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Kang J, Mao W, Wu J, Huang X, Casanova MF, Sokhadze EM, Li X, Geng X. Development of EEG connectivity from preschool to school-age children. Front Neurosci 2024; 17:1277786. [PMID: 38274502 PMCID: PMC10808652 DOI: 10.3389/fnins.2023.1277786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Many studies have collected normative developmental EEG data to better understand brain function in early life and associated changes during both aging and pathology. Higher cognitive functions of the brain do not normally stem from the workings of a single brain region that works but, rather, on the interaction between different brain regions. In this regard studying the connectivity between brain regions is of great importance towards understanding higher cognitive functions and its underlying mechanisms. Methods In this study, EEG data of children (N = 253; 3-10 years old; 113 females, 140 males) from pre-school to schoolage was collected, and the weighted phase delay index and directed transfer function method was used to find the electrophysiological indicators of both functional connectivity and effective connectivity. A general linear model was built between the indicators and age, and the change trend of electrophysiological indicators analyzed for age. Results The results showed an age trend for the functional and effective connectivity of the brain of children. Discussion The results are of importance in understanding normative brain development and in defining those conditions that deviate from typical growth trajectories.
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Affiliation(s)
- Jiannan Kang
- Child Rehabilitation Division, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Wenqin Mao
- Child Rehabilitation Division, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Juanmei Wu
- Child Rehabilitation Division, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Xinping Huang
- Child Rehabilitation Division, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Manuel F. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Prisma Health System, Greenville, SC, United States
| | - Estate M. Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Prisma Health System, Greenville, SC, United States
- Duke University, Durham, NC, United States
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xinling Geng
- School of Biomedical Engineering, Capital Medical University, Beijing, China
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Geng X, Fan X, Zhong Y, Casanova MF, Sokhadze EM, Li X, Kang J. Abnormalities of EEG Functional Connectivity and Effective Connectivity in Children with Autism Spectrum Disorder. Brain Sci 2023; 13:brainsci13010130. [PMID: 36672111 PMCID: PMC9857308 DOI: 10.3390/brainsci13010130] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder that interferes with normal brain development. Brain connectivity may serve as a biomarker for ASD in this respect. This study enrolled a total of 179 children aged 3-10 years (90 typically developed (TD) and 89 with ASD). We used a weighted phase lag index and a directed transfer function to investigate the functional and effective connectivity in children with ASD and TD. Our findings indicated that patients with ASD had local hyper-connectivity of brain regions in functional connectivity and simultaneous significant decrease in effective connectivity across hemispheres. These connectivity abnormalities may help to find biomarkers of ASD.
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Affiliation(s)
- Xinling Geng
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China
| | - Xiwang Fan
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China
| | - Yiwen Zhong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China
| | - Manuel F. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC 29605, USA
| | - Estate M. Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC 29605, USA
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100859, China
- Correspondence: (X.L.); (J.K.)
| | - Jiannan Kang
- College of Electronic & Information Engineering, Hebei University, Baoding 071000, China
- Correspondence: (X.L.); (J.K.)
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Kang J, Fan X, Zhong Y, Casanova MF, Sokhadze EM, Li X, Niu Z, Geng X. Transcranial Direct Current Stimulation Modulates EEG Microstates in Low-Functioning Autism: A Pilot Study. Bioengineering (Basel) 2023; 10:bioengineering10010098. [PMID: 36671670 PMCID: PMC9855011 DOI: 10.3390/bioengineering10010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/28/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous disorder that affects several behavioral domains of neurodevelopment. Transcranial direct current stimulation (tDCS) is a new method that modulates motor and cognitive function and may have potential applications in ASD treatment. To identify its potential effects on ASD, differences in electroencephalogram (EEG) microstates were compared between children with typical development (n = 26) and those with ASD (n = 26). Furthermore, children with ASD were divided into a tDCS (experimental) and sham stimulation (control) group, and EEG microstates and Autism Behavior Checklist (ABC) scores before and after tDCS were compared. Microstates A, B, and D differed significantly between children with TD and those with ASD. In the experimental group, the scores of microstates A and C and ABC before tDCS differed from those after tDCS. Conversely, in the control group, neither the EEG microstates nor the ABC scores before the treatment period (sham stimulation) differed from those after the treatment period. This study indicates that tDCS may become a viable treatment for ASD.
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Affiliation(s)
- Jiannan Kang
- College of Electronic & Information Engineering, Hebei University, Baoding 071000, China
| | - Xiwang Fan
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China
| | - Yiwen Zhong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China
| | - Manuel F. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, SC 29605, USA
| | - Estate M. Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, SC 29605, USA
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100859, China
| | - Zikang Niu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100859, China
- Correspondence: (Z.N.); (X.G.)
| | - Xinling Geng
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, China
- Correspondence: (Z.N.); (X.G.)
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Kang J, Li X, Casanova MF, Sokhadze EM, Geng X. Impact of repetitive transcranial magnetic stimulation on the directed connectivity of autism EEG signals: a pilot study. Med Biol Eng Comput 2022; 60:3655-3664. [DOI: 10.1007/s11517-022-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
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5
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González-Acosta CA, Ortiz-Muñoz D, Becerra-Hernández LV, Casanova MF, Buriticá E. Von Economo neurons: Cellular specialization of human limbic cortices? J Anat 2022; 241:20-32. [PMID: 35178703 DOI: 10.1111/joa.13642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 01/26/2023] Open
Abstract
Von Economo neurons (VENs) have been mentioned in the medical literature since the second half of the 19th century; however, it was not until the second decade of the 20th century that their cytomorphology was described in detail. To date, VENs have been found in limbic sectors of the frontal, temporal and insular lobes. In humans, their density seems to decrease in the caudo-rostral and ventro-dorsal direction; that is, from the anterior regions of the cingulate and insular cortices towards the frontal pole and the superior frontal gyrus. Several studies have provided similar descriptions of the shape of the VEN soma, but the size of the soma varies from one cortical region to another. There is consensus among different authors about the selective vulnerability of VENs in certain pathologies, in which a deterioration of the capacities involved in social behaviour is observed. In this review, we propose that the restriction of VENs towards the sectors linked to limbic information processing in Homo sapiens gives them a possible functional role in relation to the structures in which they are located. However, given the divergence in characteristics such as location, density, size and biochemical profile among VENs of different cortical sectors, the activities in which they participate could allow them to partake in a wide spectrum of neurological functions, including autonomic responses and executive functions.
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Affiliation(s)
| | - Daniela Ortiz-Muñoz
- Centro de Estudios Cerebrales, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | | | - Manuel F Casanova
- Center for Childhood Neurotherapeutics, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Efraín Buriticá
- Centro de Estudios Cerebrales, Facultad de Salud, Universidad del Valle, Cali, Colombia
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Kang J, Zhang Z, Wan L, Casanova MF, Sokhadze EM, Li X. Effects of 1Hz repetitive transcranial magnetic stimulation on autism with intellectual disability: A pilot study. Comput Biol Med 2021; 141:105167. [PMID: 34959111 DOI: 10.1016/j.compbiomed.2021.105167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore whether 1 Hz repetitive transcranial magnetic stimulation (rTMS) has positive effects on brain activity and behavior of autistic children with intellectual disability. METHODS 32 autistic children with intellectual disability (26 boys and 6 girls) were recruited to participate in this feasibility study. The autistic children were divided randomly and equally into an experimental group and a control group. 16 children (three girls and 13 boys; mean ± SD age: 7.8 ± 2.1 years) who received rTMS treatment twice a week were served as the experimental group, while 16 children (three girls and 13 boys; mean ± SD age: 7.2 ± 1.6 years) with sham stimulation were considered as the control group. Recurrence quantification analysis (RQA) was employed to quantify the nonlinear features of electroencephalogram (EEG) signals recorded during the resting state. Three RQA measures, including recursive rate (RR), deterministic (DET) and mean diagonal length (L) were extracted from the EEG signals to characterize the deterministic features of cortical activity. RESULTS Significant differences in RR and DET were observed between the experimental group and the control group. We also found discernible discrepancies in the Autism Behavior Checklist (ABC) score pre- and post-rTMS for the experimental group. CONCLUSIONS 1 Hz repetitive transcranial magnetic stimulation (rTMS) could positively influence brain activity and behavior of autistic children with intellectual disability.
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Affiliation(s)
- Jiannan Kang
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Zhiming Zhang
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Lingyan Wan
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, SC, USA
| | - Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, SC, USA
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
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Haweel R, Shalaby A, Mahmoud A, Seada N, Ghoniemy S, Ghazal M, Casanova MF, Barnes GN, El-Baz A. A robust DWT-CNN-based CAD system for early diagnosis of autism using task-based fMRI. Med Phys 2021; 48:2315-2326. [PMID: 33378589 DOI: 10.1002/mp.14692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Task-based fMRI (TfMRI) is a diagnostic imaging modality for observing the effects of a disease or other condition on the functional activity of the brain. Autism spectrum disorder (ASD) is a pervasive developmental disorder associated with impairments in social and linguistic abilities. Machine learning algorithms have been widely utilized for brain imaging aiming for objective ASD diagnostics. Recently, deep learning methods have been gaining more attention for fMRI classification. The goal of this paper is to develop a convolutional neural network (CNN)-based framework to help in global diagnosis of ASD using TfMRI data that are collected from a response to speech experiment. METHODS To achieve this goal, the proposed framework adopts a novel imaging marker integrating both spatial and temporal information that are related to the functional activity of the brain. The developed pipeline consists of three main components. In the first step, the collected TfMRI data are preprocessed and parcellated using the Harvard-Oxford probabilistic atlas included with the fMRIB Software Library (FSL). Second, a group analysis using FSL is performed between ASD and typically developing (TD) children to identify significantly activated brain areas in response to the speech task. In order to reduce brain spatial dimensionality, a K-means clustering technique is performed on such significant brain areas. Informative blood oxygen level-dependent (BOLD) signals are extracted from each cluster. A compression step for each extracted BOLD signal using discrete wavelet transform (DWT) has been proposed. The adopted wavelets are similar to the expected hemodynamic response which enables DWT to compress the BOLD signal while highlighting its activation information. Finally, a deep learning 2D CNN network is used to classify the patients as ASD or TD based on extracted features from the previous step. RESULTS Preliminary results on 100 TfMRI dataset (50 ASD, 50 TD) obtain 80% correct global classification using tenfold cross validation (with sensitivity = 84%, specificity = 76%). CONCLUSION The experimental results show the high accuracy of the proposed framework and hold promise for the presented framework as a helpful adjunct to currently used ASD diagnostic tools.
