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Nowak M, Schindler S, Storch M, Geyer S, Schönknecht P. Mammillary body and hypothalamic volumes in mood disorders. J Psychiatr Res 2023; 158:216-225. [PMID: 36603316 DOI: 10.1016/j.jpsychires.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
We have previously reported an in vivo enlargement of the left hypothalamus in mood disorders using 7 T magnetic resonance imaging. The aim of this follow-up study was to find out whether the hypothalamic volume difference may be located in the mammillary bodies (MB) rather than being widespread across the hypothalamus. We developed and evaluated a detailed segmentation algorithm that allowed a reliable segmentation of the MBs, and applied it to 20 unmedicated (MDDu) and 20 medicated patients with major depressive disorder, 21 medicated patients with bipolar disorder, and 23 controls. 20 out of 23 healthy controls were matched to the MDDu. We tested for group differences in MB and hypothalamus without MB (HTh) volumes using analyses of covariance. Associations between both volumes of interest were analysed using bivariate and partial correlations. In contrast to postmortem findings, we found no statistically significant differences of the MB volumes between the study groups. Left HTh volumes differed significantly across the study groups after correction for intracranial volume (ICV) and for ICV and sex. Our result of an HTh enlargement in mood disorders was confirmed by a paired t-test between the matched pairs of MDDu and healthy controls using the native MB and HTh volumes. In the whole sample, MB volumes correlated significantly with the ipsilateral HTh volumes. Our results indicate a structural relationship between both volumes, and that our previous in vivo finding of a hypothalamus enlargement does not extend to the MB, but is limited to the HTh. The enlargement is more likely related to the dysregulation of the HPA axis than to cognitive dysfunctions accompanying mood disorders.
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Affiliation(s)
- Markus Nowak
- University Hospital Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstraße 10, 04103, Leipzig, Germany; Charité University of Medicine, Department of Psychiatry and Psychotherapy and St. Hedwig Hospital Berlin, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - Stephanie Schindler
- University Hospital Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Melanie Storch
- University Hospital Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Stefan Geyer
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurophysics, Stephanstraße 1a, 04103, Leipzig, Germany
| | - Peter Schönknecht
- University Hospital Leipzig, Department of Psychiatry and Psychotherapy, Semmelweisstraße 10, 04103, Leipzig, Germany; University Hospital Leipzig, Out-patient Department for Sexual-therapeutic Prevention and Forensic Psychiatry, Semmelweisstraße 10, 04103, Leipzig, Germany; Academic State Hospital Arnsdorf, Hufelandstraße 15, 01477, Arnsdorf, Germany
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Meys KME, de Vries LS, Groenendaal F, Vann SD, Lequin MH. The Mammillary Bodies: A Review of Causes of Injury in Infants and Children. AJNR Am J Neuroradiol 2022; 43:802-812. [PMID: 35487586 PMCID: PMC9172959 DOI: 10.3174/ajnr.a7463] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
Despite their small size, the mammillary bodies play an important role in supporting recollective memory. However, they have typically been overlooked when assessing neurologic conditions that present with memory impairment. While there is increasing evidence of mammillary body involvement in a wide range of neurologic disorders in adults, very little attention has been given to infants and children. Literature searches of PubMed and EMBASE were performed to identify articles that describe mammillary body pathology on brain MR imaging in children. Mammillary body pathology is present in the pediatric population in several conditions, indicated by signal change and/or atrophy on MR imaging. The main causes of mammillary body pathology are thiamine deficiency, hypoxia-ischemia, direct damage due to masses or hydrocephalus, or deafferentation resulting from pathology within the wider Papez circuit. Optimizing scanning protocols and assessing mammillary body status as a standard procedure are critical, given their role in memory processes.
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Affiliation(s)
- K M E Meys
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - L S de Vries
- Department of Neonatology (L.S.D.V.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - F Groenendaal
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - S D Vann
- School of Psychology (S.D.V.), Cardiff University, Cardiff, UK
| | - M H Lequin
- From the Department of Radiology (K.M.E.M., F.G., M.H.L.), Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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3
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Rootman M, Kornreich L, Osherov A, Konen O. DWI Hyperintensity in the Fornix Fimbria on MRI in Children. AJNR Am J Neuroradiol 2022; 43:480-485. [PMID: 35210274 PMCID: PMC8910804 DOI: 10.3174/ajnr.a7437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The fornix-fimbria complex is mainly involved in emotions and memory. In brain MR imaging studies of young children, we have occasionally noted DWI hyperintensity in this region. The significance of this finding remains unclear. This study evaluated the DWI signal in the fornix-fimbria complex of children 0-2 years of age, including the frequency of signal hyperintensity and clinical context. MATERIALS AND METHODS Brain MR imaging of 714 children 0-2 years of age (mean, 11 months), performed between September 2018 and May 2021, was reviewed and evaluated for DWI signal changes in the fornix-fimbria. All children with available MR imaging studies including DWI were included. Children with poor image quality, poor visualization of the fornix-fimbria region, and missing medical data were excluded. Additional imaging findings were also evaluated. Demographic data were retrieved from the medical files. We compared the ADC values of the fimbria and fornix between children with and without signal changes. The unpaired 2-tailed Student t test and χ2 test were used for statistical analysis. RESULTS DWI signal hyperintensity of the Fornix-fimbria complex was noted in 53 (7.4%) children (mean age, 10 months). Their mean ADC values were significantly lower than those of the children with normal DWI findings (P < .05). About half of the children had otherwise normal MR imaging findings. When detected, the most common abnormality was parenchymal volume loss (15%). The most common indication for imaging was seizures (26.5%). CONCLUSIONS DWI hyperintensity in the fornix-fimbria complex was detected in 7.4% of children 0-2 years of age. The etiology is not entirely clear, possibly reflecting a transient phenomenon.
