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Leung ECH, Jain P, Michealson MA, Choi H, Ellsworth-Kopkowski A, Valenzuela CF. Recent breakthroughs in understanding the cerebellum's role in fetal alcohol spectrum disorder: A systematic review. Alcohol 2024; 119:37-71. [PMID: 38097146 PMCID: PMC11166889 DOI: 10.1016/j.alcohol.2023.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 06/14/2024]
Abstract
Exposure to alcohol during fetal development can lead to structural and functional abnormalities in the cerebellum, a brain region responsible for motor coordination, balance, and specific cognitive functions. In this systematic review, we comprehensively analyze a vast body of research conducted on vertebrate animals and humans over the past 13 years. We identified studies through PubMed and screened them following PRISMA guidelines. Data extraction and quality analysis were conducted using Covidence systematic review software. A total of 108 studies met our inclusion criteria, with the majority (79 studies) involving vertebrate animal models and 29 studies focusing on human subjects. Animal models included zebrafish, mice, rats, sheep, and non-human primates, investigating the impact of ethanol on cerebellar structure, gene/protein expression, physiology, and cerebellar-dependent behaviors. Additionally, some animal studies explored potential therapeutic interventions against ethanol-induced cerebellar damage. The human studies predominantly adopted cohort designs, exploring the effects of prenatal alcohol exposure on cerebellar structure and function. Certain human studies delved into innovative cerebellar-based diagnostic approaches for fetal alcohol spectrum disorder (FASD). The collective findings from these studies clearly indicate that the cerebellum is involved in various neurophysiological deficits associated with FASD, emphasizing the importance of evaluating both cerebellar structure and function in the diagnostic process for this condition. Moreover, this review sheds light into potential therapeutic strategies that can mitigate prenatal alcohol exposure-induced cerebellar damage.
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Affiliation(s)
- Eric C H Leung
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - Priyanka Jain
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - Marisa A Michealson
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - Hyesun Choi
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - Alexis Ellsworth-Kopkowski
- Health Sciences Library & Informatics Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States
| | - C Fernando Valenzuela
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
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Thompson DK, Kelly CE, Dhollander T, Muggli E, Hearps S, Lewis S, Nguyen TNN, Spittle A, Elliott EJ, Penington A, Halliday J, Anderson PJ. Associations between low-moderate prenatal alcohol exposure and brain development in childhood. Neuroimage Clin 2024; 42:103595. [PMID: 38555806 PMCID: PMC10998198 DOI: 10.1016/j.nicl.2024.103595] [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: 11/21/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The effects of low-moderate prenatal alcohol exposure (PAE) on brain development have been infrequently studied. AIM To compare cortical and white matter structure between children aged 6 to 8 years with low-moderate PAE in trimester 1 only, low-moderate PAE throughout gestation, or no PAE. METHODS Women reported quantity and frequency of alcohol consumption before and during pregnancy. Magnetic resonance imaging was undertaken for 143 children aged 6 to 8 years with PAE during trimester 1 only (n = 44), PAE throughout gestation (n = 58), and no PAE (n = 41). T1-weighted images were processed using FreeSurfer, obtaining brain volume, area, and thickness of 34 cortical regions per hemisphere. Fibre density (FD), fibre cross-section (FC) and fibre density and cross-section (FDC) metrics were computed for diffusion images. Brain measures were compared between PAE groups adjusted for age and sex, then additionally for intracranial volume. RESULTS After adjustments, the right caudal anterior cingulate cortex volume (pFDR = 0.045) and area (pFDR = 0.008), and right cingulum tract cross-sectional area (pFWE < 0.05) were smaller in children exposed to alcohol throughout gestation compared with no PAE. CONCLUSION This study reports a relationship between low-moderate PAE throughout gestation and cingulate cortex and cingulum tract alterations, suggesting a teratogenic vulnerability. Further investigation is warranted.
