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Stanwell P, Iverson GL, Van Patten R, Castellani RJ, McCrory P, Gardner AJ. Examining for Cavum Septum Pellucidum and Ventricular Enlargement in Retired Elite-Level Rugby League Players. Front Neurol 2022; 13:817709. [PMID: 35493804 PMCID: PMC9044485 DOI: 10.3389/fneur.2022.817709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveA cavum septum pellucidum (CSP) has been reported as a visible brain anomaly in normal individuals as well in some former combat and collision sport athletes. The appearance of CSP with fenestrations and ventricular enlargement are considered associated features of the neuropathological diagnosis of chronic traumatic encephalopathy. The current study examined CSP anatomic features and lateral ventricle size in retired elite rugby league players and controls.MethodsForty-one retired rugby league players and 41 healthy community controls, similar in age and education, underwent structural MRI scans. CSP grade, CSP length, corpus callosum septal length, and Evans' ratio (for lateral ventricle size) were rated by two of the current study authors. All participants also self-reported concussion exposure histories, depressive symptoms, daytime sleepiness, and impulsivity. They completed a neuropsychological test battery assessing premorbid intellectual functioning, attention, processing speed, language, visuospatial skills, memory, and aspects of executive functioning.ResultsThe two raters had high agreement for CSP grade (Cohen's κ = 0.80), CSP length [intraclass correlation (ICC) = 0.99], corpus callosum septal length (ICC = 0.73), the CSP/septal ratio (ICC = 0.99), and the Evans' ratio (ICC = 0.75). Twenty-five retired players (61.0%) had an abnormal CSP compared to 17 controls [41.5%; χ(1, 82)2 = 3.12, p = 0.08, odds ratio = 2.21]. The CSP/septal ratio was larger for retired players than for the controls. The Evans' ratio did not differ between the two groups. In the retired rugby league players (n = 41), those with normal (n = 16) and abnormal (n = 25) CSP grades did not differ across age, age of first exposure to collision sport, years of sport exposure, concussion history, or 23 clinical and cognitive variables.ConclusionThis study revealed a difference in the size of the CSP between retired professional rugby league players and controls. There was no significant difference in the size of the ventricles between the two groups. There were no significant differences between those with vs. without an abnormal CSP on age of first exposure to rugby league, years of exposure to repetitive neurotrauma, number of lifetime concussions, depression, impulsivity, perceived cognitive decline, or on any neuropsychological test.
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Affiliation(s)
- Peter Stanwell
- Priority Research Centre for Stroke and Brain Injury, School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- *Correspondence: Peter Stanwell
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Ryan Van Patten
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Providence Veterans Administration Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Rudolph J. Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Andrew J. Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Wang LX, Li P, He H, Guo F, Tian P, Li C, Cui LB, Xi YB, Yin H. The Prevalence of Cavum Septum Pellucidum in Mental Disorders Revealed by MRI: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2020; 32:175-184. [PMID: 31266410 DOI: 10.1176/appi.neuropsych.18030060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The prevalence of cavum septum pellucidum (CSP) in mental disorders, particularly schizophrenia spectrum disorders and mood disorders, remains uncertain. The authors used a meta-analytical approach to determine the prevalence of CSP in mental disorders and to compare these with the prevalence of CSP in psychiatrically healthy comparison subjects. METHODS PubMed and Embase were systematically searched for relevant articles published as of January 9, 2018. After a quality assessment of individual studies using the Newcastle-Ottawa Scale, a random-effects model within Stata statistical software was used to synthesize 25 eligible studies that included 2,392 patients with mental disorders and 1,445 psychiatrically healthy comparison subjects. RESULTS The prevalence of CSP of any size and large CSP was found to be significantly higher in individuals with mental disorders compared with healthy comparison subjects, and the prevalence of CSP in schizophrenia spectrum and mood disorders did not differ between the groups. CONCLUSIONS The meta-regression with predefined covariance indicated that imaging parameters were not associated with the heterogeneity among original studies; however, the mean age of enrolled subjects was identified as a possible source of heterogeneity. No publication bias was found.
