Anomalous cerebral structure in dyslexia revealed with magnetic resonance imaging

Cognitive deterioration associated with focal cortical dysplasia

Surgery for an area of focal cortical dysplasia in a critical region is reported in a right-handed female manifesting intractable focal epilepsy and verbal cognitive deterioration. She developed the first seizure at 2 years of age and was treated with phenytoin and zonisamide, with good control until 10 years of age. Although seizures did not occur at 9 years of age, she manifested dyscalculia, right-left disorientation, and finger agnosia, and N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (SPECT) revealed focal hypoperfusion in the left parietal lobe. At 11 years of age, she developed regular nocturnal seizures and gradually lost the ability to understand the meaning of sentences. Verbal IQ declined from 94 to 63, and the area of hypoperfusion detected by interictal N-isopropyl-p-iodoamphetamine SPECT spread over the left parietotemporal lobes. Magnetic resonance imaging revealed focal cortical dysplasia mainly in the left parietal lobe, and ictal technetium-99m-ethyl cysteinate dimer SPECT images demonstrated an area of hyperperfusion around the focal cortical dysplasia, including the left precentral gyrus. Because of the overlap between the epileptogenic and functional cortex, the authors concluded that cortical resection, including focal cortical dysplasia, was inappropriate in this patient.

The planum temporale: a systematic, quantitative review of its structural, functional and clinical significance

The planum temporale (PT) is a triangular area situated on the superior temporal gyrus (STG), which has enjoyed a resurgence of interest across several disciplines, including neurology, psychiatry and psychology. Traditionally, the planum is thought to be larger on the left side of the brain in the majority of normal subjects [N. Geschwind, W. Levitsky, Human brain: left-right asymmetries in temporal speech regions, Science 161 (1968) 186-87.]. It coincides with part of Wernicke's area and it is believed to consist cytoarchitectonically of secondary auditory cortex. Consequently, it has long been thought to be intimately involved in language function. The PT is, therefore, of relevance to disorders where language function is impaired, such as schizophrenia and dyslexia. The gross anatomical boundaries remain in dispute, and only recently has its cytoarchitecture begun to be studied again after 60 years silence, and finally its functional significance is only now being explored. In the first part of this review the structural aspects and anatomical boundaries of the PT in the normal brain from post mortem and magnetic resonance imaging (MRI) and methods of measurement are discussed. In the second part, studies of the functional significance of the PT in the normal brain are reviewed critically. Finally a meta-analysis of MRI measurements of the distribution of planum anatomy in normal subjects is presented. Comparison is made with clinical populations, including schizophrenia and dyslexia, and the influence of handedness and gender on such measurements is quantified. Although there are many ways of defining and measuring the PT with a wide variety of results, overall there is a significant leftward asymmetry in normals, which is reduced in left handers and females. The leftward asymmetry is much reduced in patients with schizophrenia due to a relatively larger right PT than normal controls. The review is intended to guide future researchers in this area.

Absence of linkage of phonological coding dyslexia to chromosome 6p23-p21.3 in a large family data set

Previous studies have suggested that a locus predisposing to specific reading disability (dyslexia) resides on chromosome 6p23-p21.3. We investigated 79 families having at least two siblings affected with phonological coding dyslexia, the most common form of reading disability (617 people genotyped, 294 affected), and we tested for linkage with the genetic markers reported to be linked to dyslexia in those studies. No evidence for linkage was found by LOD score analysis or affected-sib-pair methods. However, using the affected-pedigree-member (APM) method, we detected significant evidence for linkage and/or association with some markers when we used published allele frequencies with weighting of rarer alleles. APM results were not significant when we used marker allele frequencies estimated from parents. Furthermore, results were not significant with the more robust SIMIBD method using either published or parental marker frequencies. Finally, family-based association analysis using the AFBAC program showed no evidence for association with any marker. We conclude that the APM method should be used only with extreme caution, because it appears to have generated false-positive results. In summary, using a large data set with high power to detect linkage, we were unable to find evidence for linkage or association between phonological coding dyslexia and chromosome 6p markers.