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Affiliation(s)
- Reem Haweel
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, KY, 40208, USA
- Computer Systems Department, Faculty of Computer and Information Sciences, University of Ain Shams, Cairo, 11566, Egypt
| | - Ahmed Shalaby
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, KY, 40208, USA
| | - Ali Mahmoud
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, KY, 40208, USA
| | - Noha Seada
- Computer Systems Department, Faculty of Computer and Information Sciences, University of Ain Shams, Cairo, 11566, Egypt
| | - Said Ghoniemy
- Computer Systems Department, Faculty of Computer and Information Sciences, University of Ain Shams, Cairo, 11566, Egypt
| | - Mohammed Ghazal
- Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, 59911, UAE
| | - Manuel F Casanova
- Biomedical Sciences, University of South Carolina, Greenville, SC, 29607, USA
| | - Gregory N Barnes
- Department of Neurology, University of Louisville, Louisville, KY, 40208, USA
| | - Ayman El-Baz
- Department of Bioengineering, University of Louisville, KY, 40208, USA
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Casanova MF, Shaban M, Ghazal M, El-Baz AS, Casanova EL, Sokhadze EM. Ringing Decay of Gamma Oscillations and Transcranial Magnetic Stimulation Therapy in Autism Spectrum Disorder. Appl Psychophysiol Biofeedback 2021; 46:161-173. [PMID: 33877491 DOI: 10.1007/s10484-021-09509-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research suggest that in autism spectrum disorder (ASD) a disturbance in the coordinated interactions of neurons within local networks gives rise to abnormal patterns of brainwave activity in the gamma bandwidth. Low frequency transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex (DLPFC) has been proven to normalize gamma oscillation abnormalities, executive functions, and repetitive behaviors in high functioning ASD individuals. In this study, gamma frequency oscillations in response to a visual classification task (Kanizsa figures) were analyzed and compared in 19 ASD (ADI-R diagnosed, 14.2 ± 3.61 years old, 5 girls) and 19 (14.8 ± 3.67 years old, 5 girls) age/gender matched neurotypical individuals. The ASD group was treated with low frequency TMS (1.0 Hz, 90% motor threshold, 18 weekly sessions) targeting the DLPFC. In autistic subjects, as compared to neurotypicals, significant differences in event-related gamma oscillations were evident in amplitude (higher) pre-TMS. In addition, recordings after TMS treatment in our autistic subjects revealed a significant reduction in the time period to reach peak amplitude and an increase in the decay phase (settling time). The use of a novel metric for gamma oscillations. i.e., envelope analysis, and measurements of its ringing decay allowed us to characterize the impedance of the originating neuronal circuit. The ringing decay or dampening of gamma oscillations is dependent on the inhibitory tone generated by networks of interneurons. The results suggest that the ringing decay of gamma oscillations may provide a biomarker reflective of the excitatory/inhibitory balance of the cortex and a putative outcome measure for interventions in autism.
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Affiliation(s)
- Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Mohamed Shaban
- Electrical and Computer Engineering, University of South Alabama, Mobile, AL, USA
| | - Mohammed Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ayman S El-Baz
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, USA
| | - Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA
| | - Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Greenville, SC, 29605, USA.
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Casanova EL, Baeza-Velasco C, Buchanan CB, Casanova MF. The Relationship between Autism and Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders. J Pers Med 2020; 10:E260. [PMID: 33271870 PMCID: PMC7711487 DOI: 10.3390/jpm10040260] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022] Open
Abstract
Considerable interest has arisen concerning the relationship between hereditary connective tissue disorders such as the Ehlers-Danlos syndromes (EDS)/hypermobility spectrum disorders (HSD) and autism, both in terms of their comorbidity as well as co-occurrence within the same families. This paper reviews our current state of knowledge, as well as highlighting unanswered questions concerning this remarkable patient group, which we hope will attract further scientific interest in coming years. In particular, patients themselves are demanding more research into this growing area of interest, although science has been slow to answer that call. Here, we address the overlap between these two spectrum conditions, including neurobehavioral, psychiatric, and neurological commonalities, shared peripheral neuropathies and neuropathologies, and similar autonomic and immune dysregulation. Together, these data highlight the potential relatedness of these two conditions and suggest that EDS/HSD may represent a subtype of autism.
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Affiliation(s)
- Emily L. Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29615, USA;
| | - Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, University of Paris, 92100 Boulogne Billancourt, France;
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, 34000 Montpellier, France
| | | | - Manuel F. Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29615, USA;
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY 40292, USA
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10
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Casanova MF, Sokhadze EM, Casanova EL, Li X. Transcranial Magnetic Stimulation in Autism Spectrum Disorders: Neuropathological Underpinnings and Clinical Correlations. Semin Pediatr Neurol 2020; 35:100832. [PMID: 32892959 PMCID: PMC7477302 DOI: 10.1016/j.spen.2020.100832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite growing knowledge about autism spectrum disorder (ASD), research findings have not been translated into curative treatment. At present, most therapeutic interventions provide for symptomatic treatment. Outcomes of interventions are judged by subjective endpoints (eg, behavioral assessments) which alongside the highly heterogeneous nature of ASD account for wide variability in the effectiveness of treatments. Transcranial magnetic stimulation (TMS) is one of the first treatments that targets a putative core pathologic feature of autism, specifically the cortical inhibitory imbalance that alters gamma frequency synchronization. Studies show that low frequency TMS over the dorsolateral prefrontal cortex of individuals with ASD decreases the power of gamma activity and increases the difference between gamma responses to target and nontarget stimuli. TMS improves executive function skills related to self-monitoring behaviors and the ability to apply corrective actions. These improvements manifest themselves as a reduction of stimulus bound behaviors and diminished sympathetic arousal. Results become more significant with increasing number of sessions and bear synergism when used along with neurofeedback. When applied at low frequencies in individuals with ASD, TMS appears to be safe and to improve multiple patient-oriented outcomes. Future studies should be conducted in large populations to establish predictors of outcomes (eg, genetic profiling), length of persistence of benefits, and utility of booster sessions.
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Affiliation(s)
- Manuel F. Casanova
- Director of Childhood Neurotherapeutics, Greenville Health System, Departments of Pediatrics, Division of Developmental Behavioral Pediatrics, Greenville, SC, USA and Professor of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Estate M. Sokhadze
- Research Professor, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Emily L. Casanova
- Research Assistant Professor, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Xiaoli Li
- Director, State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
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Casanova MF, Shaban M, Ghazal M, El-Baz AS, Casanova EL, Opris I, Sokhadze EM. Effects of Transcranial Magnetic Stimulation Therapy on Evoked and Induced Gamma Oscillations in Children with Autism Spectrum Disorder. Brain Sci 2020; 10:E423. [PMID: 32635201 PMCID: PMC7408068 DOI: 10.3390/brainsci10070423] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder (ASD) is a behaviorally diagnosed neurodevelopmental condition of unknown pathology. Research suggests that abnormalities of elecltroencephalogram (EEG) gamma oscillations may provide a biomarker of the condition. In this study, envelope analysis of demodulated waveforms for evoked and induced gamma oscillations in response to Kanizsa figures in an oddball task were analyzed and compared in 19 ASD and 19 age/gender-matched neurotypical children. The ASD group was treated with low frequency transcranial magnetic stimulation (TMS), (1.0 Hz, 90% motor threshold, 18 weekly sessions) targeting the dorsolateral prefrontal cortex. In ASD subjects, as compared to neurotypicals, significant differences in evoked and induced gamma oscillations were evident in higher magnitude of gamma oscillations pre-TMS, especially in response to non-target cues. Recordings post-TMS treatment in ASD revealed a significant reduction of gamma responses to task-irrelevant stimuli. Participants committed fewer errors post-TMS. Behavioral questionnaires showed a decrease in irritability, hyperactivity, and repetitive behavior scores. The use of a novel metric for gamma oscillations. i.e., envelope analysis using wavelet transformation allowed for characterization of the impedance of the originating neuronal circuit. The results suggest that gamma oscillations may provide a biomarker reflective of the excitatory/inhibitory balance of the cortex and a putative outcome measure for interventions in autism.
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Affiliation(s)
- Manuel F. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
- Department of Psychiatry & Behavioral Sciences, University of Louisville, 401 E Chestnut Str., #600, Louisville, KY 40202, USA
| | - Mohamed Shaban
- Department of Electrical and Computer Engineering, University of South Alabama, Mobile, AL 36688, USA;
| | - Mohammed Ghazal
- BioImaging Research Lab, Electrical and Computer Engineering Abu Dhabi University, Abu Dhabi 59911, UAE;
| | - Ayman S. El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY 40202, USA;
| | - Emily L. Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
| | - Ioan Opris
- School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Estate M. Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 701 Grove Rd., Greenville, SC 29605, USA; (M.F.C.); (E.L.C.)
- Department of Psychiatry & Behavioral Sciences, University of Louisville, 401 E Chestnut Str., #600, Louisville, KY 40202, USA
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Dekhil O, Ali M, Haweel R, Elnakib Y, Ghazal M, Hajjdiab H, Fraiwan L, Shalaby A, Soliman A, Mahmoud A, Keynton R, Casanova MF, Barnes G, El-Baz A. A Comprehensive Framework for Differentiating Autism Spectrum Disorder From Neurotypicals by Fusing Structural MRI and Resting State Functional MRI. Semin Pediatr Neurol 2020; 34:100805. [PMID: 32446442 DOI: 10.1016/j.spen.2020.100805] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autism spectrum disorder is a neurodevelopmental disorder characterized by impaired social abilities and communication difficulties. The golden standard for autism diagnosis in research rely on behavioral features, for example, the autism diagnosis observation schedule, the Autism Diagnostic Interview-Revised. In this study we introduce a computer-aided diagnosis system that uses features from structural MRI (sMRI) and resting state functional MRI (fMRI) to help predict an autism diagnosis by clinicians. The proposed system is capable of parcellating brain regions to show which areas are most likely affected by autism related abnormalities and thus help in targeting potential therapeutic interventions. When tested on 18 data sets (n = 1060) from the ABIDE consortium, our system was able to achieve high accuracy (sMRI 0.75-1.00; fMRI 0.79-1.00), sensitivity (sMRI 0.73-1.00; fMRI 0.78-1.00), and specificity (sMRI 0.78-1.00; fMRI 0.79-1.00). The proposed system could be considered an important step toward helping physicians interpret results of neuroimaging studies and personalize treatment options. To the best of our knowledge, this work is the first to combine features from structural and functional MRI, use them for personalized diagnosis and achieve high accuracies on a relatively large population.
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Affiliation(s)
- Omar Dekhil
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Mohamed Ali
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Reem Haweel
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Yaser Elnakib
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Mohammed Ghazal
- Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Hassan Hajjdiab
- Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Luay Fraiwan
- Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ahmed Shalaby
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Ahmed Soliman
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Ali Mahmoud
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Robert Keynton
- Department of Bioengineering, University of Louisville, Louisville, KY
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina, Greenville, SC
| | - Gregory Barnes
- Department of Neurology, University of Louisville, Louisville, KY
| | - Ayman El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY.
