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Gimbel BA, Roediger DJ, Ernst AM, Anthony ME, Mueller BA, de Water E, Rockhold MN, Wozniak JR. Normative Magnetic Resonance Imaging Data Increase the Sensitivity to Brain Volume Abnormalities in the Classification of Fetal Alcohol Spectrum Disorder. J Pediatr 2024; 266:113868. [PMID: 38065282 PMCID: PMC10922916 DOI: 10.1016/j.jpeds.2023.113868] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE To evaluate the use of a large magnetic resonance imaging (MRI) normative dataset to quantify structural brain anomalies that may improve diagnostic sensitivity for atypical brain volume in youth with fetal alcohol spectrum disorder (FASD). STUDY DESIGN Participants included 48 children with prenatal alcohol exposure (PAE) and 43 controls, ages 8-17 years, from the longitudinal Collaborative Initiative on FASD s. Recently published lifespan brain charts were used to quantify participants' (per)centile for brain volumes (cortical and subcortical gray matter and cortical white matter), providing an index of (dis)similarity to typically developing individuals of the same age and sex. RESULTS Participants with PAE demonstrated lower mean centile scores compared with controls. Participants with PAE and scores ≤ 10th centile on at least 1 brain volume metric demonstrated significantly lower performance on measures of intellectual function and aspects of executive functioning compared with participants with PAE and "typical" volumes (>10th centile). Brain volume centiles explained a greater amount of variance in IQ and improved sensitivity to brain volume anomalies in FASD compared with the most commonly used diagnostic criterion of occipitofrontal circumference (OFC) ≤ 10th. CONCLUSION Age- and sex-adjusted brain volumes based on a large normative dataset may be useful predictors of functional outcomes and may identify a greater number of individuals with FASD than the currently used criterion of OFC.
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Affiliation(s)
- Blake A Gimbel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Donovan J Roediger
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Abigail M Ernst
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Mary E Anthony
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN
| | | | | | - Jeffrey R Wozniak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN.
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Sundermann B, Feldmann R, Mathys C, Rau JMH, Garde S, Braje A, Weglage J, Pfleiderer B. Functional connectivity of cognition-related brain networks in adults with fetal alcohol syndrome. BMC Med 2023; 21:496. [PMID: 38093292 PMCID: PMC10720228 DOI: 10.1186/s12916-023-03208-8] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) can result in cognitive dysfunction. Cognitive functions affected are subserved by few functional brain networks. Functional connectivity (FC) in these networks can be assessed with resting-state functional MRI (rs-fMRI). Alterations of FC have been reported in children and adolescents prenatally exposed to alcohol. Previous reports varied substantially regarding the exact nature of findings. The purpose of this study was to assess FC of cognition-related networks in young adults with FAS. METHODS Cross-sectional rs-fMRI study in participants with FAS (n = 39, age: 20.9 ± 3.4 years) and healthy participants without prenatal alcohol exposure (n = 44, age: 22.2 ± 3.4 years). FC was calculated as correlation between cortical regions in ten cognition-related sub-networks. Subsequent modelling of overall FC was based on linear models comparing FC between FAS and controls. Results were subjected to a hierarchical statistical testing approach, first determining whether there is any alteration of FC in FAS in the full cognitive connectome, subsequently resolving these findings to the level of either FC within each network or between networks based on the Higher Criticism (HC) approach for detecting rare and weak effects in high-dimensional data. Finally, group differences in single connections were assessed using conventional multiple-comparison correction. In an additional exploratory analysis, dynamic FC states were assessed. RESULTS Comparing FAS participants with controls, we observed altered FC of cognition-related brain regions globally, within 7 out of 10 networks, and between networks employing the HC statistic. This was most obvious in attention-related network components. Findings also spanned across subcomponents of the fronto-parietal control and default mode networks. None of the single FC alterations within these networks yielded statistical significance in the conventional high-resolution analysis. The exploratory time-resolved FC analysis did not show significant group differences of dynamic FC states. CONCLUSIONS FC in cognition-related networks was altered in adults with FAS. Effects were widely distributed across networks, potentially reflecting the diversity of cognitive deficits in FAS. However, no altered single connections could be determined in the most detailed analysis level. Findings were pronounced in networks in line with attentional deficits previously reported.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Reinhold Feldmann
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Johanna M H Rau
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stefan Garde
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anna Braje
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Josef Weglage
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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Pinner JFL, Collishaw W, Schendel ME, Flynn L, Candelaria‐Cook FT, Cerros CM, Williams M, Hill DE, Stephen JM. Examining the effects of prenatal alcohol exposure on performance of the sustained attention to response task in children with an FASD. Hum Brain Mapp 2023; 44:6120-6138. [PMID: 37792293 PMCID: PMC10619405 DOI: 10.1002/hbm.26501] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 06/07/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023] Open
Abstract
Prenatal alcohol exposure (PAE), the leading known cause of childhood developmental disability, has long-lasting effects extending throughout the lifespan. It is well documented that children prenatally exposed to alcohol have difficulties inhibiting behavior and sustaining attention. Thus, the Sustained Attention to Response Task (SART), a Go/No-go paradigm, is especially well suited to assess the behavioral and neural functioning characteristics of children with PAE. In this study, we utilized neuropsychological assessment, parent/guardian questionnaires, and magnetoencephalography during SART random and fixed orders to assess characteristics of children 8-12 years old prenatally exposed to alcohol compared to typically developing children. Compared to neurotypical control children, children with a Fetal Alcohol Spectrum Disorder (FASD) diagnosis had significantly decreased performance on neuropsychological measures, had deficiencies in task-based performance, were rated as having increased Attention-Deficit/Hyperactivity Disorder (ADHD) behaviors and as having lower cognitive functioning by their caretakers, and had decreased peak amplitudes in Broadmann's Area 44 (BA44) during SART. Further, MEG peak amplitude in BA44 was found to be significantly associated with neuropsychological test results, parent/guardian questionnaires, and task-based performance such that decreased amplitude was associated with poorer performance. In exploratory analyses, we also found significant correlations between total cortical volume and MEG peak amplitude indicating that the reduced amplitude is likely related in part to reduced overall brain volume often reported in children with PAE. These findings show that children 8-12 years old with an FASD diagnosis have decreased amplitudes in BA44 during SART random order, and that these deficits are associated with multiple behavioral measures.
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Affiliation(s)
- J. F. L. Pinner
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - W. Collishaw
- The Mind Research NetworkAlbuquerqueNew MexicoUSA
| | | | - L. Flynn
- The Mind Research NetworkAlbuquerqueNew MexicoUSA
| | | | - C. M. Cerros
- Department of PediatricsUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - M. Williams
- Department of PediatricsUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - D. E. Hill
- Department of PsychiatryUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
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Pfefferbaum A, Sullivan EV, Pohl KM, Bischoff-Grethe A, Stoner SA, Moore EM, Riley EP. Brain Volume in Fetal Alcohol Spectrum Disorders Over a 20-Year Span. JAMA Netw Open 2023; 6:e2343618. [PMID: 37976065 PMCID: PMC10656646 DOI: 10.1001/jamanetworkopen.2023.43618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Anomalous brain development and mental health problems are prevalent in fetal alcohol spectrum disorders (FASD), but there is a paucity of longitudinal brain imaging research into adulthood. This study presents long-term follow-up of brain volumetrics in a cohort of participants with FASD. Objective To test whether brain tissue declines faster with aging in individuals with FASD compared with control participants. Design, Setting, and Participants This cohort study used magnetic resonance imaging (MRI) data collected from individuals with FASD and control individuals (age 13-37 years at first magnetic resonance imaging [MRI1] acquired 1997-2000) compared with data collected 20 years later (MRI2; 2018-2021). Participants were recruited for MRI1 through the University of Washington Fetal Alcohol Syndrome (FAS) Follow-Up Study. For MRI2, former participants were recruited by the University of Washington Fetal Alcohol and Drug Unit. Data were analyzed from October 2022 to August 2023. Main Outcomes and Measures Intracranial volume (ICV) and regional cortical and cerebellar gray matter, white matter, and cerebrospinal fluid volumes were quantified automatically and analyzed, with group and sex as between-participant factors and age as a within-participant variable. Results Of 174 individuals with MRI1 data, 48 refused participation, 36 were unavailable, and 24 could not be located. The remaining 66 individuals (37.9%) were rescanned for MRI2, including 26 controls, 18 individuals with nondysmorphic heavily exposed fetal alcohol effects (FAE; diagnosed prior to MRI1), and 22 individuals with FAS. Mean (SD) age was 22.9 (5.6) years at MRI1 and 44.7 (6.5) years at MRI2, and 35 participants (53%) were male. The FAE and FAS groups exhibited enduring stepped volume deficits at MRI1 and MRI2; volumes among control participants were greater than among participants with FAE, which were greater than volumes among participants with FAS (eg, mean [SD] ICV: control, 1462.3 [119.3] cc at MRI1 and 1465.4 [129.4] cc at MRI2; FAE, 1375.6 [134.1] cc at MRI1 and 1371.7 [120.3] cc at MRI2; FAS, 1297.3 [163.0] cc at MRI1 and 1292.7 [172.1] cc at MRI2), without diagnosis-by-age interactions. Despite these persistent volume deficits, the FAE participants and FAS participants showed patterns of neurodevelopment within reference ranges: increase in white matter and decrease in gray matter of the cortex and decrease in white matter and increase in gray matter of the cerebellum. Conclusions and Relevance The findings of this cohort study support a nonaccelerating enduring, brain structural dysmorphic spectrum following prenatal alcohol exposure and a diagnostic distinction based on the degree of dysmorphia. FASD was not a progressive brain structural disorder by middle age, but whether accelerated decline occurs in later years remains to be determined.