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Affiliation(s)
- M.S. Rootman
- From the Department of Radiology (M.S.R., L.K., A.N.O., O.K.), Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel,The Sackler Faculty of Medicine (M.S.R., L.K., A.N.O., O.K.), Tel Aviv University, Tel Aviv, Israel
| | - L. Kornreich
- From the Department of Radiology (M.S.R., L.K., A.N.O., O.K.), Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel,The Sackler Faculty of Medicine (M.S.R., L.K., A.N.O., O.K.), Tel Aviv University, Tel Aviv, Israel
| | - A.N. Osherov
- From the Department of Radiology (M.S.R., L.K., A.N.O., O.K.), Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel,The Sackler Faculty of Medicine (M.S.R., L.K., A.N.O., O.K.), Tel Aviv University, Tel Aviv, Israel
| | - O. Konen
- From the Department of Radiology (M.S.R., L.K., A.N.O., O.K.), Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel,The Sackler Faculty of Medicine (M.S.R., L.K., A.N.O., O.K.), Tel Aviv University, Tel Aviv, Israel
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Amin R. Beyond the Retrotrapezoid Nucleus in Congenital Central Hypoventilation Syndrome. Am J Respir Crit Care Med 2021; 205:271-272. [PMID: 34905719 PMCID: PMC8886996 DOI: 10.1164/rccm.202111-2602ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raouf Amin
- Cincinnati Children's Hospital Medical Center, Pulmonary Medicine, Cincinnati, Ohio, United States;
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Ogata T, Muramatsu K, Miyana K, Ozawa H, Iwasaki M, Arakawa H. Neurodevelopmental outcome and respiratory management of congenital central hypoventilation syndrome: a retrospective study. BMC Pediatr 2020; 20:342. [PMID: 32660452 PMCID: PMC7358189 DOI: 10.1186/s12887-020-02239-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background Congenital central hypoventilation syndrome (CCHS) is a rare disease characterized by sleep apnea. Anoxia often occurs soon after birth, and it is important to prevent anoxia-mediated central nervous system complications; however, data on the relationship between respiratory management and the prognosis for intellectual development of patients with CCHS is not well yet investigate. Methods We performed a retrospective chart review cohort study of patients with CCHS in Japan. We investigated the risk and prognostic factors for developmental outcomes and examined the disease in terms of its symptoms, diagnosis, complications, and treatment. Results Of the 123 patients with CCHS included in the survey, 88 patients were 6 years old and older. They were divided into two group based on their intelligence quotient. Those treated using positive-pressure ventilation via tracheostomy in the first three months of life had a better developmental prognosis than those managed via tracheostomy after three months of age and those treated by ventilation using mask (OR = 3.80; 95% CI: 1.00–14.37, OR = 4.65; 95% CI: 1.11–19.37). There was no significant difference in physical development (P = 0.64). Conclusions The best respiratory treatment for patients with CCHS is ventilation via tracheostomy, initiated ideally before the age of three months.
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Affiliation(s)
- Tomomi Ogata
- Department of Pediatrics, Graduate School of Medicine, Gunma University, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.
| | - Kazuhiro Muramatsu
- Department of Pediatrics, Graduate School of Medicine, Gunma University, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.,Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Kaori Miyana
- Department of Pediatrics, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Motoki Iwasaki
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hirokazu Arakawa
- Department of Pediatrics, Graduate School of Medicine, Gunma University, 3-39-15 Showa-machi, Maebashi City, Gunma, 371-8511, Japan
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Noorani S, Roy B, Sahib AK, Cabrera-Mino C, Halnon NJ, Woo MA, Lewis AB, Pike NA, Kumar R. Caudate nuclei volume alterations and cognition and mood dysfunctions in adolescents with single ventricle heart disease. J Neurosci Res 2020; 98:1877-1888. [PMID: 32530059 DOI: 10.1002/jnr.24667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022]
Abstract
Adolescents with single ventricle heart disease (SVHD) exhibit mood and cognitive deficits, which may result from injury to the basal ganglia structures, including the caudate nuclei. However, the integrity of the caudate in SVHD adolescents is unclear. Our aim was to examine the global and regional caudate volumes, and evaluate the relationships between caudate volumes and cognitive and mood scores in SVHD and healthy adolescents. We acquired two high-resolution T1-weighted images from 23 SVHD and 37 controls using a 3.0-Tesla MRI scanner, as well as assessed mood (Patient Health Questionnaire-9 [PHQ-9]; Beck Anxiety Inventory [BAI]) and cognition (Montreal Cognitive Assessment [MoCA]; Wide Range Assessment of Memory and Learning-2; General Memory Index [GMI]) functions. Both left and right caudate nuclei were outlined, which were then used to calculate and compare volumes between groups using ANCOVA (covariates: age, gender, and head-size), as well as perform 3D surface morphometry. Partial correlations (covariates: age, gender, and head-size) were used to examine associations between caudate volumes, cognition, and mood scores in SVHD and controls. SVHD subjects showed significantly higher PHQ-9 and BAI scores, indicating more depressive and anxiety symptoms, as well as reduced GMI scores, suggesting impaired cognition, compared to controls. SVHD patients showed significantly reduced caudate volumes (left, 3,198.8 ± 490.1 vs. 3,605.0 ± 480.4 mm3 , p < 0.004; right, 3,162.1 ± 475.4 vs. 3,504.8 ± 465.9 mm3 , p < 0.011) over controls, and changes were localized in the rostral, mid-dorsolateral, and caudal areas. Significant negative correlations emerged between caudate volumes with PHQ-9 and BAI scores and positive correlations with GMI and MoCA scores in SVHD and controls. SVHD adolescents show significantly reduced caudate volumes, especially in sites that have projections to regulate mood and cognition, which may result from developmental and/or hypoxia-/ischemia-induced processes.