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13
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Casanova MF, Sokhadze EM, Casanova EL, Opris I, Abujadi C, Marcolin MA, Li X. Translational Neuroscience in Autism: From Neuropathology to Transcranial Magnetic Stimulation Therapies. Psychiatr Clin North Am 2020; 43:229-248. [PMID: 32439019 PMCID: PMC7245584 DOI: 10.1016/j.psc.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The presence of heterotopias, increased regional density of neurons at the gray-white matter junction, and focal cortical dysplasias all suggest an abnormality of neuronal migration in autism spectrum disorder (ASD). The abnormality is borne from a dissonance in timing between radial and tangentially migrating neuroblasts to the developing cortical plate. The uncoupling of excitatory and inhibitory cortical cells disturbs the coordinated interactions of neurons within local networks, thus providing abnormal patterns of brainwave activity in the gamma bandwidth. In ASD, gamma oscillation abnormalities and autonomic markers offer measures of therapeutic progress and help in the identification of subgroups.
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Affiliation(s)
- Manuel F Casanova
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Greenville Health System, 200 Patewood Drive, Suite A200, Greenville, SC 29615, USA.
| | - Estate M Sokhadze
- University of South Carolina School of Medicine Greenville, 200 Patewood Drive, Greenville, SC 29615, USA
| | - Emily L Casanova
- University of South Carolina School of Medicine Greenville, 200 Patewood Drive, Greenville, SC 29615, USA. https://twitter.com/EmLyWill
| | - Ioan Opris
- University of Miami, Miller School of Medicine, Department Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Caio Abujadi
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Marcolin
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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14
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Opris I, Lebedev MA, Pulgar VM, Vidu R, Enachescu M, Casanova MF. Editorial: Nanotechnologies in Neuroscience and Neuroengineering. Front Neurosci 2020; 14:33. [PMID: 32116495 PMCID: PMC7028747 DOI: 10.3389/fnins.2020.00033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ioan Opris
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
| | - Mikhail A Lebedev
- Department of Neurobiology, Duke University, Durham, NC, United States.,Center for Bioelectric Interfaces of the Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Department of Information and Internet Technologies of Digital Health Institute, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Victor Manuel Pulgar
- Department of Pharmaceutical Sciences, Campbell University, Buies Creek, NC, United States.,Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ruxandra Vidu
- Department of Chemical Engineering and Materials Science, University of California, Davis, Davis, CA, United States
| | - Marius Enachescu
- Center of Surface Science and Nanotechnology, Politehnica University of Bucharest, Bucharest, Romania
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine at Greenville, Greenville, SC, United States.,Department of Pediatrics, Greenville Health System, Greenville, SC, United States
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15
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Casanova MF, Casanova EL, Frye RE, Baeza-Velasco C, LaSalle JM, Hagerman RJ, Scherer SW, Natowicz MR. Editorial: Secondary vs. Idiopathic Autism. Front Psychiatry 2020; 11:297. [PMID: 32346372 PMCID: PMC7171716 DOI: 10.3389/fpsyt.2020.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Manuel F Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Emily L Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | | | | | | | - Randi Jensen Hagerman
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA, United States
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16
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Affiliation(s)
- Manuel F Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
| | | | | | - Emily L Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
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17
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Casanova MF, Casanova EL. The modular organization of the cerebral cortex: Evolutionary significance and possible links to neurodevelopmental conditions. J Comp Neurol 2019; 527:1720-1730. [PMID: 30303529 PMCID: PMC6784310 DOI: 10.1002/cne.24554] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/22/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
Abstract
The recognition of discernible anatomical regularities that appear to self-organize during development makes apparent the modular organization of the cerebral cortex. The metabolic cost engendered in sustaining interneuronal communications has emphasized the viability of short connections among neighboring neurons. This pattern of connectivity establishes a microcircuit which is repeated in parallel throughout the cerebral cortex. This canonical circuit is contained within the smallest module of information processing of the cerebral cortex; one which Vernon Mountcastle called the minicolumn. Plasticity within the brain is accounted, in part, by the presence of weak linkages that allow minicolumns to process information from a variety of sources and to quickly adapt to environmental exigencies without a need for genetic change. Recent research suggests that interlaminar correlated firing between minicolumns during the decision phase of target selection provides for the emergence of some executive functions. Bottlenecks of information processing within this modular minicolumnar organization may account for a variety of mental disorders observed in neurodevelopmental conditions.
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Affiliation(s)
- Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - Emily L Casanova
- Department of Pediatrics, Greenville Health System, Greenville, South Carolina
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18
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Kang JN, Song JJ, Casanova MF, Sokhadze EM, Li XL. Effects of repetitive transcranial magnetic stimulation on children with low-function autism. CNS Neurosci Ther 2019; 25:1254-1261. [PMID: 31228356 PMCID: PMC6834922 DOI: 10.1111/cns.13150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a very complex neurodevelopmental disorder, characterized by social difficulties and stereotypical or repetitive behavior. Some previous studies using low‐frequency repetitive transcranial magnetic stimulation (rTMS) have proven of benefit in ASD children. Methods In this study, 32 children (26 males and six females) with low‐function autism were enrolled, 16 children (three females and 13 males; mean ± SD age: 7.8 ± 2.1 years) received rTMS treatment twice every week, while the remaining 16 children (three females and 13 males; mean ± SD age: 7.2 ± 1.6 years) served as waitlist group. This study investigated the effects of rTMS on brain activity and behavioral response in the autistic children. Results Peak alpha frequency (PAF) is an electroencephalographic measure of cognitive preparedness and might be a neural marker of cognitive function for the autism. Coherence is one way to assess the brain functional connectivity of ASD children, which has proven abnormal in previous studies. The results showed significant increases in the PAF at the frontal region, the left temporal region, the right temporal region and the occipital region and a significant increase of alpha coherence between the central region and the right temporal region. Autism Behavior Checklist (ABC) scores were also compared before and after receiving rTMS with positive effects shown on behavior. Conclusion These findings supported our hypothesis by demonstration of positive effects of combined rTMS neurotherapy in active treatment group as compared to the waitlist group, as the rTMS group showed significant improvements in behavioral and functional outcomes as compared to the waitlist group.
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Affiliation(s)
- Jian-Nan Kang
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Jia-Jia Song
- College of Electronic & Information Engineering, Hebei University, Baoding, China
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, South Carolina
| | - Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Campus, Greenville Health System, Greenville, South Carolina
| | - Xiao-Li Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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19
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Casanova EL, Switala AE, Dandamudi S, Hickman AR, Vandenbrink J, Sharp JL, Feltus FA, Casanova MF. Autism risk genes are evolutionarily ancient and maintain a unique feature landscape that echoes their function. Autism Res 2019; 12:860-869. [PMID: 31025836 DOI: 10.1002/aur.2112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/22/2019] [Accepted: 04/06/2019] [Indexed: 11/09/2022]
Abstract
Previous research on autism risk (ASD), developmental regulatory (DevReg), and central nervous system (CNS) genes suggests they tend to be large in size, enriched in nested repeats, and mutation intolerant. The relevance of these genomic features is intriguing yet poorly understood. In this study, we investigated the feature landscape of these gene groups to discover structural themes useful in interpreting their function, developmental patterns, and evolutionary history. ASD, DevReg, CNS, housekeeping, and whole genome control (WGC) groups were compiled using various resources. Multiple gene features of interest were extracted from NCBI/UCSC Bioinformatics. Residual variation intolerance scores, Exome Aggregation Consortium pLI scores, and copy number variation data from Decipher were used to estimate variation intolerance. Gene age and protein-protein interactions (PPI) were estimated using Ensembl and EBI Intact databases, respectively. Compared to WGC: ASD, DevReg, and CNS genes are longer, produce larger proteins, maintain greater numbers/density of conserved noncoding elements and transposable elements, produce more transcript variants, and are comparatively variation intolerant. After controlling for gene size, mutation tolerance, and clinical association, ASD genes still retain many of these same features. In addition, we also found that ASD genes that are extremely mutation intolerant have larger PPI networks. These data support many of the recent findings within the field of autism genetics but also expand our understanding of the evolution of these broad gene groups, their potential regulatory complexity, and the extent to which they interact with the cellular network. Autism Res 2019, 12: 860-869. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism risk genes are more ancient compared to other genes in the genome. As such, they exhibit physical features related to their age, including long gene and protein size and regulatory sequences that help to control gene expression. They share many of these same features with other genes that are expressed in the brain and/or are associated with prenatal development.
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Affiliation(s)
- Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina, Greenvile, South Carolina.,Department of Pediatrics, Prisma Health System, Greenville, South Carolina
| | - Andrew E Switala
- Department of Bioengineering, University of Louisville, Louisville, Kentucky
| | - Srini Dandamudi
- Department of Statistics, Colorado State University, Fort Collins, Colorado
| | - Allison R Hickman
- Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina
| | - Joshua Vandenbrink
- School of Biological Sciences, Louisiana Tech University, Ruston, Louisiana
| | - Julia L Sharp
- Department of Statistics, Colorado State University, Fort Collins, Colorado
| | - Frank Alex Feltus
- Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina, Greenvile, South Carolina.,Department of Pediatrics, Prisma Health System, Greenville, South Carolina
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20
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Cole EJ, Enticott PG, Oberman LM, Gwynette MF, Casanova MF, Jackson SLJ, Jannati A, McPartland JC, Naples AJ, Puts NAJ. The Potential of Repetitive Transcranial Magnetic Stimulation for Autism Spectrum Disorder: A Consensus Statement. Biol Psychiatry 2019; 85:e21-e22. [PMID: 30103951 PMCID: PMC6342639 DOI: 10.1016/j.biopsych.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Eleanor J Cole
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California.
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Victoria, Australia
| | - Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - M Frampton Gwynette
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky
| | - Scott L J Jackson
- Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James C McPartland
- Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Adam J Naples
- Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Nicolaas A J Puts
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
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21
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Dekhil O, Ali M, El-Nakieb Y, Shalaby A, Soliman A, Switala A, Mahmoud A, Ghazal M, Hajjdiab H, Casanova MF, Elmaghraby A, Keynton R, El-Baz A, Barnes G. A Personalized Autism Diagnosis CAD System Using a Fusion of Structural MRI and Resting-State Functional MRI Data. Front Psychiatry 2019; 10:392. [PMID: 31333507 PMCID: PMC6620533 DOI: 10.3389/fpsyt.2019.00392] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/17/2019] [Indexed: 01/08/2023] Open
Abstract
Autism spectrum disorder is a neuro-developmental disorder that affects the social abilities of the patients. Yet, the gold standard of autism diagnosis is the autism diagnostic observation schedule (ADOS). In this study, we are implementing a computer-aided diagnosis system that utilizes structural MRI (sMRI) and resting-state functional MRI (fMRI) to demonstrate that both anatomical abnormalities and functional connectivity abnormalities have high prediction ability of autism. The proposed system studies how the anatomical and functional connectivity metrics provide an overall diagnosis of whether the subject is autistic or not and are correlated with ADOS scores. The system provides a personalized report per subject to show what areas are more affected by autism-related impairment. Our system achieved accuracies of 75% when using fMRI data only, 79% when using sMRI data only, and 81% when fusing both together. Such a system achieves an important next step towards delineating the neurocircuits responsible for the autism diagnosis and hence may provide better options for physicians in devising personalized treatment plans.