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Affiliation(s)
- Liu-Xian Wang
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Ping Li
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Hong He
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Fan Guo
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Ping Tian
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Chen Li
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Long-Biao Cui
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Yi-Bin Xi
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
| | - Hong Yin
- The Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (Wang, Guo, Tian, C. Li, Cui, Xi, Yin); the Department of Radiology, Xi'an Mental Health Center, Xi'an, Shaanxi, China (P. Li); and the Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China (He)
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de Souza Crippa JA, Zuardi AW, Busatto GF, Sanches RF, Santos AC, Araújo D, Amaro E, Hallak JEC, Ng V, McGuire PK. Cavum septum pellucidum and adhesio interthalamica in schizophrenia: an MRI study. Eur Psychiatry 2020; 21:291-9. [PMID: 16406503 DOI: 10.1016/j.eurpsy.2005.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 09/13/2005] [Indexed: 11/28/2022] Open
Abstract
AbstractSeveral studies have independently suggested that patients with schizophrenia are more likely to have an enlarged cavum septum pellucidum (CSP) and an absent adhesio interthalamica (AI), respectively. However, neither finding has been consistently replicated and it is unclear whether there is an association between these two midline brain abnormalities. Thus, we compared the prevalence of absent AI and the prevalence, size and volume of CSP in 38 patients with schizophrenia and 38 healthy controls using magnetic resonance imaging (MRI). There were no between group differences in the presence or volume of CSP; however, an enlarged CSP was commoner among patients than controls. There was also a positive correlation between CSP ratings and volumes. No differences in the presence or absence of the AI were found between patients and controls; however, an absent AI was commoner in male patients with schizophrenia than females. There was absolutely no overlap between the presence of a large CSP and an absence of AI. In conclusion, our findings are in line with several case series and other MRI investigations that have shown a higher incidence of putatively developmental brain abnormalities in patients with schizophrenia, particularly in males, and support the neurodevelopmental model of this disorder.
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Affiliation(s)
- José Alexandre de Souza Crippa
- Department of Neuropsychiatry and Medical Psychology, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Beraldi GH, Prado KS, Amann BL, Radua J, Friedman L, Elkis H. Meta-analyses of cavum septum pellucidum in mood disorders in comparison with healthy controls or schizophrenia. Eur Neuropsychopharmacol 2018; 28:1325-1338. [PMID: 30472163 DOI: 10.1016/j.euroneuro.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 08/29/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
The cavum septum pellucidum (CSP) is a neurodevelopmental abnormality significantly more prevalent in subjects with schizophrenia (SCZ) than in healthy controls (HC). Using meta-analyses, we tested the hypotheses whether CSP would be more frequent in subjects with mood disorders when compared with HC or SCZ. We performed a search in MEDLINE and EMBASE followed by 10 meta-analyses of magnetic resonance imaging studies which examined the association of CSP in bipolar disorders (BD), major depressive disorder (MDD) or mood disorders (MD; considering MDD and BD combined) with either HC or SCZ. Nine studies were included, comprising 692 cases (363 with BD, 182 with MDD and 147 with MD), 463 with SCZ and 630 HC. CSP of any size was significantly associated with BD (OR = 2.07, 95% CI: 1.48-2.90) when compared with HC. Large CSP showed a trend to be associated with BD when compared with HC, but the association was not statistically significant (OR = 1.92, 95% CI 0.64-5.78). Large CSP was significantly associated with subjects with SCZ when compared with subjects with MD (OR = 0.57, 95% CI: 0.36-0.92). There was no association between CSP and MDD in comparison to HC or subjects with SCZ. Cortical structures are known to be altered in mood disorders. The present metanalysis found that certain midline brain abnormalities, such as CSP, are also associated with BD.