MRI asymmetries of Broca's area: the pars triangularis and pars opercularis

Broca's area, which includes the pars triangularis (PTR) and pars opercularis (POP), is a neuroanatomic region important in speech-language production. Previous data demonstrated that PTR asymmetries are highly correlated with language dominance determined by selective hemispheric anesthesia or Wada testing, suggesting that asymmetries of the PTR may, in part, predict language dominance. The POP, however, has not been measured on volumetric magnetic resonance imaging (MRI), and therefore, it is unclear whether morphological asymmetries of the POP exist, and whether these asymmetries differ in right- and left-handers. The purpose of this study was to determine if measurable asymmetries of the POP exist on MRI, and whether the direction of the asymmetries differ in right- and left-handers. The PTR and POP were measured on volumetric MRI scans of 16 right-handers and 16 left-handers matched for age and gender. There was a significant leftward asymmetry of the PTR in right- and left-handers, although the asymmetry was reduced in the left-handers. In contrast, there was a leftward asymmetry of the POP in right-handers, and a rightward asymmetry in the left-handers. Handedness, derived from a handedness inventory, was positively correlated with POP asymmetry.

Age-related changes of the insular cortex and lateral ventricles: conventional MRI volumetric measures

Preliminary data suggest that the insular region may be atrophied in patients with Alzheimer's disease when compared with healthy, age-matched control subjects. Therefore, normative data on age-related changes of the insular cortex were gathered and compared with age-related changes in the bodies of the lateral ventricles, which have been studied previously. Cerebrospinal fluid (CSF) volume of the lateral ventricles and insular cortical regions were measured on T1-weighted axial magnetic resonance images in 93 healthy subjects (age 21 to 84 years). Age-related changes were found in the lateral ventricles (r = 0.57, p < 0.0001) and in the CSF insular space (r = 0.42, p < 0.0001). Increasing age accounted for a significant amount of the variance for the lateral ventricle (pc = 0.45, p < 0.0001), but not for the insula (pc = 0.15, p = 0.14). Although there was a continuous linear increase in lateral ventricular volume with age, the CSF insular space increased linearly until the fourth decade, then plateaued until the seventh decade, with a linear increase thereafter. These data suggest that age-related changes occur in the region of the insular cortex, but differ from age-related changes of the lateral ventricles.

Normal intrasylvian anatomical asymmetry in children with developmental language disorder

Symmetry of posterior intrasylvian cortices (e.g., planum temporale, planum parietale) has been suggested to represent a risk factor for developmental disorders of language and reading. Using high-resolution magnetic resonance morphometry, we studied 21 right-handed children with developmental language disorder of the phonologic-syntactic type, and found normal left-right asymmetry of the planum temporale and planum parietale when compared with 21 matched controls. The planum temporale was bilaterally smaller in the affected children, a finding accounted for by their approximately 7% smaller forebrain size. Our data do not support a role of gross visible unilateral or bilateral abnormalities of posterior intrasylvian ontogenesis in this disorder.

Dyslexia, neurolinguistic ability, and anatomical variation of the planum temporale

This article addresses the relationship between patterns of planum temporale symmetry/asymmetry and dyslexia and neurolinguistic abilities. Considerable research indicates that dyslexic individuals typically do not display the predominant pattern of leftward planum temporale asymmetry. Variable findings on the structural basis of symmetry are due partially to measurement issues, which are examined in some detail in this critical review. The physiological basis of symmetry may be reduced neuronal elimination in the right planum, although other alternatives are offered. Theories are offered to explain how symmetrical plana are related to dyslexia, and it is evident that symmetrical plana are not sufficient to produce dyslexia. However, some evidence suggests that nonleftward plana asymmetry is associated with deficits in verbal comprehension, phonological decoding, and expressive language. It is concluded that nonleftward asymmetry is associated with linguistic deficits, but that explanatory theories need to be further developed. Among the many issues that need to be addressed, future research needs to determine whether the relationship between patterns of planum temporale symmetry/asymmetry and linguistic ability is specific to dyslexia or if asymmetry covaries lawfully with linguistic abilities in nondyslexic populations.

Central auditory processing disorder in school-aged children: a critical review

The rationale to evaluate for central auditory processing disorder (CAPD) in school-aged children is based on the assumption that an auditory-specific perceptual deficit underlies many learning problems including specific reading and language disabilities. A fundamental issue in this area is whether convincing empirical evidence exists to validate this proposition. Herein, we consider the issue of modality specificity by examining the extent to which reading, language, and attention disorders in school-aged children involve perceptual dysfunctions limited to a single sensory modality. Difficulty in validating CAPD as a diagnostic label is due in large part to use of the unimodal inclusive framework, which has biased the diagnosis to favor sensitivity of test results over documenting the specificity of the deficit. Indeed, empirical research documenting modality-specific auditory-perceptual dysfunction in this population is scarce. Therefore, the existing literature on this topic has not clarified the "true" nature of the problem, and has left many questions about this disorder unanswered. It is argued that demonstrating modality specificity is one way to rule out supramodal disorders as explanations for observed dysfunction. Multimodal perceptual testing is one logical approach to help clarify this area of investigation.

