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Tunagur MT, Aksu H, Tileklioğlu E, Ertabaklar H. The impact of Toxocara-seropositivity on attention and motor skills in children with attention-deficit hyperactivity disorder. Early Hum Dev 2024; 193:106017. [PMID: 38663140 DOI: 10.1016/j.earlhumdev.2024.106017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The study aims to compare neurological soft signs and executive functions between Toxocara-seropositive and seronegative groups in children with attention-deficit/hyperactivity disorder. METHODS The study included 60 boys with ADHD, aged 7-12. After blood samples were taken, the Stroop Color Word Test and Judgment of Line Orientation test (JLOT) were implemented to measure executive functions. Neurological soft signs were evaluated with Physical and Neurological Examination for Subtle Signs (PANESS). RESULTS Serological tests were positive for Toxocara antibodies in 20 cases. There was no significant difference between Toxocara seropositive and seronegative regarding age, socioeconomic status, developmental stages, and ADHD severity. However, Toxocara-seropositive children had higher Stroop time and Stroop interference scores and lower JLOT scores than Toxocara-seronegative children. Furthermore, Toxocara-seropositive children exhibited more neurological soft signs, such as gait and station abnormalities, dysrhythmia, and a longer total time in timed movements compared to Toxocara-seronegative children. CONCLUSION Our study indicates a link between Toxocara-seropositivity and impaired neurological soft signs and executive functions in ADHD. Further research is needed to understand ADHD mechanisms, develop practical treatments considering immunological factors, and thoroughly evaluate how Toxocara seropositivity affects executive functions and motor skills in children with ADHD.
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Affiliation(s)
- Mustafa Tolga Tunagur
- Sakarya University Training and Research Hospital, Child and Adolescent Psychiatry, Sakarya, Turkiye.
| | - Hatice Aksu
- Aydın Adnan Menderes University, Child and Adolescent Psychiatry, Aydın, Turkiye
| | - Evren Tileklioğlu
- Aydın Adnan Menderes University, Department of Parasitology, Aydın, Turkiye
| | - Hatice Ertabaklar
- Aydın Adnan Menderes University, Department of Parasitology, Aydın, Turkiye
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Zebrack JE, Gao J, Verhey B, Tian L, Stave C, Farhadian B, Ma M, Silverman M, Xie Y, Tran P, Thienemann M, Wilson JL, Frankovich J. Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306193. [PMID: 38746142 PMCID: PMC11092680 DOI: 10.1101/2024.04.26.24306193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Importance Studies of brain imaging and movements during REM sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings commonly present in patients with PANS could improve diagnostic accuracy. Objective To determine the prevalence of neurological soft signs which may reflect basal ganglia dysfunction (NSS-BG) in youth presenting with PANS and whether clinical characteristics of PANS correlate with NSS-BG. Design, Setting, and Participants: 135 new patients who were evaluated at the Stanford Children's Immune Behavioral Health Clinic between November 1, 2014 and March 1, 2020 and met strict PANS criteria were retrospectively reviewed for study inclusion. 16 patients were excluded because they had no neurological exam within the first three visits and within three months of clinical presentation. Main Outcomes and Measures The following NSS-BG were recorded from medical record review: 1) glabellar tap reflex, 2) tongue movements, 3) milkmaid's grip, 4) choreiform movements, 5) spooning, and 6) overflow movements. We included data from prospectively collected symptoms and impairment scales. Results The study included 119 patients: mean age at PANS onset was 8.2 years, mean age at initial presentation was 10.4 years, 55.5% were male, and 73.9% were non-Hispanic White. At least one NSS-BG was observed in 95/119 patients (79.8%). Patients had 2.1 NSS-BG on average. Patients with 4 or more NSS-BG had higher scores of global impairment (p=0.052) and more symptoms (p=0.008) than patients with 0 NSS-BG. There was no significant difference in age at visit or reported caregiver burden. On Poisson and linear regression, the number of NSS-BG was associated with global impairment (2.857, 95% CI: 0.092-5.622, p=0.045) and the number of symptoms (1.049, 95% CI: 1.018-1.082, p=0.002), but not age or duration of PANS at presentation. Conclusions and Relevance We found a high prevalence of NSS-BG in patients with PANS and an association between NSS-BG and disease severity that is not attributable to younger age. PANS may have a unique NSS-BG profile, suggesting that targeted neurological exams may support PANS diagnosis.
