Genomics, GénopodeUniversity of LausanneLausanneCH‐1015Switzerland
| | - Winship Herr
- Center for Integrative Genomics, GénopodeUniversity of LausanneLausanneCH‐1015Switzerland
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26
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Lenge M, Barba C, Montanaro D, Aghakhanyan G, Frijia F, Guerrini R. Relationships Between Morphologic and Functional Patterns in the Polymicrogyric Cortex. Cereb Cortex 2019; 28:1076-1086. [PMID: 28334078 DOI: 10.1093/cercor/bhx036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Abstract
Polymicrogyria is a malformation of cortical folding and layering underlying different cognitive and neurological manifestations. The polymicrogyric cortex has heterogeneous morphofunctional patterns, qualitatively described at magnetic resonance imaging (MRI) by variable severity gradients and functional activations. We investigated the link between abnormal cortical folding and cortical function in order to improve surgical planning for patients with polymicrogyria and intractable epilepsy. We performed structural and functional MRI on 14 patients with perisylvian polymicrogyria and adopted surface-based methods to detect alterations of cortical thickness (CT) and local gyrification index (LGI) compared with normal cortex (30 age-matched subjects). We quantitatively assessed the grade of anatomic disruption of the polymicrogyric cortex and defined its relationship with decreased cortical function. We observed a good matching between visual analysis and morphometric measurements. CT maps revealed sparse clusters of thickening, while LGI maps disclosed circumscribed regions of maximal alteration with a uniformly decreasing centrifugal gradient. In polymicrogyric areas in which gyral and sulcal patterns were preserved, functional activation maintained the expected location, but was reduced in extent. Morphofunctional correlations, evaluated along cortico-cortical paths between maximum morphologic alterations and significant activations, identified an interindividual threshold for LGI (z-value = -1.09) beyond which functional activations were no longer identifiable.
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Affiliation(s)
- Matteo Lenge
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy
| | - Carmen Barba
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy
| | | | | | - Francesca Frijia
- Unit of Neuroradiology.,U.O.C. Bioingegneria e Ingegneria Clinica, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, 50139 Florence, Italy.,IRCCS Stella Maris Foundation, 56018 Calambrone, Pisa, Italy
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27
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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28
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Freeman-Romilly N, Mewasingh L, Coomer A, Foster C. Fits, feet and HIV: lessons from a case of coexisting epilepsy and neuropathy in a patient with perinatally acquired HIV-1 infection. BMJ Case Rep 2018; 2018:bcr-2018-226042. [PMID: 30333199 DOI: 10.1136/bcr-2018-226042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 18-year-old black African man with well-controlled perinatally acquired HIV-1 was diagnosed in late adolescence with the unrelated diagnoses of Charcot-Marie-Tooth type 1A (CMT1A), epilepsy due to polymicrogyria and subsequently developed severe depression. The CMT1A diagnosis occurred after transfer of care from a local paediatric HIV service to a tertiary paediatric referral centre and was precipitated by recognition of a history and neurological signs not typically associated with perinatal HIV. The case resulted in the establishment of a quarterly combined paediatric HIV and paediatric neurology multidisciplinary team clinic to assess children and adolescents living with HIV with neurological symptoms.