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Affiliation(s)
- Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Susan A. Stoner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Eileen M. Moore
- Department of Psychology, San Diego State University, San Diego, California
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California
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Ndou R, Bello NK, Perry V, Pillay D. Distal tibial trabecular morphometry in a Sprague Dawley rat model of fetal alcohol syndrome: a micro focus X-ray computed tomography case-control study. Pan Afr Med J 2023; 46:35. [PMID: 38145202 PMCID: PMC10746879 DOI: 10.11604/pamj.2023.46.35.37151] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/06/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction intrauterine alcohol exposure has adverse health effects on the offspring, which may result in fetal Alcohol Spectrum Disorders (FASD). The neurological and craniofacial aspects have been well studied; however, long bones have received limited attention despite the short stature reported in FASD children. Methods time-mated (n=13) pregnant Sprague Dawley dams were assigned to either the ethanol (n=5), saline control (n=5) or untreated group (n=3) which received no treatment. The ethanol and saline control dams were treated with 0.015ml/g of 25.2% ethanol or 0.9% saline, respectively. Treatment was for the first 19 days of gestation. Two pups from each dam were used and terminated at 21 days of age. Paired tibiae were harvested. Each bone was scanned using a Nikon XTH 225L 3D-μCT to investigate trabeculae morphometry. Results the ethanol group had less bone to total volume (BT/TV), thinnest trabeculae (TbTh) which were less spaced (TbSp) compared to the controls. However, number of trabecular (TbN) remained unaffected in all three groups. Tibial length was similar in all three groups; however, the distal metaphysis volume was smallest in the ethanol group. Logistic regression showed that the distal medullary canal area and trabecular separation were the main parameters affected the most in gestational alcohol. The negative correlation of trabecular thickness and spacing in the ethanol group may be a contributor to bone weakness. Conclusion gestational alcohol exposure affects bone internal morphology in addition to the bone size. Overall, this study supports the findings of clinical observation of small stature in FAS children.
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Affiliation(s)
- Robert Ndou
- Department of Anatomy and Histology, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Nura Kaura Bello
- School of Anatomical Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Parktown, South Africa
| | - Vaughan Perry
- Department of Anatomy and Histology, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Diana Pillay
- Department of Anatomy and Histology, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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Candelaria-Cook FT, Schendel ME, Flynn L, Cerros C, Hill DE, Stephen JM. Disrupted dynamic functional network connectivity in fetal alcohol spectrum disorders. Alcohol Clin Exp Res (Hoboken) 2023; 47:687-703. [PMID: 36880528 PMCID: PMC10281251 DOI: 10.1111/acer.15046] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/30/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in harmful and long-lasting neurodevelopmental changes. Children with PAE or a fetal alcohol spectrum disorder (FASD) have decreased white matter volume and resting-state spectral power compared to typically developing controls (TDC) and impaired resting-state static functional connectivity. The impact of PAE on resting-state dynamic functional network connectivity (dFNC) is unknown. METHODS Using eyes-closed and eyes-open magnetoencephalography (MEG) resting-state data, global dFNC statistics and meta-states were examined in 89 children aged 6-16 years (51 TDC, 38 with FASD). Source analyzed MEG data were used as input to group spatial independent component analysis to derive functional networks from which the dFNC was calculated. RESULTS During eyes-closed, relative to TDC, participants with FASD spent a significantly longer time in state 2, typified by anticorrelation (i.e., decreased connectivity) within and between default mode network (DMN) and visual network (VN), and state 4, typified by stronger internetwork correlation. The FASD group exhibited greater dynamic fluidity and dynamic range (i.e., entered more states, changed from one meta-state to another more often, and traveled greater distances) than TDC. During eyes-open, TDC spent significantly more time in state 1, typified by positive intra- and interdomain connectivity with modest correlation within the frontal network (FN), while participants with FASD spent a larger fraction of time in state 2, typified by anticorrelation within and between DMN and VN and strong correlation within and between FN, attention network, and sensorimotor network. CONCLUSIONS There are important resting-state dFNC differences between children with FASD and TDC. Participants with FASD exhibited greater dynamic fluidity and dynamic range and spent more time in states typified by anticorrelation within and between DMN and VN, and more time in a state typified by high internetwork connectivity. Taken together, these network aberrations indicate that prenatal alcohol exposure has a global effect on resting-state connectivity.
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Affiliation(s)
| | - Megan E. Schendel
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Lucinda Flynn
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
| | - Cassandra Cerros
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Dina E. Hill
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Julia M. Stephen
- The Mind Research Network and Lovelace Biomedical Research Institute, Albuquerque, New Mexico, USA
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Adhikari P, Shukla PK, Alharthi F, Bhandari S, Meena AS, Rao R, Pradhan P. Photonics probing of pup brain tissue and molecular-specific nuclear nanostructure alterations due to fetal alcoholism via light scattering/localization approaches. J Biomed Opt 2022; 27:076002. [PMID: 35818115 PMCID: PMC9271689 DOI: 10.1117/1.jbo.27.7.076002] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE Light is a good probe for studying the nanoscale-level structural or molecular-specific structural properties of brain cells/tissue due to stress, alcohol, or any other abnormalities. Chronic alcoholism during pregnancy, i.e., fetal alcoholism, being teratogenic, results in fetal alcohol syndrome, and other neurological disorders. Understanding the nano-to-submicron scale spatial structural properties of pup brain cells/tissues using light/photonic probes could provide a plethora of information in understanding the effects of fetal alcoholism. AIM Using both light scattering and light localization techniques to probe alterations in nano- to-submicron scale mass density or refractive index fluctuations in brain cells/tissues of mice pups, exposed to fetal alcoholism. APPROACH We use the mesoscopic physics-based dual spectroscopic imaging techniques, partial wave spectroscopy (PWS) and molecular-specific inverse participation ratio (IPR) using confocal imaging, to quantify structural alterations in brain tissues and chromatin/histone in brain cells, respectively, in 60 days postnatal mice pup brain, exposed to fetal alcoholism. RESULTS The finer focusing PWS analysis on tissues shows an increase in the degree of structural disorder strength in the pup brain tissues. Furthermore, results of the molecular-specific light localization IPR technique show an increase in the degree of spatial molecular mass density structural disorder in DNA and a decrease in the degree in histone. CONCLUSIONS In particular, we characterize the spatial pup brain structures from the molecular to tissue levels and address the plausible reasons for such as mass density fluctuations in fetal alcoholism.
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Affiliation(s)
- Prakash Adhikari
- Mississippi State University, Department of Physics and Astronomy, Mississippi State, Mississippi, United States
| | - Pradeep K. Shukla
- University of Tennessee Health Science Center, Department of Physiology, Memphis, Tennessee, United States
| | - Fatemah Alharthi
- Mississippi State University, Department of Physics and Astronomy, Mississippi State, Mississippi, United States
| | - Shiva Bhandari
- Mississippi State University, Department of Physics and Astronomy, Mississippi State, Mississippi, United States
| | - Avtar S. Meena
- University of Tennessee Health Science Center, Department of Physiology, Memphis, Tennessee, United States
| | - Radhakrishna Rao
- University of Tennessee Health Science Center, Department of Physiology, Memphis, Tennessee, United States
| | - Prabhakar Pradhan
- Mississippi State University, Department of Physics and Astronomy, Mississippi State, Mississippi, United States
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Yu X, Dunstan J, Jacobson SW, Molteno CD, Lindinger NM, Turesky TK, Meintjes EM, Jacobson JL, Gaab N. Distinctive neural correlates of phonological and reading impairment in fetal alcohol-exposed adolescents with and without facial dysmorphology. Neuropsychologia 2022; 169:108188. [PMID: 35218791 PMCID: PMC9922095 DOI: 10.1016/j.neuropsychologia.2022.108188] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/26/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
Prenatal alcohol exposure (PAE) has been linked to atypical brain and cognitive development, including poor academic performance in reading. This study utilized functional magnetic resonance imaging and diffusion tensor imaging to characterize functional and structural mechanisms mediating reading deficits in 26 adolescents with PAE-related facial dysmorphology (fetal alcohol syndrome (FAS)/partial FAS (PFAS)), 29 heavily-exposed (HE) non-syndromal adolescents, in comparison with 19 typically developing controls. The FAS/PFAS and HE groups were balanced in terms of levels of PAE and reading (dis)ability. While neural alterations in the posterior association cortices were evident in both PAE groups, distinctive neural correlates of reading (dis)abilities were observed between adolescents with and without facial dysmorphology. Specifically, compared to the HE and control groups, the syndromal adolescents showed greater activation in the right precentral gyrus during phonological processing and rightward lateralization in an important reading-related tract (inferior longitudinal fasciculus, ILF), suggesting an atypical reliance on the right hemisphere. By contrast, in the HE, better reading skills were positively correlated with neural activation in the left angular gyrus and white matter organization of the left ILF, although the brain function-behavior relation was weaker than among the controls, suggesting less efficient function of the typical reading network. Our findings provide converging evidence at both the neural functional and structural levels for distinctive brain mechanisms underlying atypical reading and phonological processing in PAE adolescents with and without facial dysmorphology.
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Affiliation(s)
- Xi Yu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA.
| | - Jade Dunstan
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA; Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa; Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Nadine M Lindinger
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Ted K Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA; Harvard Graduate School of Education, Cambridge, MA, 02138, USA
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA; Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, 7701, South Africa.
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA; Harvard Graduate School of Education, Cambridge, MA, 02138, USA.
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Stephen JM, Hill DE, Candelaria-Cook FT. Examining the effects of prenatal alcohol exposure on corticothalamic connectivity: A multimodal neuroimaging study in children. Dev Cogn Neurosci 2021; 52:101019. [PMID: 34666262 PMCID: PMC8524752 DOI: 10.1016/j.dcn.2021.101019] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/22/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023] Open
Abstract
Children with a fetal alcohol spectrum disorder (FASD) experience a range of cognitive and behavioral effects. Prior studies have demonstrated white matter changes in children with FASD relative to typically developing controls (TDC) and these changes relate to behavior. Our prior MEG study (Candelaria-Cook et al. 2020) demonstrated reduced alpha oscillations during rest in FASD relative to TDC and alpha power is correlated with behavior. However, little is known about how brain structure influences brain function. We hypothesized that alpha power was related to corticothalamic connectivity. Children 8–13 years of age (TDC: N = 25, FASD: N = 24) underwent rest MEG with eyes open or closed and MRI to collect structural and diffusion tensor imaging data. MEG spectral analysis was performed for sensor and source data. We estimated mean fractional anisotropy in regions of interest (ROIs) that included the corticothalamic tracts. The FASD group had reduced mean FA in three of the corticothalamic ROIs. FA in these tracts was significantly correlated with alpha power at the sensor and source level. The results support the hypothesis that integrity of the corticothalamic tracts influences cortical alpha power. Further research is needed to understand how brain structure and function influence behavior.