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Affiliation(s)
- Deanne K Thompson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Claire E Kelly
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Thijs Dhollander
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Evelyne Muggli
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | | | - Alicia Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Elizabeth J Elliott
- The University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Kids Research, Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Anthony Penington
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
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Fraize J, Leprince Y, Elmaleh-Bergès M, Kerdreux E, Delorme R, Hertz-Pannier L, Lefèvre J, Germanaud D. Spectral-based thickness profiling of the corpus callosum enhances anomaly detection in fetal alcohol spectrum disorders. Front Neurosci 2023; 17:1289013. [PMID: 38027471 PMCID: PMC10657855 DOI: 10.3389/fnins.2023.1289013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Fetal alcohol spectrum disorders (FASD) range from fetal alcohol syndrome (FAS) to non-syndromic forms (NS-FASD). The neuroanatomical consequences of prenatal alcohol exposure are mainly the reduction in brain size, but also focal abnormalities such as those of the corpus callosum (CC). We previously showed a narrowing of the CC for brain size, using manual measurement and its usefulness to improve diagnostic certainty. Our aim was to automate these measurements of the CC and identify more recurrent abnormalities in FAS subjects, independently of brain size reduction. Methods We developed a fast, automated, and normalization-free method based on spectral analysis to generate thicknesses of the CC continuously and at singular points (genu, body, isthmus, and splenium), and its length (LCC). We applied it on midsagittal section of the CC extracted from T1-anatomical brain MRI of 89 subjects with FASD (52 FAS, 37 NS-FASD) and 126 with typically development (6-20 y-o). After adjusting for batch effect, we compared the mean profiles and thicknesses of the singular points across the 3 groups. For each parameter, we established variations with age (growth charts) and brain size in the control group (scaling charts), then identified participants with abnormal measurements (<10th percentile). Results We confirmed the slimming of the posterior half of the CC in both FASD groups, and of the genu section in the FAS group, compared to the control group. We found a significant group effect for the LCC, genu, median body, isthmus, and splenium thicknesses (p < 0.05). We described a body hump whose morphology did not differ between groups. According to the growth charts, there was an excess of FASD subjects with abnormal LCC and isthmus, and of FAS subjects with abnormal genu and splenium. According to the scaling charts, this excess remained only for LCC, isthmus and splenium, undersized for brain size. Conclusion We characterized size-independent anomalies of the posterior part of the CC in FASD, with an automated method, confirming and extending our previous study. Our new tool brings the use of a neuroanatomical criterion including CC damage closer to clinical practice. Our results suggest that an FAS signature identified in NS-FASD, could improve diagnosis specificity.
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Affiliation(s)
- Justine Fraize
- UNIACT, NeuroSpin, Frederic Joliot Institute, Centre d’études de Saclay, CEA Paris-Saclay, Gif-sur-Yvette, France
- InDEV, NeuroDiderot, Inserm, Université Paris Cité, Paris, France
| | - Yann Leprince
- UNIACT, NeuroSpin, Frederic Joliot Institute, Centre d’études de Saclay, CEA Paris-Saclay, Gif-sur-Yvette, France
| | - Monique Elmaleh-Bergès
- Department of Pediatric Radiologic, Robert-Debré Hospital, AP-HP, Centre of Excellence InovAND, Paris, France
| | - Eliot Kerdreux
- UNIACT, NeuroSpin, Frederic Joliot Institute, Centre d’études de Saclay, CEA Paris-Saclay, Gif-sur-Yvette, France
- InDEV, NeuroDiderot, Inserm, Université Paris Cité, Paris, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, AP-HP, Centre of Excellence InovAND, Paris, France
| | - Lucie Hertz-Pannier
- UNIACT, NeuroSpin, Frederic Joliot Institute, Centre d’études de Saclay, CEA Paris-Saclay, Gif-sur-Yvette, France
- InDEV, NeuroDiderot, Inserm, Université Paris Cité, Paris, France
| | - Julien Lefèvre
- Institut de Neurosciences de La Timone, CNRS, Aix-Marseille Université, Marseille, France
| | - David Germanaud
- UNIACT, NeuroSpin, Frederic Joliot Institute, Centre d’études de Saclay, CEA Paris-Saclay, Gif-sur-Yvette, France
- InDEV, NeuroDiderot, Inserm, Université Paris Cité, Paris, France
- Department of Genetics, Robert-Debré Hospital, AP-HP, Centre de Référence Déficiences Intellectuelles de Causes Rares, Centre of Excellence InovAND, Paris, France
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Pfefferbaum A, Sullivan EV, Pohl KM, Bischoff-Grethe A, Stoner SA, Moore EM, Riley EP. Brain Volume in Fetal Alcohol Spectrum Disorders Over a 20-Year Span. JAMA Netw Open 2023; 6:e2343618. [PMID: 37976065 PMCID: PMC10656646 DOI: 10.1001/jamanetworkopen.2023.43618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Anomalous brain development and mental health problems are prevalent in fetal alcohol spectrum disorders (FASD), but there is a paucity of longitudinal brain imaging research into adulthood. This study presents long-term follow-up of brain volumetrics in a cohort of participants with FASD. Objective To test whether brain tissue declines faster with aging in individuals with FASD compared with control participants. Design, Setting, and Participants This cohort study used magnetic resonance imaging (MRI) data collected from individuals with FASD and control individuals (age 13-37 years at first magnetic resonance imaging [MRI1] acquired 1997-2000) compared with data collected 20 years later (MRI2; 2018-2021). Participants were recruited for MRI1 through the University of Washington Fetal Alcohol Syndrome (FAS) Follow-Up Study. For MRI2, former participants were recruited by the University of Washington Fetal Alcohol and Drug Unit. Data were analyzed from October 2022 to August 2023. Main Outcomes and Measures Intracranial volume (ICV) and regional cortical and cerebellar gray matter, white matter, and cerebrospinal fluid volumes were quantified automatically and analyzed, with group and sex as between-participant factors and age as a within-participant variable. Results Of 174 individuals with MRI1 data, 48 refused participation, 36 were unavailable, and 24 could not be located. The remaining 66 individuals (37.9%) were rescanned for MRI2, including 26 controls, 18 individuals with nondysmorphic heavily exposed fetal alcohol effects (FAE; diagnosed prior to MRI1), and 22 individuals with FAS. Mean (SD) age was 22.9 (5.6) years at MRI1 and 44.7 (6.5) years at MRI2, and 35 participants (53%) were male. The FAE and FAS groups exhibited enduring stepped volume deficits at MRI1 and MRI2; volumes among control participants were greater than among participants with FAE, which were greater than volumes among participants with FAS (eg, mean [SD] ICV: control, 1462.3 [119.3] cc at MRI1 and 1465.4 [129.4] cc at MRI2; FAE, 1375.6 [134.1] cc at MRI1 and 1371.7 [120.3] cc at MRI2; FAS, 1297.3 [163.0] cc at MRI1 and 1292.7 [172.1] cc at MRI2), without diagnosis-by-age interactions. Despite these persistent volume deficits, the FAE participants and FAS participants showed patterns of neurodevelopment within reference ranges: increase in white matter and decrease in gray matter of the cortex and decrease in white matter and increase in gray matter of the cerebellum. Conclusions and Relevance The findings of this cohort study support a nonaccelerating enduring, brain structural dysmorphic spectrum following prenatal alcohol exposure and a diagnostic distinction based on the degree of dysmorphia. FASD was not a progressive brain structural disorder by middle age, but whether accelerated decline occurs in later years remains to be determined.