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Affiliation(s)
- Gabriel H Beraldi
- Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Kelly S Prado
- Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Autonomous University of Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalaries, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Lee Friedman
- Department of Computer Science, Texas State University, San Marcos, TX, US
| | - Helio Elkis
- Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Liu H, Li L, Shen L, Wang X, Hou Y, Zhao Z, Gu L, Mao J. Cavum septum pellucidum and first-episode psychosis: A meta-analysis. PLoS One 2017; 12:e0177715. [PMID: 28545119 PMCID: PMC5435239 DOI: 10.1371/journal.pone.0177715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the prevalence and changes of cavum septum pellucidum (CSP) in first-episode psychosis (FEP) patients. Methods Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify eligible studies comparing FEP patients and healthy controls from inception to Feb 29, 2016. Results Ten cross-sectional studies and three longitudinal studies reported in ten articles met our criteria. Our meta-analysis found no significant differences in the prevalence of either “any CSP” (OR = 1.41; 95% CI 0.90–2.20; p = 0.13; I2 = 52.7%) or “large CSP” (OR = 1.10; 95% CI 0.77–1.58; p = 0.59; I2 = 24.1%) between FEP patients and healthy controls. However, the heterogeneity analysis of the prevalence of “any CSP” suggested bias in outcome reporting. Conclusions The results based on current evidence suggest it is unclear whether “any CSP” is a risk factor for FEP due to the heterogeneity of the studies. There is insufficient evidence to support that “large CSP” is a possible risk factor for FEP.
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Affiliation(s)
- Hanwen Liu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Internal Medicine Unit, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Shen
- Department of Psychosomatic Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xianliang Wang
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yazhu Hou
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhiqiang Zhao
- Cardiovascular Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lili Gu
- Department of Medical Administration, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jingyuan Mao
- Internal Medicine Unit, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- * E-mail:
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Clinical correlates of enlarged cavum septum pellucidum in schizophrenia: A revisit through computed tomography. Asian J Psychiatr 2015; 15:21-4. [PMID: 26001900 DOI: 10.1016/j.ajp.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/28/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
Like prevalence of abnormal cavum septum pellucidum in patients of schizophrenia remains controversial, its role in clinical outcome, duration of illness and effect on treatment remains less understood as well. Our study examined clinical correlates of enlarged cavum septum pellucidum in schizophrenia. A total of 139 patients diagnosed with schizophrenia during the year 2012 and 2013 were taken for the study. We compared them in respect to the presence and absence of enlarged cavum septum pellucidum. We found 16 patients with enlarged cavum septum pellucidum and were compared with those without enlarged cavum septum pellucidum for socio-demographic and clinical variables. We also correlated these clinical variables with dimension of cavum septum pellucidum. We found statistically significant increased current age and duration of illness in patients with enlarged cavum septum pellucidum. The implications of these findings are discussed with possible confounding effect of current age on neuroimaging. No meaningful correlation was found. No difference in clinical variables was found. Retrospective design and use of computed tomography were limitation of our study.
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Thermenos HW, Keshavan MS, Juelich RJ, Molokotos E, Whitfield-Gabrieli S, Brent BK, Makris N, Seidman LJ. A review of neuroimaging studies of young relatives of individuals with schizophrenia: a developmental perspective from schizotaxia to schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:604-35. [PMID: 24132894 DOI: 10.1002/ajmg.b.32170] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/24/2013] [Indexed: 11/08/2022]
Abstract
In an effort to identify the developing abnormalities preceding psychosis, Dr. Ming T. Tsuang and colleagues at Harvard expanded Meehl's concept of "schizotaxia," and examined brain structure and function in families affected by schizophrenia (SZ). Here, we systematically review genetic (familial) high-risk (HR) studies of SZ using magnetic resonance imaging (MRI), examine how findings inform models of SZ etiology, and suggest directions for future research. Neuroimaging studies of youth at HR for SZ through the age of 30 were identified through a MEDLINE (PubMed) search. There is substantial evidence of gray matter volume abnormalities in youth at HR compared to controls, with an accelerated volume reduction over time in association with symptoms and cognitive deficits. In structural neuroimaging studies, prefrontal cortex (PFC) alterations were the most consistently reported finding in HR. There was also consistent evidence of smaller hippocampal volume. In functional studies, hyperactivity of the right PFC during performance of diverse tasks with common executive demands was consistently reported. The only longitudinal fMRI study to date revealed increasing left middle temporal activity in association with the emergence of psychotic symptoms. There was preliminary evidence of cerebellar and default mode network alterations in association with symptoms. Brain abnormalities in structure, function and neurochemistry are observed in the premorbid period in youth at HR for SZ. Future research should focus on the genetic and environmental contributions to these alterations, determine how early they emerge, and determine whether they can be partially or fully remediated by innovative treatments.