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Affiliation(s)
- Jane E. Zebrack
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Jaynelle Gao
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Britta Verhey
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA
| | - Bahare Farhadian
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Meiqian Ma
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Melissa Silverman
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuhuan Xie
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Paula Tran
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Margo Thienemann
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jenny L. Wilson
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Frankovich
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
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3
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Bonke EM, Bonfert MV, Hillmann SM, Seitz-Holland J, Gaubert M, Wiegand TLT, De Luca A, Cho KIK, Sandmo SB, Yhang E, Tripodis Y, Seer C, Kaufmann D, Kaufmann E, Muehlmann M, Gooijers J, Lin AP, Leemans A, Swinnen SP, Bahr R, Shenton ME, Pasternak O, Tacke U, Heinen F, Koerte IK. Neurological soft signs in adolescents are associated with brain structure. Cereb Cortex 2022; 33:5547-5556. [PMID: 36424865 DOI: 10.1093/cercor/bhac441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Neurological soft signs (NSS) are minor deviations in motor performance. During childhood and adolescence, NSS are examined for functional motor phenotyping to describe development, to screen for comorbidities, and to identify developmental vulnerabilities. Here, we investigate underlying brain structure alterations in association with NSS in physically trained adolescents. Male adolescent athletes (n = 136, 13–16 years) underwent a standardized neurological examination including 28 tests grouped into 6 functional clusters. Non-optimal performance in at least 1 cluster was rated as NSS (NSS+ group). Participants underwent T1- and diffusion-weighted magnetic resonance imaging. Cortical volume, thickness, and local gyrification were calculated using Freesurfer. Measures of white matter microstructure (Free-water (FW), FW-corrected fractional anisotropy (FAt), axial and radial diffusivity (ADt, RDt)) were calculated using tract-based spatial statistics. General linear models with age and handedness as covariates were applied to assess differences between NSS+ and NSS− group. We found higher gyrification in a large cluster spanning the left superior frontal and parietal areas, and widespread lower FAt and higher RDt compared with the NSS− group. This study shows that NSS in adolescents are associated with brain structure alterations. Underlying mechanisms may include alterations in synaptic pruning and axon myelination, which are hallmark processes of brain maturation.
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Affiliation(s)
- Elena M Bonke
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich , Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Michaela V Bonfert
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Stefan M Hillmann
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Johanna Seitz-Holland
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Malo Gaubert
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- CHU Rennes Radiology Department, , Rennes, France
- University of Rennes Inria, CNRS, Inserm, IRISA UMR 6074, Empenn ERL, , Rennes, France
| | - Tim L T Wiegand
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Alberto De Luca
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
- University Medical Center Utrecht Department of Neurology, , Utrecht, the Netherlands
| | - Kang Ik K Cho
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Stian B Sandmo
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
- Oslo University Hospital Division of Mental Health and Addiction, , Oslo, Norway
| | - Eukyung Yhang
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
| | - Yorghos Tripodis
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
- Boston University School of Medicine Alzheimer’s Disease and CTE Centers, , Boston, MA , United States
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - David Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- University Hospital Augsburg Department of Diagnostic and Interventional Radiology and Neuroradiology, , Augsburg, Germany
| | - Elisabeth Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Ludwig-Maximilians-Universität Department of Neurology, , Munich, Germany
| | - Marc Muehlmann
- University Hospital Department of Clinical Radiology, , Ludwig-Maximilians-Universität, Munich, Germany
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Alexander P Lin
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
- Harvard Medical School Center for Clinical Spectroscopy, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Alexander Leemans
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Roald Bahr
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
| | - Martha E Shenton
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Ofer Pasternak
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Uta Tacke
- University Children's Hospital (UKBB) , Basel, Switzerland
| | - Florian Heinen
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Inga K Koerte
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich , Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
- Harvard Medical School Department of Psychiatry, Massachusetts General Hospital, , Boston, MA , United States
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Disorganization domain as a putative predictor of Treatment Resistant Schizophrenia (TRS) diagnosis: A machine learning approach. J Psychiatr Res 2022; 155:572-578. [PMID: 36206601 DOI: 10.1016/j.jpsychires.2022.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Treatment Resistant Schizophrenia (TRS) is the persistence of significant symptoms despite adequate antipsychotic treatment. Although consensus guidelines are available, this condition remains often unrecognized and an average delay of 4-9 years in the initiation of clozapine, the gold standard for the pharmacological treatment of TRS, has been reported. We aimed to determine through a machine learning approach which domain of the Positive and Negative Syndrome Scale (PANSS) 5-factor model was most associated with TRS. METHODS In a cross-sectional design, 128 schizophrenia patients were classified as TRS (n = 58) or non-TRS (n = 60) after a structured retrospective-prospective analysis of treatment response. The random forest algorithm (RF) was trained to analyze the relationship between the presence/absence of TRS and PANSS-based psychopathological factor scores (positive, negative, disorganization, excitement, and emotional distress). As a complementary strategy to identify the variables most associated with the diagnosis of TRS, we included the variables selected by the RF algorithm in a multivariate logistic regression model. RESULTS according to the RF model, patients with higher disorganization, positive, and excitement symptom scores were more likely to be classified as TRS. The model showed an accuracy of 67.19%, a sensitivity of 62.07%, and a specificity of 71.43%, with an area under the curve (AUC) of 76.56%. The multivariate model including disorganization, positive, and excitement factors showed that disorganization was the only factor significantly associated with TRS. Therefore, the disorganization factor was the variable most consistently associated with the diagnosis of TRS in our sample.