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Affiliation(s)
- J M Stephen
- The Mind Research Network and Lovelace Biomedical Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, United States; Psychiatry Department, University of New Mexico Health Sciences Center, Albuquerque, NM, United States.
| | - D E Hill
- The Mind Research Network and Lovelace Biomedical Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, United States; Psychiatry Department, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - F T Candelaria-Cook
- The Mind Research Network and Lovelace Biomedical Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, United States; Psychiatry Department, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Fu Z, Jiao J, Suttie M, Noble JA. Facial Anatomical Landmark Detection using Regularized Transfer Learning with Application to Fetal Alcohol Syndrome Recognition. IEEE J Biomed Health Inform 2021; 26:1591-1601. [PMID: 34495853 PMCID: PMC9209878 DOI: 10.1109/jbhi.2021.3110680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fetal alcohol syndrome (FAS) caused by prenatal alcohol exposure can result in a series of cranio-facial anomalies, and behavioral and neurocognitive problems. Current diagnosis of FAS is typically done by identifying a set of facial characteristics, which are often obtained by manual examination. Anatomical landmark detection, which provides rich geometric information, is important to detect the presence of FAS associated facial anomalies. This imaging application is characterized by large variations in data appearance and limited availability of labeled data. Current deep learning-based heatmap regression methods designed for facial landmark detection in natural images assume availability of large datasets and are therefore not wellsuited for this application. To address this restriction, we develop a new regularized transfer learning approach that exploits the knowledge of a network learned on large facial recognition datasets. In contrast to standard transfer learning which focuses on adjusting the pre-trained weights, the proposed learning approach regularizes the model behavior. It explicitly reuses the rich visual semantics of a domain-similar source model on the target task data as an additional supervisory signal for regularizing landmark detection optimization. Specifically, we develop four regularization constraints for the proposed transfer learning, including constraining the feature outputs from classification and intermediate layers, as well as matching activation attention maps in both spatial and channel levels. Experimental evaluation on a collected clinical imaging dataset demonstrate that the proposed approach can effectively improve model generalizability under limited training samples, and is advantageous to other approaches in the literature.
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Alger JR, O'Neill J, O'Connor MJ, Kalender G, Ly R, Ng A, Dillon A, Narr KL, Loo SK, Levitt JG. Neuroimaging of Supraventricular Frontal White Matter in Children with Familial Attention-Deficit Hyperactivity Disorder and Attention-Deficit Hyperactivity Disorder Due to Prenatal Alcohol Exposure. Neurotox Res 2021; 39:1054-1075. [PMID: 33751467 PMCID: PMC8442735 DOI: 10.1007/s12640-021-00342-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/24/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is common in patients with (ADHD+PAE) and without (ADHD-PAE) prenatal alcohol exposure (PAE). Many patients diagnosed with idiopathic ADHD actually have covert PAE, a treatment-relevant distinction. To improve differential diagnosis, we sought to identify brain differences between ADHD+PAE and ADHD-PAE using neurobehavioral, magnetic resonance spectroscopy, and diffusion tensor imaging metrics that had shown promise in past research. Children 8-13 were recruited in three groups: 23 ADHD+PAE, 19 familial ADHD-PAE, and 28 typically developing controls (TD). Neurobehavioral instruments included the Conners 3 Parent Behavior Rating Scale and the Delis-Kaplan Executive Function System (D-KEFS). Two dimensional magnetic resonance spectroscopic imaging was acquired from supraventricular white matter to measure N-acetylaspartate compounds, glutamate, creatine + phosphocreatine (creatine), and choline-compounds (choline). Whole brain diffusion tensor imaging was acquired and used to to calculate fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity from the same superventricular white matter regions that produced magnetic resonance spectroscopy data. The Conners 3 Parent Hyperactivity/Impulsivity Score, glutamate, mean diffusivity, axial diffusivity, and radial diffusivity were all higher in ADHD+PAE than ADHD-PAE. Glutamate was lower in ADHD-PAE than TD. Within ADHD+PAE, inferior performance on the D-KEFS Tower Test correlated with higher neurometabolite levels. These findings suggest white matter differences between the PAE and familial etiologies of ADHD. Abnormalities detected by magnetic resonance spectroscopy and diffusion tensor imaging co-localize in supraventricular white matter and are relevant to executive function symptoms of ADHD.
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Affiliation(s)
- Jeffry R Alger
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA.
- Neurospectroscopics, LLC, Sherman Oaks, CA, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Hura Imaging Inc, Calabas, CA, USA.
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Mary J O'Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Guldamla Kalender
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Ng
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Dillon
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jennifer G Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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12
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Raghunathan R, Liu CH, Kouka A, Singh M, Miranda RC, Larin KV. Dose-response analysis of microvasculature changes in the murine fetal brain and the maternal extremities due to prenatal ethanol exposure. J Biomed Opt 2020; 25:JBO-200176RR. [PMID: 33244919 PMCID: PMC7689263 DOI: 10.1117/1.jbo.25.12.126001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/06/2020] [Indexed: 05/29/2023]
Abstract
SIGNIFICANCE Prenatal exposure to ethanol causes several morphological and neurobehavioral deficits. While there are some studies on the effects of ethanol exposure on blood flow, research focusing on acute changes in the microvasculature is limited. AIM The first aim of this study was to assess the dose-dependent changes in murine fetal brain microvasculature of developing fetuses in response to maternal alcohol consumption. The second aim was to quantify changes in vasculature occurring concurrently in the mother's hindlimb and the fetus's brain after maternal exposure to alcohol. APPROACH Correlation mapping optical coherence angiography was used to evaluate the effects of prenatal exposure to different doses of ethanol (3, 1.5, and 0.75 g / kg) on murine fetal brain vasculature in utero. Additionally, simultaneous imaging of maternal peripheral vessels and the fetal brain vasculature was performed to assess changes of the vasculature occurring concurrently in response to ethanol consumption. RESULTS The fetal brain vessel diameters (VDs) decreased by ∼47 % , 30%, and 14% in response to ethanol doses of 3, 1.5, and 0.75 g / kg, respectively. However, the mother's hindlimb VD increased by 63% in response to ethanol at a dose of 3 g / kg. CONCLUSIONS Results showed a dose-dependent reduction in vascular blood flow in fetal brain vessels when the mother was exposed to ethanol, whereas vessels in the maternal hindlimb exhibited concurrent vasodilation.
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Affiliation(s)
- Raksha Raghunathan
- University of Houston, Department of Biomedical Engineering, Houston, Texas, United States
| | - Chih-Hao Liu
- University of Houston, Department of Biomedical Engineering, Houston, Texas, United States
| | - Amur Kouka
- University of Houston, Department of Biomedical Engineering, Houston, Texas, United States
| | - Manmohan Singh
- University of Houston, Department of Biomedical Engineering, Houston, Texas, United States
| | - Rajesh C. Miranda
- Texas A&M University Health Science Center College of Medicine, Department of Neuroscience and Experimental Therapeutics, Bryan, Texas, United States
| | - Kirill V. Larin
- University of Houston, Department of Biomedical Engineering, Houston, Texas, United States
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13
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Wang X, Cuzon Carlson VC, Studholme C, Newman N, Ford MM, Grant KA, Kroenke CD. In utero MRI identifies consequences of early-gestation alcohol drinking on fetal brain development in rhesus macaques. Proc Natl Acad Sci U S A 2020; 117:10035-10044. [PMID: 32312804 PMCID: PMC7211988 DOI: 10.1073/pnas.1919048117] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
One factor that contributes to the high prevalence of fetal alcohol spectrum disorder (FASD) is binge-like consumption of alcohol before pregnancy awareness. It is known that treatments are more effective with early recognition of FASD. Recent advances in retrospective motion correction for the reconstruction of three-dimensional (3D) fetal brain MRI have led to significant improvements in the quality and resolution of anatomical and diffusion MRI of the fetal brain. Here, a rhesus macaque model of FASD, involving oral self-administration of 1.5 g/kg ethanol per day beginning prior to pregnancy and extending through the first 60 d of a 168-d gestational term, was utilized to determine whether fetal MRI could detect alcohol-induced abnormalities in brain development. This approach revealed differences between ethanol-exposed and control fetuses at gestation day 135 (G135), but not G110 or G85. At G135, ethanol-exposed fetuses had reduced brainstem and cerebellum volume and water diffusion anisotropy in several white matter tracts, compared to controls. Ex vivo electrophysiological recordings performed on fetal brain tissue obtained immediately following MRI demonstrated that the structural abnormalities observed at G135 are of functional significance. Specifically, spontaneous excitatory postsynaptic current amplitudes measured from individual neurons in the primary somatosensory cortex and putamen strongly correlated with diffusion anisotropy in the white matter tracts that connect these structures. These findings demonstrate that exposure to ethanol early in gestation perturbs development of brain regions associated with motor control in a manner that is detectable with fetal MRI.