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Affiliation(s)
- H W Thermenos
- Harvard Medical School, Boston, Massachusetts; Massachusetts Mental Health Center, Division of Public Psychiatry, Boston, Massachusetts; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Trzesniak C, Schaufelberger MS, Duran FLS, Santos LC, Rosa PGP, McGuire PK, Murray RM, Scazufca M, Menezes PR, Hallak JEC, Crippa JAS, Busatto GF. Longitudinal follow-up of cavum septum pellucidum and adhesio interthalamica alterations in first-episode psychosis: a population-based MRI study. Psychol Med 2012; 42:2523-2534. [PMID: 22717008 DOI: 10.1017/s0033291712000839] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neurodevelopmental alterations have been described inconsistently in psychosis probably because of lack of standardization among studies. The aim of this study was to conduct the first longitudinal and population-based magnetic resonance imaging (MRI) evaluation of the presence and size of the cavum septum pellucidum (CSP) and adhesio interthalamica (AI) in a large sample of patients with first-episode psychosis (FEP). METHOD FEP patients (n=122) were subdivided into schizophrenia (n=62), mood disorders (n=46) and other psychosis (n=14) groups and compared to 94 healthy next-door neighbour controls. After 13 months, 80 FEP patients and 52 controls underwent a second MRI examination. RESULTS We found significant reductions in the AI length in schizophrenia FEP in comparison with the mood disorders and control subgroups (longer length) at the baseline assessment, and no differences in any measure of the CSP. By contrast, there was a diagnosis×time interaction for the CSP length, with a more prominent increase for this measure in the psychosis group. There was an involution of the AI length over time for all groups but no diagnosis×time interaction. CONCLUSIONS Our findings suggest that the CSP per se may not be linked to the neurobiology of emerging psychotic disorders, although it might be related to the progression of the disease. However, the fact that the AI length was shown to be shorter at the onset of the disorder supports the neurodevelopmental model of schizophrenia and indicates that an alteration in this grey matter junction may be a risk factor for developing psychosis.
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Affiliation(s)
- C Trzesniak
- Department of Neuroscience and Behavioural Science, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Trzesniak C, Oliveira IR, Kempton MJ, Galvão-de Almeida A, Chagas MHN, Ferrari MCF, Filho AS, Zuardi AW, Prado DA, Busatto GF, McGuire PK, Hallak JEC, Crippa JAS. Are cavum septum pellucidum abnormalities more common in schizophrenia spectrum disorders? A systematic review and meta-analysis. Schizophr Res 2011; 125:1-12. [PMID: 20965698 DOI: 10.1016/j.schres.2010.09.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/07/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
Abstract
Magnetic resonance imaging (MRI) studies have reported a variety of brain abnormalities in association with schizophrenia. These include a higher incidence of cavum septum pellucidum (CSP), which is consistent with a neurodevelopmental model for this disorder. In this meta-analytic review, we describe and discuss the main CSP MRI findings in schizophrenia spectrum disorders (SSDs) to date. We adopted as keywords cavum and schizophrenia or psychosis, and the inclusion criteria were articles in English, with samples of SSD patients compared to healthy subjects, which used MRI to assess CSP, without time limit. From 18 potential reports, fifteen were eligible to be part of the current review. These studies included 1054 patients with SSD and 866 healthy volunteers. Six out of 15 studies pointed to a higher prevalence of CSP of any size in SSD patients, while five out of 15 showed that subjects with SSD had a greater occurrence of a large CSP than healthy individuals. However, the meta-analysis demonstrated that only the incidence of a large CSP was significantly higher in SSD relative to healthy comparisons (odds ratio=1.59; 95%CI 1.07-2.38; p=0.02). Overall our results suggest that only a large CSP is associated with SSD while a small CSP may be considered a normal neuroanatomical variation. Our review revealed a large degree of variability in the methods employed across the MRI studies published to date, as well as evidence of publication bias. Studies in large, community-based samples with greater standardization of methods should clarify the true significance of CSP in SSD.