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Affiliation(s)
- Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Susan A. Stoner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Eileen M. Moore
- Department of Psychology, San Diego State University, San Diego, California
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California
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Fraize J, Fischer C, Elmaleh-Bergès M, Kerdreux E, Beggiato A, Ntorkou A, Duchesnay E, Bekha D, Boespflug-Tanguy O, Delorme R, Hertz-Pannier L, Germanaud D. Enhancing fetal alcohol spectrum disorders diagnosis with a classifier based on the intracerebellar gradient of volumetric undersizing. Hum Brain Mapp 2023. [PMID: 37209313 DOI: 10.1002/hbm.26348] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023] Open
Abstract
In fetal alcohol spectrum disorders (FASD), brain growth deficiency is a hallmark of subjects both with fetal alcohol syndrome (FAS) and with non-syndromic FASD (NS-FASD, i.e., those without specific diagnostic features). However, although the cerebellum was suggested to be more severely undersized than the rest of the brain, it has not yet been given a specific place in the FASD diagnostic criteria where neuroanatomical features still count for little if anything in diagnostic specificity. We applied a combination of cerebellar segmentation tools on a 1.5 T 3DT1 brain MRI dataset from a monocentric population of 89 FASD (52 FAS, 37 NS-FASD) and 126 typically developing controls (6-20 years old), providing 8 volumes: cerebellum, vermis and 3 lobes (anterior, posterior, inferior), plus total brain volume. After adjustment of confounders, the allometric scaling relationship between these cerebellar volumes (Vi ) and the total brain or cerebellum volume (Vt ) was fitted (Vi = bVt a ), and the effect of group (FAS, control) on allometric scaling was evaluated. We then estimated for each cerebellar volume in the FAS population the deviation from the typical scaling (v DTS) learned in the controls. Lastly, we trained and tested two classifiers to discriminate FAS from controls, one based on the total cerebellum v DTS only, the other based on all the cerebellar v DTS, comparing their performance both in the FAS and the NS-FASD group. Allometric scaling was significantly different between FAS and control group for all the cerebellar volumes (p < .001). We confirmed the excess of total cerebellum volume deficit (v DTS = -10.6%) and revealed an antero-inferior-posterior gradient of volumetric undersizing in the hemispheres (-12.4%, 1.1%, 2.0%, repectively) and the vermis (-16.7%, -9.2%, -8.6%, repectively). The classifier based on the intracerebellar gradient of v DTS performed more efficiently than the one based on total cerebellum v DTS only (AUC = 92% vs. 82%, p = .001). Setting a high probability threshold for >95% specificity of the classifiers, the gradient-based classifier identified 35% of the NS-FASD to have a FAS cerebellar phenotype, compared to 11% with the cerebellum-only classifier (pFISHER = 0.027). In a large series of FASD, this study details the volumetric undersizing within the cerebellum at the lobar and vermian level using allometric scaling, revealing an anterior-inferior-posterior gradient of vulnerability to prenatal alcohol exposure. It also strongly suggests that this intracerebellar gradient of volumetric undersizing may be a reliable neuroanatomical signature of FAS that could be used to improve the specificity of the diagnosis of NS-FASD.