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Affiliation(s)
- Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97214
| | - Verginia C Cuzon Carlson
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239
| | - Colin Studholme
- Biomedical Image Computing Group, Department of Pediatrics, University of Washington, Seattle, WA 98105
- Department of Bioengineering, University of Washington, Seattle, WA 98105
- Department of Radiology, University of Washington, Seattle, WA 98105
| | - Natali Newman
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Matthew M Ford
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239
| | - Christopher D Kroenke
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006;
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97214
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239
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14
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Blanck-Lubarsch M, Dirksen D, Feldmann R, Sauerland C, Hohoff A. Children with Fetal Alcohol Syndrome (FAS): 3D-Analysis of Palatal Depth and 3D-Metric Facial Length. Int J Environ Res Public Health 2019; 17:ijerph17010095. [PMID: 31877770 PMCID: PMC6982319 DOI: 10.3390/ijerph17010095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
Background: Drinking alcohol during pregnancy can result in severe developmental disorders in the child. Symptoms of the fetal alcohol spectrum disorder (FASD) comprise growth deficiencies, abnormal facial phenotype and damage or dysfunction of the central nervous system. Numerous diagnostic methods for facial phenotyping in FASD exist, but diagnoses are still difficult. Our aim was to find additional and objective methods for the verification of FAS(D). Methods: Three-dimensional dental models of 60 children (30 FAS and 30 controls) were used to metrically determine maximum palatal depths at the median palatine raphe. Three-dimensional facial scans were taken, and vertical distances of the face were measured at five defined facial landmarks (FP1–FP5) for each child. Results: Mean palatal height, total facial length (FP1–FP5) as well as FP4–FP5 did not significantly differ between the FAS group and the control group. Comparing vertical facial subdivisions, however, resulted in significant differences for distances FP1 to FP2 (p = 0.042, FAS > controls), FP2 to FP3 (p < 0.001, FAS < controls), FP3 to FP4 (p < 0.001, FAS > controls) and FP3 to FP5 (p = 0.007, FAS > controls). Conclusions: Metric vertical measurements of the face can be used as additional objective criteria for FAS diagnoses. However, no significant differences were reported for palatal depth evaluation in the specific age range tested in the present study.
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Affiliation(s)
- Moritz Blanck-Lubarsch
- Department of Orthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
- Correspondence: ; Tel.: +49-0251-83-47100
| | - Dieter Dirksen
- Department of Prosthodontics and Biomaterials, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Reinhold Feldmann
- Department of Pediatrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, 48149 Münster, Germany;
| | - Ariane Hohoff
- Department of Orthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
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15
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Narayanan DL, Ranganath P, Aggarwal S, Dalal A, Phadke SR, Mandal K. Computer-aided Facial Analysis in Diagnosing Dysmorphic Syndromes in Indian Children. Indian Pediatr 2019; 56:1017-1019. [PMID: 31884430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the utility of computer-aided facial analysis in identifying dysmorphic syndromes in Indian children. METHODS Fifty-one patients with a definite molecular or cytogenetic diagnosis and recognizable facial dysmorphism were enrolled in the study and their facial photographs were uploaded in the Face2Gene software. The results provided by the software were compared with the molecular diagnosis. RESULTS Of the 51 patients, the software predicted the correct diagnosis in 37 patients (72.5%); predicted as the first in the top ten suggestions in 26 (70.2%). In 14 patients, the software did not suggest a correct diagnosis. CONCLUSIONS Computer-aided facial analysis is a method that can aid in diagnosis of genetic syndromes in Indian children. As more clinicians start to use this software, its accuracy is expected to improve.
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Affiliation(s)
- Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. Correspondence to: Dr Dhanya Lakshmi Narayanan, Assistant Professor, Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad , Andhra Pradesh, India.
| | - Prajnya Ranganath
- Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Shagun Aggarwal
- Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Ashwin Dalal
- Diagnostics, Centre and DNA Fingerprinting and Diagnosis, Hyderabad, Andhra Pradesh, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kaushik Mandal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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16
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Ghazi Sherbaf F, Aarabi MH, Hosein Yazdi M, Haghshomar M. White matter microstructure in fetal alcohol spectrum disorders: A systematic review of diffusion tensor imaging studies. Hum Brain Mapp 2019; 40:1017-1036. [PMID: 30289588 PMCID: PMC6865781 DOI: 10.1002/hbm.24409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 07/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Diffusion tensor imaging (DTI) has revolutionized our understanding of the neural underpinnings of alcohol teratogenesis. This technique can detect alterations in white matter in neurodevelopmental disorders, such as fetal alcohol spectrum disorder (FASD). Using Prisma guidelines, we identified 23 DTI studies conducted on individuals with prenatal alcohol exposure (PAE). These studies confirm the widespread nature of brain damage in PAE by reporting diffusivity alterations in commissural, association, and projection fibers; and in relation to increasing cognitive impairment. Reduced integrity in terms of lower fractional anisotropy (FA) and higher mean diffusivity (MD) and radial diffusivity (RD) is reported more consistently in the corpus callosum, cerebellar peduncles, cingulum, and longitudinal fasciculi connecting frontal and temporoparietal regions. Although these interesting results provide insight into FASD neuropathology, it is important to investigate the clinical diversity of this disorder for better treatment options and prediction of progression. The aim of this review is to provide a summary of different patterns of neural structure between PAE and typically developed individuals. We further discuss the association of alterations in diffusivity with demographic features and symptomatology of PAE. With the accumulated knowledge of the neural correlates of FASD presenting symptoms, a comprehensive understanding of the heterogeneity in FASD will potentially improve the disease management and will highlight the diagnostic challenges and potential areas of future research avenues, where neural markers may be beneficial.
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Affiliation(s)
| | | | - Meisam Hosein Yazdi
- Namazee Hospital, Imaging Research Center, Department of RadiologyShiraz University of Medical SciencesShirazIran
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17
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Suttie M, Wozniak JR, Parnell SE, Wetherill L, Mattson SN, Sowell ER, Kan E, Riley EP, Jones KL, Coles C, Foroud T, Hammond P. Combined Face-Brain Morphology and Associated Neurocognitive Correlates in Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2018; 42:1769-1782. [PMID: 29935097 PMCID: PMC6120799 DOI: 10.1111/acer.13820] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Received: 03/05/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since the 1970s, a range of facial, neurostructural, and neurocognitive adverse effects have been shown to be associated with prenatal alcohol exposure. Typically, these effects are studied individually and not in combination. Our objective is to improve the understanding of the teratogenic effects of prenatal alcohol exposure by simultaneously considering face-brain morphology and neurocognitive measures. METHODS Participants were categorized as control (n = 47), fetal alcohol syndrome (FAS, n = 22), or heavily exposed (HE) prenatally, but not eligible for a FAS diagnosis (HE, n = 50). Structural brain MRI images and high-resolution 3D facial images were analyzed using dense surface models of features of the face and surface shape of the corpus callosum (CC) and caudate nucleus (CN). Asymmetry of the CN was evaluated for correlations with neurocognitive measures. RESULTS (i) Facial growth delineations for FAS, HE, and controls are replicated for the CN and the CC. (ii) Concordance of clinical diagnosis and face-based control-FAS discrimination improves when the latter is combined with specific brain regions. In particular, midline facial regions discriminate better when combined with a midsagittal profile of the CC. (iii) A subset of HE individuals was identified with FAS-like CN dysmorphism. The average of this HE subset was FAS-like in its facial dysmorphism. (iv) Right-left asymmetry found in the CNs of controls is not apparent for FAS, is diminished for HE, and correlates with neurocognitive measures in the combined FAS and HE population. CONCLUSIONS Shape analysis which combines facial regions with the CN, and with the CC, better identify those with FAS. CN asymmetry was reduced for FAS compared to controls and is strongly associated with general cognitive ability, verbal learning, and recall in those with prenatal alcohol exposure. This study further extends the brain-behavior relationships known to be vulnerable to alcohol teratogenesis.
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Affiliation(s)
- Michael Suttie
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | | | - Scott E. Parnell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Sarah N. Mattson
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elizabeth R. Sowell
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Eric Kan
- Department of Pediatrics, University of Southern California and Children’s Hospital Los Angeles, USA
| | - Edward P. Riley
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Kenneth L. Jones
- Department of Pediatrics, School of Medicine, UCSD, San Diego, USA
| | - Claire Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Peter Hammond
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | - CIFASD
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
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18
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Cheng DT, Meintjes EM, Stanton ME, Dodge NC, Pienaar M, Warton CM, Desmond JE, Molteno CD, Peterson BS, Jacobson JL, Jacobson SW. Functional MRI of Human Eyeblink Classical Conditioning in Children with Fetal Alcohol Spectrum Disorders. Cereb Cortex 2017; 27:3752-3767. [PMID: 28169393 PMCID: PMC6075216 DOI: 10.1093/cercor/bhw273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/16/2015] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022] Open
Abstract
Prenatal alcohol exposure has been linked to a broad range of developmental deficits, with eyeblink classical conditioning (EBC) among the most sensitive endpoints. This fMRI study compared EBC-related brain activity in 47 children with fetal alcohol syndrome (FAS), partial FAS (PFAS), heavily exposed (HE) non-syndromal children, and healthy controls. All of the children had previously participated in two EBC studies conducted as part of our longitudinal study of fetal alcohol spectrum disorders. Although learning-related behavioral differences were seen in all groups during the scans, controls showed more conditioned responses (CR) than the alcohol-exposed groups. Despite lower conditioning levels relative to controls, the exposed groups exhibited extensive cerebellar activations. Specifically, children with FAS/PFAS showed increased activation of cerebellar lobule VI in session 2, while HE children showed increased activation in session 1. Continuous measures of prenatal alcohol use correlated with learning-related activations in cerebellum and frontal cortices. Only controls showed significant cerebellar activation-CR correlations in the deep nuclei and lateral lobule VI, suggesting that these key regions supporting EBC may be functionally disorganized in alcohol-exposed children. These findings are the first to characterize abnormalities in brain function associated with the behavioral conditioning deficits seen in children with prenatal alcohol exposure.