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Affiliation(s)
- Omar Dekhil
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Mohamed Ali
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Yaser El-Nakieb
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Ahmed Shalaby
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Ahmed Soliman
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Andrew Switala
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Ali Mahmoud
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Mohammed Ghazal
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States.,Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Hassan Hajjdiab
- Department of Electrical and Computer Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina, Greenville, SC, United States
| | - Adel Elmaghraby
- Computer Engineering and Computer Science Department, University of Louisville, Louisville, KY, United States
| | - Robert Keynton
- Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Ayman El-Baz
- Bioimaging Lab, Bioengineering Department, University of Louisville, Louisville, KY, United States
| | - Gregory Barnes
- Department of Neurology, University of Louisville, Louisville, KY, United States
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22
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Lebedev MA, Opris I, Casanova MF. Editorial: Augmentation of Brain Function: Facts, Fiction and Controversy. Front Syst Neurosci 2018; 12:45. [PMID: 30258355 PMCID: PMC6143785 DOI: 10.3389/fnsys.2018.00045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ioan Opris
- Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Manuel F Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
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23
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Sokhadze EM, Lamina EV, Casanova EL, Kelly DP, Opris I, Tasman A, Casanova MF. Exploratory Study of rTMS Neuromodulation Effects on Electrocortical Functional Measures of Performance in an Oddball Test and Behavioral Symptoms in Autism. Front Syst Neurosci 2018; 12:20. [PMID: 29892214 PMCID: PMC5985329 DOI: 10.3389/fnsys.2018.00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
There is no accepted pathology to autism spectrum disorders (ASD) but research suggests the presence of an altered excitatory/inhibitory (E/I) bias in the cerebral cortex. Repetitive transcranial magnetic stimulation (rTMS) offers a non-invasive means of modulating the E/I cortical bias with little in terms of side effects. In this study, 124 high functioning ASD children (IQ > 80, <18 years of age) were recruited and assigned using randomization to either a waitlist group or one of three different number of weekly rTMS sessions (i.e., 6, 12, and 18). TMS consisted of trains of 1.0 Hz frequency pulses applied over the dorsolateral prefrontal cortex (DLPFC). The experimental task was a visual oddball with illusory Kanizsa figures. Behavioral response variables included reaction time and error rate along with such neurophysiological indices such as stimulus and response-locked event-related potentials (ERP). One hundred and twelve patients completed the assigned number of TMS sessions. Results showed significant changes from baseline to posttest period in the following measures: motor responses accuracy [lower percentage of committed errors, slower latency of commission errors and restored normative post-error reaction time slowing in both early and later-stage ERP indices, enhanced magnitude of error-related negativity (ERN), improved error monitoring and post-error correction functions]. In addition, screening surveys showed significant reductions in aberrant behavior ratings and in both repetitive and stereotypic behaviors. These differences increased with the total number of treatment sessions. Our results suggest that rTMS, particularly after 18 sessions, facilitates cognitive control, attention and target stimuli recognition by improving discrimination between task-relevant and task-irrelevant illusory figures in an oddball test. The noted improvement in executive functions of behavioral performance monitoring further suggests that TMS has the potential to target core features of ASD.
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Affiliation(s)
- Estate M. Sokhadze
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Eva V. Lamina
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Emily L. Casanova
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Desmond P. Kelly
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Pediatrics, Greenville Health System, Greenville, SC, United States
| | - Ioan Opris
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Manuel F. Casanova
- Department of Biomedical Sciences, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, United States
- Department of Pediatrics, Greenville Health System, Greenville, SC, United States
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24
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Kang J, Cai E, Han J, Tong Z, Li X, Sokhadze EM, Casanova MF, Ouyang G, Li X. Transcranial Direct Current Stimulation (tDCS) Can Modulate EEG Complexity of Children With Autism Spectrum Disorder. Front Neurosci 2018; 12:201. [PMID: 29713261 PMCID: PMC5911939 DOI: 10.3389/fnins.2018.00201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 03/14/2018] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder which affects the developmental trajectory in several behavioral domains, including impairments of social communication, cognitive and language abilities. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, and it was used for modulating the brain disorders. In this paper, we enrolled 13 ASD children (11 males and 2 females; mean ± SD age: 6.5 ± 1.7 years) to participate in our trial. Each patient received 10 treatments over the dorsolateral prefrontal cortex (DLPFC) once every 2 days. Also, we enrolled 13 ASD children (11 males and 2 females; mean ± SD age: 6.3 ± 1.7 years) waiting to receive therapy as controls. A maximum entropy ratio (MER) method was adapted to measure the change of complexity of EEG series. It was found that the MER value significantly increased after tDCS. This study suggests that tDCS may be a helpful tool for the rehabilitation of children with ASD.
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Affiliation(s)
- Jiannan Kang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Erjuan Cai
- Institute of Biomedical Engineering, Yanshan University, Qinhuangdao, China
| | - Junxia Han
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zhen Tong
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xin Li
- Institute of Biomedical Engineering, Yanshan University, Qinhuangdao, China.,Key Laboratory of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, China
| | - Estate M Sokhadze
- Department of Biomedical Sciences, School of Medicine Greenville Campus, Greenville Health System, University of South Carolina, Greenville, SC, United States
| | - Manuel F Casanova
- Department of Biomedical Sciences, School of Medicine Greenville Campus, Greenville Health System, University of South Carolina, Greenville, SC, United States
| | - Gaoxiang Ouyang
- Key Laboratory of Measurement Technology and Instrumentation of Hebei Province, Qinhuangdao, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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25
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Casanova EL, Sharp JL, Edelson SM, Kelly DP, Casanova MF. A Cohort Study Comparing Women with Autism Spectrum Disorder with and without Generalized Joint Hypermobility. Behav Sci (Basel) 2018; 8:bs8030035. [PMID: 29562607 PMCID: PMC5867488 DOI: 10.3390/bs8030035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/26/2018] [Accepted: 03/15/2018] [Indexed: 01/22/2023] Open
Abstract
Reports suggest comorbidity between autism spectrum disorder (ASD) and the connective tissue disorder, Ehlers-Danlos syndrome (EDS). People with EDS and the broader spectrum of Generalized Joint Hypermobility (GJH) often present with immune- and endocrine-mediated conditions. Meanwhile, immune/endocrine dysregulation is a popular theme in autism research. We surveyed a group of ASD women with/without GJH to determine differences in immune/endocrine exophenotypes. ASD women 25 years or older were invited to participate in an online survey. Respondents completed a questionnaire concerning diagnoses, immune/endocrine symptom history, experiences with pain, and seizure history. ASD women with GJH (ASD/GJH) reported more immune- and endocrine-mediated conditions than their non-GJH counterparts (p = 0.001). Autoimmune conditions were especially prominent in the ASD/GJH group (p = 0.027). Presence of immune-mediated symptoms often co-occurred with one another (p < 0.001–0.020), as did endocrine-mediated symptoms (p < 0.001–0.045), irrespective of the group. Finally, the numbers of immune- and endocrine-mediated symptoms shared a strong inter-relationship (p < 0.001), suggesting potential system crosstalk. While our results cannot estimate comorbidity, they reinforce concepts of an etiological relationship between ASD and GJH. Meanwhile, women with ASD/GJH have complex immune/endocrine exophenotypes compared to their non-GJH counterparts. Further, we discuss how connective tissue regulates the immune system and how the immune/endocrine systems in turn may modulate collagen synthesis, potentially leading to higher rates of GJH in this subpopulation.
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Affiliation(s)
- Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA.
- Department of Pediatrics, Greenville Health System Children's Hospital, Greenville, SC 29605, USA.
| | - Julia L Sharp
- Department of Statistics, Colorado State University, Fort Collins, CO 80523, USA.
| | | | - Desmond P Kelly
- Department of Pediatrics, Greenville Health System Children's Hospital, Greenville, SC 29605, USA.
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA.
- Department of Pediatrics, Greenville Health System Children's Hospital, Greenville, SC 29605, USA.
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Sokhadze EM, Casanova MF, Tasman A, Brockett S. Electrophysiological and Behavioral Outcomes of Berard Auditory Integration Training (AIT) in Children with Autism Spectrum Disorder. Appl Psychophysiol Biofeedback 2018; 41:405-420. [PMID: 27573986 DOI: 10.1007/s10484-016-9343-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Autism is a pervasive developmental disorder of childhood characterized by deficits in social interaction, language, and stereotyped behaviors along with a restricted range of interests. It is further marked by an inability to perceive and respond to social and emotional signals in a typical manner. This might due to the functional disconnectivity of networks important for specific aspects of social cognition and behavioral control resulting in deficits of sensory information integration. According to several recent theories sensory processing and integration abnormalities may play an important role in impairments of perception, cognition, and behavior in individuals with autism. Among these sensory abnormalities, auditory perception distortion may contribute to many typical symptoms of autism. The present study used Berard's technique of auditory integration training (AIT) to improve sound integration in children with autism. It also aimed to understand the abnormal neural and functional mechanisms underlying sound processing distortion in autism by incorporating behavioral, psychophysiological and neurophysiological outcomes. It was proposed that exposure to twenty 30-min AIT sessions (total 10 h of training) would result in improved behavioral evaluation scores, improve profile of cardiorespiratory activity, and positively affect both early [N1, mismatch negativity (MMN)] and late (P3) components of evoked potentials in auditory oddball task. Eighteen children with autism spectrum disorder (ASD) participated in the study. A group of 16 typically developing children served as a contrast group in the auditory oddball task. Autonomic outcomes of the study reflected a linear increase of heart rate variability measures and respiration rate. Comparison of evoked potential characteristics of children with ASD versus typically developing children revealed several group difference findings, more specifically, a delayed latency of N1 to rare and frequent stimuli, larger MMN; higher P3a to frequent stimuli, and at the same time delayed latency of P3b to rare stimuli in the autism group. Post-AIT changes in evoked potentials could be summarized as a decreased magnitude of N1 to rare stimuli, marginally lower negativity of MMN, and decrease of the P3a to frequent stimuli along with delayed latency and higher amplitude of the P3b to the rare stimuli. These evoked potential changes following completion of Berard AIT course are in a positive direction, making them less distinct from those recorded in age-matched group of typical children, thus could be considered as changes towards normalization. Parental questionnaires clearly demonstrated improvements in behavioral symptoms such as irritability, hyperactivity, repetitive behaviors and other important behavioral domains. The results of the study propose that more controlled research is necessary to document behavioral and psychophysiological changes resulting from Berard AIT and to provide explanation of the neural mechanisms of how auditory integration training may affect behavior and psychophysiological responses of children with ASD.