Temporal lobe asymmetry and dyslexia: an in vivo study using MRI

Three measures of the right and left temporal lobes were taken with magnetic resonance imaging (MRI) in groups of dyslexics (N = 17), retarded readers (N = 6), and normal controls (N = 12). The most pronounced differences among the groups were found with measures on coronal slices of the cross sectional area of the temporal cortex with subcortical white matter--in particular lateral to insula. While most of the normal and the retarded readers (13 of 18) had left asymmetry (left area larger than right), most of the dyslexics (14 of 17) had symmetry or right asymmetry. The degree of left asymmetry, (L-R)/[0.5(L + R)], was found to correlate with both reading skills and skills in phonemic analysis of spoken language. These results were also found when differences in non-verbal IQ were accounted for. The implications for definitions of dyslexia, for psycholinguistic research on dyslexia, and for remedial teaching are discussed.

Morphology of the inferior frontal gyrus in developmentally language-disordered adults

The inferior frontal gyrus has traditionally been considered an important cortical region for language and may be important for understanding developmental language disorders. The morphology of the inferior frontal gyrus, as it appeared on T1-weighted sagittal magnetic resonance imaging (MRI) scans, was evaluated using a classification system that distinguished between seven basic morphological variants of the gyral and sulcal patterns in this region. This classification scheme was applied to the MRI scans of 41 neurologically normal adult subjects. To examine the relation between sulcal morphology and subject status, these subjects were sorted first by family history for developmental language disorders and then resorted by expression of behavioral signs consistent with a diagnosis of this disorder as determined by standardized testing. Morphological types that included an extra sulcus in the inferior frontal gyrus were statistically associated with the behaviorally based classification of subjects, but not with a positive family history for developmental language disorders. Because gyral patterns are prenatally determined, this finding is consistent with the theory that altered prenatal development contributes to the expression of a developmental language disorder.

Technology in the assessment of learning disability

Recent neuroradiologic and brain imaging technologies, along with methods for displaying electrophysiologic data, have promulgated active exploration in the assessment of learning disability with attempts to improve diagnostic precision and elucidate the neurobiological substrates of learning disorders. The following article reviews these techniques and explores the research that has been conducted in this area over the past two decades. Initial investigations attempted to elucidate irregularities or abnormalities of brain morphology in individuals with learning disability utilizing computerized tomography (CT). The current standard for structural imaging of the brain is magnetic resonance (MR) imaging, which has allowed for greater specificity in identifying brain abnormalities. More recently, functional magnetic resonance imaging (fMRI) has been postulated as holding some promise in distinguishing anatomic/function differences in LD. Electrophysiological (EEG) and metabolic imaging techniques offer methods by which human brain activity can be studied during cognitive processes. Computerized EEG studies including evoked potentials (EP) or event-related potentials (ERP), spectral EEG analysis, and topographic EEG brain mapping have also identified a number of brain irregularities in individuals with learning disabilities, though no consistent exemplars have emerged. Studies with positron emission tomography (PET) and single photon emission computerized tomography (SPECT) have also demonstrated a number of abnormalities and inconsistencies in individuals with learning disabilities, but, again, no systematic research has demonstrated specific diagnostic abnormalities. Though inroads and some consistent patterns have begun to emerge in the assessment of learning disability with the preceding technologies, a number of challenges persist with neuroimaging and neurophysiological and metabolic imaging techniques. To date, no diagnostic conclusions have been drawn utilizing these methods in the assessment of the neurobiologic basis to LD.

Resistance to thyroid hormone: implications for neurodevelopmental research on the effects of thyroid hormone disruptors

Thyroid hormones are essential for normal behavioral, intellectual, and neurological development. Congenital hypothyroidism, if not treated, can result in irreversible mental retardation, whereas thyroid diseases with more moderate impairment of thyroid function, such as resistance to thyroid hormone, cause less severe intellectual and behavioral abnormalities, including attention deficit hyperactivity disorder. There is increasing evidence that exposure to certain synthetic compounds, including dioxins and polychlorinated biphenyls (PCBs), during the perinatal period can also impair learning, memory, and attentional processes in offspring. Animal and human studies suggest that exposure to these environmental toxicants impair normal thyroid function. Although the precise mechanisms of action of the adverse effects these toxicants have on neurodevelopment have not yet been elucidated, it is possible that they are partially or predominantly mediated by alterations in hormone binding to the thyroid hormone receptor. The convergence of studies that examine the neurodevelopmental consequences of moderate impairment of thyroid function, such as is found in resistance to thyroid hormone, with those studies that demonstrate the adverse behavioral and cognitive effects of perinatal exposure to dioxins and PCBs serves to generate new hypotheses to test in a research setting. Such studies may provide new insights into the basic pathogenesis of developmental neurotoxicity following exposure to thyroid-disrupting synthetic compounds.