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Affiliation(s)
- Dominic T. Cheng
- Johns Hopkins University, School of Medicine, Baltimore, MD
21205, USA
| | - Ernesta M. Meintjes
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
| | | | - Neil C. Dodge
- Wayne State University, School of Medicine, Detroit, MI 48207,
USA
| | - Mariska Pienaar
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
| | - Christopher M.R. Warton
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
| | - John E. Desmond
- Johns Hopkins University, School of Medicine, Baltimore, MD
21205, USA
| | - Christopher D. Molteno
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
| | - Bradley S. Peterson
- Children's Hospital Los Angeles andUniversity of Southern California, Los Angeles, CA 90027,
USA
| | - Joseph L. Jacobson
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
- Wayne State University, School of Medicine, Detroit, MI 48207,
USA
| | - Sandra W. Jacobson
- University of Cape Town, Faculty of
Health Sciences, Observatory, Western Cape 7925, South
Africa
- Wayne State University, School of Medicine, Detroit, MI 48207,
USA
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19
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Hendrickson TJ, Mueller BA, Sowell ER, Mattson SN, Coles CD, Kable JA, Jones KL, Boys CJ, Lim KO, Riley EP, Wozniak JR. Cortical gyrification is abnormal in children with prenatal alcohol exposure. Neuroimage Clin 2017; 15:391-400. [PMID: 28580296 PMCID: PMC5447653 DOI: 10.1016/j.nicl.2017.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 11/17/2016] [Revised: 04/18/2017] [Accepted: 05/21/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Prenatal alcohol exposure (PAE) adversely affects early brain development. Previous studies have shown a wide range of structural and functional abnormalities in children and adolescents with PAE. The current study adds to the existing literature specifically on cortical development by examining cortical gyrification in a large sample of children with PAE compared to controls. Relationships between cortical development and intellectual functioning are also examined. EXPERIMENTAL DESIGN Included were 92 children with PAE and 83 controls ages 9-16 from four sites in the Collaborative Initiative on FASD (CIFASD). All PAE participants had documented heavy PAE. All underwent a formal evaluation of physical anomalies and dysmorphic facial features. MRI data were collected using modified matched protocols on three platforms (Siemens, GE, and Philips). Cortical gyrification was examined using a semi-automated procedure. PRINCIPAL OBSERVATIONS Whole brain group comparisons using Monte Carlo z-simulation for multiple comparisons showed significantly lower cortical gyrification across a large proportion of the cerebral cortex amongst PAE compared to controls. Whole brain comparisons and ROI based analyses showed strong positive correlations between cortical gyrification and IQ (i.e. less developed cortex was associated with lower IQ). CONCLUSIONS Abnormalities in cortical development were seen across the brain in children with PAE compared to controls. Cortical gyrification and IQ were strongly correlated, suggesting that examining mechanisms by which alcohol disrupts cortical formation may yield clinically relevant insights and potential directions for early intervention.
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Affiliation(s)
| | | | - Elizabeth R Sowell
- Children's Hospital of Los Angeles, University of Southern California, United States
| | | | | | | | | | | | - Kelvin O Lim
- University of Minnesota, Twin Cities, United States
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Fish EW, Holloway HT, Rumple A, Baker LK, Wieczorek LA, Moy SS, Paniagua B, Parnell SE. Acute alcohol exposure during neurulation: Behavioral and brain structural consequences in adolescent C57BL/6J mice. Behav Brain Res 2016; 311:70-80. [PMID: 27185739 DOI: 10.1016/j.bbr.2016.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 02/10/2016] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 12/14/2022]
Abstract
Prenatal alcohol exposure (PAE) can induce physical malformations and behavioral abnormalities that depend in part on thedevelopmental timing of alcohol exposure. The current studies employed a mouse FASD model to characterize the long-term behavioral and brain structural consequences of a binge-like alcohol exposure during neurulation; a first-trimester stage when women are typically unaware that they are pregnant. Time-mated C57BL/6J female mice were administered two alcohol doses (2.8g/kg, four hours apart) or vehicle starting at gestational day 8.0. Male and female adolescent offspring (postnatal day 28-45) were then examined for motor activity (open field and elevated plus maze), coordination (rotarod), spatial learning and memory (Morris water maze), sensory motor gating (acoustic startle and prepulse inhibition), sociability (three-chambered social test), and nociceptive responses (hot plate). Regional brain volumes and shapes were determined using magnetic resonance imaging. In males, PAE increased activity on the elevated plus maze and reduced social novelty preference, while in females PAE increased exploratory behavior in the open field and transiently impaired rotarod performance. In both males and females, PAE modestly impaired Morris water maze performance and decreased the latency to respond on the hot plate. There were no brain volume differences; however, significant shape differences were found in the cerebellum, hypothalamus, striatum, and corpus callosum. These results demonstrate that alcohol exposure during neurulation can have functional consequences into adolescence, even in the absence of significant brain regional volumetric changes. However, PAE-induced regional shape changes provide evidence for persistent brain alterations and suggest alternative clinical diagnostic markers.
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Affiliation(s)
- E W Fish
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - H T Holloway
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - A Rumple
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - L K Baker
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - L A Wieczorek
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - S S Moy
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - B Paniagua
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States
| | - S E Parnell
- Bowles Center for Alcohol Studies (EWF, HTH, LKB, LAW, SEP), Department of Cell Biology and Physiology (SEP), Department of Psychiatry (AMR, SSM, BP), and Carolina Institute for Developmental Disabilities (SSM, BP, SEP), University of North Carolina, Chapel Hill, NC 27599, United States.
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Menezes C, Ribeiro I, Coelho P, Mateus C, Teixeira C. Pattern of Retinal Nerve Fiber Layer Thickness Loss in Fetal Alcohol Syndrome: A Spectral-Domain Optical Coherence Tomography Analysis. ACTA MEDICA PORT 2016; 29:254-60. [PMID: 27349777 DOI: 10.20344/amp.6871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/02/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Optic disc hypoplasia is a common feature in fetal alcohol syndrome. Thus, we aimed to evaluate the optic disc morphology changes and the peripapillary retinal nerve fiber layer thickness in these patients. MATERIAL AND METHODS We performed spectral-domain optical coherence tomography in a cohort of 11 patients (22 eyes) with fetal alcohol syndrome and in an age-matched control group. We evaluated optic nerve head parameters (optic disc area and diameter, rim area, cup/disc horizontal and vertical ratios) and peripapillary retinal nerve fiber layer thickness. RESULTS Mean optic disc area, rim area and optic disc diameter were, respectively, in fetal alcohol syndrome patients and control subjects: 1.540 ± 0.268 and 1.748 ± 0.326 mm2; 1.205 ± 0.286 and 1.461 ± 0.314 mm2; 1.417 ± 0.124 and 1.501 ± 0.148 mm (p < 0.05). We found no significant differences between groups for cup/disc ratios. Mean retinal nerve fiber layer thickness was significantly lower in fetal alcohol syndrome patients (90.500 ± 9.344 µm) as compared to controls (111.000 ± 7.855 µm) (p < 0.0001). Analysis showed a significant decrease in retinal nerve fiber layer thickness for the superior, inferior and nasal quadrants (p < 0.005). The temporal quadrant showed no significant differences. DISCUSSION Optic disc area, rim area and optic disc diameters were significantly reduced in fetal alcohol syndrome patients. Although mean peripapillary retinal nerve fiber layer thickness was decreased, the temporal quadrant was spared. CONCLUSION In addition to a smaller optic disc area/ diameter and rim area, we found a heterogeneous peripapillary retinal nerve fiber layer thickness loss in fetal alcohol syndrome patients with sparing of the temporal quadrant. Spectral-domain optical coherence tomography may be useful to determine the presence of fetal alcohol syndrome status.
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Affiliation(s)
- Carlos Menezes
- Ophthalmology Department. Hospital Pedro Hispano. Matosinhos
| | - Isabel Ribeiro
- Ophthalmology Department. Hospital Pedro Hispano. Matosinhos
| | - Pedro Coelho
- Ophthalmology Department. Hospital Pedro Hispano. Matosinhos
| | - Catarina Mateus
- Ophthalmology Department. Hospital Pedro Hispano. Matosinhos
| | - Carla Teixeira
- Ophthalmology Department. Hospital Pedro Hispano. Matosinhos
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Anna Dyląg K, Sikora-Sporek A, Bańdo B, Boroń-Zyss J, Drożdż D, Dumnicka P, Przybyszewska K, Sporek M, Walocha JW, Wojciechowski W, Urbanik A. Magnetic resonance imaging (MRI) findings among children with fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS) and alcohol related neurodevelopmental disorders (ARND). Przegl Lek 2016; 73:605-609. [PMID: 29688653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The aim of the study was to analyze the findings in MRI (magnetic resonance imaging) of the brain amongst children diagnosed with fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS) or alcohol related neurodevelopmental disorders (ARND). The issue has been studied in several researches previously but the experts agree that there is still few data on the MRI results in the group of younger children. MATERIAL AND METHODS MRI results of 121 patients with either FAS or pFAS or ARND diagnosed with Canadian criteria were analyzed regarding the presence of abnormalities. The group consisted of 71 patients diagnosed with FAS, 33 diagnosed with pFAS and 17 diagnosed with ARND. The mean age of the patients was 8.03 years (standard deviation 4.07). RESULTS In the total group of FASD patients 61.98% of the patients’ MRI results were abnormal. The most common abnormality in MRI of the patients were demyelination plaques (incidence 23.1%) and corpus callosum narrowing (20.7%) as well as ventricular asymmetry (18.8%).The demyelination plaques and corpus callosum narrowing were more frequent among children ≤4 years old (41.7% vs 18.6%; p=0.016 and 50.0% vs.13.4%; p<0.001, respectively). Age ≤4 years predicted the presence of demyelination plaques and corpus callosum narrowing independently of FAS diagnosis. Among younger children, multiple central nervous system abnormalities were observed more often than in the older age group (54.2% vs. 14.4%; p<0.001). Odds ratio for multiple changes was 0.84 per one-year increase in age (95% CI 0.73-0.97), p=0.016. Furthermore, in the analysis according to the specific diagnosis, among the patients diagnosed with FAS, multiple anomalies were more common than in pFAS and ARND. Both age ≤4 years and FAS diagnosis were independent predictors for multiple anomalies in multiple logistic regression. CONCLUSION In structural brain MRI of younger children, multiple anomalies were found more frequently than among older children. Demyelination plaques and corpus callosum narrowing were more common in younger FASD patients than in older ones.