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Affiliation(s)
- Estate M Sokhadze
- University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC, USA. .,University of Louisville, Louisville, KY, USA.
| | - Manuel F Casanova
- University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC, USA.,University of Louisville, Louisville, KY, USA
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El-Gamal FEA, Elmogy MM, Ghazal M, Atwan A, Casanova MF, Barnes GN, Keynton R, El-Baz AS, Khalil A. A Novel Early Diagnosis System for Mild Cognitive Impairment Based on Local Region Analysis: A Pilot Study. Front Hum Neurosci 2018; 11:643. [PMID: 29375343 PMCID: PMC5767309 DOI: 10.3389/fnhum.2017.00643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
Alzheimer's disease (AD) is an irreversible neurodegenerative disorder that accounts for 60–70% of cases of dementia in the elderly. An early diagnosis of AD is usually hampered for many reasons including the variable clinical and pathological features exhibited among affected individuals. This paper presents a computer-aided diagnosis (CAD) system with the primary goal of improving the accuracy, specificity, and sensitivity of diagnosis. In this system, PiB-PET scans, which were obtained from the ADNI database, underwent five essential stages. First, the scans were standardized and de-noised. Second, an Automated Anatomical Labeling (AAL) atlas was utilized to partition the brain into 116 regions or labels that served for local (region-based) diagnosis. Third, scale-invariant Laplacian of Gaussian (LoG) was used, per brain label, to detect the discriminant features. Fourth, the regions' features were analyzed using a general linear model in the form of a two-sample t-test. Fifth, the support vector machines (SVM) and their probabilistic variant (pSVM) were constructed to provide local, followed by global diagnosis. The system was evaluated on scans of normal control (NC) vs. mild cognitive impairment (MCI) (19 NC and 65 MCI scans). The proposed system showed superior accuracy, specificity, and sensitivity as compared to other related work.
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Affiliation(s)
- Fatma E A El-Gamal
- Faculty of Computers and Information, Information Technology Department, Mansoura University, Mansoura, Egypt.,BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Mohammed M Elmogy
- Faculty of Computers and Information, Information Technology Department, Mansoura University, Mansoura, Egypt.,BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Mohammed Ghazal
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, United States.,Department of Electrical and Computer Engineering, College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ahmed Atwan
- Faculty of Computers and Information, Information Technology Department, Mansoura University, Mansoura, Egypt
| | - Manuel F Casanova
- School of Medicine, University of South Carolina, Greenville, SC, United States
| | - Gregory N Barnes
- University of Louisville Autism Center, Department of Neurology, University of Louisville, Louisville, KY, United States
| | - Robert Keynton
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Ayman S El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, United States
| | - Ashraf Khalil
- Department of Computer Science and Information Technology, College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Casanova EL, Gerstner Z, Sharp JL, Casanova MF, Feltus FA. Widespread Genotype-Phenotype Correlations in Intellectual Disability. Front Psychiatry 2018; 9:535. [PMID: 30420816 PMCID: PMC6217001 DOI: 10.3389/fpsyt.2018.00535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/09/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Linking genotype to phenotype is a major aim of genetics research, yet the underlying biochemical mechanisms of many complex conditions continue to remain elusive. Recent research provides evidence that relevant gene-phenotype associations are discoverable in the study of intellectual disability (ID). Here we expand on that work, identifying distinctive gene interaction modules with unique enrichment patterns reflective of associated clinical features in ID. Methods: Two hundred twelve forms of monogenic ID were curated according to comorbidities with autism and epilepsy. These groups were further subdivided according to secondary clinical manifestations of complex vs. simple facial dysmorphia and neurodegenerative-like features due to their clinical prominence, modest symptom overlap, and probable etiological divergence. An aggregate gene interaction ID network for these phenotype subgroups was discovered via a public database of known gene interactions: protein-protein, genetic, and mRNA coexpression. Additional annotation resources (Gene Ontology, Human Phenotype Ontology, TRANSFAC/JASPAR, and KEGG/WikiPathways) were utilized to assess functional and phenotypic enrichment patterns within subgroups. Results: Phenotypic analysis revealed high rates of complex facial dysmorphia in ID with comorbid autism. In contrast, neurodegenerative-like features were overrepresented in ID with epilepsy. Network analysis subsequently showed that gene groups divided according to clinical features of interest resulted in distinctive interaction clusters, with unique functional enrichments according to gene set. Conclusions: These data suggest that specific comorbid and secondary clinical features in ID are predictive of underlying genotype. In summary, ID form unique clusters, which are comprised of individual conditions with remarkable genotypic and phenotypic overlap.
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Affiliation(s)
- Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine at Greenville, Greenville, SC, United States.,Department of Pediatrics, Greenville Health System, Greenville, SC, United States
| | - Zachary Gerstner
- Department of Genetics and Biochemistry, Clemson University, Clemson, SC, United States
| | - Julia L Sharp
- Department of Statistics, Colorado State University, Fort Collins, CO, United States
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine at Greenville, Greenville, SC, United States.,Department of Pediatrics, Greenville Health System, Greenville, SC, United States
| | - Frank Alex Feltus
- Department of Genetics and Biochemistry, Clemson University, Clemson, SC, United States.,Center for Human Genetics, Clemson University, Clemson, SC, United States.,Biomedical Data Science and Informatics Program, Clemson University, Clemson, SC, United States
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Sokhadze EM, Lamina EV, Casanova EL, Kelly DP, Opris I, Khachidze I, Casanova MF. Atypical Processing of Novel Distracters in a Visual Oddball Task in Autism Spectrum Disorder. Behav Sci (Basel) 2017; 7:bs7040079. [PMID: 29144422 PMCID: PMC5746688 DOI: 10.3390/bs7040079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022] Open
Abstract
Several studies have shown that children with autism spectrum disorder (ASD) show abnormalities in P3b to targets in standard oddball tasks. The present study employed a three-stimulus visual oddball task with novel distracters that analyzed event-related potentials (ERP) to both target and non-target items at frontal and parietal sites. The task tested the hypothesis that children with autism are abnormally orienting attention to distracters probably due to impaired habituation to novelty. We predicted a lower selectivity in early ERPs to target, frequent non-target, and rare distracters. We also expected delayed late ERPs in autism. The study enrolled 32 ASD and 24 typically developing (TD) children. Reaction time (RT) and accuracy were analyzed as behavioral measures, while ERPs were recorded with a dense-array EEG system. Children with ASD showed higher error rate without normative post-error RT slowing and had lower error-related negativity. Parietal P1, frontal N1, as well as P3a and P3b components were higher to novels in ASD. Augmented exogenous ERPs suggest low selectivity in pre-processing of stimuli resulting in their excessive processing at later stages. The results suggest an impaired habituation to unattended stimuli that incurs a high load at the later stages of perceptual and cognitive processing and response selection when novel distracter stimuli are differentiated from targets.
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Affiliation(s)
- Estate M Sokhadze
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 200 Patewood Dr., Ste A200, Greenville, SC 29615, USA.
- Developmental Behavioral Unit, Department of Pediatrics, Children's Hospital, Greenville Health System, Greenville, SC 29615, USA.
| | - Eva V Lamina
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 200 Patewood Dr., Ste A200, Greenville, SC 29615, USA.
| | - Emily L Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 200 Patewood Dr., Ste A200, Greenville, SC 29615, USA.
- Developmental Behavioral Unit, Department of Pediatrics, Children's Hospital, Greenville Health System, Greenville, SC 29615, USA.
| | - Desmond P Kelly
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 200 Patewood Dr., Ste A200, Greenville, SC 29615, USA.
- Developmental Behavioral Unit, Department of Pediatrics, Children's Hospital, Greenville Health System, Greenville, SC 29615, USA.
| | - Ioan Opris
- School of Medicine, University of Miami, Miami, FL 33136, USA.
| | - Irma Khachidze
- Centre of Experimental Biomedicine, 14 Gotya str., Tbilisi 0160, Georgia.
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine-Greenville, 200 Patewood Dr., Ste A200, Greenville, SC 29615, USA.
- Developmental Behavioral Unit, Department of Pediatrics, Children's Hospital, Greenville Health System, Greenville, SC 29615, USA.
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Sokhadze EM, Casanova MF, Casanova EL, Lamina E, Kelly DP, Khachidze I. Event-related Potentials (ERP) in Cognitive Neuroscience Research and Applications. NR 2017. [DOI: 10.15540/nr.4.1.14] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang Y, Hensley MK, Tasman A, Sears L, Casanova MF, Sokhadze EM. Heart Rate Variability and Skin Conductance During Repetitive TMS Course in Children with Autism. Appl Psychophysiol Biofeedback 2016; 41:47-60. [PMID: 26341093 DOI: 10.1007/s10484-015-9311-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder marked by difficulty in social interactions and communication. ASD also often present symptoms of autonomic nervous system (ANS) functioning abnormalities. In individuals with autism the sympathetic branch of the ANS presents an over-activation on a background of the parasympathetic activity deficits, creating an autonomic imbalance, evidenced by a faster heart rate with little variation and increased tonic electrodermal activity. The objective of this study was to explore the effect of 12 sessions of 0.5 Hz repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on autonomic activity in children with ASD. Electrocardiogram and skin conductance level (SCL) were recorded and analyzed during each session of rTMS. The measures of interest were time domain (i.e., R-R intervals, standard deviation of cardiac intervals, NN50-cardio-intervals >50 ms different from preceding interval) and frequency domain heart rate variability (HRV) indices [i.e., power of high frequency (HF) and low frequency (LF) components of HRV spectrum, LF/HF ratio]. Based on our prior pilot studies it was proposed that the course of 12 weekly inhibitory low-frequency rTMS bilaterally applied to the DLPFC will improve autonomic balance probably through improved frontal inhibition of the ANS activity, and will be manifested in an increased length of cardiointervals and their variability, and in higher frequency-domain HRV in a form of increased HF power, decreased LF power, resulting in decreased LF/HF ratio, and in decreased SCL. Our post-12 TMS results showed significant increases in cardiac intervals variability measures and decrease of tonic SCL indicative of increased cardiac vagal control and reduced sympathetic arousal. Behavioral evaluations showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings that correlated with several autonomic variables.
