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Frazier MR, Hoffman LJ, Popal H, Sullivan-Toole H, Olino TM, Olson IR. A missing link in affect regulation: the cerebellum. Soc Cogn Affect Neurosci 2022; 17:1068-1081. [PMID: 35733348 PMCID: PMC9714429 DOI: 10.1093/scan/nsac042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/05/2022] [Accepted: 06/21/2022] [Indexed: 01/12/2023] Open
Abstract
The cerebellum is one-third the size of the cerebrum yet holds twice the number of neurons. Historically, its sole function was thought to be in the calibration of smooth movements through the creation and ongoing modification of motor programs. This traditional viewpoint has been challenged by findings showing that cerebellar damage can lead to striking changes in non-motor behavior, including emotional changes. In this manuscript, we review the literature on clinical and subclinical affective disturbances observed in individuals with lesions to the cerebellum. Disorders include pathological laughing and crying, bipolar disorder, depression and mixed mood changes. We propose a theoretical model based on cerebellar connectivity to explain how the cerebellum calibrates affect. We conclude with actionable steps for future researchers to test this model and improve upon the limitations of past literature.
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Affiliation(s)
| | - Linda J Hoffman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Haroon Popal
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | | | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Ingrid R Olson
- Correspondence should be addressed to Ingrid R. Olson, Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA. E-mail:
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Beucler N, Boissonneau S, Ruf A, Fuentes S, Carron R, Dufour H. Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case. BMC Neurol 2021; 21:204. [PMID: 34016062 PMCID: PMC8136125 DOI: 10.1186/s12883-021-02223-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. CASE PRESENTATION We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. DISCUSSION A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient. CONCLUSIONS In the setting of a CBS, neuroimaging work-up may not infrequently reveal a BCM requiring complex multidisciplinary team management including neurosurgical advice.
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Affiliation(s)
- Nathan Beucler
- Department of Neurosurgery, Timone University Hospital, APHM, 264 rue Saint-Pierre, 13005, Marseille, France. .,Ecole du Val-de-Grâce, French Military Health Service Academy, 1 place Alphonse Laveran, 75230, Paris Cedex 5, France.
| | - Sébastien Boissonneau
- Department of Neurosurgery, Timone University Hospital, APHM, 264 rue Saint-Pierre, 13005, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Aurélia Ruf
- Emergency Department, Timone University Hospital, APHM, 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Timone University Hospital, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Romain Carron
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Stereotactic and Functional Neurosurgery, Timone University Hospital, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, Timone University Hospital, APHM, 264 rue Saint-Pierre, 13005, Marseille, France.,Aix-Marseille Univ, INSERM, MMG, Marseille, France
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Jiang X, Wang X, Jia L, Sun T, Kang J, Zhou Y, Wei S, Wu F, Kong L, Wang F, Tang Y. Structural and functional alterations in untreated patients with major depressive disorder and bipolar disorder experiencing first depressive episode: A magnetic resonance imaging study combined with follow-up. J Affect Disord 2021; 279:324-333. [PMID: 33096331 DOI: 10.1016/j.jad.2020.09.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) could assist in identifying objective biomarkers and follow-up study could effectively improve subjective diagnostic accuracy. By combining MRI with follow-up, this study aims to determine the shared and distinct alterations between major depressive disorder (MDD) and bipolar disorder (BD). METHODS Untreated patients with MDD experiencing the first episode were subjected to MRI and subsequent follow-up. Fifteen patients with mania or hypomania were regrouped into BD group. Twenty patients were still grouped as MDD after an average of 37.95 months follow-up. Thirty healthy controls (HCs) were recruited to match the patients. Gray matter volume (GMV) and amygdala-seed functional connectivity (FC) in the whole brain were detected and compared among the three groups. RESULTS GMV analysis revealed that the MDD and BD groups presented reduced GMV predominantly in the parietal, occipital, and frontal regions in the bilateral cerebrum compared with the HCs. The BD group had reduced GMV predominantly in the parietal, temporal, insular regions and the Rolandic operculum in the right-side cerebrum compared with MDD and HC groups. FC analysis revealed that the MDD and BD patients displayed increased FC values mainly in the bilateral parietal, and left occipital regions. Only the BD group displayed increased FC values in the temporal, occipital, parietal and limbic regions in the right-side cerebrum relative to HCs. LIMITATIONS The main limitation is the relatively small sample size. CONCLUSIONS Alterations in the cortical regions and cortico-limbic neural system may provide the scientific basis for differential diagnosis in affective disorders.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Xinrui Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Linna Jia
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Ting Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Fei Wang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
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Barahona-Corrêa JB, Cotovio G, Costa RM, Ribeiro R, Velosa A, Silva VCE, Sperber C, Karnath HO, Senova S, Oliveira-Maia AJ. Right-sided brain lesions predominate among patients with lesional mania: evidence from a systematic review and pooled lesion analysis. Transl Psychiatry 2020; 10:139. [PMID: 32398699 PMCID: PMC7217919 DOI: 10.1038/s41398-020-0811-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022] Open
Abstract
Despite claims that lesional mania is associated with right-hemisphere lesions, supporting evidence is scarce, and association with specific brain areas has not been demonstrated. Here, we aimed to test whether focal brain lesions in lesional mania are more often right- than left-sided, and if lesions converge on areas relevant to mood regulation. We thus performed a systematic literature search (PROSPERO registration CRD42016053675) on PubMed and Web-Of-Science, using terms that reflect diagnoses and structures of interest, as well as lesional mechanisms. Two researchers reviewed the articles separately according to PRISMA Guidelines, selecting reports of adult-onset hypomania, mania or mixed state following a focal brain lesion, for pooled-analyses of individual patient data. Eligible lesion images were manually traced onto the corresponding MNI space slices, and lesion topography analyzed using standard brain atlases. Using this approach, data from 211 lesional mania patients was extracted from 114 reports. Among 201 cases with focal lesions, more patients had lesions involving exclusively the right (60.7%) than exclusively the left (11.4%) hemisphere. In further analyses of 56 eligible lesion images, while findings should be considered cautiously given the potential for selection bias of published lesion images, right-sided predominance of lesions was confirmed across multiple brain regions, including the temporal lobe, fusiform gyrus and thalamus. These, and several frontal lobe areas, were also identified as preferential lesion sites in comparisons with control lesions. Such pooled-analyses, based on the most comprehensive dataset of lesional mania available to date, confirm a preferential association with right-hemisphere lesions, while suggesting that several brain areas/circuits, relevant to mood regulation, are most frequently affected.