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Tongsong T, Puntachai P, Mekjarasnapha M, Traisrisilp K. Severe fetal brain shrinkage following heavy maternal alcohol consumption. Ultrasound Obstet Gynecol 2014; 44:245-247. [PMID: 24777961 DOI: 10.1002/uog.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/06/2014] [Accepted: 04/17/2014] [Indexed: 06/03/2023]
Affiliation(s)
- T Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Sudheendran N, Bake S, Miranda RC, Larin KV. Comparative assessments of the effects of alcohol exposure on fetal brain development using optical coherence tomography and ultrasound imaging. J Biomed Opt 2013; 18:20506. [PMID: 23386196 PMCID: PMC3563965 DOI: 10.1117/1.jbo.18.2.020506] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 05/19/2023]
Abstract
The developing fetal brain is vulnerable to a variety of environmental agents including maternal ethanol consumption. Preclinical studies on the development and amelioration of fetal teratology would be significantly facilitated by the application of high resolution imaging technologies like optical coherence tomography (OCT) and high-frequency ultrasound (US). This study investigates the ability of these imaging technologies to measure the effects of maternal ethanol exposure on brain development, ex vivo, in fetal mice. Pregnant mice at gestational day 12.5 were administered ethanol (3 g/Kg b.wt.) or water by intragastric gavage, twice daily for three consecutive days. On gestational day 14.5, fetuses were collected and imaged. Three-dimensional images of the mice fetus brains were obtained by OCT and high-resolution US, and the volumes of the left and right ventricles of the brain were measured. Ethanol-exposed fetuses exhibited a statistically significant, 2-fold increase in average left and right ventricular volumes compared with the ventricular volume of control fetuses, with OCT-derived measures of 0.38 and 0.18 mm3, respectively, whereas the boundaries of the fetal mouse lateral ventricles were not clearly definable with US imaging. Our results indicate that OCT is a useful technology for assessing ventriculomegaly accompanying alcohol-induced developmental delay. This study clearly demonstrated advantages of using OCT for quantitative assessment of embryonic development compared with US imaging.
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Affiliation(s)
- Narendran Sudheendran
- University of Houston, Department of Biomedical Engineering, 2028 SERC Building, Houston, Texas 77204
| | - Shameena Bake
- TAMHSC College of Medicine, Department of Neuroscience and Experimental Therapeutics, Bryan, Texas 77807
| | - Rajesh C. Miranda
- TAMHSC College of Medicine, Department of Neuroscience and Experimental Therapeutics, Bryan, Texas 77807
| | - Kirill V. Larin
- University of Houston, Department of Biomedical Engineering, 2028 SERC Building, Houston, Texas 77204
- Saratov State University, Institute of Optics and Biophotonics, Saratov 410012, Russia
- Address all correspondence to: Kirill V. Larin, University of Houston, Department of Biomedical Engineering, 2028 SERC Building, Houston, Texas 77204. E-mail:
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Kfir M, Yevtushok L, Onishchenko S, Wertelecki W, Bakhireva L, Chambers CD, Jones KL, Hull AD. Can prenatal ultrasound detect the effects of in-utero alcohol exposure? A pilot study. Ultrasound Obstet Gynecol 2009; 33:683-9. [PMID: 19444822 PMCID: PMC3746738 DOI: 10.1002/uog.6379] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The aim of this pilot study was to explore possible ultrasound parameters for the early detection of alcohol-mediated fetal somatic and central nervous system (CNS) maldevelopment. Maternal alcohol ingestion during pregnancy may lead to fetal alcohol spectrum disorders (FASD), which encompass a broad range of structural abnormalities including growth impairment, specific craniofacial features and CNS abnormalities. Early detection of fetuses at risk of FASD would support earlier interventions. METHODS We performed a longitudinal prospective pilot study from 2004 to 2006 at two sites in Ukraine. A sample of pregnant women who reported consuming moderate-to-heavy amounts of alcohol participated in a comprehensive maternal interview, and received ultrasound evaluation of fetal growth and specific fetal brain measurements during the second and third trimesters. These measurements were compared with those collected from a group of pregnant women who consumed little-to-no alcohol during pregnancy, and who were recruited and followed in the same manner. RESULTS From 6745 screened women, 84 moderate-to-heavy alcohol users and 82 comparison women were identified and ultrasound examinations performed. After controlling for maternal smoking, alcohol-exposed fetuses had shorter mean femur length, caval-calvarial distance and frontothalamic measurements in the second trimester (P < 0.05), and alcohol-exposed fetuses also had shorter frontothalamic distance measurements in the third trimester relative to comparison fetuses (P < 0.05). In addition, after controlling for maternal smoking, both mean orbital diameter and biparietal diameter measurements were significantly smaller on average in the alcohol-exposed group in the third trimester relative to comparison fetuses (P < 0.05). CONCLUSIONS Significant differences in selected somatic and brain measurements were noted between alcohol-exposed and comparison fetuses, suggesting these markers may be further explored for clinical utility in prenatal identification of affected children. Further study correlating these findings with alcohol-related physical features of the newborn and subsequent comparisons of neuro-developmental outcomes will help define potential uses of prenatal ultrasound for intervention and prevention of FASD.
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Affiliation(s)
- M Kfir
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA 92103-8433, USA
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26
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Bookstein FL, Connor PD, Huggins JE, Barr HM, Pimentel KD, Streissguth AP. Many infants prenatally exposed to high levels of alcohol show one particular anomaly of the corpus callosum. Alcohol Clin Exp Res 2007; 31:868-79. [PMID: 17386071 DOI: 10.1111/j.1530-0277.2007.00367.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Effects of prenatal alcohol exposure on the brain are seen at every age. The earlier they can be quantified, the better the prognosis for the affected child. Here we show measurable alcohol effects at birth on a structure currently used for nosology only much later in life. METHODS Midline shape of the corpus callosum was imaged in infants via averaged unwarped transfontanelle ultrasound. We compared measures of these shapes among 23 infants prenatally exposed to high levels of alcohol and 21 infants unexposed to alcohol or only lightly exposed. RESULTS A particular feature of the corpus callosum, the appearance of a "hook" (obtuse angle) between the splenium and the long diameter of the arch in this plane, is strongly associated with prenatal alcohol exposure. In half of the high-exposed infants, the splenium angle is larger than in any of the unexposed brains. Simply characterizing this angle as less than or greater than 90 degrees detects 12 of the 23 exposed infants as anomalous with only 1 false positive among the unexposed. This apparently direct effect of prenatal ethanol exposure on the details of the callosum in about half the at-risk subjects cannot be attributed to any of several plausible competing exposures or other confounding factors applying during or after gestation. CONCLUSION An average of the images for the unexposed subjects has the geometry of textbook images of normal babies; but the average for the subgroup of high-angle subjects may serve as a template or guide to this regional damage parallel to the familiar photographic exemplars that help to assess facial signs.
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Affiliation(s)
- Fred L Bookstein
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, The University of Washington, Seattle, Washington 98195, USA.
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27
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Abstract
Three-dimensional ultrasound has become an essential tool for visualization of fetal structures in the past few years. The recent improvements in transducers and signal processing provide new information, particularly in obstetrics and gynecology sonography. The present paper will present the most recent advances in volume acquisition and presentation modes followed by results of fetal organ visualization in normal and abnormal cases as well as applications in gynecology.
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Affiliation(s)
- Jm Levaillant
- Hôpital Antoine Béclère, 157, rue de la Porte de Trivaux, 92141 Clamart Cedex
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28
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Abstract
Foetal alcohol syndrome (FAS) consists of multisystem abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human foetus has now been established beyond reasonable doubt and FAS is one of the most important human teratogenic conditions known today. The purpose of this study was to assess the dental age (DA) and skeletal age (SA) of children with FAS and compare them with matched controls. The samples of 90 children diagnosed with FAS and 90 controls were matched for age, gender, and social class. The mean chronological age (CA) of the FAS subjects was 8.95 years, with the controls slightly older at 9.04 years. This difference was not significant. Dental maturity was determined by assessing the stage of tooth formation and SA assessment was made from hand-wrist radiographs for the patients and controls by assigning a SA and comparing it with standard plates. The means and standard deviations of CA and DA for the stages of calcification were calculated and the Pearson ranked order correlation coefficient was applied to measure the associations between skeletal maturity indicators and DA. t-tests were used to test for group differences between independent groups, and paired t-tests to determine paired group differences. This study provided evidence of a positive association between DA and SA in both the FAS children and the controls. The data suggest that both DA and SA may be a reflection of general somatic growth. It must be acknowledged that growth of individuals is often irregular, when any norms of development based on central tendencies and variabilities of healthy children are applied. Some aspects of growth and development for healthy children may show a variable pattern of growth. Therefore, correlation of these aspects of growth and development will often not show the degree of correlation that theoretically exists between different areas of growth and development. A more complete appraisal of the entire skeleton and an evaluation of the entire dentition, rather than just the mandibular teeth, might improve the correlation between the variables.
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Affiliation(s)
- Sudeshni Naidoo
- Department of Community Oral Health, Tygerberg, South Africa.
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Bode MK, Karttunen A, Karttunen V, Jartti P. [Radiological findings of brain, connected to alcohol overuse]. Duodecim 2006; 122:315-23. [PMID: 16619889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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30
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Abstract
Foetal alcohol syndrome (FAS) consists of multi-system abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human foetus has now been established beyond reasonable doubt and FAS is the most important human teratogenic condition known today. The purpose of this study was to analyse the craniofacial parameters of children with FAS and compare them with matched controls. Ninety children diagnosed with FAS (45 males, 45 females) and 90 controls were matched for age, gender, and social class. The mean age of the FAS children was 8.9 years with the controls slightly older at 9.1 years. This age difference was not significant (P = 0.34). A standard lateral cephalometric radiograph of each subject was taken. The radiographs were digitized for 20 linear and 17 angular measurements. These 37 variables were formulated to assess the size, shape, and relative position of three craniofacial complexes: (1) the cranial base, (2) midface, and (3) mandible. In addition, nine variables were computed to compare the soft tissue profiles. The study showed that measurements related to face height and mandibular size appear to be the most important features when distinguishing FAS children. Overall, the FAS children in the present study presented with vertically and horizontally underdeveloped maxillae, together with features of long face syndrome with large gonial angles and a short ramus in relation to total face height. There was also a tendency for the development of an anterior open bite, which appears to be compensated for by an increase in the vertical dimension of the anterior alveolar process to bring the incisor teeth into occlusion. The latter adaptation occurred mainly in the mandible.
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Affiliation(s)
- Sudeshni Naidoo
- Department of Community Oral Health, Tygerberg, South Africa.