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29
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Jalloh I, Cho N, Nga VD, Whitney R, Jain P, Al-Mehmadi S, Yau I, Okura H, Widjaja E, Otsubo H, Ochi A, Donner E, McCoy B, Drake J, Go C, Rutka JT. The role of surgery in refractory epilepsy secondary to polymicrogyria in the pediatric population. Epilepsia 2018; 59:1982-1996. [DOI: 10.1111/epi.14556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Ibrahim Jalloh
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Newton Cho
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Vincent D.W. Nga
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Division of Neurosurgery; National University Hospital; Singapore City Singapore
| | - Robyn Whitney
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Puneet Jain
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
- Division of Pediatric Neurology; Department of Pediatrics; BLK Super Speciality Hospital; New Delhi India
| | - Sameer Al-Mehmadi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ivanna Yau
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hidehiro Okura
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Juntendo University School of Medicine; Tokyo Japan
| | - Elysa Widjaja
- Division of Diagnostic Imaging; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Hiroshi Otsubo
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Ayako Ochi
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Elizabeth Donner
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - Blathnaid McCoy
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James Drake
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
| | - Cristina Go
- Division of Neurology; The Hospital for Sick Children; The University of Toronto; Toronto Ontario Canada
| | - James T. Rutka
- Division of Neurosurgery; The Hospital for Sick Children; Department of Surgery; The University of Toronto; Toronto Ontario Canada
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30
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Foesleitner O, Nenning KH, Traub-Weidinger T, Feucht M, Bonelli S, Czech T, Dorfer C, Prayer D, Kasprian G. Assessing Corticospinal Tract Asymmetry in Unilateral Polymicrogyria. AJNR Am J Neuroradiol 2018; 39:1530-1535. [PMID: 29954815 DOI: 10.3174/ajnr.a5715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/02/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Asymmetry of the corticospinal tract in congenital lesions is a good prognostic marker for preserved motor function after hemispherectomy. This study aimed to assess this marker and provide a clinically feasible approach in selected cases of unilateral polymicrogyria. MATERIALS AND METHODS Corticospinal tract asymmetry of 9 patients with unilateral polymicrogyria substantially affecting the central region was retrospectively assessed on axial T1WI and DTI. Volumes of the brain stem and thalamus and DTI parameters of the internal capsule were measured. Two neuroradiologists independently rated the right-left asymmetry at 4 levels along the corticospinal tract. DTI tractography was used to determine the motor cortex within polymicrogyria, with task-based functional MR imaging available in 3/9 cases. RESULTS Visual assessment of the brain stem asymmetry showed excellent correlation with quantitative measures on both T1WI and color-coded DTI maps (P = .007 and P = .023). Interrater reliability regarding structural and DTI-based corticospinal tract asymmetry was best at the midbrain (Cohen κ = 0.77, P = .018). Three patients underwent functional hemispherectomy with postsurgical stable motor function, all showing marked corticospinal tract asymmetry preoperatively. Following the DTI-based corticospinal tract trajectories allowed identifying the presumed primary motor region within the dysplastic cortex in 9/9 patients, confirmed by functional MR imaging in 3/3 cases. CONCLUSIONS Visual assessment of corticospinal tract asymmetry in unilateral polymicrogyria involving the motor cortex is most reliable with T1WI and color-coded DTI maps at the level of the midbrain. Pronounced asymmetry predicts preserved motor function after hemispherectomy. DTI-based tractography can be used as a guidance tool to the motor cortex within polymicrogyria.
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Affiliation(s)
- O Foesleitner
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.)
| | - K-H Nenning
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.)
| | - T Traub-Weidinger
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.)
| | - M Feucht
- Pediatrics and Adolescent Medicine (M.F.)
| | | | - T Czech
- Neurosurgery (T.C., C.D.), Medical University of Vienna, Vienna, Austria
| | - C Dorfer
- Neurosurgery (T.C., C.D.), Medical University of Vienna, Vienna, Austria
| | - D Prayer
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.)
| | - G Kasprian
- From the Departments of Biomedical Imaging and Image-Guided Therapy (O.F., K.-H.N., T.T.-W., D.P., G.K.)
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31
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Genetics and mechanisms leading to human cortical malformations. Semin Cell Dev Biol 2018; 76:33-75. [DOI: 10.1016/j.semcdb.2017.09.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
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32
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Singh A, Malhotra HS, Tripathi A, Kar SK. Personality Changes in Bilateral Superior Frontal and Parafalcine Frontoparietal Polymicrogyria: A Rare Case Report. Indian J Psychol Med 2018; 40:186-188. [PMID: 29962577 PMCID: PMC6008994 DOI: 10.4103/ijpsym.ijpsym_159_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polymicrogyria is a neurodevelopmental abnormality which results in the formation of excessive, small, abnormal, partially fused gyri with superficially located sulci replacing the normal gyral pattern. Intellectual disability, global developmental delay, epilepsy, language deficits, and motor deficits are commonly reported in patients with polymicrogyria. We present here the case of a young male with a rare pattern of bilateral superior frontal and parafalcine frontoparietal polymicrogyria, who had a mild intellectual disability, intractable seizures along with personality changes. This case report also highlights the relevance of neuroimaging in such cases, possible explanations of personality change in polymicrogyria and relevant management issues with a review of the literature.