Brain morphology in children with specific language impairment

The planum temporale and pars triangularis have been found to be larger in the left hemisphere than the right in individuals with normal language skills. Brain morphology studies of individuals with developmental language disorders report reversed asymmetry or symmetry of the planum, although the bulk of this research has been completed on adults with dyslexia. Pars triangularis has not been studied in the developmental language impaired population. In this study, magnetic resonance imaging (MRI) was used for quantitative comparisons of the planum temporale (Wernicke's area) and pars triangularis (Broca's area) in children with specific language impairment (SLI) and children with normal language skills. The subjects were 11 children with SLI and 19 age- and sex-matched controls between 5.6 and 13.0 years old. Each subject received a neurolinguistic battery of tests and a high resolution volumetric MRI scan. Major results were that (a) pars triangularis was significantly smaller in the left hemisphere of children with SLI, and (b) children with SLI were more likely to have rightward asymmetry of language structures. Furthermore, anomalous morphology in these language areas correlated with depressed language ability. These findings support the hypothesis that language impairment is a consequence of an underlying neurobiological defect in areas of the brain known to subserve language.

The relation of planum temporale asymmetry and morphology of the corpus callosum to handedness, gender, and dyslexia: a review of the evidence

Asymmetry of the planum temporale in relation to handedness, gender, and dyslexia is reviewed. The frequency of rightward asymmetry is rather higher than are estimates of the proportion of right hemisphere speech representation in the general population. Conversely, the frequency of leftward asymmetry is lower than the proportion of the population with left hemisphere speech. Neuro-anatomic asymmetry may relate more to handedness than to language lateralization. There are suggestions that neuroanatomic asymmetry is reduced in females compared to males but the data are inconclusive. Reports concerning handedness and gender differences in callosal structure are conflicting but, as with planum asymmetry, any effect of handedness is as likely to relate to degree as to direction of handedness. It has been reported that the plana are more often symmetrical in size or larger on the right side among dyslexics than controls but this has not always been found. However, greater frequency of atypical (a)symmetry of the planum in dyslexia would be consistent with the absence of a factor which, when present, biases the distribution of planum asymmetry toward the left (and handedness towards the right) as hypothesized by Annett (1985). Studies of the size of the corpus callosum in dyslexia have produced conflicting findings.

Evidence from imaging on the relationship between brain structure and developmental language disorders

This article discusses findings using various imaging techniques regarding the neurological underpinnings of developmental language and learning disorders. Evidence from magnetic resonance imaging, functional magnetic resonance imaging, single photon emission spectroscopy, and positron emission tomography implicates the left perisylvian regions in the processing of phonemes and auditory information, as had been predicted from lesion data and from neurobiological theory. The areas of the planum temporale and angular gyrus have been found to be compromised in children and adults with dyslexia or language impairment. Emerging evidence suggests that these differences are also present in members of families with a history of developmental language disorders, which provides support for a transmittable, biological factor involved in such disorders. Dynamic imaging procedures are beginning to provide an understanding of the relationship between structure and function in normal and abnormal language acquisition.

Specific learning disabilities: a neuropsychological perspective

A dispersion in cognitive abilities is expected in normal populations. Specific learning disabilities would represent an extreme polarity in a continuum of normal cognitive dispersion. Three propositions relative to learning disabilities are advanced in the present paper. First, specific learning disabilities are expected to be found for diverse cognitive functions, even though some of these specific learning disorders have yet to be described in scientific literature. Second, it is noted that specific "factors" can be affected in cases of learning disabilities. Lastly, a parallel between focal neuropsychological syndromes and specific learning disabilities is proposed. Developmental learning difficulties would represent dysfunctional or dysmaturational defects; whereas neuropsychological syndromes represent a consequence of acquired structural brain pathology.

Neurobiology of speech perception

The mechanisms by which human speech is processed in the brain are reviewed from both behavioral and neurobiological perspectives. Special consideration is given to the separation of speech processing as a complex acoustic-processing task versus a linguistic task. Relevant animal research is reviewed, insofar as these data provide insight into the neurobiological basis of complex acoustic processing in the brain.

