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Gabaldon-Albero A, Mayo S, Martinez F. NR4A2 as a Novel Target Gene for Developmental and Epileptic Encephalopathy: A Systematic Review of Related Disorders and Therapeutic Strategies. Int J Mol Sci 2024; 25:5198. [PMID: 38791237 PMCID: PMC11120677 DOI: 10.3390/ijms25105198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The NR4A2 gene encodes an orphan transcription factor of the steroid-thyroid hormone-retinoid receptor superfamily. This review focuses on the clinical findings associated with the pathogenic variants so far reported, including three unreported cases. Also, its role in neurodegenerative diseases, such as Parkinson's or Alzheimer's disease, is examined, as well as a brief exploration on recent proposals to develop novel therapies for these neurological diseases based on small molecules that could modulate NR4A2 transcriptional activity. The main characteristic shared by all patients is mild to severe developmental delay/intellectual disability. Moderate to severe disorder of the expressive and receptive language is present in at least 42%, while neuro-psychiatric issues were reported in 53% of patients. Movement disorders, including dystonia, chorea or ataxia, are described in 37% patients, although probably underestimated because of its frequent onset in late adolescence-young adulthood. Finally, epilepsy was surprisingly present in 42% of patients, being drug-resistant in three of them. The age at onset varied widely, from five months to twenty-six years, as did the classification of epilepsy, which ranged from focal epilepsy to infantile spasms or Lennox-Gastaut syndrome. Accordingly, we propose that NR4A2 should be considered as a first-tier target gene for the genetic diagnosis of developmental and epileptic encephalopathy.
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Affiliation(s)
- Alba Gabaldon-Albero
- Translational Research Group in Genetics, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain;
| | - Sonia Mayo
- Genetics and Inheritance Research Group, Instituto de Investigación Sanitaria Hospital 12 de Octubre, 28041 Madrid, Spain
- Department of Genetics, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Francisco Martinez
- Translational Research Group in Genetics, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain;
- Genetics Unit, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain
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Du L, Ye F, Gao W, Yang A, Luan J, Xu M, Lv K, Hu P, Liu B, Yu H, Wang Y, Huang W, Shu N, Ouyang G, Yin Q, Shmuel A, Wang Y, Zhang Q, Xu P, Ma G. Decreased brain iron deposition based on quantitative susceptibility mapping correlates with reduced neurodevelopmental status in children with autism spectrum disorder. Cereb Cortex 2024; 34:63-71. [PMID: 38696609 DOI: 10.1093/cercor/bhae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024] Open
Abstract
To investigate potential correlations between the susceptibility values of certain brain regions and the severity of disease or neurodevelopmental status in children with autism spectrum disorder (ASD), 18 ASD children and 15 healthy controls (HCs) were recruited. The neurodevelopmental status was assessed by the Gesell Developmental Schedules (GDS) and the severity of the disease was evaluated by the Autism Behavior Checklist (ABC). Eleven brain regions were selected as regions of interest and the susceptibility values were measured by quantitative susceptibility mapping. To evaluate the diagnostic capacity of susceptibility values in distinguishing ASD and HC, the receiver operating characteristic (ROC) curve was computed. Pearson and Spearman partial correlation analysis were used to depict the correlations between the susceptibility values, the ABC scores, and the GDS scores in the ASD group. ROC curves showed that the susceptibility values of the left and right frontal white matter had a larger area under the curve in the ASD group. The susceptibility value of the right globus pallidus was positively correlated with the GDS-fine motor scale score. These findings indicated that the susceptibility value of the right globus pallidus might be a viable imaging biomarker for evaluating the neurodevelopmental status of ASD children.