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Affiliation(s)
- Astha Singh
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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33
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Zhao X, Zhou Z, Zhu W, Xiang H. Role of conventional magnetic resonance imaging in the screening of epilepsy with structural abnormalities: a pictorial essay. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2017; 7:126-137. [PMID: 28721306 PMCID: PMC5511122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/04/2017] [Indexed: 06/07/2023]
Abstract
Epilepsy is a chronic neurological disease with serious impact on patients and society. The causes of epilepsy comprise a heterogeneous group of disorders, rendering epilepsy diagnoses rather difficult and challenging. The primary role of MRI is to locate and define the probable anatomic epileptogenic lesions. In the developing countries, where functional MRI (fMRI) is not popular, conventional MRI (cMRI) becomes especially important in epilepsy diagnoses. Apart from that, an experienced radiologist can increase the diagnostic yield of MRI to epileptogenic lesions. Thus, we present a pictorial review focusing on the role of cMRI in the screening of epilepsy with structural abnormalities and highlighting the key findings on cMRI to help radiologists to be familiar with the characteristic findings. Considering the complexity and diversity of the structural abnormalities, we propse a mnemonic "MAGIC TVs" approach to reduce false negative diagnosis and improve the diagnosis rate.
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Affiliation(s)
- Xu Zhao
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei, P. R. China
| | - Zhiqiang Zhou
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei, P. R. China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei, P. R. China
| | - Hongbing Xiang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei, P. R. China
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34
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Bohm LA, Zhou TC, Mingo TJ, Dugan SL, Patterson RJ, Sidman JD, Roby BB. Neuroradiographic findings in 22q11.2 deletion syndrome. Am J Med Genet A 2017; 173:2158-2165. [PMID: 28577347 DOI: 10.1002/ajmg.a.38304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/20/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is a common genetic disorder with enormous phenotypic heterogeneity. Despite the established prevalence of developmental and neuropsychiatric issues in this syndrome, its neuroanatomical correlates are not as well understood. A retrospective chart review was performed on 111 patients diagnosed with 22q11.2DS. Of the 111 patients, 24 with genetically confirmed 22q11.2 deletion and brain MRI or MRA were included in this study. The most common indications for imaging were unexplained developmental delay (6/24), seizures of unknown etiology (5/24), and unilateral weakness (3/24). More than half (13/24) of the patients had significant radiographic findings, including persistent cavum septi pellucidi and/or cavum vergae (8/24), aberrant cortical veins (6/24), polymicrogyria or cortical dysplasia (4/24), inner ear deformities (3/24), hypoplastic internal carotid artery (2/24), and hypoplastic cerebellum (1/24). These findings reveal the types and frequencies of brain malformations in this case series, and suggest that the prevalence of neuroanatomical abnormalities in 22q11.2DS may be underestimated. Understanding indications for imaging and frequently encountered brain malformations will result in early diagnosis and intervention in an effort to optimize patient outcomes.
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Affiliation(s)
- Lauren A Bohm
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota.,Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Tom C Zhou
- University of Minnesota, Minneapolis, Minnesota
| | | | - Sarah L Dugan
- Medical Genetics, Children's Minnesota, Minneapolis, Minnesota.,Division of Pediatric Genetics, University of Utah, Salt Lake City, Utah
| | | | - James D Sidman
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota
| | - Brianne B Roby
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota
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35
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Abstract
Epilepsy is one of the most common neurologic disorders, affecting about 50 million people worldwide. The disease is characterized by recurrent seizures, which are due to aberrant neuronal networks resulting in synchronous discharges. The term epilepsy encompasses a large spectrum of syndromes and diseases with different etiopathogenesis. The recent development of imaging and epilepsy surgery techniques is now enabling the identification of structural abnormalities that are part of the epileptic network, and the removal of these lesions may result in control of seizures. Access of this clinically well-characterized neurosurgical material has provided neuropathologists with the opportunity to study a variety of structural brain abnormalities associated with epilepsy, by combining traditional routine histopathologic methods with molecular genetics and functional analysis of the resected tissue. This approach has contributed greatly to a better diagnosis and classification of these structural lesions, and has provided important new insights into their pathogenesis and epileptogenesis. The present chapter provides a detailed description of the large spectrum of histopathologic findings encountered in epilepsy surgery patients, addressing in particular the nonneoplastic pathologies, including hippocampal sclerosis, malformations of cortical development, Sturge-Weber syndrome, and Rasmussen encephalitis, and reviews current knowledge regarding the underlying molecular pathomechanisms and cellular mechanisms mediating hyperexcitability.