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Affiliation(s)
- Sarah Noorani
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Bhaswati Roy
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashish K Sahib
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Nancy J Halnon
- Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Alan B Lewis
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nancy A Pike
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
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7
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Cabrera-Mino C, Roy B, Woo MA, Singh S, Moye S, Halnon NJ, Lewis AB, Kumar R, Pike NA. Reduced brain mammillary body volumes and memory deficits in adolescents who have undergone the Fontan procedure. Pediatr Res 2020; 87:169-175. [PMID: 31499515 PMCID: PMC6962527 DOI: 10.1038/s41390-019-0569-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adolescents with single ventricle heart disease (SVHD) who have undergone the Fontan procedure show cognitive/memory deficits. Mammillary bodies are key brain sites that regulate memory; however, their integrity in SVHD is unclear. We evaluated mammillary body (MB) volumes and their associations with cognitive/memory scores in SVHD and controls. METHODS Brain MRI data were collected from 63 adolescents (25 SVHD; 38 controls) using a 3.0-Tesla MRI scanner. Cognition and memory were assessed using Montreal Cognitive Assessment (MoCA) and Wide Range Assessment of Memory and Learning 2. MB volumes were calculated and compared between groups (ANCOVA, covariates: age, sex, and total brain volume [TBV]). Partial correlations and linear regression were performed to examine associations between volumes and cognitive scores (covariates: age, sex, and TBV). RESULTS SVHD group showed significantly lower MoCA and WRAML2 scores over controls. MB volumes were significantly reduced in SVHD over controls. After controlling for age, sex, and TBV, MB volumes correlated with MoCA and delayed memory recall scores in SVHD and controls. CONCLUSION Adolescents with SVHD show reduced MB volumes associated with cognitive/memory deficits. Potential mechanisms of volume losses may include developmental and/or hypoxic/ischemic-induced processes. Providers should screen for cognitive deficits and explore possible interventions to improve memory.
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Affiliation(s)
| | - Bhaswati Roy
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Sadhana Singh
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefanie Moye
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy J Halnon
- Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Alan B Lewis
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy A Pike
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.
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8
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Pringsheim M, Mitter D, Schröder S, Warthemann R, Plümacher K, Kluger G, Baethmann M, Bast T, Braun S, Büttel HM, Conover E, Courage C, Datta AN, Eger A, Grebe TA, Hasse-Wittmer A, Heruth M, Höft K, Kaindl AM, Karch S, Kautzky T, Korenke GC, Kruse B, Lutz RE, Omran H, Patzer S, Philippi H, Ramsey K, Rating T, Rieß A, Schimmel M, Westman R, Zech FM, Zirn B, Ulmke PA, Sokpor G, Tuoc T, Leha A, Staudt M, Brockmann K. Structural brain anomalies in patients with FOXG1 syndrome and in Foxg1+/- mice. Ann Clin Transl Neurol 2019; 6:655-668. [PMID: 31019990 PMCID: PMC6469254 DOI: 10.1002/acn3.735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/22/2019] [Indexed: 01/11/2023] Open
Abstract
Objective FOXG1 syndrome is a rare neurodevelopmental disorder associated with heterozygous FOXG1 variants or chromosomal microaberrations in 14q12. The study aimed at assessing the scope of structural cerebral anomalies revealed by neuroimaging to delineate the genotype and neuroimaging phenotype associations. Methods We compiled 34 patients with a heterozygous (likely) pathogenic FOXG1 variant. Qualitative assessment of cerebral anomalies was performed by standardized re-analysis of all 34 MRI data sets. Statistical analysis of genetic, clinical and neuroimaging data were performed. We quantified clinical and neuroimaging phenotypes using severity scores. Telencephalic phenotypes of adult Foxg1+/- mice were examined using immunohistological stainings followed by quantitative evaluation of structural anomalies. Results Characteristic neuroimaging features included corpus callosum anomalies (82%), thickening of the fornix (74%), simplified gyral pattern (56%), enlargement of inner CSF spaces (44%), hypoplasia of basal ganglia (38%), and hypoplasia of frontal lobes (29%). We observed a marked, filiform thinning of the rostrum as recurrent highly typical pattern of corpus callosum anomaly in combination with distinct thickening of the fornix as a characteristic feature. Thickening of the fornices was not reported previously in FOXG1 syndrome. Simplified gyral pattern occurred significantly more frequently in patients with early truncating variants. Higher clinical severity scores were significantly associated with higher neuroimaging severity scores. Modeling of Foxg1 heterozygosity in mouse brain recapitulated the associated abnormal cerebral morphology phenotypes, including the striking enlargement of the fornix. Interpretation Combination of specific corpus callosum anomalies with simplified gyral pattern and hyperplasia of the fornices is highly characteristic for FOXG1 syndrome.