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Affiliation(s)
- Justine Fraize
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - Clara Fischer
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, BAOBAB, Centre d'études de Saclay, Gif-sur-Yvette, France
| | - Monique Elmaleh-Bergès
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
- Department of Pediatric Radiology, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Eliot Kerdreux
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - Anita Beggiato
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Alexandra Ntorkou
- Department of Pediatric Radiology, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Edouard Duchesnay
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, BAOBAB, Centre d'études de Saclay, Gif-sur-Yvette, France
| | - Dhaif Bekha
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | | | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
| | - Lucie Hertz-Pannier
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
| | - David Germanaud
- CEA Paris-Saclay, Joliot Institute, NeuroSpin, UNIACT, Centre d'études de Saclay, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, U1141 NeuroDiderot, inDEV, Paris, France
- Department of Genetics, Centre of Excellence InovAND, AP-HP, Robert-Debré Hospital, Paris, France
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Adams JW, Negraes PD, Truong J, Tran T, Szeto RA, Guerra BS, Herai RH, Teodorof-Diedrich C, Spector SA, Del Campo M, Jones KL, Muotri AR, Trujillo CA. Impact of alcohol exposure on neural development and network formation in human cortical organoids. Mol Psychiatry 2023; 28:1571-1584. [PMID: 36385168 PMCID: PMC10208963 DOI: 10.1038/s41380-022-01862-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Prenatal alcohol exposure is the foremost preventable etiology of intellectual disability and leads to a collection of diagnoses known as Fetal Alcohol Spectrum Disorders (FASD). Alcohol (EtOH) impacts diverse neural cell types and activity, but the precise functional pathophysiological effects on the human fetal cerebral cortex are unclear. Here, we used human cortical organoids to study the effects of EtOH on neurogenesis and validated our findings in primary human fetal neurons. EtOH exposure produced temporally dependent cellular effects on proliferation, cell cycle, and apoptosis. In addition, we identified EtOH-induced alterations in post-translational histone modifications and chromatin accessibility, leading to impairment of cAMP and calcium signaling, glutamatergic synaptic development, and astrocytic function. Proteomic spatial profiling of cortical organoids showed region-specific, EtOH-induced alterations linked to changes in cytoskeleton, gliogenesis, and impaired synaptogenesis. Finally, multi-electrode array electrophysiology recordings confirmed the deleterious impact of EtOH on neural network formation and activity in cortical organoids, which was validated in primary human fetal tissues. Our findings demonstrate progress in defining the human molecular and cellular phenotypic signatures of prenatal alcohol exposure on functional neurodevelopment, increasing our knowledge for potential therapeutic interventions targeting FASD symptoms.
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Affiliation(s)
- Jason W Adams
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
- Department of Neurosciences, University of California San Diego, School of Medicine, La Jolla, CA, 92093, USA
- Center for Academic Research and Training in Anthropogeny, University of California San Diego, La Jolla, CA, 92093, USA
| | - Priscilla D Negraes
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
| | - Justin Truong
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
| | - Timothy Tran
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
| | - Ryan A Szeto
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
| | - Bruno S Guerra
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
- Experimental Multiuser Laboratory, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Roberto H Herai
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA
- Experimental Multiuser Laboratory, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Carmen Teodorof-Diedrich
- Department of Pediatrics, Division of Infectious Diseases, University of California San Diego, La Jolla, CA, 92093, USA
| | - Stephen A Spector
- Department of Pediatrics, Division of Infectious Diseases, University of California San Diego, La Jolla, CA, 92093, USA
| | - Miguel Del Campo
- Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, La Jolla, CA, 92093, USA
| | - Kenneth L Jones
- Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, La Jolla, CA, 92093, USA
| | - Alysson R Muotri
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA.
- Center for Academic Research and Training in Anthropogeny, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Cleber A Trujillo
- Department of Pediatrics/Rady Children's Hospital, Department of Cellular & Molecular Medicine, University of California San Diego, School of Medicine, La Jolla, CA, 92037, USA.
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7
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Fraize J, Garzón P, Ntorkou A, Kerdreux E, Boespflug-Tanguy O, Beggiato A, Delorme R, Hertz-Pannier L, Elmaleh-Berges M, Germanaud D. Combining neuroanatomical features to support diagnosis of fetal alcohol spectrum disorders. Dev Med Child Neurol 2023; 65:551-562. [PMID: 36137006 DOI: 10.1111/dmcn.15411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/27/2022]
Abstract
AIM To identify easily accessible neuroanatomical abnormalities useful for diagnosing fetal alcohol spectrum disorders (FASD) in fetal alcohol syndrome (FAS) but more importantly for the probabilistic diagnosis of non-syndromic forms (NS-FASD). METHOD We retrospectively collected monocentric data from 52 individuals with FAS, 37 with NS-FASD, and 94 paired typically developing individuals (6-20 years, 99 males, 84 females). On brain T1-weighted magnetic resonance imaging, we measured brain size, corpus callosum length and thicknesses, vermis height, then evaluated vermis foliation (Likert scale). For each parameter, we established variations with age and brain size in comparison individuals (growth and scaling charts), then identified participants with abnormal measurements (<10th centile). RESULTS According to growth charts, there was an excess of FAS with abnormally small brain, isthmus, splenium, and vermis. According to scaling charts, this excess remained only for isthmus thickness and vermis height. The vermis foliation was pathological in 18% of those with FASD but in no comparison individual. Overall, 39% of those with FAS, 27% with NS-FASD, but only 2% of comparison individuals presented with two FAS-recurrent abnormalities, and 19% of those with FAS had all three. Considering the number of anomalies, there was a higher likelihood of a causal link with alcohol in 14% of those with NS-FASD. INTERPRETATION Our results suggest that adding an explicit composite neuroanatomical-radiological criterion for FASD diagnosis may improve its specificity, especially in NS-FASD. WHAT THIS PAPER ADDS Neuroanatomical anomalies independent of microcephaly can be measured with clinical-imaging tools. Small-for-age brain, small-for-brain-size callosal isthmus or vermian height, and disrupted vermis foliation are fetal alcohol syndrome (FAS)-recurrent anomalies. Associations of these anomalies are frequent in fetal alcohol spectrum disorder (FASD) even without FAS, while exceptional in typically developing individuals. These associations support higher likelihood of causal link with alcohol in some individuals with non-syndromic FASD. A new explicit and composite neuroanatomical-radiological criterion can improve the specificity of FASD diagnosis.