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Cai D, Wang X, Kong L. The role of neurological soft signs in different mathematical skills in second and third grade children. Psych J 2022; 11:401-408. [PMID: 35023332 DOI: 10.1002/pchj.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/23/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022]
Abstract
Neurological soft signs (NSSs) are subtle motor and sensory deficits, and are associated with poor cognitive abilities. Although cognitive ability has been found to be a significant predictor for academic performance in children, it remains unclear whether NSSs could contribute to academic abilities such as mathematical skills, and its contribution varies according to grade level. Therefore, in this cross-sectional study, we examined the relationships between NSSs and different mathematical skills (calculation fluency, numerical operations, and mathematical problem-solving) in 105 Chinese children (Mean age = 7.76 years, SD age = 0.67 years; 52 from second grade, 53 from third grade; 56 boys and 49 girls) recruited from a primary public school located in Shanghai. The results of regression analyses revealed that NSSs significantly predicted calculation fluency (β = -.32, p < .050), numerical operations (β = -.38, p < .050), and mathematical problem-solving (β = -0.40, p < .010) in second but not third grade, even controlling for cognitive processes. Our results implicate that NSSs could be a potential predictor for mathematical skills in the early years of primary school.
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Affiliation(s)
- Dan Cai
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Xingsong Wang
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Li Kong
- Department of Psychology, Shanghai Normal University, Shanghai, China
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Detrick JA, Zink C, Rosch KS, Horn PS, Huddleston DA, Crocetti D, Wu SW, Pedapati EV, Wassermann EM, Mostofsky SH, Gilbert DL. Motor cortex modulation and reward in children with attention-deficit/hyperactivity disorder. Brain Commun 2021; 3:fcab093. [PMID: 34041478 PMCID: PMC8134834 DOI: 10.1093/braincomms/fcab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
Attention-deficit/hyperactivity disorder, the most prevalent developmental disorder in childhood, is a biologically heterogenous condition characterized by impaired attention and impulse control as well as motoric hyperactivity and anomalous motor skill development. Neuropsychological testing often demonstrates impairments in motivation and reward-related decision making in attention-deficit/hyperactivity disorder, believed to indicate dysfunction of the dopamine reward pathway. Development of reliable, non-invasive, easily obtained and quantitative biomarkers correlating with the presence and severity of clinical symptoms and impaired domains of function could aid in identifying meaningful attention-deficit/hyperactivity disorder subgroups and targeting appropriate treatments. To this end, 55 (37 male) 8–12-year-old children with attention-deficit/hyperactivity disorder and 50 (32 male) age-matched, typically-developing controls were enrolled in a transcranial magnetic stimulation protocol—used previously to quantify cortical disinhibition in both attention-deficit/hyperactivity disorder and Parkinson’s Disease—with a child-friendly reward motivation task. The primary outcomes were reward task-induced changes in short interval cortical inhibition and up-modulation of motor evoked potential amplitudes, evaluated using mixed model, repeated measure regression. Our results show that both reward cues and reward receipt reduce short-interval cortical inhibition, and that baseline differences by diagnosis (less inhibition in attention-deficit/hyperactivity disorder) were no longer present when reward was cued or received. Similarly, both reward cues and reward receipt up-modulated motor evoked potential amplitudes, but, differentiating the two groups, this Task-Related-Up-Modulation was decreased in children with attention-deficit/hyperactivity disorder. Furthermore, more severe hyperactive/impulsive symptoms correlated significantly with less up-modulation with success in obtaining reward. These results suggest that in children with attention-deficit/hyperactivity disorder, short interval cortical inhibition may reflect baseline deficiencies as well as processes that normalize performance under rewarded conditions. Task-Related-Up-Modulation may reflect general hypo-responsiveness in attention-deficit/hyperactivity disorder to both reward cue and, especially in more hyperactive/impulsive children, to successful reward receipt. These findings support transcranial magnetic stimulation evoked cortical inhibition and task-induced excitability as biomarkers of clinically relevant domains of dysfunction in childhood attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Jordan A Detrick
