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Bonke EM, Bonfert MV, Hillmann SM, Seitz-Holland J, Gaubert M, Wiegand TLT, De Luca A, Cho KIK, Sandmo SB, Yhang E, Tripodis Y, Seer C, Kaufmann D, Kaufmann E, Muehlmann M, Gooijers J, Lin AP, Leemans A, Swinnen SP, Bahr R, Shenton ME, Pasternak O, Tacke U, Heinen F, Koerte IK. Neurological soft signs in adolescents are associated with brain structure. Cereb Cortex 2022; 33:5547-5556. [PMID: 36424865 DOI: 10.1093/cercor/bhac441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Neurological soft signs (NSS) are minor deviations in motor performance. During childhood and adolescence, NSS are examined for functional motor phenotyping to describe development, to screen for comorbidities, and to identify developmental vulnerabilities. Here, we investigate underlying brain structure alterations in association with NSS in physically trained adolescents. Male adolescent athletes (n = 136, 13–16 years) underwent a standardized neurological examination including 28 tests grouped into 6 functional clusters. Non-optimal performance in at least 1 cluster was rated as NSS (NSS+ group). Participants underwent T1- and diffusion-weighted magnetic resonance imaging. Cortical volume, thickness, and local gyrification were calculated using Freesurfer. Measures of white matter microstructure (Free-water (FW), FW-corrected fractional anisotropy (FAt), axial and radial diffusivity (ADt, RDt)) were calculated using tract-based spatial statistics. General linear models with age and handedness as covariates were applied to assess differences between NSS+ and NSS− group. We found higher gyrification in a large cluster spanning the left superior frontal and parietal areas, and widespread lower FAt and higher RDt compared with the NSS− group. This study shows that NSS in adolescents are associated with brain structure alterations. Underlying mechanisms may include alterations in synaptic pruning and axon myelination, which are hallmark processes of brain maturation.
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Affiliation(s)
- Elena M Bonke
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich , Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Michaela V Bonfert
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Stefan M Hillmann
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Johanna Seitz-Holland
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Malo Gaubert
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- CHU Rennes Radiology Department, , Rennes, France
- University of Rennes Inria, CNRS, Inserm, IRISA UMR 6074, Empenn ERL, , Rennes, France
| | - Tim L T Wiegand
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Alberto De Luca
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
- University Medical Center Utrecht Department of Neurology, , Utrecht, the Netherlands
| | - Kang Ik K Cho
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Stian B Sandmo
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
- Oslo University Hospital Division of Mental Health and Addiction, , Oslo, Norway
| | - Eukyung Yhang
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
| | - Yorghos Tripodis
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
- Boston University School of Medicine Alzheimer’s Disease and CTE Centers, , Boston, MA , United States
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - David Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- University Hospital Augsburg Department of Diagnostic and Interventional Radiology and Neuroradiology, , Augsburg, Germany
| | - Elisabeth Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Ludwig-Maximilians-Universität Department of Neurology, , Munich, Germany
| | - Marc Muehlmann
- University Hospital Department of Clinical Radiology, , Ludwig-Maximilians-Universität, Munich, Germany
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Alexander P Lin
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
- Harvard Medical School Center for Clinical Spectroscopy, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Alexander Leemans
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Roald Bahr
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
| | - Martha E Shenton
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Ofer Pasternak
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Uta Tacke
- University Children's Hospital (UKBB) , Basel, Switzerland
| | - Florian Heinen
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Inga K Koerte
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich , Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
- Harvard Medical School Department of Psychiatry, Massachusetts General Hospital, , Boston, MA , United States
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Straathof EJM, Heineman KR, Hamer EG, Hadders-Algra M. Patterns of atypical muscle tone in the general infant population - Prevalence and associations with perinatal risk and neurodevelopmental status. Early Hum Dev 2021; 152:105276. [PMID: 33220644 DOI: 10.1016/j.earlhumdev.2020.105276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Muscle tone is an indispensable element in motor development. Its assessment forms an integral part of the infant neurological examination. Knowledge on the prevalence of atypical tone in infancy is lacking. AIM To assess the prevalence of atypical muscle tone in infancy and of the most common atypical muscle tone patterns, and associations between atypical tone and perinatal risk and neurodevelopmental status. STUDY DESIGN Cross-sectional study. SUBJECTS 1100 infants (585 boys; gestational age 39.4 weeks (27.3-42.4)), 6 weeks-12 months corrected age, representative of the Dutch population. OUTCOME MEASURES Muscle tone and neurodevelopmental status were assessed with the Standardized Infant NeuroDevelopmental Assessment (SINDA). Perinatal information was obtained by questionnaire and medical records. Univariable and multivariable statistics were applied. RESULTS Ninety-two infants (8%) had atypical muscle tone in 3-4 body parts (impaired pattern), while atypical muscle tone in 1-2 body parts was observed in 50%. Isolated leg hypotonia and isolated arm hypertonia were most common. Isolated arm hypertonia and the impaired pattern were most clearly but only moderately associated with perinatal risk. These patterns were also most clearly associated with lower neurological scores. Only the impaired pattern was associated with lower developmental scores. CONCLUSION Atypical muscle tone in one or two body parts is common in infancy and has in general little clinical significance. This finding corresponds to the well-known high prevalence of a typical but non-optimal neurological condition. Eight percent of infants show atypical muscle tone in 3-4 body parts. This clinically relevant pattern is associated with perinatal risk and less favourable neurodevelopmental status.