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Affiliation(s)
- Eleonora Aronica
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, the Netherlands.
| | - Angelika Mühlebner
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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36
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Görkem SB, Doganay S, Gumus K, Bayram A, Kumandas S, Coskun A. The Role of Diffusion-Weighted Imaging in the Evaluation of the Whole Brain in Isolated Unilateral Polymicrogyria. J Child Neurol 2016; 31:1575-1578. [PMID: 27625015 DOI: 10.1177/0883073816665311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/02/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
The aim is to evaluate normal-appearing brain regions in isolated unilateral polymicrogyria patients and compare them with controls by using diffusion-weighted imaging and apparent diffusion coefficient. The diffusion-weighted images (b = 0-1000 s/mm2) of 10 pediatric patients (7 boys, 3 girls; mean age = 5.8 ± 4.3 years) with isolated unilateral polymicrogyria and age-sex matched 10 control patients were assessed retrospectively. There was a significant increase in apparent diffusion coefficient values of white matter underlying polymicrogyria, uninvolved white matter, deep gray matter (thalami, lentiform nuclei, caudate nuclei) and corpus callosum in polymicrogyria patients compared to control group (P < .01). The whole brain might be affected in isolated unilateral polymicrogyria patients. The abnormal deep gray matter in polymicrogyria patients would indicate a new point of view for pediatric neurologists about the probability of additional future neurological disorders.
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Affiliation(s)
- Sureyya Burcu Görkem
- Radiology, Pediatric Radiology Section, Erciyes University School of Medicine, Kayseri, Turkey
| | - Selim Doganay
- Radiology, Pediatric Radiology Section, Erciyes University School of Medicine, Kayseri, Turkey
| | - Kazim Gumus
- Biomedical Imaging Research Center, Erciyes University, Kayseri, Turkey
| | - Ayse Bayram
- Pediatric Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Sefer Kumandas
- Pediatric Neurology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdulhakim Coskun
- Radiology, Pediatric Radiology Section, Erciyes University School of Medicine, Kayseri, Turkey
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37
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Vesnaver TV, Tul N, Mehrabi S, Parissone F, Štrafela P, Mlakar J, Pižem J, Korva M, Zupanc TA, Popović M. Zika virus associated microcephaly/micrencephaly-fetal brain imaging in comparison with neuropathology. BJOG 2016; 124:521-525. [PMID: 27885789 DOI: 10.1111/1471-0528.14423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- T Vipotnik Vesnaver
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Tul
- Division of Gynecology and Obstetrics, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - S Mehrabi
- Institute of Radiology, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - F Parissone
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Obstetrics and Gynaecology Section, University of Verona, Verona, Italy
| | - P Štrafela
- Institute of Pathology, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - J Mlakar
- Faculty of Medicine, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
| | - J Pižem
- Faculty of Medicine, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
| | - M Korva
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - T Avšič Zupanc
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - M Popović
- Faculty of Medicine, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
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38
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Li X, Chen H, Zhang T, Yu X, Jiang X, Li K, Li L, Razavi MJ, Wang X, Hu X, Han J, Guo L, Hu X, Liu T. Commonly preserved and species-specific gyral folding patterns across primate brains. Brain Struct Funct 2016; 222:2127-2141. [PMID: 27796591 DOI: 10.1007/s00429-016-1329-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/18/2016] [Indexed: 02/05/2023]
Abstract
Cortical folding pattern analysis is very important to understand brain organization and development. Since previous studies mostly focus on human brain cortex, the regularity and variability of cortical folding patterns across primate brains (macaques, chimpanzees and human) remain largely unknown. This paper presents a novel computational framework to identify common or unique gyral folding patterns in macaque, chimpanzee and human brains using magnetic resonance imaging (MRI) data. We quantitatively characterize gyral folding patterns via hinge numbers with cortical surfaces constructed from MRI data, and identify 6 common three-hinge gyral folds that exhibit consistent anatomical locations across these three species as well as 2 unique three hinges in macaque, 6 ones in chimpanzee and 14 ones in human. A novel morphology descriptor is then applied to classify three-hinge gyral folds, and the increasing complexity is identified among the species analyzed. This study may provide novel insights into the regularity and variability of the cerebral cortex from developmental perspective and may potentially facilitate novel neuroimage analyses such as cortical parcellation with correspondences across species in the future.