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caroline Zink
- Baltimore Research and Education Foundation, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Keri Shiels Rosch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neuropsychology, Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Paul S Horn
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David A Huddleston
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deana Crocetti
- Department of Neuropsychology, Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Steve W Wu
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Stewart H Mostofsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neuropsychology, Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donald L Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Antipsychotics Do Not Influence Neurological Soft Signs in Children and Adolescents at Ultra-High Risk for Psychosis: A Pilot Study. J Psychiatr Pract 2019; 25:186-191. [PMID: 31083030 DOI: 10.1097/pra.0000000000000387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ultra-high risk for psychosis (UHR) is considered as the condition that temporally precedes the onset of psychotic symptoms. In addition to the core symptoms, patients with schizophrenia show motor abnormalities, also known as neurological soft signs (NSS), that are considered an endophenotype for psychotic disorders and particularly for schizophrenia. Antipsychotic medications do not appear to influence NSS in individuals with schizophrenia. However, NSS in UHR subjects have been poorly studied and, to date, we do not know what effects antipsychotics have in early treated UHR subjects. Therefore, we evaluated NSS in treated UHR subjects in comparison with drug-naive UHR subjects and a group of healthy control subjects and the effect of pharmacological treatment on early treated UHR children and adolescents. PATIENTS AND METHODS Fifteen UHR subjects receiving pharmacological treatment, 15 drug-naive UHR subjects, and 25 healthy control subjects were evaluated for NSS to analyze any differences between clinical subjects and healthy controls and to evaluate the effect of antipsychotic medications in early treated UHR subjects. RESULTS Both clinical groups showed a greater number of NSS compared with the healthy control subjects. However, no significant differences in NSS were found between treated and drug-naive UHR subjects. CONCLUSIONS Consistent with what has been observed in the population of patients with a first psychotic episode and/or with schizophrenia, our results support the conclusion that antipsychotic medications do not influence NSS in children and adolescents who are at high risk for psychosis.
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Functional and structural asymmetry in primary motor cortex in Asperger syndrome: a navigated TMS and imaging study. Brain Topogr 2019; 32:504-518. [PMID: 30949863 PMCID: PMC6477009 DOI: 10.1007/s10548-019-00704-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/25/2019] [Indexed: 12/27/2022]
Abstract
Motor functions are frequently impaired in Asperger syndrome (AS). In this study, we examined the motor cortex structure and function using navigated transcranial magnetic stimulation (nTMS) and voxel-based morphometry (VBM) and correlated the results with the box and block test (BBT) of manual dexterity and physical activity in eight boys with AS, aged 8–11 years, and their matched controls. With nTMS, we found less focused cortical representation areas of distinct hand muscles in AS. There was hemispheric asymmetry in the motor maps, silent period duration and active MEP latency in the AS group, but not in controls. Exploratory VBM analysis revealed less gray matter in the left postcentral gyrus, especially in the face area, and less white matter in the precentral area in AS as compared to controls. On the contrary, in the right leg area, subjects with AS displayed an increased density of gray matter. The structural findings of the left hemisphere correlated negatively with BBT score in controls, whereas the structure of the right hemisphere in the AS group correlated positively with motor function as assessed by BBT. These preliminary functional (neurophysiological and behavioral) findings are indicative of asymmetry, and co-existing structural alterations may reflect the motor impairments causing the deteriorations in manual dexterity and other motor functions commonly encountered in children with AS.
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