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Affiliation(s)
- Lei Du
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian, Beijing 100142, China
| | - Fang Ye
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Wenwen Gao
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
- Department of Radiology, the Sixth Medical Center of People's Liberation Army (PLA) General Hospital, No. 6 Fucheng Road, Haidian, Beijing 100048, China
| | - Aocai Yang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Jixin Luan
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Manxi Xu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Kuan Lv
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Pianpian Hu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Bing Liu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Hongwei Yu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Yuli Wang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Weijie Huang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai Road, Haidian, Beijing 100875, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai Road, Haidian, Beijing 100875, China
| | - Gaoxiang Ouyang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai Road, Haidian, Beijing 100875, China
| | - Qian Yin
- School of Artificial Intelligence, Beijing Normal University, No. 19 Xinjiekouwai Road, Haidian, Beijing 100875, China
| | - Amir Shmuel
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 45 Sherbrooke St W, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Physiology, and Biomedical Engineering, McGill University, 45 Sherbrooke St W, Montreal, QC, Canada
| | - Yunfeng Wang
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Qi Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Pengfei Xu
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang, Beijing 100029, China
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Avantaggiato F, Farokhniaee A, Bandini A, Palmisano C, Hanafi I, Pezzoli G, Mazzoni A, Isaias IU. Intelligibility of speech in Parkinson's disease relies on anatomically segregated subthalamic beta oscillations. Neurobiol Dis 2023; 185:106239. [PMID: 37499882 DOI: 10.1016/j.nbd.2023.106239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Speech impairment is commonly reported in Parkinson's disease and is not consistently improved by available therapies - including deep brain stimulation of the subthalamic nucleus (STN-DBS), which can worsen communication performance in some patients. Improving the outcome of STN-DBS on speech is difficult due to our incomplete understanding of the contribution of the STN to fluent speaking. OBJECTIVE To assess the relationship between subthalamic neural activity and speech production and intelligibility. METHODS We investigated bilateral STN local field potentials (LFPs) in nine parkinsonian patients chronically implanted with DBS during overt reading. LFP spectral features were correlated with clinical scores and measures of speech intelligibility. RESULTS Overt reading was associated with increased beta-low ([1220) Hz) power in the left STN, whereas speech intelligibility correlated positively with beta-high ([2030) Hz) power in the right STN. CONCLUSION We identified separate contributions from frequency and brain lateralization of the STN in the execution of an overt reading motor task and its intelligibility. This subcortical organization could be exploited for new adaptive stimulation strategies capable of identifying the occurrence of speaking behavior and facilitating its functional execution.
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Affiliation(s)
- Federica Avantaggiato
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - AmirAli Farokhniaee
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy.
| | - Andrea Bandini
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Alberto Mazzoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
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Alherz M, Almusawi H, Alsayegh A. Diglossia Correlates With Prodromal Symptoms of Psychosis Among First-Generation Migrants. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac066. [PMID: 39144785 PMCID: PMC11205960 DOI: 10.1093/schizbullopen/sgac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis We have previously hypothesized that diglossia may be a risk factor for psychosis, drawing from observations on migration, ethnicity, social adversity, and language disturbances among others. However, empirical data on this association and the tools necessary for its measurement are limited. Study Design In a cross-sectional online sample of first-generation migrants residing in majority English-speaking countries, a response-based decision tree was introduced to classify the sociolinguistic profiles of 1497 participants as either with or without diglossia. Using multivariate logistic regression, the association of diglossia with psychosis risk screening outcomes in the Prodromal Questionnaire-16 was calculated, adjusting for demographic and linguistic confounders. Differences in the symptom categories endorsed between the 2 groups were also examined. Study Results Diglossia was identified in 18.4% of participants and was associated with an adjusted odds ratio of 2.58 for a positive risk screening outcome. Other significant factors included subjective social status, hearing difficulty, age, sex, country of residence, education level, and cannabis consumption. The effects of ethnicity, age at migration, fluency, relationship, and employment status were no more significant in the multivariate model. Finally, the largest differences in the proportion of positively responding participants between the two groups were found in symptoms relating to thought insertion and thought broadcasting. Conclusions In a sociolinguistic hierarchical framework, diglossia is correlated with prodromal symptoms of psychosis in first-generation migrants.
