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Pur DR, Sivakumar GK, Bursztyn LLCD, Iordanous Y, de Ribaupierre S. Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00244-2. [PMID: 37640228 DOI: 10.1016/j.jcjo.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Children undergoing hemispheric surgery for intractable seizures are susceptible to visual complications including strabismus. This systematic review aims to investigate the rates and characteristics of strabismus development after hemispheric surgery and evaluate clinical implications for ophthalmologic care. METHODS A systematic search of MEDLINE, EMBASE, Cochrane, PsychINFO, and Web of Science databases was performed from database inception to May 2022. Included articles referred to strabismus outcomes in pediatric populations after hemispherectomy or hemispherotomy. Reviews and non-English-language publications were excluded. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Demographic data and characteristics of strabismus were extracted and tabulated. RESULTS Of 41 articles identified, 10 studies consisting of 384 pediatric participants (48% females) and age at surgery between 6 months and 16 years were included. Preoperative strabismus rates ranged between 3% and 56%, whereas postoperative rates ranged between 38% and 100%. With respect to the site of hemispheric surgery, contralateral exodeviation was the most common (16%-67%; n = 7) and then ipsilateral exodeviation (16%-56%; n = 2), whereas ipsilateral esodeviation was infrequent (4%-9%; n = 3). CONCLUSIONS Contralateral exotropia and ipsilateral esotropia may occur after hemispheric surgery and may have the potential to be field expanding. Concerns regarding negative social reactions should be balanced with the risk of visual field reduction and (or) diplopia by strabismus surgery. Higher-quality articles with large, homogeneous, and well-described populations (i.e., complete pre- and postoperative ophthalmologic assessments) are required to establish the risks and rates of strabismus development after hemispheric surgery.
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Affiliation(s)
- Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON.
| | - Gayathri K Sivakumar
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Lulu L C D Bursztyn
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON; Department of Clinical Neurological Sciences, Western University, London, ON
| | - Yiannis Iordanous
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences, Western University, London, ON; Brain and Mind Institute, Western University, London, ON; Children's Health Research Institute, Western University, London, ON
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2
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Pinto CR, Duarte JV, Marques C, Vicente IN, Paiva C, Éloi J, Pereira DJ, Correia BR, Castelo-Branco M, Oliveira G. The role of early functional neuroimaging in predicting neurodevelopmental outcomes in neonatal encephalopathy. Eur J Pediatr 2023; 182:1191-1200. [PMID: 36607412 PMCID: PMC10023620 DOI: 10.1007/s00431-022-04778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
Reliably assessing the early neurodevelopmental outcomes in infants with neonatal encephalopathy (NE) is of utmost importance to advise parents and implement early and personalized interventions. We aimed to evaluate the accuracy of neuroimaging modalities, including functional magnetic resonance imaging (fMRI) in predicting neurodevelopmental outcomes in NE. Eighteen newborns with NE due to presumed perinatal asphyxia (PA) were included in the study, 16 of whom underwent therapeutic hypothermia. Structural magnetic resonance imaging (MRI), and fMRI during passive visual, auditory, and sensorimotor stimulation were acquired between the 10th and 14th day of age. Clinical follow-up protocol included visual and auditory evoked potentials and a detailed neurodevelopmental evaluation at 12 and 18 months of age. Infants were divided according to sensory and neurodevelopmental outcome: severe, moderate disability, or normal. Structural MRI findings were the best predictor of severe disability with an AUC close to 1.0. There were no good predictors to discriminate between moderate disability versus normal outcome. Nevertheless, structural MRI measures showed a significant correlation with the scores of neurodevelopmental assessments. During sensorimotor stimulation, the fMRI signal in the right hemisphere had an AUC of 0.9 to predict absence of cerebral palsy (CP). fMRI measures during auditory and visual stimulation did not predict sensorineural hearing loss or cerebral visual impairment. CONCLUSION In addition to structural MRI, fMRI with sensorimotor stimulation may open the gate to improve the knowledge of neurodevelopmental/motor prognosis if proven in a larger cohort of newborns with NE. WHAT IS KNOWN • Establishing an early, accurate neurodevelopmental prognosis in neonatal encephalopathy remains challenging. • Although structural MRI has a central role in neonatal encephalopathy, advanced MRI modalities are gradually being explored to optimize neurodevelopmental outcome knowledge. WHAT IS NEW • Newborns who later developed cerebral palsy had a trend towards lower fMRI measures in the right sensorimotor area during sensorimotor stimulation. • These preliminary fMRI results may improve future early delineation of motor prognosis in neonatal encephalopathy.