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Affiliation(s)
- Justine Fraize
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
| | - Pauline Garzón
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
| | - Alexandra Ntorkou
- Department of Paediatric Radiologic, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Eliot Kerdreux
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
| | | | - Anita Beggiato
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Lucie Hertz-Pannier
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
| | - Monique Elmaleh-Berges
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
- Department of Paediatric Radiologic, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - David Germanaud
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, InDEV, Paris, France
- Department of Genetics, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
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8
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Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, Riley EP, Elliott EJ. Fetal alcohol spectrum disorders. Nat Rev Dis Primers 2023; 9:11. [PMID: 36823161 DOI: 10.1038/s41572-023-00420-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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9
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Roozen S, Ehrhart F. Fetal alcohol spectrum disorders and the risk of crime. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:197-204. [PMID: 37633710 DOI: 10.1016/b978-0-12-821375-9.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are an important preventable global health concern. FASD is an umbrella term describing a range of mild to severe cognitive and behavioral problems among individuals prenatally exposed to alcohol. Alcohol causes FASD by interfering with molecular pathways during fetal development involving increased oxidative stress, disturbed organ development, and change of epigenetic gene expression control. Neuroimaging studies into FASD show several neuropathological abnormalities including abnormal brain structure, cortical development, white matter microstructure, and functional connectivity. Individuals with FASD experience a wide range of cognitive and behavioral challenges. Risks of violent behavior, criminality, and criminalization have been indicated by a limited number of epidemiological studies. The relationship between prenatal alcohol exposure and the increase of these risks remains unclear. This is further impeded by the complexity of an FASD diagnosis, the lack of a clear dose-response relationship of brain impact to alcohol use, and the lack of a clear FASD behavioral phenotype. Literature with respect to FASD and crime is still in its infancy. From the studies available, it is recommended to pay close attention to individuals with FASD and the relation with the criminal justice system and the risk for discrimination. There is a clear need for FASD-related stigma reduction programs within the correctional system. Further investigations into reliable biomarkers for diagnosis and treatment are needed.
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Affiliation(s)
- Sylvia Roozen
- Governor Kremers Centre-Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
| | - Friederike Ehrhart
- Department of Bioinformatics, NUTRIM/MHeNs, Maastricht University, Maastricht, The Netherlands
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10
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Licheri V, Brigman JL. Altering Cell-Cell Interaction in Prenatal Alcohol Exposure Models: Insight on Cell-Adhesion Molecules During Brain Development. Front Mol Neurosci 2022; 14:753537. [PMID: 34975396 PMCID: PMC8715949 DOI: 10.3389/fnmol.2021.753537] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Alcohol exposure during pregnancy disrupts the development of the brain and produces long lasting behavioral and cognitive impairments collectively known as Fetal Alcohol Spectrum Disorders (FASDs). FASDs are characterized by alterations in learning, working memory, social behavior and executive function. A large body of literature using preclinical prenatal alcohol exposure models reports alcohol-induced changes in architecture and activity in specific brain regions affecting cognition. While multiple putative mechanisms of alcohol’s long-lasting effects on morphology and behavior have been investigated, an area that has received less attention is the effect of alcohol on cell adhesion molecules (CAMs). The embryo/fetal development represents a crucial period for Central Nervous System (CNS) development during which the cell-cell interaction plays an important role. CAMs play a critical role in neuronal migration and differentiation, synaptic organization and function which may be disrupted by alcohol. In this review, we summarize the physiological structure and role of CAMs involved in brain development, review the current literature on prenatal alcohol exposure effects on CAM function in different experimental models and pinpoint areas needed for future study to better understand how CAMs may mediate the morphological, sensory and behavioral outcomes in FASDs.