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Affiliation(s)
- Milka Pringsheim
- Klinik für Neuropädiatrie und Neurologische Rehabilitation Epilepsiezentrum für Kinder und Jugendliche Schön Klinik Vogtareuth Vogtareuth Germany.,Research Institute "Rehabilitation, Transition, Rehabilitation" Paracelsus Medical University Salzburg Austria
| | - Diana Mitter
- Institute of Human Genetics University of Leipzig Medical Center Leipzig Germany
| | - Simone Schröder
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders University Medical Center Göttingen Göttingen Germany
| | - Rita Warthemann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders University Medical Center Göttingen Göttingen Germany
| | - Kim Plümacher
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders University Medical Center Göttingen Göttingen Germany
| | - Gerhard Kluger
- Klinik für Neuropädiatrie und Neurologische Rehabilitation Epilepsiezentrum für Kinder und Jugendliche Schön Klinik Vogtareuth Vogtareuth Germany.,Research Institute "Rehabilitation, Transition, Rehabilitation" Paracelsus Medical University Salzburg Austria
| | | | - Thomas Bast
- Epilepsiezentrum Kork Kehl-Kork Germany.,Medical Faculty University of Freiburg Freiburg Germany
| | - Sarah Braun
- Asklepios Children's Hospital St. Augustin Germany
| | | | - Elizabeth Conover
- Department of Genetic Medicine Munroe Meyer Institute University of Nebraska Medical Center Omaha Omaha Nebraska USA
| | - Carolina Courage
- Division of Human Genetics Department of Pediatrics, Inselspital University of Bern Bern Switzerland.,The Folkhälsan Institute of Genetics University of Helsinki Helsinki Finland
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine University of Basel Children's Hospital Basel Switzerland
| | - Angelika Eger
- Sozialpädiatrisches Zentrum Leipzig (Frühe Hilfe Leipzig) Leipzig Germany
| | - Theresa A Grebe
- Division of Genetics and Metabolism Phoenix Children's Hospital Phoenix Arizona USA
| | | | - Marion Heruth
- Klinik für Kinder- und Jugendmedizin Sana Kliniken Leipziger Land Borna Germany
| | - Karen Höft
- Klinik für Kinder- und Jugendmedizin Klinikum Magdeburg gGmbH Magdeburg Germany
| | - Angela M Kaindl
- Klinik für Pädiatrie m.S. Neurologie Sozialpädiatrisches Zentrum Institut für Zell- und Neurobiologie Charité-Universitätsmedizin Berlin Berlin Germany
| | - Stephanie Karch
- Klinik für Kinder- und Jugendmedizin Sozialpädiatrisches Zentrum Universitätsklinikum Heidelberg Heidelberg Germany
| | | | - Georg C Korenke
- Klinik für Neuropädiatrie und angeborene Stoffwechselerkrankungen Elisabeth Kinderkrankenhaus Klinikum Oldenburg Germany
| | - Bernd Kruse
- Neuropediatric Department Helios-Klinikum Hildesheim Hildesheim Germany
| | - Richard E Lutz
- Department of Genetic Medicine Munroe Meyer Institute University of Nebraska Medical Center Omaha Omaha Nebraska USA
| | - Heymut Omran
- Department of General Pediatrics University Children's Hospital Muenster Muenster Germany
| | - Steffi Patzer
- Klinik für Kinder- und Jugendmedizin Krankenhaus St. Elisabeth und St. Barbara Halle/Saale Germany
| | - Heike Philippi
- Sozialpädiatrisches Zentrum Frankfurt Mitte Frankfurt am Main Germany
| | - Keri Ramsey
- Center for Rare Childhood Disorders Translational Genomics Research Institute Phoenix Arizona USA
| | - Tina Rating
- Sozialpädiatrisches Institut Klinikum Bremen-Mitte Bremen Germany
| | - Angelika Rieß
- Institut für Medizinische Genetik und angewandte Genomik Universitätsklinikum Tübingen Tübingen Germany
| | - Mareike Schimmel
- Children's Hospital Section of Neuropaediatrics Klinikum Augsburg Augsburg Germany
| | - Rachel Westman
- Children's Specialty Center St. Luke's Children's Hospital Boise Idaho USA
| | - Frank-Martin Zech
- Klinik für Kinder- und Jugendmedizin St. Vincenz-Krankenhaus Paderborn Paderborn Germany
| | - Birgit Zirn
- Genetic Counselling and Diagnostic, genetikum Stuttgart Stuttgart Germany
| | - Pauline A Ulmke
- Institute of Neuroanatomy University Medical Center Georg August University Göttingen Germany
| | - Godwin Sokpor
- Institute of Neuroanatomy University Medical Center Georg August University Göttingen Germany
| | - Tran Tuoc
- Institute of Neuroanatomy University Medical Center Georg August University Göttingen Germany
| | - Andreas Leha
- 'Core Facility Medical Biometry and Statistical Bioinformatics' Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
| | - Martin Staudt
- Klinik für Neuropädiatrie und Neurologische Rehabilitation Epilepsiezentrum für Kinder und Jugendliche Schön Klinik Vogtareuth Vogtareuth Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders University Medical Center Göttingen Göttingen Germany
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Effect of Hypoxic Injury in Mood Disorder. Neural Plast 2017; 2017:6986983. [PMID: 28717522 PMCID: PMC5498932 DOI: 10.1155/2017/6986983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/26/2017] [Accepted: 06/06/2017] [Indexed: 12/12/2022] Open
Abstract
Hypoxemia is a common complication of the diseases associated with the central nervous system, and neurons are highly sensitive to the availability of oxygen. Neuroplasticity is an important property of the neural system controlling breathing, memory, and cognitive ability. However, the underlying mechanism has not yet been clearly elucidated. In recent years, several pieces of evidence have highlighted the effect of hypoxic injury on neuronal plasticity in the pathogenesis and treatment of mood disorder. Therefore, the present study reviewed the relevant articles regarding hypoxic injury and neuronal plasticity and discussed the pathological changes and physiological functions of neurons in hypoxemia in order to provide a translational perspective to the relevance of hypoxic injury and mood disorder.