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Affiliation(s)
- Xiao Li
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Hanbo Chen
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science and Bioimaging Research Center, The University of Georgia, Athens, GA, USA
| | - Tuo Zhang
- School of Automation, Northwestern Polytechnical University, Xi'an, China.,Brain Decoding Research Center, Northwestern Polytechnical University, Xi'an, China
| | - Xiang Yu
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Xi Jiang
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science and Bioimaging Research Center, The University of Georgia, Athens, GA, USA
| | - Kaiming Li
- Department of Bioengineering, UC Riverside, Riverside, GA, USA.,West China Hospital of Sichuan University, Chengdu, China
| | - Longchuan Li
- Marcus Autism Center, Emory University, Atlanta, GA, USA
| | - Mir Jalil Razavi
- College of Engineering, The University of Georgia, Athens, GA, USA
| | - Xianqiao Wang
- College of Engineering, The University of Georgia, Athens, GA, USA
| | - Xintao Hu
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Junwei Han
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Lei Guo
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Xiaoping Hu
- Department of Bioengineering, UC Riverside, Riverside, GA, USA
| | - Tianming Liu
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science and Bioimaging Research Center, The University of Georgia, Athens, GA, USA.
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39
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Štrafela P, Vizjak A, Mraz J, Mlakar J, Pižem J, Tul N, Županc TA, Popović M. Zika Virus-Associated Micrencephaly: A Thorough Description of Neuropathologic Findings in the Fetal Central Nervous System. Arch Pathol Lab Med 2016; 141:73-81. [PMID: 27726416 DOI: 10.5858/arpa.2016-0341-sa] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -The 2015 outbreak of Zika virus in Brazil resulted in a 20-times increased prevalence of congenital microcephaly in stillborns and neonates and was instrumental in raising the suspicion of a causal association between Zika virus and microcephaly. OBJECTIVE -To provide a comprehensive description of the neuropathologic features of congenital Zika virus infection. DESIGN -Autopsy evaluation of the brain from a fetus of 32 weeks and 6 days of gestation, with a prenatal diagnosis of microcephaly associated with polymerase chain reaction-confirmed, fetal, Zika virus infection. RESULTS -Multiple severe pathology findings were present. These included lissencephaly, except for the occipital lobes, where some pachygyria was observed. Also present was reduction and thinning of white matter, ventriculomegaly of the lateral ventricles, and coalescent calcifications in the cortical-subcortical white matter border associated with glioneuronal outbursting into the subarachnoid space above and heterotopias below. There were small, scattered calcifications in the basal ganglia, with fewer in the white matter and germinal matrix, and none in the cerebellum and brainstem. The cerebellum and pontine base were atrophic because of Wallerian degeneration or maldevelopment of descending tracts and pontocerebellar connections. CONCLUSION -Our findings are in agreement with neuroimaging of Zika virus-associated fetal and infant micrencephalic brains and, to some extent, with neuroimaging of other intrauterine infections causing microcephaly.
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Affiliation(s)
| | | | | | | | | | | | | | - Mara Popović
- From the Department of Pathology, University Clinical Centre, Maribor, Slovenia (Dr Štrafela); the Institutes of Pathology (Drs Vizjak, Mlakar, Pižem, and Popović and Mrs Mraz) and Microbiology and Immunology (Dr Županc), Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; and the Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre, Ljubljana, Slovenia (Dr Tul)
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40
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Kappou D, Chlapoutaki C, Papastefanou I, Theodorou G, Kassanos D, Souka AP. Second-Trimester Sonographic Diagnosis of Polymicrogyria. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2296-2299. [PMID: 27672235 DOI: 10.7863/ultra.15.11074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Dimitra Kappou
- First Department of Obstetrics and Gynecology, University of Athens Medical School, Alexandra Hospital, Athens, Greece
| | | | - Ioannis Papastefanou
- Department of Fetal Medicine, Lito Maternity Hospital, Athens, Greece, Fetal Medicine Unit, Emvryomitriki Athens, Greece
| | - Georgia Theodorou
- Fetal Medicine Unit, Third Department of Obstetrics and Gynecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Kassanos
- Fetal Medicine Unit, Third Department of Obstetrics and Gynecology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Athena P Souka
- Department of Fetal Medicine, Lito Maternity Hospital, Athens, Greece, Fetal Medicine Unit, Emvryomitriki Athens, Greece, Fetal Medicine Unit, Third Department of Obstetrics and Gynecology, University of Athens, Attikon University Hospital, Athens, Greece
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41
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Abstract
AbstractAbnormal fetal corticogenesis results in malformations of cortical development (MCD). Abnormal cell proliferation leads to microcephaly or megalencephaly, incomplete neuronal migration results in heterotopia and lissencephaly, neuronal overmigration manifests as cobblestone malformations, and anomalous postmigrational cortical organization is responsible for polymicrogyria and focal cortical dysplasias. MCD comprises various congenital brain disorders, caused by different genetic, infectious, or vascular etiologies and is associated with significant neurological morbidity. Although MCD are rarely diagnosed prenatally, both dedicated multiplanar neurosonography and magnetic resonance imaging enable good demonstration of fetal cortical development. The imaging signs of fetal MCD are: delayed or absent cerebral sulcation; premature abnormal sulci; thin and irregular hemispheric parenchyma; wide abnormal overdeveloped gyri; wide opening of isolated sulci; nodular bulging into the lateral ventricles; cortical clefts; intraparenchymal echogenic nodules; and cortical thickening. The postnatal and prenatal imaging features of four main malformations of cortical development—lissencephaly, cobblestone malformations, periventricular nodular heterotopia, and polymicrogyria—are described.