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Affiliation(s)
- Carla R Pinto
- Pediatric Intensive Care Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Avenida Afonso Romão, Coimbra, 3000-602, Portugal.
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
| | - João V Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carla Marques
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês N Vicente
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Paiva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Éloi
- Otorhinolaryngology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela J Pereira
- Neuroradiology Unit, Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bárbara R Correia
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Quantitative Methods, Information and Management Systems Department, Coimbra Business School, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Guiomar Oliveira
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Child Developmental Center, Research and Clinical Training Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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3
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Vishnubhotla RV, Zhao Y, Wen Q, Dietrich J, Sokol GM, Sadhasivam S, Radhakrishnan R. Brain structural connectome in neonates with prenatal opioid exposure. Front Neurosci 2022; 16:952322. [PMID: 36188457 PMCID: PMC9523134 DOI: 10.3389/fnins.2022.952322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionInfants with prenatal opioid exposure (POE) are shown to be at risk for poor long-term neurobehavioral and cognitive outcomes. Early detection of brain developmental alterations on neuroimaging could help in understanding the effect of opioids on the developing brain. Recent studies have shown altered brain functional network connectivity through the application of graph theoretical modeling, in infants with POE. In this study, we assess global brain structural connectivity through diffusion tensor imaging (DTI) metrics and apply graph theoretical modeling to brain structural connectivity in infants with POE.MethodsIn this prospective observational study in infants with POE and control infants, brain MRI including DTI was performed before completion of 3 months corrected postmenstrual age. Tractography was performed on the whole brain using a deterministic fiber tracking algorithm. Pairwise connectivity and network measure were calculated based on fiber count and fractional anisotropy (FA) values. Graph theoretical metrics were also derived.ResultsThere were 11 POE and 18 unexposed infants included in the analysis. Pairwise connectivity based on fiber count showed alterations in 32 connections. Pairwise connectivity based on FA values showed alterations in 24 connections. Connections between the right superior frontal gyrus and right paracentral lobule and between the right superior occipital gyrus and right fusiform gyrus were significantly different after adjusting for multiple comparisons between POE infants and unexposed controls. Additionally, alterations in graph theoretical network metrics were identified with fiber count and FA value derived tracts.ConclusionComparisons show significant differences in fiber count in two structural connections. The long-term clinical outcomes related to these findings may be assessed in longitudinal follow-up studies.
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Affiliation(s)
- Ramana V. Vishnubhotla
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yi Zhao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Qiuting Wen
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jonathan Dietrich
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Rupa Radhakrishnan,
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Chandwani R, Harpster K, Kline JE, Mehta V, Wang H, Merhar SL, Schwartz TL, Parikh NA. Brain microstructural antecedents of visual difficulties in infants born very preterm. Neuroimage Clin 2022; 34:102987. [PMID: 35290855 PMCID: PMC8918861 DOI: 10.1016/j.nicl.2022.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age. We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3-4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function. Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention. Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
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Affiliation(s)
- Rahul Chandwani
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Karen Harpster
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Julia E Kline
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ved Mehta
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hui Wang
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; MR Clinical Science, Philips, Cincinnati, OH, United States
| | - Stephanie L Merhar
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Terry L Schwartz
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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5