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10
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Harper RM, Kumar R, Macey PM, Harper RK, Ogren JA. Impaired neural structure and function contributing to autonomic symptoms in congenital central hypoventilation syndrome. Front Neurosci 2015; 9:415. [PMID: 26578872 PMCID: PMC4626648 DOI: 10.3389/fnins.2015.00415] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/15/2015] [Indexed: 12/30/2022] Open
Abstract
Congenital central hypoventilation syndrome (CCHS) patients show major autonomic alterations in addition to their better-known breathing deficiencies. The processes underlying CCHS, mutations in the PHOX2B gene, target autonomic neuronal development, with frame shift extent contributing to symptom severity. Many autonomic characteristics, such as impaired pupillary constriction and poor temperature regulation, reflect parasympathetic alterations, and can include disturbed alimentary processes, with malabsorption and intestinal motility dyscontrol. The sympathetic nervous system changes can exert life-threatening outcomes, with dysregulation of sympathetic outflow leading to high blood pressure, time-altered and dampened heart rate and breathing responses to challenges, cardiac arrhythmia, profuse sweating, and poor fluid regulation. The central mechanisms contributing to failed autonomic processes are readily apparent from structural and functional magnetic resonance imaging studies, which reveal substantial cortical thinning, tissue injury, and disrupted functional responses in hypothalamic, hippocampal, posterior thalamic, and basal ganglia sites and their descending projections, as well as insular, cingulate, and medial frontal cortices, which influence subcortical autonomic structures. Midbrain structures are also compromised, including the raphe system and its projections to cerebellar and medullary sites, the locus coeruleus, and medullary reflex integrating sites, including the dorsal and ventrolateral medullary nuclei. The damage to rostral autonomic sites overlaps metabolic, affective and cognitive regulatory regions, leading to hormonal disruption, anxiety, depression, behavioral control, and sudden death concerns. The injuries suggest that interventions for mitigating hypoxic exposure and nutrient loss may provide cellular protection, in the same fashion as interventions in other conditions with similar malabsorption, fluid turnover, or hypoxic exposure.
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Affiliation(s)
- Ronald M Harper
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Rajesh Kumar
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Department of Bioengineering, University of California, Los Angeles Los Angeles, CA, USA
| | - Paul M Macey
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; UCLA School of Nursing, University of California, Los Angeles Los Angeles, CA, USA
| | - Rebecca K Harper
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
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Harper RM, Kumar R, Macey PM, Woo MA, Ogren JA. Affective brain areas and sleep-disordered breathing. PROGRESS IN BRAIN RESEARCH 2014; 209:275-93. [PMID: 24746053 DOI: 10.1016/b978-0-444-63274-6.00014-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The neural damage accompanying the hypoxia, reduced perfusion, and other consequences of sleep-disordered breathing, found in obstructive sleep apnea, heart failure, and congenital central hypoventilation syndrome (CCHS), appears in areas that serve multiple functions, including emotional drives to breathe, and involve systems that serve affective, cardiovascular, and breathing roles. The damage, assessed with structural magnetic resonance imaging (MRI) procedures, shows tissue loss or water content and diffusion changes indicative of injury, and impaired axonal integrity between structures; damage is preferentially unilateral. Functional MRI responses in affected areas also are time- or amplitude-distorted to ventilatory or autonomic challenges. Among the structures injured are the insular, cingulate, and ventral medial prefrontal cortices, as well as cerebellar deep nuclei and cortex, anterior hypothalamus, caudal raphé, ventrolateral medulla, portions of the basal ganglia and, in CCHS, the locus coeruleus. Caudal raphé and locus coeruleus injury have the potential to modify serotonergic and adrenergic modulation of upper airway and arousal characteristics, as well as affective drive to breathe. Since both axons and gray matter show injury, the consequences to function, especially to autonomic, cognitive, and mood regulation, are major. Several of the affected rostral sites mediate aspects of dyspnea, especially in CCHS, while others participate in initiation of inspiration after central breathing pauses, and the medullary injury can impair baroreflex and breathing control. The ancillary injury associated with sleep-disordered breathing to central structures can elicit multiple other distortions in cardiovascular, cognitive, and emotional functions in addition to effects on breathing regulation.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Rajesh Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Ogren
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
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Harper RM, Kumar R, Ogren JA, Macey PM. Sleep-disordered breathing: effects on brain structure and function. Respir Physiol Neurobiol 2013; 188:383-91. [PMID: 23643610 DOI: 10.1016/j.resp.2013.04.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 01/07/2023]
Abstract