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42
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Kelly JP, Ishak GE, Phillips JO, Nguyen H, Weiss AH. Visual sensory and ocular motor function in children with polymicrogyria: relationship to magnetic resonance imaging. J AAPOS 2016; 20:37-43. [PMID: 26917070 DOI: 10.1016/j.jaapos.2015.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE To assess visual and ocular motor function in children with polymicrogyria (PMG). METHODS The medical records of 15 children (0.4-4 years of age) with PMG documented by magnetic resonance imaging (MRI) and with age-corrected visual acuity measured by Teller acuity cards were reviewed retrospectively. Cortical function was assessed by pattern visually evoked potentials (VEP). Ocular motor function was assessed by video-oculography or clinical assessment. Results were compared to age-matched controls. RESULTS Extent of PMG involvement varied from bilateral fronto-parietal to bilateral-diffuse. Nine children had involvement of the occipital lobe. Visual acuity at presentation was normal in 5 children (≥20/40 Snellen equivalent for age) and subnormal in 10 (average 20/200 equivalent). Visual acuity was similar in children with or without involvement of the occipital lobe (P = 0.4). Follow-up visual acuity was available for 9 children; 3 improved and 6 failed to improve (5 of whom had seizures). PMG involving the occipital lobe significantly reduced VEP amplitude and signal-to-noise ratios. Three infants without visually-guided behaviors had VEP responses. All 3 children with cytomegalovirus-related PMG without retinal disease had preserved visual function despite generalized MRI abnormalities. CONCLUSIONS All children with PMG had recordable visual function either by visual acuity or VEP testing, however the majority did not show longitudinal improvement in acuity. Seizures may impose limits on visual acuity development. Children with cytomegalovirus-related PMG, microcephaly, and developmental delay can have normal visual acuity. Children with a recordable VEP but without visually guided behaviors may have a defect in sensorimotor transformation.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle
| | - Gisele E Ishak
- Division of Radiology, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, University of Washington Medical Center, Seattle
| | - James O Phillips
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Otolaryngology, University of Washington Medical Center, Seattle
| | - Ho Nguyen
- Division of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Avery H Weiss
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle.
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43
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Sethi M, Pedersen M, Jackson GD. Polymicrogyric Cortex may Predispose to Seizures via Abnormal Network Topology: An fMRI Connectomics Study. Epilepsia 2016; 57:e64-8. [PMID: 26763051 DOI: 10.1111/epi.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 12/22/2022]
Abstract
Polymicrogyria is a significant malformation of cortical development with a high incidence of epilepsy and cognitive deficits. Graph theoretic analysis is a useful approach to studying network organization in brain disorders. In this study, we used task-free functional magnetic resonance imaging (fMRI) data from four patients with polymicrogyria and refractory epilepsy. Gray matter masks from structural MRI data were parcellated into 1,024 network nodes. Functional "connectomes" were obtained based on fMRI time series between the parcellated network nodes; network analysis was conducted using clustering coefficient, path length, node degree, and participation coefficient. These graph metrics were compared between nodes within polymicrogyric cortex and normal brain tissue in contralateral homologous cortical regions. Polymicrogyric nodes showed significantly increased clustering coefficient and characteristic path length. This is the first study using functional connectivity analysis in polymicrogyria--our results indicate a shift toward a regular network topology in polymicrogyric nodes. Regularized network topology has been demonstrated previously in patients with focal epilepsy and during focal seizures. Thus, we postulate that these network alterations predispose to seizures and may be relevant to cognitive deficits in patients with polymicrogyria.