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Parikh MN, Chen M, Braimah A, Kline J, McNally K, Logan JW, Tamm L, Yeates KO, Yuan W, He L, Parikh NA. Diffusion MRI Microstructural Abnormalities at Term-Equivalent Age Are Associated with Neurodevelopmental Outcomes at 3 Years of Age in Very Preterm Infants. AJNR Am J Neuroradiol 2021; 42:1535-1542. [PMID: 33958330 DOI: 10.3174/ajnr.a7135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Microstructural white matter abnormalities on DTI using Tract-Based Spatial Statistics at term-equivalent age are associated with cognitive and motor outcomes at 2 years of age or younger. However, neurodevelopmental tests administered at such early time points are insufficiently predictive of mild-moderate motor and cognitive impairment at school age. Our objective was to evaluate the microstructural antecedents of cognitive and motor outcomes at 3 years' corrected age in a cohort of very preterm infants. MATERIALS AND METHODS We prospectively recruited 101 very preterm infants (<32 weeks' gestational age) and performed DTI at term-equivalent age. The Differential Ability Scales, 2nd ed, Verbal and Nonverbal subtests, and the Bayley Scales of Infant and Toddler Development, 3rd ed, Motor subtest, were administered at 3 years of age. We correlated DTI metrics from Tract-Based Spatial Statistics with the Bayley Scales of Infant and Toddler Development, 3rd ed, and the Differential Ability Scales, 2nd ed, scores with correction for multiple comparisons. RESULTS Of the 101 subjects, 84 had high-quality DTI data, and of these, 69 returned for developmental testing (82%). Their mean (SD) gestational age was 28.4 (2.5) weeks, and birth weight was 1121.4 (394.1) g. DTI metrics were significantly associated with Nonverbal Ability in the corpus callosum, posterior thalamic radiations, fornix, and inferior longitudinal fasciculus and with Motor scores in the corpus callosum, internal and external capsules, posterior thalamic radiations, superior and inferior longitudinal fasciculi, cerebral peduncles, and corticospinal tracts. CONCLUSIONS We identified widespread microstructural white matter abnormalities in very preterm infants at term that were significantly associated with cognitive and motor development at 3 years' corrected age.
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Affiliation(s)
- M N Parikh
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - M Chen
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Electronic Engineering and Computer Science (M.C.), College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
| | - A Braimah
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J Kline
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K McNally
- Center for Perinatal Research (K.M., J.W.L.), The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - J W Logan
- Center for Perinatal Research (K.M., J.W.L.), The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - L Tamm
- Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio.,Center for ADHD (L.T.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - K O Yeates
- Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, and University of Calgary, Alberta, Canada
| | - W Yuan
- Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology (W.Y.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - L He
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Imaging Research Center (M.C., A.B., W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - N A Parikh
- From the Perinatal Institute (M.N.P., J.K., L.H., N.A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio .,Department of Pediatrics (L.T., L.H., N.A.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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6
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Turesky TK, Vanderauwera J, Gaab N. Imaging the rapidly developing brain: Current challenges for MRI studies in the first five years of life. Dev Cogn Neurosci 2021; 47:100893. [PMID: 33341534 PMCID: PMC7750693 DOI: 10.1016/j.dcn.2020.100893] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/21/2020] [Accepted: 12/05/2020] [Indexed: 12/20/2022] Open
Abstract
Rapid and widespread changes in brain anatomy and physiology in the first five years of life present substantial challenges for developmental structural, functional, and diffusion MRI studies. One persistent challenge is that methods best suited to earlier developmental stages are suboptimal for later stages, which engenders a trade-off between using different, but age-appropriate, methods for different developmental stages or identical methods across stages. Both options have potential benefits, but also biases, as pipelines for each developmental stage can be matched on methods or the age-appropriateness of methods, but not both. This review describes the data acquisition, processing, and analysis challenges that introduce these potential biases and attempts to elucidate decisions and make recommendations that would optimize developmental comparisons.
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Affiliation(s)
- Ted K Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Jolijn Vanderauwera
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Psychological Sciences Research Institute, Université Catholique De Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience, Université Catholique De Louvain, Louvain-la-Neuve, Belgium
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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7
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Merhar SL, Gozdas E, Tkach JA, Parikh NA, Kline-Fath BM, He L, Yuan W, Altaye M, Leach JL, Holland SK. Neonatal Functional and Structural Connectivity Are Associated with Cerebral Palsy at Two Years of Age. Am J Perinatol 2020; 37:137-145. [PMID: 30919395 PMCID: PMC8103821 DOI: 10.1055/s-0039-1683874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP. STUDY DESIGN We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination. RESULTS Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group. CONCLUSION DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury.