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Affiliation(s)
- J Bernardo Barahona-Corrêa
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1340-019, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - Gonçalo Cotovio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1340-019, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - Rui M Costa
- Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
- Department of Neuroscience, Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, 10027, USA
| | - Ricardo Ribeiro
- Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
| | - Ana Velosa
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1340-019, Lisboa, Portugal
| | - Vera Cruz E Silva
- Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1340-019, Lisboa, Portugal
- Department of Neuroradiology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Christoph Sperber
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Suhan Senova
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal
- Neurosurgery and PePsy Departments, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Henri-Mondor Albert-Chenevier, Créteil, France
- Equipe 14, U955 INSERM, Institut Mondor de Recherche Biomedicale and Faculté de Médecine, Université Paris Est, Créteil, France
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal.
- Champalimaud Research, Champalimaud Centre for the Unknown, Av. Brasilia, 1400-038, Lisboa, Portugal.
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira 126, 1340-019, Lisboa, Portugal.
- NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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Lupo M, Siciliano L, Leggio M. From cerebellar alterations to mood disorders: A systematic review. Neurosci Biobehav Rev 2019; 103:21-28. [PMID: 31195001 DOI: 10.1016/j.neubiorev.2019.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have shown cerebellar abnormalities during depressive and manic states, although the specific cerebellar role in mood fluctuations remains poorly defined. Therefore, the study of pathologies characterized by frequent mood swings, such as bipolar disorder, is of great interest to investigate the relationship between the cerebellum and mood alterations. METHODS A systematic literature search on the occurrence of mood disorders in patients with cerebellar pathologies (1st research strategy) and on the presence of cerebellar alterations in mood disorders (2nd research strategy) was conducted using the PubMed electronic Internet database. For this systematic review all information was written based on the PRISMA-P statement. RESULTS The results of the 1st research strategy generated 9 articles, and in one of these, a direct correlation between cerebellar damage and the onset of mood disorder was reported. The 2nd research strategy generated 14 articles that were grouped according to the patient's mood phase (manic or depressive) or diagnosis (bipolar I or bipolar II). CONCLUSIONS The present review suggests that the cerebellum should be considered a key structure involved in the regulation of mood.
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Affiliation(s)
- Michela Lupo
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy.
| | - Libera Siciliano
- Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Maria Leggio
- Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179, Rome, Italy; Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
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Shinn AK, Roh YS, Ravichandran CT, Baker JT, Öngür D, Cohen BM. Aberrant cerebellar connectivity in bipolar disorder with psychosis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:438-448. [PMID: 28730183 DOI: 10.1016/j.bpsc.2016.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The cerebellum, which modulates affect and cognition in addition to motor functions, may contribute substantially to the pathophysiology of mood and psychotic disorders, such as bipolar disorder. A growing literature points to cerebellar abnormalities in bipolar disorder. However, no studies have investigated the topographic representations of resting state cerebellar networks in bipolar disorder, specifically their functional connectivity to cerebral cortical networks. METHODS Using a well-defined cerebral cortical parcellation scheme as functional connectivity seeds, we compared ten cerebellar resting state networks in 49 patients with bipolar disorder and a lifetime history of psychotic features and 55 healthy control participants matched for age, sex, and image signal-to-noise ratio. RESULTS Patients with psychotic bipolar disorder showed reduced cerebro-cerebellar functional connectivity in somatomotor A, ventral attention, salience, and frontoparietal control A and B networks relative to healthy control participants. These findings were not significantly correlated with current symptoms. CONCLUSIONS Patients with psychotic bipolar disorder showed evidence of cerebro-cerebellar dysconnectivity in selective networks. These disease-related changes were substantial and not explained by medication exposure or substance use. Therefore, they may be mechanistically relevant to the underlying susceptibility to mood dysregulation and psychosis. Cerebellar mechanisms deserve further exploration in psychiatric conditions, and this study's findings may have value in guiding future studies on pathophysiology and treatment of mood and psychotic disorders, in particular.
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Affiliation(s)
- Ann K Shinn
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Youkyung S Roh
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Caitlin T Ravichandran
- Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, USA.,Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Justin T Baker
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bruce M Cohen
- Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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