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Affiliation(s)
- Valentina Licheri
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jonathan L Brigman
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States.,New Mexico Alcohol Research Center, UNM Health Sciences Center, Albuquerque, NM, United States
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11
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Roos A, Wedderburn CJ, Fouche JP, Subramoney S, Joshi SH, Woods RP, Zar HJ, Narr KL, Stein DJ, Donald KA. Central white matter integrity alterations in 2-3-year-old children following prenatal alcohol exposure. Drug Alcohol Depend 2021; 225:108826. [PMID: 34182371 PMCID: PMC8299546 DOI: 10.1016/j.drugalcdep.2021.108826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) remains a potentially preventable, but pervasive risk factor to neurodevelopment. Yet, evidence is lacking on the impact of alcohol on brain development in toddlers. This study aimed to investigate the impact of PAE on brain white matter integrity in 2-3-year-old children. METHODS Children (n = 83, 30-37 months old) of the Drakenstein Child Health Study birth cohort, underwent diffusion MRI on a 3 T Siemens scanner during natural sleep. Parameters were extracted in children with PAE (n = 25, 56 % boys) and unexposed controls (n = 58, 62 % boys) using Tract-based Spatial Statistics, and compared by group. The contribution of maternal tobacco smoking to white matter differences was also explored. RESULTS Children with PAE had altered fractional anisotropy, radial diffusivity and axial diffusivity in brain stem, limbic and association tracts compared to unexposed controls. Notably lower fractional anisotropy was found in the uncinate fasciculus, and lower mean and radial diffusivity were found in the fornix stria terminalis and corticospinal tract (FDR corrected p < 0.05). There was a significant interaction effect of PAE and prenatal tobacco exposure which lowered mean, radial and axial diffusivity in the corticospinal tract significantly in the PAE group but not controls. CONCLUSION Widespread altered white matter microstructural integrity at 2-3 years of age is consistent with findings in neonates in the same and other cohorts, indicating persistence of effects of PAE through early life. Findings also highlight that prenatal tobacco exposure impacts the association of PAE on white matter alterations, amplifying effects in tracts underlying motor function.
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Affiliation(s)
- Annerine Roos
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa; Department of Pediatrics and Child Health, University of Cape Town, South Africa; Neuroscience Institute, University of Cape Town, South Africa.
| | - Catherine J. Wedderburn
- Department of Pediatrics and Child Health, University of Cape Town, South Africa,Neuroscience Institute, University of Cape Town, South Africa,Department of Clinical Research, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Jean-Paul Fouche
- Neuroscience Institute, University of Cape Town, South Africa,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Sivenesi Subramoney
- Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Shantanu H. Joshi
- Departments of Neurology and of Bioengineering, University of California, Los Angeles, USA
| | - Roger P. Woods
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Heather J. Zar
- Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Katherine L. Narr
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Dan J. Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa,Neuroscience Institute, University of Cape Town, South Africa,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Kirsten A. Donald
- Department of Pediatrics and Child Health, University of Cape Town, South Africa,Neuroscience Institute, University of Cape Town, South Africa
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12
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Kar P, Reynolds JE, Grohs MN, Gibbard WB, McMorris C, Tortorelli C, Lebel C. White matter alterations in young children with prenatal alcohol exposure. Dev Neurobiol 2021; 81:400-410. [PMID: 33829663 DOI: 10.1002/dneu.22821] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
Prenatal alcohol exposure (PAE) can lead to cognitive, behavioural, and social-emotional challenges. Previous neuroimaging research has identified structural brain alterations in newborns, older children, adolescents, and adults with PAE; however, little is known about brain structure in young children. Extensive brain development occurs during early childhood; therefore, understanding the neurological profiles of young children with PAE is critical for early identification and effective intervention. We studied 54 children (5.21 ± 1.11 years; 27 males) with confirmed PAE (94% also had other prenatal exposures, 74% had adverse postnatal experiences) compared with 54 age- and sex-matched children without PAE. Children underwent diffusion tensor imaging between 2 and 7 years of age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were obtained for 10 major white matter tracts. Univariate analyses of covariance were used to test group differences (PAE vs. control) controlling for age and sex. The PAE group had higher FA in the genu of the corpus callosum and lower MD in the bilateral uncinate fasciculus. The PAE group also had lower tract volume in the corpus callosum, the bilateral inferior fronto-occipital fasciculi, and the right superior longitudinal fasciculus. Our findings align with studies of newborns with PAE reporting lower diffusivity, but contrast those in older populations with PAE, which consistently report lower FA and higher MD. Further research is needed to understand trajectories of white matter development and how our results of higher FA/lower MD in young children connect with lower FA/higher MD observed at older ages.