Sleep-disordered breathing is accompanied by neural injury that affects a wide range of physiological systems which include processes for sensing chemoreception and airflow, driving respiratory musculature, timing circuitry for coordination of breathing patterning, and integration of blood pressure mechanisms with respiration. The damage also occurs in regions mediating emotion and mood, as well as areas regulating memory and cognitive functioning, and appears in structures that serve significant glycemic control processes. The injured structures include brain areas involved in hormone release and action of major neurotransmitters, including those playing a role in depression. The injury is reflected in a range of structural magnetic resonance procedures, and also appears as functional distortions of evoked activity in brain areas mediating vital autonomic and breathing functions. The damage is preferentially unilateral, and includes axonal projections; the asymmetry of the injury poses unique concerns for sympathetic discharge and potential consequences for arrhythmia. Sleep-disordered breathing should be viewed as a condition that includes central nervous system injury and impaired function; the processes underlying injury remain unclear.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA.
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Rand CM, Patwari PP, Carroll MS, Weese-Mayer DE. Congenital central hypoventilation syndrome and sudden infant death syndrome: disorders of autonomic regulation. Semin Pediatr Neurol 2013; 20:44-55. [PMID: 23465774 DOI: 10.1016/j.spen.2013.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Long considered a rare and unique disorder of respiratory control, congenital central hypoventilation syndrome has recently been further distinguished as a disorder of autonomic regulation. Similarly, more recent evidence suggests that sudden infant death syndrome is also a disorder of autonomic regulation. Congenital central hypoventilation syndrome typically presents in the newborn period with alveolar hypoventilation, symptoms of autonomic dysregulation and, in a subset of cases, Hirschsprung disease or tumors of neural crest origin or both. Genetic investigation identified PHOX2B, a crucial gene during early autonomic development, as disease defining for congenital central hypoventilation syndrome. Although sudden infant death syndrome is most likely defined by complex multifactorial genetic and environmental interactions, it is also thought to result from central deficits in the control of breathing and autonomic regulation. The purpose of this article is to review the current understanding of these autonomic disorders and discuss the influence of this information on clinical practice and future research directions.
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Affiliation(s)
- Casey M Rand
- Center for Autonomic Medicine in Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Abstract
INTRODUCTION Patients with congenital central hypoventilation syndrome (CCHS) show brain injury in areas that control chemosensory, autonomic, motor, cognitive, and emotion functions, which are deficient in the condition. Many of these abnormal characteristics are present from the neonatal period; however, it is unclear whether tissue injury underlying the characteristics progressively worsens with time. We hypothesized that several brain areas in subjects with CCHS would show increased gray matter volume loss over time. METHODS We collected high-resolution T1-weighted images twice (4 years apart) from seven subjects with CCHS (age at first study, 16.1 ± 2.7 years; four males) and three control subjects (15.9 ± 2.1 years; three males) using a 3.0-Tesla magnetic resonance imaging (MRI) scanner, and evaluated regional gray matter volume changes with voxel-based morphometry (VBM) procedures. RESULTS Multiple brain sites in CCHS, including frontal, prefrontal, insular, and cingulate cortices; caudate nuclei and putamen; ventral temporal and parietal cortices; and cerebellar cortices showed significantly reduced gray matter volume over time. Only limited brain areas, including sensory, temporal, and medullary regions, emerged with increased gray matter at the later age. DISCUSSION Patients with CCHS show reduced gray matter volume with age progression in autonomic, respiratory, and cognitive regulatory areas, an outcome that may contribute to deterioration of functions found in the syndrome with increasing age.
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Macey PM, Moiyadi AS, Kumar R, Woo MA, Harper RM. Decreased cortical thickness in central hypoventilation syndrome. Cereb Cortex 2011; 22:1728-37. [PMID: 21965438 DOI: 10.1093/cercor/bhr235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Central hypoventilation syndrome (CHS) is a rare condition characterized by hypoventilation during sleep, reduced ventilatory responsiveness to CO(2) and O(2), impaired perception of air hunger, and autonomic abnormalities. Neural impairments accompany the condition, including structural injury, impaired cerebral autoregulation, and dysfunctional autonomic control. The hypoventilation may induce cortical hypoxic injury, additional to consequences of maldevelopment from PHOX2B mutations present in most CHS subjects. We assessed cortical injury in clinically diagnosed CHS using high-resolution magnetic resonance imaging scans, collected from 14 CHS (mean age ± standard deviation [SD] 17.7 ± 5.0 years; 6 female) and 29 control (mean age ± SD, 17.9 ± 4.3 years; 12 female) subjects. We measured group differences in mean cortical thickness and age-thickness correlations using FreeSurfer software, accounting for age and sex (0.1 false discovery rate). Reduced thickness in CHS appeared in the dorsomedial frontal cortex and anterior cingulate; medial prefrontal, parietal, and posterior cingulate cortices; the insular cortex; anterior and lateral temporal lobes; and mid- and accessory motor strips. Normal age-related cortical thinning in multiple regions did not appear in CHS. The cortical thinning may contribute to CHS cardiovascular and memory deficits and may impair affect and perception of breathlessness. Extensive axonal injury in CHS is paralleled by reduced cortical tissue and absence of normal developmental patterns.