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Batra S, Wrigley ECW. Alcohol: the teratogen. J OBSTET GYNAECOL 2005; 25:308-9. [PMID: 16147750 DOI: 10.1080/01443610500106751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S Batra
- Department of Obstetrics & Gynaecology, Wythenshawe Hospital, Manchester, UK.
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Kulwa E, Tharakan T, Baxi L. Congenital Cystic Adenomatoid Malformation in the Fetus: A Hypothesis of Its Development. Fetal Diagn Ther 2005; 20:472-4. [PMID: 16113577 DOI: 10.1159/000086836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 12/20/2004] [Indexed: 11/19/2022]
Abstract
We present a case of congenital cystic adenomatoid malformation of the lung diagnosed at 34 weeks of gestation in the setting of polyhydramnios. The fetus had CCAM in the L lung, with mediastinal shift to the right and ascites. The neonate underwent drainage of cysts and subsequent left lung lobar resection with improvement in respiratory function. The pathology of CCAM is reviewed in detail. We speculate the role of alcohol as a teratogen through retinoic acid at 8-10 weeks of gestation when fetal lungs are actively developing.
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Affiliation(s)
- Ema Kulwa
- Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia University Medical Center of New York Presbyterian Hospital and College of Physicians and Surgeons of Columbia University, New York, N.Y. 10032, USA
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Bookstein FL, Connor PD, Covell KD, Barr HM, Gleason CA, Sze RW, McBroom JA, Streissguth AP. Preliminary evidence that prenatal alcohol damage may be visible in averaged ultrasound images of the neonatal human corpus callosum. Alcohol 2005; 36:151-60. [PMID: 16377456 DOI: 10.1016/j.alcohol.2005.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 04/11/2005] [Revised: 07/01/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
Brain damage consequent to prenatal alcohol exposure can be detected by measurements of the corpus callosum in the midline magnetic resonance (MR) brain image in adolescents and adults. The present article extends this finding into the neonatal period, when the power of detection to ameliorate the quality of the child's future life is greatest. The midline corpus callosum of the very young infant can be located reliably in multiple frames of clinical transfontanelle ultrasound. We studied a sample of 18 children aged 17 weeks or less, 7 of whom were exposed to high levels of alcohol prenatally and 11 of whom were not exposed or only minimally exposed. The midline callosum of each child was imaged up to 50 times by a standard clinical device, and coplanar subsets of these series were averaged with reference to fiducial image structures. On each average image four semilandmark points were set and their configuration quantified by standard landmark methods. The angle between the terminal bulb of splenium and the long axis of the callosal outline classifies four of the seven exposed infants as different from all 11 of the unexposed infants. This simple angle measurement upon averaged ultrasound images of the human neonatal midline corpus callosum, perhaps a version of the long-sought "biomarker of prenatal alcohol damage," may be able to discriminate baby brains affected by prenatal alcohol exposure from those that were unaffected.
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Affiliation(s)
- Fred L Bookstein
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
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Riikonen RS, Nokelainen P, Valkonen K, Kolehmainen AI, Kumpulainen KI, Könönen M, Vanninen RLS, Kuikka JT. Deep serotonergic and dopaminergic structures in fetal alcoholic syndrome: a study with nor-beta-CIT-single-photon emission computed tomography and magnetic resonance imaging volumetry. Biol Psychiatry 2005; 57:1565-72. [PMID: 15953494 DOI: 10.1016/j.biopsych.2005.01.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Revised: 12/27/2004] [Accepted: 01/18/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND In prenatally alcohol exposed children, the relationship between brain structure and function is highlighted to be important to study. METHODS We studied 12 children with fetal alcoholic syndrome (FAS) and fetal alcoholic effects (FAE) by magnetic resonance imaging volumetry and by single-photon emission computed tomography with iodine-123 labeled 2beta-carbomethoxy-3beta-(4-iodophenyl) ([123I]nor-beta-CIT) and related these findings to those from neuropsychological and psychiatric tests. RESULTS The absolute volumes of studied nuclei, including the brain volume, were significantly smaller in FAS/FAE children than in control patients. After normalization of volumes, significant differences were not found. Left hippocampus was smaller than the right (p<.003) but did not significantly differ from the control subjects. The children with FAS/FAE showed reduced serotonin (p=.02) in the medial frontal cortex and slightly increased striatal dopamine transporter binding. All FAS/FAE children had attention-deficit/hyperkinetic disorder (ADHD). None had depression. The internalization scores correlated with dopamine transporter binding (r=-.65; p=.03). CONCLUSIONS The results indicate that the serotonin (5-HT) system may be vulnerable to the effects of ethanol in utero. The high dopamine transporter levels may correlate with the ADHD findings. Reduced serotonin and increased binding of dopamine transporter are also seen in type 2 alcoholism. Some behavioral problems of FAS/FAE might be preventable by early intervention and treatment.
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Affiliation(s)
- Raili S Riikonen
- Department of Child Neurology, Kuopio University Hospital, Kuopio, Finland.
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Abstract
Midaortic syndrome (MAS) is an uncommon condition characterized by progressive narrowing of the abdominal aorta and its branches and impressive formation of collateral circulation. It affects children and young adults and presents predominantly as untreatable hypertension. Fetal alcohol syndrome (FAS) refers to a constellation of physical, behavioral, and cognitive abnormalities secondary to alcohol exposure in utero. The authors present an unusual association between a hypoplastic abdominal aorta and fetal alcohol syndrome. The patient discussed in this article presented with severe hypertension that was successfully treated with renal angioplasty.
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Affiliation(s)
- Marco A Cura
- Department of Radiology, Mount Sinai Medical Center of Miami Beach, Florida 33140, USA.
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Bhatara VS, Lovrein F, Kirkeby J, Swayze V, Unruh E, Johnson V. Brain function in fetal alcohol syndrome assessed by single photon emission computed tomography. S D J Med 2002; 55:59-62. [PMID: 11865707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This case series reports results of single photon emission computed tomography (SPECT) studies in three patients with fetal alcohol syndrome (FAS), who had previously undergone structural magnetic resonance imaging (MR). The MR studies revealed several brain anomalies, including microcephaly, agenesis or hypoplasia of corpus callosum and agenesis of hippocampal commissure. The SPECT data revealed that the CBF was reduced by at least 25% in the temporal region relative to the cerebellum in all three patients. By contrast, the temporal-cerebellar differences were between 4% and 7% in two controls. The functional abnormalities in FAS, like neuroanatomical abnormalities, are likely to be multiple and varied because of heterogeneity of this syndrome. Our findings suggest the need for a larger study to test the hypothesis that temporal lobe abnormalities are a notable occurrence in FAS. Discovery of specific regional brain dysfunctions (such as temporal lobe dysfunction) that are particularly vulnerable to alcohol's teratogenic effect may allow clinicians and researchers to look for markers useful in FAS screening and may have implications for prevention and treatment of FAS.
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Jouitteau B, Massias C, Sanyas P. [Fetal alcohol syndrome]. J Radiol 2000; 81:1709-12. [PMID: 11173763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Fetal alcohol syndrome is frequently observed. It is estimated that 0.2% of newborns in France have fetal alcohol syndrome, a rate which reaches 1% in certain studies. Ultrasound diagnosis is straightforward, based on: - intrauterine growth retardation, predominantly involving the limbs and occurring early without oligoamnios; - specific facial dysmorphism with two essential signs, frontal rounding of the philtrum, suppression of the Cupidon arch; - several malformations involving the corpus callosum, ocular and renal tissue; - markedly higher incidence in multiple parity women over thirty who gain little weight during pregnancy. We report seven cases observed between 1994 and 1999 and discuss the growth curve and the facial dysmorphism.
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Abstract
Six boys and five girls with a mean age of 8.6 (range 3 to 13) years with foetal alcohol syndrome (FAS) were studied by MRI and single photon emission computed tomography (SPECT) to find specific areas of vulnerability. Morphological anomalies shown in six of 11 patients by MRI were situated both cortically and subcortically: cortical atrophy (N = 2), dilated ventricle (N = 1), corpus callosum hypoplasia (N = 1), cerebellar atrophy (N = 2), one of the latter with Arnold-Chiari malformation (N = 1). Delayed myelination of the white matter was seen in two patients. Volumetric studies of the hippocampus showed morphological left-right asymmetry in five of eight patients. However, SPECT showed mild hypoperfusion of the left hemisphere in all 10 subjects. The negative left-right index was located especially in the left parietooccipital region, i.e. in the brain areas implicated in arithmetical and logical-grammatical functions, which are known to be affected in FAS. Normal left-right dominance was also lacking in the frontal area, i.e. the brain area affected in attention-deficit-hyperactivity disorder (ADHD). Detection of these abnormalities, although they are not unique to FAS, may be helpful in the diagnosis and any attempts at rehabilitation. Diverse morphological and functional abnormalities are more frequent than has usually been believed even in less impaired children with FAS.
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Affiliation(s)
- R Riikonen
- Department of Child Neurology, Children's Hospital, Kuopio, Finland
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Mathelier AC, Karachorlu K. Vanished twin and fetal alcohol syndrome in the surviving twin. A case report. J Reprod Med 1999; 44:394-8. [PMID: 10319316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The diagnosis of twin pregnancy can be made early in pregnancy by ultrasonography (US). Follow-up examination occasionally demonstrates the disappearance of one of the twins. CASE A twin disappeared on US examination; the surviving twin exhibited signs of fetal alcohol syndrome and other congenital anomalies, accompanied by a placental form of fetus papyraceus. CONCLUSION Early US examination is useful for diagnosing multiple gestation. However, a follow-up examination is required to alert the clinician to the disappearance of one twin. Careful examination of the placenta may document fetal remnants. In this case a small, atretic nodule on the placental surface was evidence of the vanished twin.