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Affiliation(s)
- Moksh Sethi
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Mangor Pedersen
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
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Wang DD, Knox R, Rolston JD, Englot DJ, Barkovich AJ, Tihan T, Auguste KI, Knowlton RC, Cornes SB, Chang EF. Surgical management of medically refractory epilepsy in patients with polymicrogyria. Epilepsia 2015; 57:151-61. [PMID: 26647903 DOI: 10.1111/epi.13264] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Polymicrogyria (PMG) is a malformation of cortical development characterized by formation of an excessive number of small gyri. Sixty percent to 85% of patients with PMG have epilepsy that is refractory to medication, but surgical options are usually limited. We characterize a cohort of patient with polymicrogyria who underwent epilepsy surgery and document seizure outcomes. METHODS A retrospective study of all patients with PMG who underwent epilepsy surgery (focal seizure foci resection and/or hemispherectomy) at our center was performed by review of all clinical data related to their treatment. RESULTS We identified 12 patients (7 males and 5 female) with mean age of 18 (ranging from 3 months to 44 years) at time of surgery. Mean age at seizure onset was 8 years, with the majority (83%) having childhood onset. Six patients had focal, five had multifocal, and one patient had diffuse PMG. Perisylvian PMG was the most common pattern seen on magnetic resonance imaging (MRI). Eight patients had other cortical malformations including hemimegalencephaly and cortical dysplasia. Scalp electroencephalography (EEG) often showed diffuse epileptic discharges that poorly lateralized but were focal on intracranial electrocorticography (ECoG). Eight patients underwent seizure foci resection and four underwent hemispherectomy. Mean follow-up was 7 years (ranging from one to 19 years). Six patients (50%) were seizure-free at last follow-up. One patient had rare seizures (Engel class II). Three patients were Engel class III, having either decreased seizure frequency or severity, and two patients were Engel class IV. Gross total resection of the PMG cortex trended toward good seizure control. SIGNIFICANCE Our study shows that even in patients with extensive or bilateral PMG malformations, some may still be good candidates for surgery because the epileptogenic zone may involve only a portion of the malformation. Intracranial ECoG can provide additional localizing information compared to scalp EEG in guiding resection of epileptogenic foci.
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Affiliation(s)
- Doris D Wang
- Department of Neurological Surgery, UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California, U.S.A
| | - Renatta Knox
- Department of Neurology, University of California, San Francisco, California, U.S.A
| | - John D Rolston
- Department of Neurological Surgery, UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California, U.S.A
| | - Dario J Englot
- Department of Neurological Surgery, UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California, U.S.A
| | - A James Barkovich
- Department of Radiology, University of California, San Francisco, California, U.S.A
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, California, U.S.A
| | - Kurtis I Auguste
- Department of Neurological Surgery, UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California, U.S.A.,Benioff Children's Hospital, University of California, San Francisco, California, U.S.A
| | - Robert C Knowlton
- Department of Neurology, University of California, San Francisco, California, U.S.A
| | - Susannah B Cornes
- Department of Neurology, University of California, San Francisco, California, U.S.A
| | - Edward F Chang
- Department of Neurological Surgery, UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California, U.S.A
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Battal B, Ince S, Akgun V, Kocaoglu M, Ozcan E, Tasar M. Malformations of cortical development: 3T magnetic resonance imaging features. World J Radiol 2015; 7:329-335. [PMID: 26516429 PMCID: PMC4620113 DOI: 10.4329/wjr.v7.i10.329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/07/2015] [Accepted: 08/21/2015] [Indexed: 02/06/2023] Open
Abstract
Malformation of cortical development (MCD) is a term representing an inhomogeneous group of central nervous system abnormalities, referring particularly to embriyological aspect as a consequence of any of the three developmental stages, i.e., cell proliferation, cell migration and cortical organization. These include cotical dysgenesis, microcephaly, polymicrogyria, schizencephaly, lissencephaly, hemimegalencephaly, heterotopia and focal cortical dysplasia. Since magnetic resonance imaging is the modality of choice that best identifies the structural anomalies of the brain cortex, we aimed to provide a mini review of MCD by using 3T magnetic resonance scanner images.