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Affiliation(s)
- Preeti Kar
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jess E Reynolds
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Melody N Grohs
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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13
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Sullivan EV, Moore EM, Lane B, Pohl KM, Riley EP, Pfefferbaum A. Graded Cerebellar Lobular Volume Deficits in Adolescents and Young Adults with Fetal Alcohol Spectrum Disorders (FASD). Cereb Cortex 2020; 30:4729-4746. [PMID: 32133485 DOI: 10.1093/cercor/bhaa020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
The extensive prenatal developmental growth period of the cerebellum renders it vulnerable to unhealthy environmental agents, especially alcohol. Fetal alcohol spectrum disorders (FASD) is marked by neurodysmorphology including cerebral and cerebellar volume deficits, but the cerebellar lobular deficit profile has not been delineated. Legacy MRI data of 115 affected and 59 unaffected adolescents and young adults were analyzed for lobular gray matter volume and revealed graded deficits supporting a spectrum of severity. Graded deficits were salient in intracranial volume (ICV), where the fetal alcohol syndrome (FAS) group was smaller than the fetal alcohol effects (FAE) group, which was smaller than the controls. Adjusting for ICV, volume deficits were present in VIIB and VIIIA of the FAE group and were more widespread in FAS and included lobules I, II, IV, V, VI, Crus II, VIIB, and VIIIA. Graded deficits (FAS < FAE) were consistently present in lobules VI; neither group showed volume deficits in Crus I or IX. Neuroradiological readings blind to diagnosis identified 20 anomalies, 8 involving the cerebellum, 5 of which were in the FAS group. We speculate that the regional cerebellar FASD-related volume deficits may contribute to diagnostically characteristic functional impairment involving emotional control, visuomotor coordination, and postural stability.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eileen M Moore
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Barton Lane
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kilian M Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Edward P Riley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
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14
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Wozniak JR, Fink BA, Fuglestad AJ, Eckerle JK, Boys CJ, Sandness KE, Radke JP, Miller NC, Lindgren C, Brearley AM, Zeisel SH, Georgieff MK. Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder. J Neurodev Disord 2020; 12:9. [PMID: 32164522 PMCID: PMC7066854 DOI: 10.1186/s11689-020-09312-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial. METHODS The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2-5-year-olds with FASD. Participants include 31 children (16 placebo; 15 choline) seen 4 years after trial completion. The mean age at follow-up was 8.6 years. Diagnoses were 12.9% fetal alcohol syndrome (FAS), 41.9% partial FAS, and 45.1% alcohol-related neurodevelopmental disorder. The follow-up included measures of intelligence, memory, executive functioning, and behavior. RESULTS Children who received choline had higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder than the placebo group. No differences were seen for verbal intelligence, visual memory, or other executive functions. CONCLUSIONS These data support choline as a potential neurodevelopmental intervention for FASD and highlight the need for long-term follow-up to capture treatment effects on neurodevelopmental trajectories. TRIAL REGISTRATION ClinicalTrials.Gov #NCT01149538; Registered: June 23, 2010; first enrollment July 2, 2010.
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Affiliation(s)
- Jeffrey R Wozniak
- University of Minnesota Twin Cities, Minneapolis, MN, USA.
- Department of Psychiatry, University of Minnesota, F282 / 2A West, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
| | - Birgit A Fink
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | | | | | | | | | - Neely C Miller
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Ann M Brearley
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Steven H Zeisel
- University of North Carolina, Nutrition Research Institute, Kannapolis, NC, USA
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15
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Treit S, Jeffery D, Beaulieu C, Emery D. Radiological Findings on Structural Magnetic Resonance Imaging in Fetal Alcohol Spectrum Disorders and Healthy Controls. Alcohol Clin Exp Res 2020; 44:455-462. [PMID: 31840819 DOI: 10.1111/acer.14263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) describe a range of physical, behavioral, and cognitive impairments stemming from prenatal alcohol exposure (PAE). Although case studies have demonstrated striking visible brain abnormalities in humans (enlargement of the lateral ventricles, thinning or absence of the corpus callosum, etc.), few studies have systematically determined how these radiological findings generalize to the wider population of individuals living with FASD. METHODS This study examines rates of structural brain anomalies on magnetic resonance imaging (MRI) as determined by 2 radiologists in a retrospective blinded review of 163 controls and 164 individuals with PAE who were previously scanned as participants of past research studies. Incidental findings were categorized as normal variants, nonclinically significant incidental findings, or clinically significant incidental findings. Rates were compared between diagnostic subgroups using chi-square analysis. RESULTS There was no significant difference in the overall rate of incidental findings between groups: 75% of controls and 73% of PAE participants had no incidental findings of any kind, and only 1% of controls and 3% of PAE participants had incidental finding of clinical significance (the remaining findings were considered nonsignificant anomalies or normal variants). When the PAE group was split by diagnosis, low-lying cerebellar tonsils, polymicrogyria, and ventricular asymmetry/enlargement were all most prevalent in subjects with fetal alcohol syndrome/partial fetal alcohol syndrome. In addition, the overall rate of incidental findings was higher (41%) in participants with FAS/pFAS, compared to 25% in controls. No participants in this relatively large sample had corpus callosum agenesis. CONCLUSIONS Although advanced quantitative MRI research has uncovered a range of differences in brain structure associated with FASD, this qualitative radiological study suggests that routine clinical MRI does not reveal a consistent pattern of brain abnormalities that can be used diagnostically in this population.