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Affiliation(s)
- Stephanie L. Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Elveda Gozdas
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Jean A. Tkach
- Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Nehal A. Parikh
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,University of Cincinnati Department of Pediatrics, Cincinnati OH
| | - Beth M. Kline-Fath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Lili He
- Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati OH,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - James L. Leach
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
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8
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Hemispherotomy can cause post-operative strabismus. Brain Dev 2020; 42:41-47. [PMID: 31521421 DOI: 10.1016/j.braindev.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hemispherotomy, which involves disconnecting hemispherical fibers, is a treatment option for medically intractable epilepsy. As various neurological disorders can cause strabismus, we hypothesized that hemispherotomy can cause post-operative strabismus in patients with medically intractable epilepsy. METHODS Nineteen patients underwent the Hirschberg test before and after hemispherical disconnection surgery. Among the 19 patients, 16 patients (six females and 10 males; mean age, 12.2 years; range, 0.17-43 years) who underwent hemispherotomy were included in this study. RESULTS The difference in the angle between the left and right eyes was significantly widened (p = 0.025). Nine (56%) of 16 patients exhibited post-operative chronic strabismus as evaluated with the Hirschberg test. Intermittent strabismus was noticed by family members or caregivers in 10 (63%) of 16 patients. Patients older than 12 years did not show post-operative strabismus as evaluated by the Hirschberg test. CONCLUSION Hemispherotomy can cause or worsen post-operative strabismus in pediatric patients.
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9
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Turesky TK, Jensen SK, Yu X, Kumar S, Wang Y, Sliva DD, Gagoski B, Sanfilippo J, Zöllei L, Boyd E, Haque R, Hafiz Kakon S, Islam N, Petri WA, Nelson CA, Gaab N. The relationship between biological and psychosocial risk factors and resting-state functional connectivity in 2-month-old Bangladeshi infants: A feasibility and pilot study. Dev Sci 2019; 22:e12841. [PMID: 31016808 PMCID: PMC6713583 DOI: 10.1111/desc.12841] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 01/25/2023]
Abstract
Childhood poverty has been associated with structural and functional alterations in the developing brain. However, poverty does not alter brain development directly, but acts through associated biological or psychosocial risk factors (e.g. malnutrition, family conflict). Yet few studies have investigated risk factors in the context of infant neurodevelopment, and none have done so in low-resource settings such as Bangladesh, where children are exposed to multiple, severe biological and psychosocial hazards. In this feasibility and pilot study, usable resting-state fMRI data were acquired in infants from extremely poor (n = 16) and (relatively) more affluent (n = 16) families in Dhaka, Bangladesh. Whole-brain intrinsic functional connectivity (iFC) was estimated using bilateral seeds in the amygdala, where iFC has shown susceptibility to early life stress, and in sensory areas, which have exhibited less susceptibility to early life hazards. Biological and psychosocial risk factors were examined for associations with iFC. Three resting-state networks were identified in within-group brain maps: medial temporal/striatal, visual, and auditory networks. Infants from extremely poor families compared with those from more affluent families exhibited greater (i.e. less negative) iFC in precuneus for amygdala seeds; however, no group differences in iFC were observed for sensory area seeds. Height-for-age, a proxy for malnutrition/infection, was not associated with amygdala/precuneus iFC, whereas prenatal family conflict was positively correlated. Findings suggest that it is feasible to conduct infant fMRI studies in low-resource settings. Challenges and practical steps for successful implementations are discussed.