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Affiliation(s)
- Clarissa Trzesniak
- Department of Neuroscience and Behavior, Medical School, University of São Paulo (USP), Ribeirão Preto (SP), Brazil and INCT Translational Medicine, Brazil.
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Abstract
Schizophrenia (SZ) is a complex, heterogeneous, and disabling psychiatric disorder that impairs multiple aspects of human cognitive, perceptual, emotional, and behavioral functioning. SZ is relatively frequent (prevalence around 1%), with onset usually during adolescence or early adulthood, and has a deteriorating course. The rapidly growing area of neuroimaging research has has found clear evidence of many cortical and subcortical abnormalities in individuals with SZ. In this article the most recent findings from multiple studies on neurological disorders in SZ are reviewed, and the authors make a strong argument for a neurological basis of the schizophrenic process.
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Affiliation(s)
- Arman Danielyan
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45244, USA
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Takahashi T, Yung AR, Yücel M, Wood SJ, Phillips LJ, Harding IH, Soulsby B, McGorry PD, Suzuki M, Velakoulis D, Pantelis C. Prevalence of large cavum septi pellucidi in ultra high-risk individuals and patients with psychotic disorders. Schizophr Res 2008; 105:236-44. [PMID: 18693084 DOI: 10.1016/j.schres.2008.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
An increased prevalence of large cavum septum pellucidum (CSP), a marker of midline neurodevelopmental abnormality, has been reported in schizophrenia. However, not all studies have been able to replicate this finding and very few studies have been conducted in large samples. In the current study, magnetic resonance imaging was used to assess the presence of an abnormal CSP in 162 patients with first-episode psychosis (FEP), 89 patients with chronic schizophrenia, 135 ultra high-risk (UHR) individuals, and 87 controls. The prevalence of a large CSP (>5.6 mm) did not differ between the groups (9.3% of the FEP patients, 11.2% of the chronic schizophrenia patients, 11.1% of the UHR individuals, and 11.5% of the controls). The length of the CSP was not associated with sulcal morphology of the anterior cingulate cortex (ACC), suggesting different biological processes responsible for the CSP enlargement versus ACC folding. These findings suggest that the CSP is not a neurodevelopmental marker of psychosis and cast doubt over the notion that it plays a major role in the neurobiology of psychosis.
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Affiliation(s)
- Tsutomu Takahashi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia.
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Rajarethinam R, Sohi J, Arfken C, Keshavan MS. No difference in the prevalence of cavum septum pellucidum (CSP) between first-episode schizophrenia patients, offspring of schizophrenia patients and healthy controls. Schizophr Res 2008; 103:22-5. [PMID: 18248791 DOI: 10.1016/j.schres.2007.11.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 11/15/2007] [Accepted: 11/19/2007] [Indexed: 11/29/2022]
Abstract
The reported prevalence of cavum septum pellucidum (CSP), is extremely variable (from 0.1% to 85%) depending upon the measurement method or imaging resolution. Higher prevalence of CSP has been found in schizophrenia. In this study, we examined the prevalence of CSP in a large number of first-episode schizophrenia patients, young relatives of schizophrenia patients and healthy controls. We manually measured CSP using 1.5 mm T1 MRI scans from ongoing studies at University of Pittsburgh in 89 first-episode patients with schizophrenia (age=23.8+/-7.4, M/F=61/28), 64 genetically at-risk individuals (offspring and siblings of schizophrenia patients, age 15.2+/-3.7, M/F=29/32) and 120 comparison subjects (n=120, age=22.1+/-7.9, M/F62/50). CSP was present in 64% of the first-episode patients (mean length 1.87+/-2.3 mm), 64.6% of the at-risk individuals (1.64+/-1.96 mm) and 64.2% of the normal controls (1.88+/-2.0 mm). There was no difference in the prevalence of CSP exceeding 4 mm. We also did not find any influence of the sex or age in the presence or size of CSP. Our data cast doubt on the significance of CSP as markers of neurodevelopmental pathology in schizophrenia.