Differences between Caucasians and American Indians on the cognitive laterality battery

Caucasians scored significantly better than American Indian college students on verbal-sequential tests, but not on visuospatial tests, of Gordon's Cognitive Laterality Battery (CLB). Caucasians scored more right-biased than American Indians on the Edinburgh Handedness Inventory (EHI). The effects of percentage of Native American ancestry, strategy employed to recall serial sounds, bilingualism, familial sinistrality and handedness laterality on test performance were also analyzed. Results are consistent with hypotheses drawn from Annett's genetic theory of human laterality, if frequency distributions for the hypothesized rs+ gene are assumed to vary across the parent populations from which the samples were drawn.

Gyral morphology in the posterior Sylvian region in families affected by developmental language disorder

This study describes the family aggregation of gyral morphology in the posterior perisylvian region in families that contain one or more children with a developmental language disorder. The probands in these families were 8 male and 2 female children referred through therapy programs and schools for children with language and reading problems. Family members included both biological parents (10 m, 10 f) and all available siblings (6 m, 4 f). Gyral morphology in the members of these families was compared with control subjects (10 m, 10 f) who were without a personal or family history of developmental language disorders. Gyral morphology was evaluated using T1-weighted sagittal scans from a GE Signa 1.5T magnet, 5 mm consecutive slices through the full brain volume. A less common type of Sylvian fissure morphology was more frequently found in the hemispheres of language-disordered subjects and their first-degree relatives than in control subjects. In addition, the pattern of Sylvian fissure morphology across generations within the families suggests that this feature might be inherited from either parent. The elevated rate of extra gyri in the posterior perisylvian region in families affected by language disorder links an anomaly within a language-related brain region with familial risk for this disorder.

Elevated androgen, brain development and language/learning disabilities in children with congenital adrenal hyperplasia

Individuals with congenital adrenal hyperplasia (CAH) provide a test population for the theory that elevated testosterone levels alter prenatal brain development and increase the risk of learning disabilities. Eleven subjects with CAH, five of their non-CAH siblings and 16 matched control subjects participated in two studies. The first study documented hand preference, verbal skills and non-verbal skills. A higher prevalence of language/learning disability was found in both the CAH subjects and their families than in the control subjects. The second study examined the prevalence of atypical perisylvian asymmetries on MRI scans. These revealed an atypical pattern of asymmetry (R = L or R > L) in the majority of the subjects with CAH and in all of their siblings. One subject with CAH also showed evidence of a neuromigratory disturbance in the posterior left hemisphere. Of the control subjects, only one showed an atypical pattern of asymmetry and none showed evidence of a neuromigratory disorder. The findings indicate that an elevated familial rate for language-based learning disabilities and altered brain asymmetries co-occur in families with the gene for CAH.

Corpus callosum morphology, as measured with MRI, in dyslexic men

To test the hypothesis of anomalous anatomy in posterior brain regions associated with language and reading, the corpus callosum was imaged in the midsagittal plane with magnetic resonance. The areas of the anterior, middle, and posterior segments were measured in 21 dyslexic men (mean age 27 yrs, SD 6) and in 19 matched controls. As predicted, the area of the posterior third of the corpus callosum, roughly equivalent to the isthmus and splenium, was larger in dyslexic men than in controls. No differences were seen in the anterior or middle corpus callosum. The increased area of the posterior corpus callosum may reflect anatomical variation associated with deficient lateralization of function in posterior language regions of the cortex and their right-sided homologues, hypothesized to differ in patients with dyslexia.

Quantified volumes of temporal lobe structures in patients with epilepsy

The T1-weighted volumetric magnetic resonance images of 31 patients with intractable temporal lobe epilepsy, and 13 control subjects matched for age and sex, were subjected to semiautomated threshold analysis. The method used proved to be relatively fast and reliable. An index of temporal lobe interhemispheric asymmetry was extracted by thresholding high-signal (white matter) pixels. Patients had significantly more asymmetrical indices for white matter and hippocampal volumes that did control subjects, and the two indices were significantly correlated, providing evidence for the validity of the white matter index. Differences in both indices were consistent with decreased tissue on the side of the focus. In classification analyses a combination of these two indices correctly predicted the side of focus at a greater rate than did either used alone. Findings provide support for the hypothesis that seizure activity is associated with atrophy in both mesial and lateral temporal lobe structures.