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Affiliation(s)
- A C Mathelier
- Department of Obstetrics and Gynecology, St. Bernard Hospital, Chicago, Illinois, USA
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Abstract
PURPOSE This study set out to collect reference data for normal ocular growth and to study the teratological effects of alcohol on eye development. METHODS Eye size was studied in 92 healthy Swedish children (age 1 month to 16 years) as reference and in 13 children (age 1.4 months to 17 years) with fetal alcohol syndrome (FAS) using ultrasonographic axial length measurements. Another three children with FAS were evaluated by clinical examination only. RESULTS The control group demonstrated a marked increase in total axial length during the first 2 years of life. Girls with FAS had a shorter total axial length (p = 0.045) than their controls. Both boys and girls with FAS demonstrated a relatively smaller vitreous body than the controls, p = 0.015 and 0.068, respectively. Three children with FAS had severe structural anomalies. CONCLUSION The observations support previous studies indicating that alcohol has an adverse effect on growth and configuration of the eye.
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Affiliation(s)
- A Hellström
- Department of Clinical Neurosciences, Chalmers University of Technology, Gothenburg, Sweden
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MacGregor SN, Tamura R, Sabbagha R, Brenhofer JK, Kambich MP, Pergament E. Isolated hyperechoic fetal bowel: significance and implications for management. Am J Obstet Gynecol 1995; 173:1254-8. [PMID: 7485332 DOI: 10.1016/0002-9378(95)91365-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of this study was to determine the significance of isolated hyperechoic fetal bowel. STUDY DESIGN Forty-five cases with prospective, ultrasonographic diagnosis of isolated hyperechoic fetal bowel were reviewed. Fetal variables, including aneuploidy, deoxyribonucleic acid studies for cystic fibrosis, congenital infection, growth retardation, and intrauterine death were reported. RESULTS Thirty-four of the 45 cases (76%) resulted in live-born infants without detected abnormalities. However, hyperechoic bowel was associated with cystic fibrosis in two cases (4%), congenital infection in two cases (4%), and fetal alcohol syndrome in one case. Termination of pregnancy was elected in three cases and intrauterine fetal death occurred in three cases (7%). Growth retardation was observed in five of 39 (13%) live-born infants. CONCLUSION Isolated hyperechoic fetal bowel is associated with significant pathologic disorders. Women whose fetuses are diagnosed as having isolated hyperechoic bowel should be offered additional prenatal diagnostic options, including maternal serologic studies for congenital infection, fetal karyotype, and deoxyribonucleic acid testing for cystic fibrosis. In addition, continuing ultrasonographic evaluation of fetal growth and antenatal biophysical assessment should be considered.
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Affiliation(s)
- S N MacGregor
- Department of Obstetrics, Northwestern University Medical School, Evanston, IL, USA
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Taylor CL, Jones KL, Jones MC, Kaplan GW. Incidence of renal anomalies in children prenatally exposed to ethanol. Pediatrics 1994; 94:209-12. [PMID: 8036075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Based on a number of studies involving animals as well as human case reports indicating an association between prenatal ethanol exposure and renal malformations, it has been suggested that children with fetal alcohol syndrome (FAS) should be screened for renal anomalies. The purpose of this study was to evaluate a group of children prenatally exposed to alcohol to determine the incidence of renal anomalies and to evaluate the need for such a screening procedure. METHODS Renal ultrasounds were performed on a total of 84 patients (68 children, 13 adolescents, and three adults). In addition to screening for malformations, renal size was studied. Data were analyzed using both chronologic and height-age as determinants of kidney size. PATIENTS Of these 84 patients, 51 (61%) had FAS, and 33 (39%) had a history of prenatal ethanol exposure but did not have FAS. RESULTS Three (3.6%) patients (one with FAS, two with prenatal ethanol exposure who did not have FAS) had significant renal abnormalities. This incidence was not significantly different from that found in ultrasound screening of newborns. The kidneys of children with both FAS and prenatal ethanol exposure who did not have FAS were significantly smaller than normal for both chronologic and height-age. When children were compared across chronologic ages, those with FAS had significantly smaller kidneys than those who had no evidence of FAS. After adjusting for height, the difference between these two groups was no longer significant. CONCLUSIONS Based on these data, children prenatally exposed to ethanol do not need to be screened for renal anomalies.
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Affiliation(s)
- C L Taylor
- Department of Pediatrics, University of California, San Diego
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Escobar LF, Bixler D, Padilla LM. Quantitation of craniofacial anomalies in utero: fetal alcohol and Crouzon syndromes and thanatophoric dysplasia. Am J Med Genet 1993; 45:25-9. [PMID: 8418654 DOI: 10.1002/ajmg.1320450109] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The study of fetal growth and development by ultrasound has been greatly facilitated in the past few years by the availability of anthropometric standards for the fetal body. Thus, the obstetrician is able to discern between normal and grossly abnormal, and even to quantitate certain fine fetal structures such as the face. This paper presents results obtained from a group of 5 patients referred to the Medical Center from private practices in Indianapolis, Indiana. Prenatal cephalometric analyses by ultrasound suggested the presence of craniofacial anomalies in all 5 cases. However, such defects were not detectable by routine ultrasonographic examination. A clinical examination after birth of each of these 5 patients suggested the following diagnoses: Fetal Alcohol Syndrome (FAS) in 2 individuals, Fetal Alcohol Effects (FAE) in one individual, Crouzon Syndrome (CS) in one patient, and Thanatophoric Dysplasia (TD) in one patient. In order to compare the craniofacial measurement values for each patient to normal standards, we developed Z-Score profiles and Pattern Variability Indexes (PVI) as described by Garn et al. [1984, 1985]. The values presented here support the idea that even mildly abnormal fetal craniofacial patterns are detectable by this relatively new application of ultrasound. At the present time, no conclusions can be made regarding the diagnostic accuracy of these patterns and profiles. However, the potential value of fetal cephalometry for documenting craniofacial dysmorphology is clearly indicated.
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Affiliation(s)
- L F Escobar
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
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Abstract
Six representative patients with fetal alcohol syndrome (FAS) were studied for craniofacial and oral anomalies, dental development, and long-term bodily growth patterns. The craniofacial features observed were reduction of total head size, increased head-body ratio, the existence of upper and middle craniofacial asymmetry and telecanthus in some instances, and the features of a long face syndrome with a large gonial angle. Dental development was mildly to moderately delayed, and enamel anomalies were present. Analysis of growth patterns demonstrated compensatory growth in stature, weight, or head circumference and a delayed bone age in some instances. It is suggested that the semiquantitative score system for fetal alcohol syndrome study may fail to diagnose individual cases and that craniofacial features are more important in diagnosis than seems to have been appreciated in the past.
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Affiliation(s)
- I T Jackson
- Section of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minn
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Abstract
We report on punctate epiphyseal calcifications (stippled epiphyses) in the fetal alcohol syndrome and present the differential diagnosis of chondrodysplasia punctata. A literature survey shows that epiphyseal calcifications accompanying alcoholic embryopathy are regularly located in the lower limbs and rarely found in the upper extremities.
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Affiliation(s)
- A Leicher-Düber
- Institut für Klinische Strahlenkunde, Johannes-Gutenberg Universität Mainz, FRG
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Maroteaux P, Lavollay B, Bomsell F, Gautry P, Vigneron J, Walbaum R. [Chondrodysplasia punctata and maternal alcohol intoxication. Apropos of 7 cases]. Arch Fr Pediatr 1984; 41:547-50. [PMID: 6508483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors report 7 cases of chondrodysplasia punctata in whom maternal alcohol intoxication was found. Most often, it consisted of chronic and confirmed alcoholism, except for the last case, in which an acute intoxication had occurred at about the 4th or 5th week of pregnancy. Clinically, the appearance of the children was evocative of fetal alcohol syndrome, except in the last case when, in contrast, the facial dysmorphy was very typical of chondrodysplasia punctata. The skeletal anomalies preferentially involve the lower limbs, sometimes the sacrum, and in one single case, the dorsal spine. Upper limbs are always spared. The maternal hepatic lesions may be responsible for the skeletal impairment, due to their repercussion on the metabolism of vitamin K. This skeletal impairment would then be close to that induced by treatments with warfarin during pregnancy. Whatever, it is absolutely necessary to X-ray the lower limbs in cases with fetal alcohol syndrome, in order to not overlook associated bone lesions.
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Abstract
Analysis of cephalometric radiographs of 12 children with fetal alcohol syndrome corroborated the clinical observation of midfacial deficiency described in patients with this disorder. Contrary to previous reports, however, our data show that this abnormality is not caused by true maxillary hypoplasia but by retrusion of the maxilla. We postulate that this abnormal position is secondary to restricted forward growth of the face, resulting from abnormal brain growth and subsequent shortening of the anterior cranial base.
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Abstract
Fifty cases of well-documented fetal alcohol syndrome were reviewed with the intent of describing the cervical vertebral anomalies. Thirty-eight cases had adequately detailed x-ray examination to be included in this study. Of these, 19 or 53% showed congenital fusion of two or more cervical vertebrae. The associated findings were minor anomalies on the intravenous pyelogram (IVP) in three of 18 IVPs done, mild to moderate microcephaly in 53%, and significant congenital heart anomalies in 41%. Although the vertebral anomalies bear a resemblance to the Klippel Feil syndrome, it is thought that the two syndromes are separate. The patterns of occurrence of the vertebral anomalies are different in the two groups, and the visceral expression of the disorder is also different. The major visceral anomaly in the Klippel Feil syndrome being in the genitourinary system and in the fetal alcohol syndrome being in the cardiovascular system. The patterns, however, are close enough to imply teratogenic event as the etiology in the Klippel Feil group. The occurrence of neck fusion in the fetal alcohol syndrome is common enough for it to be used in making the diagnosis.
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Abstract
Clinical examinations and radiographic skeletal surveys have been carried out in 15 patients with foetal alcohol syndrome. Fusion of the capitate and hamate bones in the carpus was bilateral in one patient and unilateral in two. All three had accessory ossification centres at the proximal ends of both second metacarpals. Two of these patients also had radio-ulnar synostosis. Digital shortening, which was demonstrated by pattern profile analysis, was very variable in degree and anatomical distribution. Other skeletal changes of uncertain significance were a "beaten copper" appearance of the calvarium in four patients, and coxa valga in one other. Diagnosis of the foetal alcohol syndrome warrants consideration in any individual presenting with carpal fusion or with radio-ulnar synostosis.
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