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Affiliation(s)
- Rajaprabhakaran Rajarethinam
- Brain Research and Imaging Neuroscience, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 4201, St Antoine street, Detroit, MI 48201, USA.
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Choi JS, Kang DH, Park JY, Jung WH, Choi CH, Chon MW, Jung MH, Lee JM, Kwon JS. Cavum septum pellucidum in subjects at ultra-high risk for psychosis: compared with first-degree relatives of patients with schizophrenia and healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1326-30. [PMID: 18513845 DOI: 10.1016/j.pnpbp.2008.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 04/12/2008] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The cavum septum pellucidum (CSP) is a space between the two leaflets of the septum pellucidum, and is a putative marker of disturbance in early brain development. We examined whether CSP was present more frequently in subjects at ultra-high risk (UHR) for psychosis compared to first-degree relatives of patients with schizophrenia (genetic high risk, GHR) and healthy controls (HC). METHODS We evaluated CSP in 87 subjects (30 UHR, 23 GHR, and 34 HC) according to a published grading system using high-resolution magnetic resonance imaging (MRI) with 0.45-mm slice thickness. We also assessed two other criteria: presence of CSP on at least one MRI slice, and abnormally large CSP (i.e., > or =6 mm in length). Correlational analysis between CSP measures and clinical symptoms was also examined. RESULTS Based on the grading scale, the UHR group exhibited a significantly higher incidence of abnormal CSP (grades 2, 3, and 4) compared to the HC group, but there were no significant differences in the incidence of abnormal CSP between the UHR and GHR or the GHR and HC groups. There were no significant differences among the groups in the presence of CSP on at least one MRI slice or abnormally large CSP based on the length of CSP. In addition, no significant correlations between CSP measures and clinical symptoms were found. CONCLUSION These findings suggest that abnormal CSP might be associated with susceptibility to psychosis, although the CSP itself might be a normal anatomical variant. Further studies using a larger sample are needed to clarify issues on neurodevelopmental perspective in subjects at high risk for psychosis.
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Affiliation(s)
- Jung-Seok Choi
- Department of Psychiatry, Seoul National University College of Medicine and Clinical Cognitive Neuroscience Center, SNU-MRC, Seoul, Republic of Korea
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Takahashi T, Suzuki M, Hagino H, Niu L, Zhou SY, Nakamura K, Tanino R, Kawasaki Y, Seto H, Kurachi M. Prevalence of large cavum septi pellucidi and its relation to the medial temporal lobe structures in schizophrenia spectrum. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1235-41. [PMID: 17553605 DOI: 10.1016/j.pnpbp.2007.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 04/02/2007] [Accepted: 04/30/2007] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging was used to evaluate the prevalence of the cavum septi pellucidi (CSP) in 154 schizophrenia patients, 47 schizotypal disorder patients, and 163 healthy controls. We also explored the relation of a large CSP (> or =6 mm) with medial temporal lobe structures. No significant difference was found in the prevalence of the CSP (76.0% of the schizophrenia patients, 81.6% of the controls, and 85.1% of the schizotypal patients) or the large CSP (6.5% of the schizophrenia patients, 7.4% of the controls, and 10.6% of the schizotypal patients) among the groups, but patients with a large CSP (10 schizophrenia and 5 schizotypal patients) had smaller volumes of bilateral amygdala and left posterior parahippocampal gyrus than patients without it. In the control subjects, the large CSP did not affect the volumes of the medial temporal lobe structures. These findings might reflect neurodevelopmental abnormalities in midline and associated limbic structures of the brain in schizophrenia spectrum.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
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Brisch R, Bernstein HG, Krell D, Stauch R, Trübner K, Dobrowolny H, Kropf S, Bielau H, Bogerts B. Volumetric analysis of septal region in schizophrenia and affective disorder. Eur Arch Psychiatry Clin Neurosci 2007; 257:140-8. [PMID: 17180571 DOI: 10.1007/s00406-006-0697-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 08/28/2006] [Indexed: 10/23/2022]
Abstract