Developmental dyslexia: a motor-articulatory feedback hypothesis

Reading is mediated by parallel and widely distributed modular systems. There are, therefore, multiple loci in these systems where dysfunction may lead to developmental dyslexia. However, most normal children learn to read using the alphabetic system. Learning to use this system requires awareness that words are comprised of a system of speech sounds (phonological awareness) and the knowledge of how to convert letters (graphemes) into these speech sounds (phonemes). Most dyslexic children have deficient phonological awareness and have difficulty converting graphemes into phonemes. Studies of patients with acquired lesions who are unable to convert graph-emes into phonemes, as well as positron emission tomographic studies of normal subjects, suggest that the left inferior frontal lobe is important in phonologic reading. Phonetic gestures are represented in the brain as invariant motor commands that program the articulators. Phonologic reading may activate the left inferior frontal lobe because grapheme-to-phoneme conversion requires activation of these motor-articulatory gestures. Dyslexic children are unaware of the position of their articulators during speech. The inability to associate the position of their articulators with speech sounds may impair the development of phonological awareness and the ability to convert graphemes to phonemes. Unawareness of their articulators may be related to programming or feedback deficits.

Pars triangularis asymmetry and language dominance

The pars triangular is a portion of Broca's area. The convolutions that form the inferior and caudal extent of the pars triangularis include the anterior horizontal and anterior ascending rami of the sylvian fissure, respectively. To learn if there are anatomic asymmetries of the pars triangularis, these convolutions were measured on volumetric magnetic resonance imaging scans of 11 patients who had undergone selective hemispheric anesthesia (Wada testing) to determine hemispheric speech and language lateralization. Of the 10 patients with language lateralized to the left hemisphere, 9 had a leftward asymmetry of the pars triangularis. The 1 patient with language lateralized to the right hemisphere had a significant rightward asymmetry of the pars triangularis. Our data suggest that asymmetries of the pars triangularis may be related to speech-language lateralization.

Structure, functional and cerebral asymmetry: in vivo morphometry of the planum temporale

Using high-resolution magnetic resonance (MR) imaging, the normal left-right asymmetry of the planum temporale (PT) can be quantified accurately and reliably in the intact human brain. The following main results have emerged from MR measurements of individual direction and degree of PT asymmetry. (1) Normal left-handers are less left-lateralized than normal right-handers, without significant gender effects. This confirms a structural-functional correlation in cerebral asymmetry. (2) The aforementioned handedness difference in PT asymmetry is also found in pairs of normal monozygotic twins discordant for handedness. Thus, structural brain asymmetry may not be genetically determined. (3) Whereas right-handed patients with developmental deficits of phonological processing have been reported to show decrease PT asymmetry, musicians with perfect pitch display exaggerated leftward asymmetry. Thus, increasing leftward asymmetry of auditory-related cortices covering the PT may be correlated with the processing capacity for certain auditory features. Studies of the PT as a structural marker of cerebral asymmetry will continue to contribute to a better understanding of the phylogeny and ontogeny of laterality.

Neuroimaging in child and adolescent neuropsychiatric disorders

OBJECTIVE

To review the major findings and pathophysiological implications of imaging studies of neuropsychiatric disorders that onset in childhood or adolescence.

METHOD

More than 200 neuroimaging studies were selected for review from Medline searches if the studies concerned developmental neuropsychiatric disorders such as autism, fragile X syndrome, Down syndrome, schizophrenia, obsessive-compulsive disorder, Tourette's syndrome, attention-deficit hyperactivity disorder, and dyslexia.

RESULTS

Disordered central nervous system development may produce evidence of cortical neuronal migration abnormalities in autism, smaller cortical structures in Down syndrome, frontal lobe deficits and larger basal ganglia in schizophrenia, hypoplastic basal ganglia in Tourette's syndrome, aberrancies of the planum temporale in dyslexia, and hypoplastic cerebellar structures in numerous developmental disorders. Normal cerebral asymmetries appear to be disrupted in a number of disorders, including schizophrenia, Tourette's syndrome, attention deficit disorder, and dyslexia.

CONCLUSIONS

Neuroimaging data regarding pathological central nervous system development in childhood are still sparse, and many of the findings in developmental disorders of childhood onset concern the study of adult subjects with those disorders. Nevertheless, imaging modalities previously used only in adults are with increasing frequency being applied to the study of children, which will likely continue to contribute to the understanding of pathological brain structure and function throughout childhood and to the improved treatment of these disorders.