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Affiliation(s)
- Ted K. Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Sarah K.G. Jensen
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Xi Yu
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Swapna Kumar
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
| | - Yingying Wang
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
- College of Education and Human SciencesUniversity of Nebraska‐LincolnLincolnNebraska
| | - Danielle D. Sliva
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Department of NeuroscienceBrown UniversityProvidenceRhode Island
| | - Borjan Gagoski
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Joseph Sanfilippo
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
| | - Lilla Zöllei
- A.A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMassachusetts
| | - Emma Boyd
- A.A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMassachusetts
| | - Rashidul Haque
- The International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | | | - Nazrul Islam
- National Institute of Neurosciences & HospitalDhakaBangladesh
| | - William A. Petri
- Division of Infectious Diseases and International Health, Department of Medicine, School of MedicineUniversity of VirginiaCharlottesvilleVirginia
| | - Charles A. Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
- Harvard Graduate School of EducationCambridgeMassachusetts
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of MedicineBoston Children’s HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
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Gozdas E, Holland SK, Altaye M. Developmental changes in functional brain networks from birth through adolescence. Hum Brain Mapp 2018; 40:1434-1444. [PMID: 30582266 DOI: 10.1002/hbm.24457] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 02/02/2023] Open
Abstract
Investigation of the brain connectome using functional magnetic resonance imaging (fMRI) and measures derived from graph theory analysis has emerged as a new approach to study brain development, cognitive function, and neurophysiological disorders. Here we use graph theory analysis to examine the influence of age, sex, and neurocognitive measures on developmental changes to the global and regional topology of functional brain networks derived from fMRI data recorded in 189 healthy subjects from the age of 0-18 years during rest. We observed that Global Efficiency and Rich-Club coefficient increased with age and Local Efficiency and Small-Worldness decreased with age, while Modularity at the global level showed an inverted U-shaped trajectory during development. Marginally significant differences were observed in Local Efficiency, Small-Worldness, and Modularity at a global level between boys and girls throughout development. We also examine the effects of neurocognitive measures in boys and girls globally and locally. Our results provide new insight to understand brain maturation of functional brain connectome and its relation to cognitive development from birth through adolescence.
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Affiliation(s)
- Elveda Gozdas
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Scott K Holland
- Medpace Imaging Core Laboratory, Medpace Inc, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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11
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Gozdas E, Parikh NA, Merhar SL, Tkach JA, He L, Holland SK. Altered functional network connectivity in preterm infants: antecedents of cognitive and motor impairments? Brain Struct Funct 2018; 223:3665-3680. [PMID: 29992470 DOI: 10.1007/s00429-018-1707-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
Very preterm infants (≤ 31 weeks gestational age) are at high risk for brain injury and delayed development. Applying functional connectivity and graph theory methods to resting state MRI data (fcMRI), we tested the hypothesis that preterm infants would demonstrate alterations in connectivity measures both globally and in specific networks related to motor, language and cognitive function, even when there is no anatomical imaging evidence of injury. Fifty-one healthy full-term controls and 24 very preterm infants without significant neonatal brain injury, were evaluated at term-equivalent age with fcMRI. Preterm subjects showed lower functional connectivity from regions associated with motor, cognitive, language and executive function, than term controls. Examining brain networks using graph theory measures of functional connectivity, very preterm infants also exhibited lower rich-club coefficient and assortativity but higher small-worldness and no significant difference in modularity when compared to term infants. The findings provide evidence that functional connectivity exhibits deficits soon after birth in very preterm infants in key brain networks responsible for motor, language and executive functions, even in the absence of anatomical lesions. These functional network measures could serve as prognostic biomarkers for later developmental disabilities and guide decisions about early interventions.
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Affiliation(s)
- Elveda Gozdas
- Department of Physics, University of Cincinnati, Cincinnati, OH, USA.,Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nehal A Parikh
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephanie L Merhar
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean A Tkach
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Medpace Inc., Cincinnati, OH, USA
| | - Scott K Holland
- Department of Physics, University of Cincinnati, Cincinnati, OH, USA. .,Medpace Inc., Cincinnati, OH, USA.