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Pathophysiological analyses of cortical malformation using gyrencephalic mammals. Sci Rep 2015; 5:15370. [PMID: 26482531 PMCID: PMC4613358 DOI: 10.1038/srep15370] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/23/2015] [Indexed: 12/12/2022] Open
Abstract
One of the most prominent features of the cerebral cortex of higher mammals is the presence of gyri. Because malformations of the cortical gyri are associated with severe disability in brain function, the mechanisms underlying malformations of the cortical gyri have been of great interest. Combining gyrencephalic carnivore ferrets and genetic manipulations using in utero electroporation, here we successfully recapitulated the cortical phenotypes of thanatophoric dysplasia (TD) by expressing fibroblast growth factor 8 in the ferret cerebral cortex. Strikingly, in contrast to TD mice, our TD ferret model showed not only megalencephaly but also polymicrogyria. We further uncovered that outer radial glial cells (oRGs) and intermediate progenitor cells (IPs) were markedly increased. Because it has been proposed that increased oRGs and/or IPs resulted in the appearance of cortical gyri during evolution, it seemed possible that increased oRGs and IPs underlie the pathogenesis of polymicrogyria. Our findings should help shed light on the molecular mechanisms underlying the formation and malformation of cortical gyri in higher mammals.
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Recessive Mutations in POLR3B Encoding RNA Polymerase III Subunit Causing Diffuse Hypomyelination in Patients with 4H Leukodystrophy with Polymicrogyria and Cataracts. Clin Neuroradiol 2015; 27:213-220. [PMID: 26478204 PMCID: PMC5487884 DOI: 10.1007/s00062-015-0472-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
The diagnosis of 4H leukodystrophy (hypomyelination, hypogonadotropic hypogonadism, and hypodontia) is based on clinical findings and magnetic resonance imaging (MRI). Recently, mutations of the genes encoding Pol III (RNA polymerase III) subunit A (POLR3A) and subunit B (POL3B) have been identified as the genetic causes of hypomyelination. We describe two Polish female siblings aged 5 and 10 years with compound heterozygous mutations in POLR3B. They both presented with similar clinical symptoms and MRI findings presenting as 4H leukodystrophy, and the association of polymicrogyria and cataract. According to our observation in young children with the absence of hypogonadotropic hypogonadism, brain MRI pattern is very essential in proper early diagnosis of 4H leukodystrophy. All clinical and radiological results are of course helpful, however genetic conformation is always necessary.
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Failure to Identify the Left Arcuate Fasciculus at Diffusion Tractography Is a Specific Marker of Language Dysfunction in Pediatric Patients with Polymicrogyria. Behav Neurol 2015; 2015:351391. [PMID: 26180373 PMCID: PMC4477425 DOI: 10.1155/2015/351391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Polymicrogyric cortex demonstrates interindividual variation with regard to both extent of dyslamination and functional capacity. Given the relationship between laminar structure and white matter fibers, we sought to define the relationship between polymicrogyria (PMG), intrahemispheric association pathways, and network function. Methods. Each arcuate fasciculus (AF) was categorized as present or absent. Language was characterized by a pediatric neurologist. The presence of dysplastic cortex in the expected anatomic locations of Broca's (BA) and Wernicke's areas (WA) was evaluated by two pediatric neuroradiologists blinded to DTI and language data. Results. 16 PMG patients and 16 age/gender-matched controls were included. All normative controls had an identifiable left AF. 6/7 PMG patients with dysplastic cortex within BA and/or WA had no left AF; PMG patients without involvement of these regions had a lower frequency of absence of the left AF (p < 0.006). All patients without a left AF had some degree of language impairment. PMG patients without a left AF had a significantly greater frequency of language impairment compared to those PMG patients with a left AF (p < 0.003). Conclusion. In patients with PMG (1) the presence of dysplastic cortex within WA and/or BA is associated with absence of the left AF and (2) absence of the left AF is associated with language impairment.
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Griffiths PD, Sharrack S, Chan KL, Bamfo J, Williams F, Kilby MD. Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed byin uteroMR imaging. Prenat Diagn 2015; 35:583-91. [DOI: 10.1002/pd.4577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 11/05/2022]
Affiliation(s)
- P. D. Griffiths
- Academic Unit of Radiology; University of Sheffield; Sheffield UK
| | - S. Sharrack
- Academic Unit of Radiology; University of Sheffield; Sheffield UK
| | - K. L. Chan
- Fetal Medicine Unit; St Mary's Hospital; Manchester UK
| | - J. Bamfo
- Fetal Medicine Unit; St Mary's Hospital; Manchester UK
| | - F. Williams
- Academic Unit of Radiology; University of Sheffield; Sheffield UK
| | - M. D. Kilby
- Birmingham Centre of Women's and Children's Health, College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
- Fetal Medicine Centre, Birmingham Women's Foundation Trust; Birmingham UK
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