MRI and post-mortem studies indicate an increased prevalence of cavum septi pellucidi (CSP) in schizophrenia and affective disorder. The aim of this study was to characterize the CSP and the septal tissue among patients with schizophrenia, patients with affective disorder, and control subjects. The volumes of CSP and septal tissue were measured in post-mortem brains in 42 patients with schizophrenia, 14 patients with affective disorder, and 17 normal control cases by planimetry of serial sections. Enlargements of CSP (>100 mm(3)) were found in eight of the 42 (19%) patients with schizophrenia. There were no significant differences in CSP volumes between patients with affective disorder and controls. Enlarged CSP in schizophrenia were not associated with reduced septal tissue volumes. By contrast, a significant positive correlation between volumes of CSP and septal tissue volumes in patients with schizophrenia (P = 0.03) and in control cases (P < 0.01) was found, but not in patients with affective disorder (P = 0.53). The finding of enlarged CSP in schizophrenia strongly supports the hypothesis of an early developmental abnormality in this key structure of the limbic system.
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Affiliation(s)
- Ralf Brisch
- Dept. of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
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Kumari V, Cooke M. Use of magnetic resonance imaging in tracking the course and treatment of schizophrenia. Expert Rev Neurother 2006; 6:1005-16. [PMID: 16831115 DOI: 10.1586/14737175.6.7.1005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Confirming the early conceptualization of Bleuler (1911) and Kraepelin (1919), magnetic resonance imaging (MRI) studies have demonstrated structural and functional brain abnormalities, predominantly involving the frontal and temporal lobes, in schizophrenia. Most of the abnormalities are already present at illness onset. However, there is, growing evidence for treatment-related neural changes in schizophrenia, such as enlargement of the caudate nucleus (neurotoxic effect) with the use of typical antipsychotics and increases in cortical volumes and improved functional responses (neurotrophic effect) with the use of atypical antipsychotics. More recently, brain changes during the prodrome and transition-to-illness stages of schizophrenia have begun to be characterized. Another area of importance is the use of MRI, as a biological marker, to monitor and define partial or full resistance to medication. Understanding the trait- and state-related influences of brain abnormalities during the course of the illness is critical for developing effective treatment and possibly prevention strategies in schizophrenia.
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Affiliation(s)
- Veena Kumari
- King's College London, Institute of Psychiatry Department of Psychology, PO78, London, SE5 8AF, UK.
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Borgwardt SJ, Radue EW, Götz K, Aston J, Drewe M, Gschwandtner U, Haller S, Pflüger M, Stieglitz RD, McGuire PK, Riecher-Rössler A. Radiological findings in individuals at high risk of psychosis. J Neurol Neurosurg Psychiatry 2006; 77:229-33. [PMID: 16421128 PMCID: PMC2077602 DOI: 10.1136/jnnp.2005.069690] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the prevalence of radiological magnetic resonance imaging (MRI) findings in individuals at high risk of schizophrenia. METHODS MRI scans from individuals at high risk of schizophrenia (HR; n = 37) were assessed by a radiologist blind to group status and compared with scans from patients with first episode psychosis (FE; n = 30), depressive controls (DC; n = 17), and healthy controls (HC; n = 26). RESULTS There was a significantly higher proportion of radiological findings in individuals at high risk of schizophrenia (35%) and patients with first-episode psychosis (40%) than in patients with depression (18%) or healthy controls (12%). These differences were specific to findings regarded as potentially clinically significant as opposed to normal variants; however, there was no indication for medical treatment. CONCLUSIONS The results suggest that a large proportion of those at high risk of psychosis have radiological findings on MRI scanning, and that the prevalence of radiological findings in this group is similar to that in patients with first episode psychosis.
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Affiliation(s)
- S J Borgwardt
- Psychiatric Outpatient Department, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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