Magnetic resonance imaging of cerebral anomalies in subjects with resistance to thyroid hormone

OBJECTIVE

Resistance to thyroid hormone (RTH) is an autosomal dominant disease caused by mutations in the human thyroid receptor beta gene on chromosome 3. Individuals with RTH have an increased incidence of attention deficit hyperactivity disorder (ADHD). The purpose of this study was to search for developmental brain malformations associated with RTH.

METHOD

Forty-three subjects (20 affected males [AM], 23 affected females [AF]) with resistance to thyroid hormone and 32 unaffected first degree relatives (18 unaffected males [UM], 14 unaffected females [UF]) underwent MRI brain scans with a volumetric acquisition that provided 90 contiguous 2 mm thick sagittal images. Films of six contiguous images beginning at a standard sagittal position lateral to the insula were analyzed by an investigator who was blind with respect to subject characteristics. The presence of extra or missing gyri in the parietal bank of the Sylvian fissure (multimodal association cortex) and multiple Heschl's transverse gyri (primary auditory cortex) were noted.

RESULTS

There was a significantly increased frequency of anomalous Sylvian fissures in the left hemisphere in males with RTH (AM: 70%; AF: 30%; UM: 28% UF: 28%). Also, there was an increased frequency of anomalous Sylvian fissures on the left combined with multiple Heschl's gyri in either hemisphere in males with RTH (AM: 50%; AF: 9%; UM: 6%; UF: 0%). However, RTH subjects with anomalies did not have an increased frequency of ADHD as compared with RTH subjects with no anomalies.

CONCLUSIONS

Abnormal thyroid hormone action in the male fetus early during brain development may be associated with grossly observable cerebral anomalies of the left hemisphere. The effects of mutations in the thyroid receptor beta gene provide a model system for studying the complex interaction of genetic and nongenetic factors on brain and behavioral development.

Normal asymmetry of the planum temporale in patients with schizophrenia. Three-dimensional cortical morphometry with MRI

BACKGROUND

Abnormal cerebral anatomical lateralisation has been reported in schizophrenia and may implicate anomalous neurodevelopment in the aetiology of this disease. A popular recent hypothesis has predicted that such disturbances in normal lateralisation should be especially apparent in the morphology of the temporal lobes.

METHOD

A temporal cortical region lying in the plane of the Sylvian fissure--known as the planum temporale--exhibits pronounced leftward asymmetry in normal right-handed males. We compared lateralisation of the planum temporale in schizophrenic and control males using MRI surface-rendering morphometry of the supratemporal cortex.

RESULTS

Contrary to the lateralisation hypothesis, normal patterns of leftward planum asymmetry were detected in both the schizophrenic and control groups. Schizophrenics and controls also exhibited a predicted symmetry in the bilateral areas of Heschl's gyrus, a supratemporal cortical structure immediately anterior to the planum.

CONCLUSION

These data do not support the notion that neurodevelopmental mechanisms of cerebral asymmetry are abnormal in schizophrenia.

Speech and other central auditory processes: insights from cognitive neuroscience

Recent advances in cognitive neuroscience, particularly studies utilizing functional neural imaging and animal models, are providing unique insights into the neural substrates of speech and other central auditory processes. In particular, the acoustic-phonetic aspects of speech appear to provide an important organizing principle for linking systems neuroscience research to cognitive and linguistic theories.

Planum temporale asymmetry and language dominance

Language is lateralized to the left hemisphere in most individuals, and leftward asymmetry of the planum temporale has been reported in postmortem and imaging studies. In this study we measured the planum temporale on magnetic resonance imaging (MR) scans of patients (11 right-handers, 1 non-right-hander) who had selective hemispheric anesthesia or Wada testing performed for language lateralization. All subjects who had language lateralized to the left hemisphere (11 right-handers) had a leftward asymmetry of the planum temporale. One subject who had language lateralized to the right hemisphere (non-right-hander) had a strong rightward asymmetry of the planum temporale. These data suggest that planum temporale asymmetries determined by MR are associated with language dominance and may predict language laterality.

Right frontotemporal activation by tonal memory in dyslexia, an O15 PET Study

A prior study documented the failure of dyslexic men to activate left temporoparietal cortex during phonologic processing. Because of reports of an anomalous right planum temporale in developmental dyslexia, the functional implications of which are unknown, this study examined the ability of dyslexics to activate right temporal cortex. Regional cerebral blood flow was measured in 15 right-handed dyslexic men during rest and during a tonal memory task expected to activate right-sided cortex in controls. A matched control sample (n = 18) showed significant activation of several right frontotemporal regions as well as of left temporal cortex. In contrast, severely dyslexic men activated fewer right frontotemporal regions, while making many more errors than controls, but showed normal activation of left mid to anterior temporal cortex. These results support hypothesized underlying deficits in rapid temporal processing and possible involvement of right (in addition to left) temporal cortex in severe dyslexia.