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Affiliation(s)
- Yao Wang
- University of Louisville, Louisville, KY, USA
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai St., Hai Dian District, Beijing, 100875, People's Republic of China
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DuBois D, Ameis SH, Lai M, Casanova MF, Desarkar P. Interoception in Autism Spectrum Disorder: A review. Int J Dev Neurosci 2016; 52:104-11. [DOI: 10.1016/j.ijdevneu.2016.05.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- Denise DuBois
- Adult Neurodevelopmental Services, Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
- Rehabilitation Science InstituteUniversity of TorontoTorontoOntarioCanada
| | - Stephanie H. Ameis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
- Research Imaging CentreCampbell Family Mental Health Research Institute, The Centre for Addiction and Mental HealthTorontoOntarioCanada
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick ChildrenDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Meng‐Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick ChildrenDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Autism Research CentreDepartment of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
- Department of PsychiatryNational Taiwan University Hospital and College of MedicineTaipeiTaiwan
| | - Manuel F. Casanova
- Department of Psychiatry and Behavioral SciencesUniversity of LouisvilleLouisvilleKYUSA
| | - Pushpal Desarkar
- Adult Neurodevelopmental Services, Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
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Ismail MMT, Keynton RS, Mostapha MMMO, ElTanboly AH, Casanova MF, Gimel'farb GL, El-Baz A. Studying Autism Spectrum Disorder with Structural and Diffusion Magnetic Resonance Imaging: A Survey. Front Hum Neurosci 2016; 10:211. [PMID: 27242476 PMCID: PMC4862981 DOI: 10.3389/fnhum.2016.00211] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/25/2016] [Indexed: 12/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) modalities have emerged as powerful means that facilitate non-invasive clinical diagnostics of various diseases and abnormalities since their inception in the 1980s. Multiple MRI modalities, such as different types of the sMRI and DTI, have been employed to investigate facets of ASD in order to better understand this complex syndrome. This paper reviews recent applications of structural magnetic resonance imaging (sMRI) and diffusion tensor imaging (DTI), to study autism spectrum disorder (ASD). Main reported findings are sometimes contradictory due to different age ranges, hardware protocols, population types, numbers of participants, and image analysis parameters. The primary anatomical structures, such as amygdalae, cerebrum, and cerebellum, associated with clinical-pathological correlates of ASD are highlighted through successive life stages, from infancy to adulthood. This survey demonstrates the absence of consistent pathology in the brains of autistic children and lack of research investigations in patients under 2 years of age in the literature. The known publications also emphasize advances in data acquisition and analysis, as well as significance of multimodal approaches that combine resting-state, task-evoked, and sMRI measures. Initial results obtained with the sMRI and DTI show good promise toward the early and non-invasive ASD diagnostics.
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Affiliation(s)
- Marwa M. T. Ismail
- BioImaging Laboratory, Department of Bioengineering, University of LouisvilleLouisville, KY, USA
| | - Robert S. Keynton
- BioImaging Laboratory, Department of Bioengineering, University of LouisvilleLouisville, KY, USA
| | | | - Ahmed H. ElTanboly
- BioImaging Laboratory, Department of Bioengineering, University of LouisvilleLouisville, KY, USA
| | - Manuel F. Casanova
- Departments of Pediatrics and Biomedical Sciences, University of South CarolinaColumbia, SC, USA
| | | | - Ayman El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of LouisvilleLouisville, KY, USA
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Frye RE, Casanova MF, Fatemi SH, Folsom TD, Reutiman TJ, Brown GL, Edelson SM, Slattery JC, Adams JB. Neuropathological Mechanisms of Seizures in Autism Spectrum Disorder. Front Neurosci 2016; 10:192. [PMID: 27242398 PMCID: PMC4861974 DOI: 10.3389/fnins.2016.00192] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/18/2016] [Indexed: 01/09/2023] Open
Abstract
This manuscript reviews biological abnormalities shared by autism spectrum disorder (ASD) and epilepsy. Two neuropathological findings are shared by ASD and epilepsy: abnormalities in minicolumn architecture and γ-aminobutyric acid (GABA) neurotransmission. The peripheral neuropil, which is the region that contains the inhibition circuits of the minicolumns, has been found to be decreased in the post-mortem ASD brain. ASD and epilepsy are associated with inhibitory GABA neurotransmission abnormalities including reduced GABAA and GABAB subunit expression. These abnormalities can elevate the excitation-to-inhibition balance, resulting in hyperexcitablity of the cortex and, in turn, increase the risk of seizures. Medical abnormalities associated with both epilepsy and ASD are discussed. These include specific genetic syndromes, specific metabolic disorders including disorders of energy metabolism and GABA and glutamate neurotransmission, mineral and vitamin deficiencies, heavy metal exposures and immune dysfunction. Many of these medical abnormalities can result in an elevation of the excitatory-to-inhibitory balance. Fragile X is linked to dysfunction of the mGluR5 receptor and Fragile X, Angelman and Rett syndromes are linked to a reduction in GABAA receptor expression. Defects in energy metabolism can reduce GABA interneuron function. Both pyridoxine dependent seizures and succinic semialdehyde dehydrogenase deficiency cause GABA deficiencies while urea cycle defects and phenylketonuria cause abnormalities in glutamate neurotransmission. Mineral deficiencies can cause glutamate and GABA neurotransmission abnormalities and heavy metals can cause mitochondrial dysfunction which disrupts GABA metabolism. Thus, both ASD and epilepsy are associated with similar abnormalities that may alter the excitatory-to-inhibitory balance of the cortex. These parallels may explain the high prevalence of epilepsy in ASD and the elevated prevalence of ASD features in individuals with epilepsy.
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Affiliation(s)
- Richard E Frye
- Autism Research Program, Arkansas Children's Research InstituteLittle Rock, AR, USA; Department of Pediatrics, University of Arkansas for Medical SciencesLittle Rock, AR, USA
| | - Manuel F Casanova
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville Greenville, SC, USA
| | - S Hossein Fatemi
- Department of Psychiatry, University of Minnesota Medical School Minneapolis, MN, USA
| | - Timothy D Folsom
- Department of Psychiatry, University of Minnesota Medical School Minneapolis, MN, USA
| | - Teri J Reutiman
- Department of Psychiatry, University of Minnesota Medical School Minneapolis, MN, USA
| | | | | | - John C Slattery
- Autism Research Program, Arkansas Children's Research InstituteLittle Rock, AR, USA; Department of Pediatrics, University of Arkansas for Medical SciencesLittle Rock, AR, USA
| | - James B Adams
- School for Engineering of Matter, Transport, and Energy, Arizona State University Tempe, AZ, USA
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Alansary A, Ismail M, Soliman A, Khalifa F, Nitzken M, Elnakib A, Mostapha M, Black A, Stinebruner K, Casanova MF, Zurada JM, El-Baz A. Infant Brain Extraction in T1-Weighted MR Images Using BET and Refinement Using LCDG and MGRF Models. IEEE J Biomed Health Inform 2016; 20:925-935. [DOI: 10.1109/jbhi.2015.2415477] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Casanova EL, Sharp JL, Chakraborty H, Sumi NS, Casanova MF. Genes with high penetrance for syndromic and non-syndromic autism typically function within the nucleus and regulate gene expression. Mol Autism 2016; 7:18. [PMID: 26985359 PMCID: PMC4793536 DOI: 10.1186/s13229-016-0082-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intellectual disability (ID), autism, and epilepsy share frequent yet variable comorbidities with one another. In order to better understand potential genetic divergence underlying this variable risk, we studied genes responsible for monogenic IDs, grouped according to their autism and epilepsy comorbidities. METHODS Utilizing 465 different forms of ID with known molecular origins, we accessed available genetic databases in conjunction with gene ontology (GO) to determine whether the genetics underlying ID diverge according to its comorbidities with autism and epilepsy and if genes highly penetrant for autism or epilepsy share distinctive features that set them apart from genes that confer comparatively variable or no apparent risk. RESULTS The genetics of ID with autism are relatively enriched in terms associated with nervous system-specific processes and structural morphogenesis. In contrast, we find that ID with highly comorbid epilepsy (HCE) is modestly associated with lipid metabolic processes while ID without autism or epilepsy comorbidity (ID only) is enriched at the Golgi membrane. Highly comorbid autism (HCA) genes, on the other hand, are strongly enriched within the nucleus, are typically involved in regulation of gene expression, and, along with IDs with more variable autism, share strong ties with a core protein-protein interaction (PPI) network integral to basic patterning of the CNS. CONCLUSIONS According to GO terminology, autism-related gene products are integral to neural development. While it is difficult to draw firm conclusions regarding IDs unassociated with autism, it is clear that the majority of HCA genes are tightly linked with general dysregulation of gene expression, suggesting that disturbances to the chronology of neural maturation and patterning may be key in conferring susceptibility to autism spectrum conditions.
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Affiliation(s)
- Emily L. Casanova
- />Department of Biomedical Sciences, University of South Carolina, South Carolina, USA
- />Department of Pediatrics, Greenville Health System, Patewood Medical Campus, 200A Patewood Dr, Greenville, SC 29615 USA
| | - Julia L. Sharp
- />Department of Mathematical Sciences, Clemson University, Clemson, USA
| | - Hrishikesh Chakraborty
- />Department of Biostatistics and Epidemiology, University of South Carolina, South Carolina, USA
| | - Nahid Sultana Sumi
- />Department of Biostatistics and Epidemiology, University of South Carolina, South Carolina, USA
| | - Manuel F. Casanova
- />Department of Biomedical Sciences, University of South Carolina, South Carolina, USA
- />Department of Pediatrics, Greenville Health System, Patewood Medical Campus, 200A Patewood Dr, Greenville, SC 29615 USA
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Sokhadze EM, Tasman A, Sokhadze GE, El-Baz AS, Casanova MF. Behavioral, Cognitive, and Motor Preparation Deficits in a Visual Cued Spatial Attention Task in Autism Spectrum Disorder. Appl Psychophysiol Biofeedback 2016; 41:81-92. [PMID: 26377686 PMCID: PMC4840413 DOI: 10.1007/s10484-015-9313-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abnormalities in motor skills have been regarded as part of the symptomatology characterizing autism spectrum disorder (ASD). It has been estimated that 80 % of subjects with autism display "motor dyspraxia" or clumsiness that are not readily identified in a routine neurological examination. In this study we used behavioral measures, event-related potentials (ERP), and lateralized readiness potential (LRP) to study cognitive and motor preparation deficits contributing to the dyspraxia of autism. A modified Posner cueing task was used to analyze motor preparation abnormalities in children with autism and in typically developing children (N = 30/per group). In this task, subjects engage in preparing motor response based on a visual cue, and then execute a motor movement based on the subsequent imperative stimulus. The experimental conditions, such as the validity of the cue and the spatial location of the target stimuli were manipulated to influence motor response selection, preparation, and execution. Reaction time and accuracy benefited from validly cued targets in both groups, while main effects of target spatial position were more obvious in the autism group. The main ERP findings were prolonged and more negative early frontal potentials in the ASD in incongruent trials in both types of spatial location. The LRP amplitude was larger in incongruent trials and had stronger effect in the children with ASD. These effects were better expressed at the earlier stages of LRP, specifically those related to response selection, and showed difficulties at the cognitive phase of stimulus processing rather that at the motor execution stage. The LRP measures at different stages reflect the chronology of cognitive aspects of movement preparation and are sensitive to manipulations of cue correctness, thus representing very useful biomarker in autism dyspraxia research. Future studies may use more advance and diverse manipulations of movement preparation demands in testing more refined specifics of dyspraxia symptoms to investigate functional connectivity abnormalities underlying motor skills deficits in autism.