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12
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Bielczyk NZ, Walocha F, Ebel PW, Haak KV, Llera A, Buitelaar JK, Glennon JC, Beckmann CF. Thresholding functional connectomes by means of mixture modeling. Neuroimage 2018; 171:402-414. [PMID: 29309896 PMCID: PMC5981009 DOI: 10.1016/j.neuroimage.2018.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022] Open
Abstract
Functional connectivity has been shown to be a very promising tool for studying the large-scale functional architecture of the human brain. In network research in fMRI, functional connectivity is considered as a set of pair-wise interactions between the nodes of the network. These interactions are typically operationalized through the full or partial correlation between all pairs of regional time series. Estimating the structure of the latent underlying functional connectome from the set of pair-wise partial correlations remains an open research problem though. Typically, this thresholding problem is approached by proportional thresholding, or by means of parametric or non-parametric permutation testing across a cohort of subjects at each possible connection. As an alternative, we propose a data-driven thresholding approach for network matrices on the basis of mixture modeling. This approach allows for creating subject-specific sparse connectomes by modeling the full set of partial correlations as a mixture of low correlation values associated with weak or unreliable edges in the connectome and a sparse set of reliable connections. Consequently, we propose to use alternative thresholding strategy based on the model fit using pseudo-False Discovery Rates derived on the basis of the empirical null estimated as part of the mixture distribution. We evaluate the method on synthetic benchmark fMRI datasets where the underlying network structure is known, and demonstrate that it gives improved performance with respect to the alternative methods for thresholding connectomes, given the canonical thresholding levels. We also demonstrate that mixture modeling gives highly reproducible results when applied to the functional connectomes of the visual system derived from the n-back Working Memory task in the Human Connectome Project. The sparse connectomes obtained from mixture modeling are further discussed in the light of the previous knowledge of the functional architecture of the visual system in humans. We also demonstrate that with use of our method, we are able to extract similar information on the group level as can be achieved with permutation testing even though these two methods are not equivalent. We demonstrate that with both of these methods, we obtain functional decoupling between the two hemispheres in the higher order areas of the visual cortex during visual stimulation as compared to the resting state, which is in line with previous studies suggesting lateralization in the visual processing. However, as opposed to permutation testing, our approach does not require inference at the cohort level and can be used for creating sparse connectomes at the level of a single subject.
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Affiliation(s)
- Natalia Z Bielczyk
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Geert Groteplein Zuid 10, 6525GA Nijmegen, The Netherlands.
| | - Fabian Walocha
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; University of Osnabrück, Neuer Graben 29/Schloss, 49074 Osnabrück, Germany
| | - Patrick W Ebel
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Radboud University Nijmegen, Comeniuslaan 4, 6525 HP Nijmegen, The Netherlands
| | - Koen V Haak
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Geert Groteplein Zuid 10, 6525GA Nijmegen, The Netherlands
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Radboud University Nijmegen, Comeniuslaan 4, 6525 HP Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Geert Groteplein Zuid 10, 6525GA Nijmegen, The Netherlands
| | - Jeffrey C Glennon
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Geert Groteplein Zuid 10, 6525GA Nijmegen, The Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Geert Groteplein Zuid 10, 6525GA Nijmegen, The Netherlands; Oxford Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
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13
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Using Functional Connectivity Magnetic Resonance Imaging to Measure Brain Connectivity in Preterm Infants. Nurs Res 2017; 66:490-495. [PMID: 29095379 DOI: 10.1097/nnr.0000000000000241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of functional connectivity magnetic resonance imaging (fcMRI) in research involving preterm infants is relatively new, and its feasibility in this population is not fully established. However, fcMRI images reveal functional neural connections that may be useful in establishing the mechanisms of neuroprotective interventions in preterm infants. OBJECTIVE The aim of this study was to determine the feasibility of using fcMRI to measure differences in functional neural connections in nursing intervention studies. METHODS A pilot study was conducted as part of a longitudinal, randomized controlled trial (RCT) testing the effect of a feeding intervention on neurodevelopmental and clinical outcomes of preterm infants randomly assigned to one of two groups: a patterned feeding experience (PFE) group and a usual feeding care (UFC) group. The fcMRIs were done at term-equivalent age. Visual, motor, and default mode networks were analyzed. RESULTS Seven infants were studied (four were in the PFE group, and three were in the UFC group). Participants were selected sequentially from the parent RCT. Clear images were obtained from all participants. Differences were noted among PFE and UFC infants: Infants receiving PFE were hyperconnective in the default mode (caudate, anterior cingulate cortex, and precuneus) and motor networks (middle temporal and middle occipital areas) and hypoconnective in others areas of the default mode (hippocampal and lingual regions) and motor networks (precentral and superior frontal cortices) relative to UFC infants. No differences were noted in visual networks. DISCUSSION The feasibility of using fcMRI at term-equivalent age in preterm infants who participated in an RCT on the effect of a nursing intervention was shown. Differences in connectivity among infants by group were detected. Further research is needed to show the benefit of fcMRI in studies of preterm infants given the costs of the procedure as well as the uncertain relationship of this early outcome measure to long-term neurodevelopment.
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