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Affiliation(s)
- Elisabeth J M Straathof
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Dokter Denekampweg 20, 8025 BV Zwolle, the Netherlands
| | - Elisa G Hamer
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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Broström L, Vollmer B, Bolk J, Eklöf E, Ådén U. Minor neurological dysfunction and associations with motor function, general cognitive abilities, and behaviour in children born extremely preterm. Dev Med Child Neurol 2018; 60:826-832. [PMID: 29573402 DOI: 10.1111/dmcn.13738] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
AIM To study the prevalence of minor neurological dysfunction (MND) at 6 years of age in a cohort of children born extremely preterm without cerebral palsy (CP) and to investigate associations with motor function, cognitive abilities, and behaviour. METHOD This study assessed 80 children born at less than 27 weeks of gestation and 90 children born at term age between 2004 and 2007 at a mean age of 6 years 6 months. The assessments included a simplified version of the Touwen Infant Neurological Examination, the Movement Assessment Battery for Children, Second Edition (MABC-2), Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV), the Strengths and Difficulties Questionnaire (SDQ), and the parent version of the Five to Fifteen questionnaire. RESULTS Fifty-one of the children born preterm had normal neurology, 23 had simple MND, and six had complex MND compared with 88 who had normal neurology and two simple MND in the term-born group (p<0.001). There were significant differences between the children with normal neurology and MND in the preterm group in MABC-2-assessed motor function (p<0.001), general cognitive abilities with WISC-IV (p=0.005), and SDQ overall behavioural problems and peer problems reported by the parents (p=0.021 and p=0.003 respectively). SDQ teacher-reported overall behavioural and hyperactivity problems were significantly different between children with normal and simple MND (p=0.036 and p=0.019). INTERPRETATION Children born extremely preterm, in the absence of CP, are at risk of MND and this is associated with motor function, cognitive ability, and behaviour. WHAT THIS PAPER ADDS Extremely preterm birth carries a risk of minor neurological dysfunction (MND). MND in children born extremely preterm is associated with impaired motor function and cognitive abilities, and behavioural problems. Male sex is associated with MND in children born extremely preterm.
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Affiliation(s)
- Lina Broström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Vollmer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jenny Bolk
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Eva Eklöf
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Kavas N, Arısoy AE, Bayhan A, Kara B, Günlemez A, Türker G, Oruç M, Gökalp AS. Neonatal sepsis and simple minor neurological dysfunction. Pediatr Int 2017; 59:564-569. [PMID: 27935218 DOI: 10.1111/ped.13217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/05/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low-birthweight newborns followed until preschool age. METHODS This was a prospective longitudinal study. Children with birthweight <1500 g were assessed at 4-6 years of age. Twenty-eight children with normal neurological examination and 35 children with SMND were included in the final analysis. Risk factors for the development of SMND and its association with certain neuropsychiatric conditions were studied. RESULTS Based on neonatal data, in children with SMND, Apgar score at 1 min (6.13 ± 2.37 vs 7.66 ± 1.04, P = 0.008) and at 5 min (8.63 ± 1.29 vs 9.45 ± 0.65, P = 0.019) was lower, duration of hospital stay was longer (45.8 ± 21.8 vs 35.1 ± 18.2 days, P = 0.037), and the frequency of sepsis was higher (73.5 vs 25%, P < 0.001). Sepsis was found to be an independent risk factor for SMND (OR, 7.6; 95% CI: 2.2-26.0; P = 0.001). The children with SMND had lower intelligence quotient and higher prevalence of hyperactivity and refraction error. CONCLUSION Postnatal sepsis was the single most important risk factor for the development of SMND, and these children with SMND are at great risk for certain neuropsychiatric conditions. Preventive strategies, particularly for sepsis in the neonatal period, and early diagnosis and rehabilitation of future neuropsychiatric disorders are needed for better management of these cases.
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Affiliation(s)
- Nazan Kavas
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Ayşe Engin Arısoy
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Asuman Bayhan
- Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Bülent Kara
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Ayla Günlemez
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Gülcan Türker
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Meral Oruç
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
| | - Ayşe Sevim Gökalp
- Division of Neonatology, Department of Pediatrics, Kocaeli University Medical School, Kocaeli, Turkey
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Kurpershoek T, Potharst-Sirag ES, Aarnoudse-Moens CSH, van Wassenaer-Leemhuis AG. Minor neurological dysfunction in five year old very preterm children is associated with lower processing speed. Early Hum Dev 2016; 103:55-60. [PMID: 27513713 DOI: 10.1016/j.earlhumdev.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Minor neurological dysfunction (MND) is present in one quarter to one third of children born very preterm (VP). The more severe form, complex (c)-MND has been associated with learning disabilities, behavioural and motor problems. OBJECTIVE To study the association between c-MND and neurocognitive and motor disabilities at age five in VP children without CP. METHODS Ninety-four children born with gestational age<30weeks and/or a birth weight<1000g were assessed at five years corrected age. MND was classified according to Touwen. The Wechsler Preschool and Primary School Scale of Intelligence (WPPSI-III-NL) was used to measure intelligence. Simple reaction time, focused attention and visuomotor coordination were measured using the Amsterdam Neuropsychological Tasks, and working memory using a Digit Span Task. For motor skills the Movement Assessment Battery for children (M-ABC2) was used. RESULTS Eighty-one percent was classified as 'normal' (no or simple (s-)-MND) and 19% as 'abnormal'(c-MND or mild CP). The abnormal group had a significantly lower processing speed quotient (PSQ), M-ABC percentile score and slower simple Reaction Time than the normal group. Verbal IQ, Performance IQ, working memory, focused attention and visuomotor coordination did not differ between groups. Exclusion of the mild CP cases (n=4) led to similar results. CONCLUSIONS Five year old VP children with c-MND have lower PSQ, slower reaction time, and poorer motor skills, than those without c-MND. Neurological examination should include identification of MND to help identify children at risk for neurocognitive disabilities.
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Affiliation(s)
- Tinka Kurpershoek
- Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Eva S Potharst-Sirag
- Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
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