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Affiliation(s)
- Estate M Sokhadze
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Guela E Sokhadze
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ayman S El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY, 40202, USA
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Wang Y, Sokhadze EM, El-Baz AS, Li X, Sears L, Casanova MF, Tasman A. Relative Power of Specific EEG Bands and Their Ratios during Neurofeedback Training in Children with Autism Spectrum Disorder. Front Hum Neurosci 2016; 9:723. [PMID: 26834615 PMCID: PMC4712412 DOI: 10.3389/fnhum.2015.00723] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/24/2015] [Indexed: 11/13/2022] Open
Abstract
Neurofeedback is a mode of treatment that is potentially useful for improving self-regulation skills in persons with autism spectrum disorder. We proposed that operant conditioning of EEG in neurofeedback mode can be accompanied by changes in the relative power of EEG bands. However, the details on the change of the relative power of EEG bands during neurofeedback training course in autism are not yet well explored. In this study, we analyzed the EEG recordings of children diagnosed with autism and enrolled in a prefrontal neurofeedback treatment course. The protocol used in this training was aimed at increasing the ability to focus attention, and the procedure represented the wide band EEG amplitude suppression training along with upregulation of the relative power of gamma activity. Quantitative EEG analysis was completed for each session of neurofeedback using wavelet transform to determine the relative power of gamma and theta/beta ratio, and further to detect the statistical changes within and between sessions. We found a linear decrease of theta/beta ratio and a liner increase of relative power of gamma activity over 18 weekly sessions of neurofeedback in 18 high functioning children with autism. The study indicates that neurofeedback is an effective method for altering EEG characteristics associated with the autism spectrum disorder. Also, it provides information about specific changes of EEG activities and details the correlation between changes of EEG and neurofeedback indexes during the course of neurofeedback. This pilot study contributes to the development of more effective approaches to EEG data analysis during prefrontal neurofeedback training in autism.
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Affiliation(s)
- Yao Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Estate M. Sokhadze
- Department of Bioengineering, J.B Speed School of Engineering, University of LouisvilleLouisville, KY, USA
- Greenville Health System, Departments of Pediatrics and Biomedical Sciences, University of South Carolina School of Medicine GreenvilleGreenville, SC, USA
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
| | - Ayman S. El-Baz
- Department of Bioengineering, J.B Speed School of Engineering, University of LouisvilleLouisville, KY, USA
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Lonnie Sears
- Department of Pediatrics, University of Louisville School of MedicineLouisville, KY, USA
| | - Manuel F. Casanova
- Greenville Health System, Departments of Pediatrics and Biomedical Sciences, University of South Carolina School of Medicine GreenvilleGreenville, SC, USA
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of MedicineLouisville, KY, USA
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Oberman LM, Enticott PG, Casanova MF, Rotenberg A, Pascual-Leone A, McCracken JT. Transcranial magnetic stimulation in autism spectrum disorder: Challenges, promise, and roadmap for future research. Autism Res 2015; 9:184-203. [PMID: 26536383 DOI: 10.1002/aur.1567] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 12/26/2022]
Abstract
Autism Spectrum Disorder (ASD) is a behaviorally defined complex neurodevelopmental syndrome characterized by impairments in social communication, by the presence of restricted and repetitive behaviors, interests and activities, and by abnormalities in sensory reactivity. Transcranial magnetic stimulation (TMS) is a promising, emerging tool for the study and potential treatment of ASD. Recent studies suggest that TMS measures provide rapid and noninvasive pathophysiological ASD biomarkers. Furthermore, repetitive TMS (rTMS) may represent a novel treatment strategy for reducing some of the core and associated ASD symptoms. However, the available literature on the TMS use in ASD is preliminary, composed of studies with methodological limitations. Thus, off-label clinical rTMS use for therapeutic interventions in ASD without an investigational device exemption and outside of an IRB approved research trial is premature pending further, adequately powered and controlled trials. Leaders in this field have gathered annually for a two-day conference (prior to the 2014 and 2015 International Meeting for Autism Research, IMFAR) to share recent progress, promote collaboration across laboratories, and establish consensus on protocols. Here we review the literature in the use of TMS in ASD in the context of the unique challenges required for the study and exploration of treatment strategies in this population. We also suggest future directions for this field of investigations. While its true potential in ASD has yet to be delineated, TMS represents an innovative research tool and a novel, possibly transformative approach to the treatment of neurodevelopmental disorders.
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Affiliation(s)
- Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode, Island
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Science, University of Louisville, Louisville, Kentucky
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alvaro Pascual-Leone
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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Wegiel J, Flory M, Schanen NC, Cook EH, Nowicki K, Kuchna I, Imaki H, Ma SY, Wegiel J, London E, Casanova MF, Wisniewski T, Brown WT. Significant neuronal soma volume deficit in the limbic system in subjects with 15q11.2-q13 duplications. Acta Neuropathol Commun 2015; 3:63. [PMID: 26463344 PMCID: PMC4603300 DOI: 10.1186/s40478-015-0241-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/24/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Autism is diagnosed in numerous genetic and genomic developmental disorders associated with an overlap in high-risk genes and loci that underlie intellectual disability (ID) and epilepsy. The aim of this stereological study of neuronal soma volume in 25 brain structures and their subdivisions in eight individuals 9 to 26 years of age who were diagnosed with chromosome 15q11.2-13.1 duplication syndrome [dup(15)], autism, ID and epilepsy; eight age-matched subjects diagnosed with autism of unknown etiology (idiopathic autism) and seven control individuals was to establish whether defects of neuronal soma growth are a common denominator of developmental pathology in idiopathic and syndromic autism and how genetic modifications alter the trajectory of neuronal soma growth in dup(15) autism. Results Application of the Nucleator software to estimate neuronal size revealed significant neuronal soma volume deficits in 11 of 25 structures and their subregions (44 %) in subjects diagnosed with dup(15) autism, including consistent neuronal soma volume deficits in the limbic system (sectors CA2, 3 and 4 in Ammon’s horn, the second and third layers of the entorhinal cortex and in the amygdala), as well as in the thalamus, nucleus accumbens, external globus pallidus, and Ch3 nucleus in the magnocellular basal complex, and in the inferior olive in the brainstem. The second feature distinguishing dup(15) autism was persistent neuronal soma deficits in adolescents and young adults, whereas in idiopathic autism, neuronal volume deficit is most prominent in 4- to 8-year-old children but affects only a few brain regions in older subjects. Conclusions This study demonstrates that alterations in the trajectory of neuronal growth throughout the lifespan are a core pathological features of idiopathic and syndromic autism. However, dup(15) causes persistent neuronal volume deficits in adolescence and adulthood, with prominent neuronal growth deficits in all major compartments of the limbic system. The more severe neuronal nuclear and cytoplasic volume deficits in syndromic autism found in this study and the more severe focal developmental defects in the limbic system in dup(15) previously reported in this cohort may contribute to the high prevalence of early onset intractable epilepsy and sudden unexpected death in epilepsy.
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Hutsler JJ, Casanova MF. Review: Cortical construction in autism spectrum disorder: columns, connectivity and the subplate. Neuropathol Appl Neurobiol 2015; 42:115-34. [PMID: 25630827 DOI: 10.1111/nan.12227] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/16/2015] [Indexed: 01/28/2023]
Abstract
The cerebral cortex undergoes protracted maturation during human development and exemplifies how biology and environment are inextricably intertwined in the construction of complex neural circuits. Autism spectrum disorders are characterized by a number of pathological changes arising from this developmental process. These include: (i) alterations to columnar structure that have significant implications for the organization of cortical circuits and connectivity; (ii) alterations to synaptic spines on individual cortical units that may underlie specific types of connectional changes; and (iii) alterations within the cortical subplate, a region that plays a role in proper cortical development and in regulating interregional communication in the mature brain. Although the cerebral cortex is not the only structure affected in the disorder, it is a fundamental contributor to the behaviours that characterize autism. These alterations to cortical circuitry likely underlie the behavioural phenotype in autism and contribute to the unique pattern of deficits and strengths that characterize cognitive functioning. Recent findings within the cortical subplate may indicate that alterations to cortical construction begin prenatally, before activity-dependent connections are established, and are in need of further study. A better understanding of cortical development in autism spectrum disorders will draw bridges between the microanatomical computational circuitry and the atypical behaviours that arise when that circuitry is modified. In addition, it will allow us to better exploit the constructional plasticity within the brain to design more targeted interventions that better manage atypical cortical construction and that can be applied very early in postnatal life.
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Affiliation(s)
- Jeffrey J Hutsler
- Department of Psychology, Program in Neuroscience, University of Nevada, Reno, USA
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Science, University of Louisville School of Medicine, Louisville, USA
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Abstract
The survey outlines and compares popular computational techniques for quantitative description of shapes of major structural parts of the human brain, including medial axis and skeletal analysis, geodesic distances, Procrustes analysis, deformable models, spherical harmonics, and deformation morphometry, as well as other less widely used techniques. Their advantages, drawbacks, and emerging trends, as well as results of applications, in particular, for computer-aided diagnostics, are discussed.
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Casanova MF, Sokhadze E, Opris I, Wang Y, Li X. Autism spectrum disorders: linking neuropathological findings to treatment with transcranial magnetic stimulation. Acta Paediatr 2015; 104:346-55. [PMID: 25626149 DOI: 10.1111/apa.12943] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 01/09/2023]
Abstract
UNLABELLED Postmortem studies in autism spectrum disorder (ASD) individuals indicate the presence of abnormalities within the peripheral neuropil space (PNS) of cortical minicolumns. The geometrical orientation of inhibitory elements within the PNS suggests using repetitive transcranial magnetic stimulation (rTMS) to up-regulate their activity. Several rTMS trials in ASD have shown marked improvements in motor symptomatology, attention and perceptual binding. CONCLUSION rTMS is the first therapeutic attempt at ASD aimed at correcting some of its core pathology.