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Affiliation(s)
- Paul M Macey
- School of Nursing, Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
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Kumar R, Macey PM, Woo MA, Harper RM. Selectively diminished corpus callosum fibers in congenital central hypoventilation syndrome. Neuroscience 2011; 178:261-9. [PMID: 21256194 DOI: 10.1016/j.neuroscience.2011.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 01/10/2011] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS), a condition associated with mutations in the PHOX2B gene, is characterized by loss of breathing drive during sleep, insensitivity to CO2 and O2, and multiple somatomotor, autonomic, neuropsychological, and ophthalmologic deficits, including impaired intrinsic and extrinsic eye muscle control. Brain structural studies show injury in peri-callosal regions and the corpus callosum (CC), which has the potential to affect functions disturbed in the syndrome; however, the extent of CC injury in CCHS is unclear. Diffusion tensor imaging (DTI)-based fiber tractography procedures display fiber directional information and allow quantification of fiber integrity. We performed DTI in 13 CCHS children (age, 18.2±4.7 years; eight male) and 31 control (17.4±4.9 years; 18 male) subjects using a 3.0-Tesla magnetic resonance imaging scanner; CC fibers were assessed globally and regionally with tractography procedures, and fiber counts and densities compared between groups using analysis-of-covariance (covariates; age and sex). Global CC evaluation showed reduced fiber counts and densities in CCHS over control subjects (CCHS vs. controls; fiber-counts, 4490±854 vs. 5232±777, P<0.001; fiber-density, 10.0±1.5 vs. 10.8±0.9 fibers/mm2, P<0.020), and regional examination revealed that these changes are localized to callosal axons projecting to prefrontal (217±47 vs. 248±32, P<0.005), premotor (201±51 vs. 241±47, P<0.012), parietal (179±64 vs. 238±54, P<0.002), and occipital regions (363±46 vs. 431±82, P<0.004). Corpus callosum fibers in CCHS are compromised in motor, cognitive, speech, and ophthalmologic regulatory areas. The mechanisms of fiber injury are unclear, but may result from hypoxia or perfusion deficits accompanying the syndrome, or from consequences of PHOX2B action.
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Affiliation(s)
- R Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-1763, USA
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Patwari PP, Carroll MS, Rand CM, Kumar R, Harper R, Weese-Mayer DE. Congenital central hypoventilation syndrome and the PHOX2B gene: a model of respiratory and autonomic dysregulation. Respir Physiol Neurobiol 2010; 173:322-35. [PMID: 20601214 DOI: 10.1016/j.resp.2010.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 11/20/2022]
Abstract
The paired-like homeobox 2B gene (PHOX2B) is the disease-defining gene for congenital central hypoventilation syndrome (CCHS). Individuals with CCHS typically present in the newborn period with alveolar hypoventilation during sleep and often during wakefulness, altered respiratory control including reduced or absent ventilatory responses to hypercarbia and hypoxemia, and autonomic nervous system (ANS) dysregulation; however, a subset of individuals present well into adulthood. Thermoregulation is altered and perception of shortness of breath is absent, but voluntary breathing is retained. Structural and functional magnetic resonance imaging (MRI) and limited post-mortem studies in subjects with CCHS reveal abnormalities in both forebrain and brainstem. MRI changes appear in the hypothalamus (responsible for thermal drive to breathing), posterior thalamus and midbrain (mediating O(2) and oscillatory motor patterns), caudal raphé and locus coeruleus (regulating serotonergic and noradrenergic systems), the lateral medulla, parabrachial pons, and cerebellum (coordinating chemoreceptor and somatic afferent activity with breathing), and insular and cingulate cortices (mediating shortness of breath perception). Structural and functional alterations in these sites may result from PHOX2B mutations or be secondary to hypoxia/perfusion alterations from suboptimal management/compliance. The study of CCHS, with collaboration between physician-scientists and basic scientists, offers a rare opportunity to investigate control of breathing within the complex physiological network of the ANS.