Auditory M100 component 1: relationship to Heschl's gyri

This study was designed to localize the neuroanatomic generator of the 100 ms latency magnetic auditory evoked field (EF) component (M100) activated by an unattended tone pip. Magnetic EFs in response to 25 ms duration, 90 dB, 1 kHz tone pips were recorded from both hemispheres of nine normal adults, five males and four females, using a seven-channel second-order gradiometer. The source of the M100 was estimated, with confidence intervals, by a least squares based inverse solution algorithm. Magnetic resonance (MR) images of the brain were acquired with a 1.5 T system using a standard head coil. The superior temporal gyri (STG) were manually segmented from 1.7 mm thick coronal images, and the superior surfaces were then rendered from the 3-D volume data. Translation and rotation matrices were identified to locate the magnetoencephalography (MEG) determined sources within the reconstructed STGs. This population of 18 STGs in 9 individuals demonstrated two transverse gyri in 4 of 9 left hemispheres, and 5 of 9 right hemispheres. All 9 left hemisphere M100 sources were in or included Heschl's gyrus(i) in the confidence intervals. Seven of the 9 included Heschl's gyrus(i) on the right: the remaining two, both males, had sources slightly anterior to Heschl's gyrus(i). We conclude that all M100 source location estimates were compatible with an auditory koniocortex source in or adjacent to Heschl's gyri.

Brain morphology in normal and dyslexic children: the influence of sex and age

Morphometric magnetic resonance imaging techniques were used to compare the convolutional surface area of the planum temporale, temporal lobe volume and superior surface area, and an estimate of overall brain volume in a homogeneous sample of 17 dyslexic children (7 girls) and 14 nonimpaired children (7 girls). Substantial sex differences were apparent for all measured regions, with all the measurements in boys being significantly larger. Age, even within the narrow range employed here (7.5-9.7 years), was positively correlated with the size of each brain region. While initial analyses suggested smaller left hemisphere structures in dyslexics compared to control subjects, subsequent analyses controlling for age and overall brain size revealed no significant differences between dyslexics and nonimpaired children on a variety of measures, in particular surface area and symmetry of the planum temporale. We suggest that differences in subject characteristics (i.e., sex, age, handedness, and definition of dyslexia) as well as procedural variations in the methods used to acquire images and to define and measure anatomical regions of interest such as the planum temporale all may play an important role in explaining apparent discrepant results in the neuroimaging literature on dyslexia.

Developmental dyslexia and animal studies: at the interface between cognition and neurology

Recent findings in autopsy studies, neuroimaging, and neurophysiology indicate that dyslexia is accompanied by fundamental changes in brain anatomy and physiology, involving several anatomical and physiological stages in the processing stream, which can be attributed to anomalous prenatal and immediately postnatal brain development. Epidemiological evidence in dyslexic families led to the discovery of animal models with immune disease, comparable anatomical changes and learning disorders, which have added needed detail about mechanisms of injury and plasticity to indicate that substantial changes in neural networks concerned with perception and cognition are present. It is suggested that the disorder of language, which is the cardinal finding in dyslexic subjects, results from early perceptual anomalies that interfere with the establishment of normal cognitive-linguistic structures, coupled with primarily disordered cognitive processing associated with developmental anomalies of cortical structure and brain asymmetry. This notion is supported by electrophysiological data and by findings of anatomical involvement in subcortical structures close to the input as well as cortical structures involved in language and other cognitive functions. It is not possible at present to determine where the initial insult lies, whether near the input or in high-order cortex, or at both sites simultaneously.

Comparison of deficits in cognitive and motor skills among children with dyslexia

There is a growing body of evidence that children with dyslexia have problems not just in reading but in a range of skills including several unrelated to reading. In an attempt to compare the severity and incidence of deficits across these varied domains, children with dyslexia (mean ages 8, 12, and 16 years), and control groups of normally achieving children matched for IQ and for age or reading age, were tested on a range of primitive (basic) skills. The children with dyslexia performed significantly worse than the same-age controls on most tasks, and significantly worse even than the reading-age controls on phoneme segmentation, picture naming speed, word tachistoscopic word recognition, speeded bead threading and some balance tasks. The overall performance of the children with dyslexia is interpreted as showing less complete automatization than normal.