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Affiliation(s)
- Sarah Treit
- From the, Department of Biomedical Engineering, (ST, CB), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean Jeffery
- Department of Radiology and Diagnostic Imaging, (DJ, DE), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christian Beaulieu
- From the, Department of Biomedical Engineering, (ST, CB), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Derek Emery
- Department of Radiology and Diagnostic Imaging, (DJ, DE), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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16
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Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol 2019; 18:760-770. [PMID: 31160204 DOI: 10.1016/s1474-4422(19)30150-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/21/2022]
Abstract
Although prenatal alcohol exposure causes craniofacial anomalies, growth retardation, neurological abnormalities, cognitive impairment, and birth defects, fetal alcohol spectrum disorder is underdiagnosed. Global prevalence of fetal alcohol spectrum disorder is 0·77%, with a higher prevalence of 2-5% in Europe and North America, highlighting the need for increased diagnosis and treatment. However, diagnosis remains challenging because of the poor reliability of self-reported maternal drinking histories, an absence of sensitive biomarkers, and the infrequency of diagnostic dysmorphic facial features among individuals with fetal alcohol spectrum disorder. Different diagnostic systems and disagreements over criteria have slowed progress in the diagnosis and management of the disorder. Neuroimaging shows abnormalities in brain structure, cortical development, white matter microstructure, and functional connectivity in individuals with fetal alcohol spectrum disorder. These abnormalities modify developmental trajectories and are associated with deficits in cognition, executive function, memory, vision, hearing, motor skills, behaviour, and social adaptation. Promising trials of nutritional interventions and cognitive rehabilitation therapies are underway, with the aim of treating cognitive deficits in fetal alcohol spectrum disorders.
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17
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Lennon JC, Czochara B. Questioning Fetal Alcohol Syndrome: a Case Report of Multiple Etiological Factors. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Zhao D, Cai A, Zhang J, Wang Y, Wang B. Measurement of normal fetal cerebellar vermis at 24-32 weeks of gestation by transabdominal ultrasound and magnetic resonance imaging: A prospective comparative study. Eur J Radiol 2018; 100:30-35. [PMID: 29496076 DOI: 10.1016/j.ejrad.2018.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/08/2017] [Accepted: 01/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fetal cerebellar vermis may be assessed by ultrasound (US) or magnetic resonance imaging (MRI), and median-plane views are best for evaluation. The purpose of this study was to compare measurements of normal fetal vermis at 24-32 weeks of gestation obtained in median plane by transabdominal 2D-US, 3D-US, and MRI. METHODS A prospective study was conducted, examining normal singleton fetuses between 24 and 32 weeks of gestation. Within a 24-h period, median-plane views of posterior fossa were generated using 2D-US, 3D-US, and MRI. Measurements of anteroposterior (AP) diameter, craniocaudal (CC) diameter, mid-sagittal surface area, brainstem-vermis (BV) angle and brainstem-tentorium (BT) angle were obtained to compare these imaging modalities. RESULTS A total of 180 fetuses were studied. Correlation among imaging methods was good, marked by the following intraclass correlation coefficients: AP diameter, 0.955; CC diameter, 0.956; mid-sagittal surface area, 0.982; BV angle, 0.810; and BT angle, 0.865 (p < 0.001). CONCLUSIONS Visualization rates of MRI, 3D-US, and transabdominal 2D-US were decremental, MRI being superior in this regard. However, these three imaging modalities correlated well in measuring cerebellar vermis and its surroundings.
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Affiliation(s)
- Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Jun Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Yan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Bing Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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19
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Jarmasz JS, Basalah DA, Chudley AE, Del Bigio MR. Human Brain Abnormalities Associated With Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder. J Neuropathol Exp Neurol 2017; 76:813-833. [PMID: 28859338 PMCID: PMC5901082 DOI: 10.1093/jnen/nlx064] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental problem, but neuropathologic descriptions are rare and focused on the extreme abnormalities. We conducted a retrospective survey (1980–2016) of autopsies on 174 individuals with prenatal alcohol exposure or an FASD diagnosis. Epidemiologic details and neuropathologic findings were categorized into 5 age groups. Alcohol exposure was difficult to quantify. When documented, almost all mothers smoked tobacco, many abused other substances, and prenatal care was poor or nonexistent. Placental abnormalities were common (68%) in fetal cases. We identified micrencephaly (brain weight <5th percentile) in 31, neural tube defects in 5, isolated hydrocephalus in 6, corpus callosum defects in 6 (including some with complex anomalies), probable prenatal ischemic lesions in 5 (excluding complications of prematurity), minor subarachnoid heterotopias in 4, holoprosencephaly in 1, lissencephaly in 1, and cardiac anomalies in 26 cases. The brain abnormalities associated with prenatal alcohol exposure are varied; cause–effect relationships cannot be determined. FASD is likely not a monotoxic disorder. The animal experimental literature, which emphasizes controlled exposure to ethanol alone, is therefore inadequate. Prevention must be the main societal goal, however, a clear understanding of the neuropathology is necessary for provision of care to individuals already affected.
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Affiliation(s)
- Jessica S Jarmasz
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pathology, University of Manitoba, Winnipeg, Manitoba; and Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and Diagnostic Services Manitoba, Winnipeg, Manitoba, Canada
| | - Duaa A Basalah
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pathology, University of Manitoba, Winnipeg, Manitoba; and Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and Diagnostic Services Manitoba, Winnipeg, Manitoba, Canada
| | - Albert E Chudley
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pathology, University of Manitoba, Winnipeg, Manitoba; and Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and Diagnostic Services Manitoba, Winnipeg, Manitoba, Canada
| | - Marc R Del Bigio
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pathology, University of Manitoba, Winnipeg, Manitoba; and Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; and Diagnostic Services Manitoba, Winnipeg, Manitoba, Canada
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