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Ogren JA, Macey PM, Kumar R, Woo MA, Harper RM. Central autonomic regulation in congenital central hypoventilation syndrome. Neuroscience 2010; 167:1249-56. [PMID: 20211704 DOI: 10.1016/j.neuroscience.2010.02.078] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/26/2010] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) patients show significant autonomic dysfunction in addition to the well-described loss of breathing drive during sleep. Some characteristics, for example, syncope, may stem from delayed sympathetic outflow to the vasculature; other symptoms, including profuse sweating, may derive from overall enhanced sympathetic output. The dysregulation suggests significant alterations to autonomic regulatory brain areas. Murine models of the genetic mutations present in the human CCHS condition indicate brainstem autonomic nuclei are targeted; however, the broad range of symptoms suggests more widespread alterations. We used functional magnetic resonance imaging (fMRI) to assess neural response patterns to the Valsalva maneuver, an autonomic challenge eliciting a sequence of sympathetic and parasympathetic actions, in nine CCHS and 25 control subjects. CCHS patients showed diminished and time-lagged heart rate responses to the Valsalva maneuver, and muted fMRI signal responses across multiple brain areas. During the positive pressure phase of the Valsalva maneuver, CCHS responses were muted, but were less so in recovery phases. In rostral structures, including the amygdala and hippocampus, the normal declining patterns were replaced by increasing trends or more modest declines. Earlier onset responses appeared in the hypothalamus, midbrain, raphé pallidus, and left rostral ventrolateral medulla. Phase-lagged responses appeared in cerebellar pyramis and anterior cingulate cortex. The time-distorted and muted central responses to autonomic challenges likely underlie the exaggerated sympathetic action and autonomic dyscontrol in CCHS, impairing cerebral autoregulation, possibly exacerbating neural injury, and enhancing the potential for cardiac arrhythmia.
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Affiliation(s)
- J A Ogren
- UCLA School of Nursing, Los Angeles, CA 90095, USA
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Hippocampal volume reduction in congenital central hypoventilation syndrome. PLoS One 2009; 4:e6436. [PMID: 19649271 PMCID: PMC2713409 DOI: 10.1371/journal.pone.0006436] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 06/30/2009] [Indexed: 11/19/2022] Open
Abstract
Children with congenital central hypoventilation syndrome (CCHS), a genetic disorder characterized by diminished drive to breathe during sleep and impaired CO(2) sensitivity, show brain structural and functional changes on magnetic resonance imaging (MRI) scans, with impaired responses in specific hippocampal regions, suggesting localized injury.We assessed total volume and regional variation in hippocampal surface morphology to identify areas affected in the syndrome. We studied 18 CCHS (mean age+/-std: 15.1+/-2.2 years; 8 female) and 32 healthy control (age 15.2+/-2.4 years; 14 female) children, and traced hippocampi on 1 mm(3) resolution T1-weighted scans, collected with a 3.0 Tesla MRI scanner. Regional hippocampal volume variations, adjusted for cranial volume, were compared between groups based on t-tests of surface distances to the structure midline, with correction for multiple comparisons. Significant tissue losses emerged in CCHS patients on the left side, with a trend for loss on the right; however, most areas affected on the left also showed equivalent right-sided volume reductions. Reduced regional volumes appeared in the left rostral hippocampus, bilateral areas in mid and mid-to-caudal regions, and a dorsal-caudal region, adjacent to the fimbria.The volume losses may result from hypoxic exposure following hypoventilation during sleep-disordered breathing, or from developmental or vascular consequences of genetic mutations in the syndrome. The sites of change overlap regions of abnormal functional responses to respiratory and autonomic challenges. Affected hippocampal areas have roles associated with memory, mood, and indirectly, autonomic regulation; impairments in these behavioral and physiological functions appear in CCHS.
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Kumar R, Ahdout R, Macey PM, Woo MA, Avedissian C, Thompson PM, Harper RM. Reduced caudate nuclei volumes in patients with congenital central hypoventilation syndrome. Neuroscience 2009; 163:1373-9. [PMID: 19632307 DOI: 10.1016/j.neuroscience.2009.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/16/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) children show cognitive and affective deficits, in addition to state-specific loss of respiratory drive. The caudate nuclei serve motor, cognitive, and affective roles, and show structural deficits in CCHS patients, based on gross voxel-based analytic procedures. However, the magnitude and regional sites of caudate injury in CCHS are unclear. We assessed global caudate nuclei volumes with manual volumetric procedures, and regional volume differences with three-dimensional surface morphometry in 14 CCHS (mean age+/-SD: 15.1+/-2.3 years; 8 male) and 31 control children (15.1+/-2.4 years; 17 male) using brain magnetic resonance imaging (MRI). Two high-resolution T1-weighted image series were collected using a 3.0 Tesla MRI scanner; images were averaged and reoriented (rigid-body transformation) to common space. Both left and right caudate nuclei were outlined in the reoriented images, and global volumes calculated; surface models were derived from manually-outlined caudate structures. Global caudate nuclei volume differences between groups were evaluated using a multivariate analysis of covariance (covariates: age, gender, and total intracranial volume). Both left and right caudate nuclei volumes were significantly reduced in CCHS over control subjects (left, 4293.45+/-549.05 vs. 4626.87+/-593.41 mm(3), P<0.006; right, 4376.29+/-565.42 vs. 4747.81+/-578.13 mm(3), P<0.004). Regional deficits in CCHS caudate volume appeared bilaterally, in the rostral head, ventrolateral mid, and caudal body. Damaged caudate nuclei may contribute to CCHS neuropsychological and motor deficits; hypoxic processes, or maldevelopment in the condition may underlie the injury.
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Affiliation(s)
- R Kumar
- Department of Neurobiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
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