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Affiliation(s)
| | - Estate Sokhadze
- Department of Psychiatry; University of Louisville; Louisville KA USA
| | - Ioan Opris
- Department of Physiology and Pharmacology; Wake Forest University School of Medicine; Winston-Salem NA USA
| | - Yao Wang
- Department of Psychiatry; University of Louisville; Louisville KA USA
- State Key Laboratory of Cognitive Neuroscience and Learning; Beijing Normal University; Beijing China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning; Beijing Normal University; Beijing China
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Oberman LM, Enticott PG, Casanova MF, Rotenberg A, Pascual-Leone A, McCracken JT. Transcranial magnetic stimulation (TMS) therapy for autism: an international consensus conference held in conjunction with the international meeting for autism research on May 13th and 14th, 2014. Front Hum Neurosci 2015; 8:1034. [PMID: 25642178 PMCID: PMC4295436 DOI: 10.3389/fnhum.2014.01034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/09/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University Providence, RI, USA
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University Burwood, VIC, Australia
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Science, University of Louisville Louisville, KY, USA
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School Boston, MA, USA ; Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles Los Angeles, CA, USA
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Sokhadze EM, El-Baz AS, Tasman A, Sears LL, Wang Y, Lamina EV, Casanova MF. Neuromodulation integrating rTMS and neurofeedback for the treatment of autism spectrum disorder: an exploratory study. Appl Psychophysiol Biofeedback 2014; 39:237-57. [PMID: 25267414 PMCID: PMC4221494 DOI: 10.1007/s10484-014-9264-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 years). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N = 20) and waitlist (WTL, N = 22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the WTL group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control WTL group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the WTL group.
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Affiliation(s)
- Estate M Sokhadze
- University of Louisville, 401 E Chestnut Street, Suite 600, Louisville, KY, 40202, USA,
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Casanova EL, Casanova MF. Genetics studies indicate that neural induction and early neuronal maturation are disturbed in autism. Front Cell Neurosci 2014; 8:397. [PMID: 25477785 PMCID: PMC4237056 DOI: 10.3389/fncel.2014.00397] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/05/2014] [Indexed: 01/11/2023] Open
Abstract
Postmortem neuropathological studies of autism consistently reveal distinctive types of malformations, including cortical dysplasias, heterotopias, and various neuronomorphometric abnormalities. In keeping with these observations, we review here that 88% of high-risk genes for autism influence neural induction and early maturation of the neuroblast. In addition, 80% of these same genes influence later stages of differentiation, including neurite and synapse development, suggesting that these gene products exhibit long-lasting developmental effects on cell development as well as elements of redundancy in processes of neural proliferation, growth, and maturation. We also address the putative genetic overlap of autism with conditions like epilepsy and schizophrenia, with implications to shared and divergent etiologies. This review imports the necessity of a frameshift in our understanding of the neurodevelopmental basis of autism to include all stages of neuronal maturation, ranging from neural induction to synaptogenesis.
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Affiliation(s)
- Emily L Casanova
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Louisville Louisville, KY, USA
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Louisville Louisville, KY, USA
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Elnakib A, Soliman A, Nitzken M, Casanova MF, Gimel'farb G, El-Baz A. Magnetic Resonance Imaging Findings for Dyslexia: A Review. J Biomed Nanotechnol 2014; 10:2778-805. [DOI: 10.1166/jbn.2014.1895] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sokhadze EM, El-Baz AS, Sears LL, Opris I, Casanova MF. rTMS neuromodulation improves electrocortical functional measures of information processing and behavioral responses in autism. Front Syst Neurosci 2014; 8:134. [PMID: 25147508 PMCID: PMC4123734 DOI: 10.3389/fnsys.2014.00134] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 07/09/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives: Reports in autism spectrum disorders (ASD) of a minicolumnopathy with consequent deficits of lateral inhibition help explain observed behavioral and executive dysfunctions. We propose that neuromodulation based on low frequency repetitive Transcranial Magnetic Stimulation (rTMS) will enhance lateral inhibition through activation of inhibitory double bouquet interneurons and will be accompanied by improvements in the prefrontal executive functions. In addition we proposed that rTMS will improve cortical excitation/inhibition ratio and result in changes manifested in event-related potential (ERP) recorded during cognitive tests. Materials and Methods: Along with traditional clinical behavioral evaluations the current study used ERPs in a visual oddball task with illusory figures. We compared clinical, behavioral and electrocortical outcomes in two groups of children with autism (TMS, wait-list group). We predicted that 18 session long course in autistic patients will have better behavioral and ERP outcomes as compared to age- and IQ-matched WTL group. We used 18 sessions of 1 Hz rTMS applied over the dorso-lateral prefrontal cortex in 27 individuals with ASD diagnosis. The WTL group was comprised of 27 age-matched subjects with ASD tested twice. Both TMS and WTL groups were assessed at the baseline and after completion of 18 weekly sessions of rTMS (or wait period) using clinical behavioral questionnaires and during performance on visual oddball task with Kanizsa illusory figures. Results: Post-TMS evaluations showed decreased irritability and hyperactivity on the Aberrant Behavior Checklist (ABC), and decreased stereotypic behaviors on the Repetitive Behavior Scale (RBS-R). Following rTMS course we found decreased amplitude and prolonged latency in the frontal and fronto-central N100, N200 and P300 (P3a) ERPs to non-targets in active TMS treatment group. TMS resulted in increase of P2d (P2a to targets minus P2a to non-targets) amplitude. These ERP changes along with increased centro-parietal P100 and P300 (P3b) to targets are indicative of more efficient processing of information post-TMS treatment. Another important finding was decrease of the latency and increase of negativity of error-related negativity (ERN) during commission errors that may reflect improvement in error monitoring and correction function. Enhanced information processing was also manifested in lower error rate. In addition we calculated normative post-error treaction time (RT) slowing response in both groups and found that rTMS treatment was accompanied by post-error RT slowing and higher accuracy of responses, whereas the WTL group kept on showing typical for ASD post-error RT speeding and higher commission and omission error rates. Conclusion: Results from our study indicate that rTMS improves executive functioning in ASD as evidenced by normalization of ERP responses and behavioral reactions (RT, accuracy) during executive function test, and also by improvements in clinical evaluations.
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Affiliation(s)
- Estate M Sokhadze
- Department of Psychiatry and Behavioral Sciences, University of Louisville Louisville, KY, USA
| | - Ayman S El-Baz
- Department of Bioengineering, University of Louisville Louisville, KY, USA
| | - Lonnie L Sears
- Department of Pediatrics, University of Louisville Louisville, KY, USA
| | - Ioan Opris
- Department of Physiology and Pharmacology, Wake Forest University Winston-Salem, NC, USA
| | - Manuel F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville Louisville, KY, USA
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Casanova MF. Autism as a sequence: from heterochronic germinal cell divisions to abnormalities of cell migration and cortical dysplasias. Med Hypotheses 2014; 83:32-8. [PMID: 24780284 PMCID: PMC4070182 DOI: 10.1016/j.mehy.2014.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/11/2014] [Accepted: 04/06/2014] [Indexed: 02/07/2023]
Abstract
The considerable heterogeneity in the number and severity of symptoms observed in autism spectrum disorders (ASD) has been regarded as an obstacle to any future research. Some authors believe that clinical heterogeneity results from the complex interplay of the many genetic and environmental factors that themselves define a condition as multifactorial. However, it is important to note that neuropathological findings in both idiopathic and syndromic autism suggests a single pathophysiological mechanism acting during brain development: the heterochronic division of germinal cells and subsequent migrational abnormalities of daughter cells to their target fields. Multiple exogenous (e.g., viruses, drugs) and endogenous (e.g., genetic mutations) factors are known to disrupt the division of germinal cells and provide for an autism phenotype. The variety of endogenous and exogenous factors, their timing of action during brain development, and the genetic susceptibility of affected individuals (a Triple Hit hypothesis) may all account for the clinical heterogeneity of ASD.
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Affiliation(s)
- Manuel F Casanova
- Department of Psychiatry, University of Louisville, 500 South Preston Street, Building A, Room 217, Louisville, KY 40202, United States.
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50
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Zeidán-Chuliá F, de Oliveira BHN, Salmina AB, Casanova MF, Gelain DP, Noda M, Verkhratsky A, Moreira JCF. Altered expression of Alzheimer's disease-related genes in the cerebellum of autistic patients: a model for disrupted brain connectome and therapy. Cell Death Dis 2014; 5:e1250. [PMID: 24853428 PMCID: PMC4047885 DOI: 10.1038/cddis.2014.227] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/13/2014] [Accepted: 04/16/2014] [Indexed: 11/09/2022]
Abstract
Autism and Alzheimer's disease (AD) are, respectively, neurodevelopmental and degenerative diseases with an increasing epidemiological burden. The AD-associated amyloid-β precursor protein-α has been shown to be elevated in severe autism, leading to the 'anabolic hypothesis' of its etiology. Here we performed a focused microarray analysis of genes belonging to NOTCH and WNT signaling cascades, as well as genes related to AD and apoptosis pathways in cerebellar samples from autistic individuals, to provide further evidence for pathological relevance of these cascades for autism. By using the limma package from R and false discovery rate, we demonstrated that 31% (116 out of 374) of the genes belonging to these pathways displayed significant changes in expression (corrected P-values <0.05), with mitochondria-related genes being the most downregulated. We also found upregulation of GRIN1, the channel-forming subunit of NMDA glutamate receptors, and MAP3K1, known activator of the JNK and ERK pathways with anti-apoptotic effect. Expression of PSEN2 (presinilin 2) and APBB1 (or F65) were significantly lower when compared with control samples. Based on these results, we propose a model of NMDA glutamate receptor-mediated ERK activation of α-secretase activity and mitochondrial adaptation to apoptosis that may explain the early brain overgrowth and disruption of synaptic plasticity and connectome in autism. Finally, systems pharmacology analyses of the model that integrates all these genes together (NOWADA) highlighted magnesium (Mg(2+)) and rapamycin as most efficient drugs to target this network model in silico. Their potential therapeutic application, in the context of autism, is therefore discussed.
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Affiliation(s)
- F Zeidán-Chuliá
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - B-H N de Oliveira
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A B Salmina
- Department of Biochemistry, Medical, Pharmaceutical and Toxicological Chemistry, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - M F Casanova
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - D P Gelain
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M Noda
- Laboratory of Pathophysiology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - A Verkhratsky
- 1] Faculty of Life Sciences, The University of Manchester, Manchester, UK [2] IKERBASQUE, Basque Foundation for Science, Bilbao, Spain [3] Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
| | - J C F Moreira
- Centro de Estudos em Estresse Oxidativo, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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