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Affiliation(s)
- Mohammad Alherz
- Department of Anatomy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Kuwait Center for Mental Health, Asimah, Kuwait
- Department of Surgery, Farwaniya Hospital, Farwaniya, Kuwait
| | - Hashemiah Almusawi
- Department of Special Education, The Public Authority for Applied Education and Training, Farwaniya, Kuwait
| | - Ammar Alsayegh
- Department of Psychiatry, Kuwait Center for Mental Health, Asimah, Kuwait
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Almeida VN, Radanovic M. Semantic priming and neurobiology in schizophrenia: A theoretical review. Neuropsychologia 2021; 163:108058. [PMID: 34655651 DOI: 10.1016/j.neuropsychologia.2021.108058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/11/2022]
Abstract
In this theoretical review we bridge the cognitive and neurobiological sciences to shed light on the neurocognitive foundations of the semantic priming effect in schizophrenia. We review and theoretically evaluate the neurotransmitter systems (dopaminergic, GABAergic and glutamatergic) and neurobiological underpinnings of behavioural and electrophysiological (N400) semantic priming in the pathology, and the main hypotheses on their geneses: a disinhibition of the semantic spread of activation, a disorganised semantic storage or noisy lexical-semantic associations, a psychomotor artefact, an artefact of relatedness proportions, or an inability to mobilise contextual information. We further assess the literature on the endophenotype of Formal Thought Disorder from multiple standpoints, ranging from neurophysiology to cognition: considerations are weaved on neuronal (PV basket cell, SST, VIP) and receptor deficits (DRD1, NMDA), neurotransmitter imbalances (dopamine), cortical and dopaminergic lateralisation, inter alia. In conclusion, we put forth novel postulates on the underlying causes of controlled hypopriming, automatic hyperpriming, N400 reversals (larger amplitudes for close associations), indirect versus direct hyperpriming, and the endophenotype of lexical-semantic disturbances in schizophrenia.
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Affiliation(s)
- Victor N Almeida
- Faculdade de Letras, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
| | - Marcia Radanovic
- Laboratório de Neurociências (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Brazil
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Turk AZ, SheikhBahaei S. Morphometric analysis of astrocytes in vocal production circuits of common marmoset (Callithrix jacchus). J Comp Neurol 2021; 530:574-589. [PMID: 34387357 PMCID: PMC8716418 DOI: 10.1002/cne.25230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022]
Abstract
Astrocytes, the star-shaped glial cells, are the most abundant non-neuronal cell population in the central nervous system. They play a key role in modulating activities of neural networks, including those involved in complex motor behaviors. Common marmosets (Callithrix jacchus), the most vocal non-human primate (NHP), have been used to study the physiology of vocalization and social vocal production. However, the neural circuitry involved in vocal production is not fully understood. In addition, even less is known about the involvement of astrocytes in this circuit. To understand the role, that astrocytes may play in the complex behavior of vocalization, the initial step may be to study their structural properties in the cortical and subcortical regions that are known to be involved in vocalization. Here, in the common marmoset, we identify all astrocytic subtypes seen in other primate's brains, including intralaminar astrocytes. In addition, we reveal detailed structural characteristics of astrocytes and perform morphometric analysis of astrocytes residing in the cortex and midbrain regions that are associated with vocal production. We found that cortical astrocytes in these regions illustrate a higher level of complexity when compared to those in the midbrain. We hypothesize that this complexity that is expressed in cortical astrocytes may reflect their functions to meet the metabolic/structural needs of these regions.
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Affiliation(s)
- Ariana Z Turk
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Turk AZ, Lotfi Marchoubeh M, Fritsch I, Maguire GA, SheikhBahaei S. Dopamine, vocalization, and astrocytes. BRAIN AND LANGUAGE 2021; 219:104970. [PMID: 34098250 PMCID: PMC8260450 DOI: 10.1016/j.bandl.2021.104970] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 05/06/2023]
Abstract
Dopamine, the main catecholamine neurotransmitter in the brain, is predominately produced in the basal ganglia and released to various brain regions including the frontal cortex, midbrain and brainstem. Dopamine's effects are widespread and include modulation of a number of voluntary and innate behaviors. Vigilant regulation and modulation of dopamine levels throughout the brain is imperative for proper execution of motor behaviors, in particular speech and other types of vocalizations. While dopamine's role in motor circuitry is widely accepted, its unique function in normal and abnormal speech production is not fully understood. In this perspective, we first review the role of dopaminergic circuits in vocal production. We then discuss and propose the conceivable involvement of astrocytes, the numerous star-shaped glia cells of the brain, in the dopaminergic network modulating normal and abnormal vocal productions.
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Affiliation(s)
- Ariana Z Turk
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892 MD, USA
| | - Mahsa Lotfi Marchoubeh
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, 72701 AR, USA
| | - Ingrid Fritsch
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, 72701 AR, USA
| | - Gerald A Maguire
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, 92521 CA, USA
| | - Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892 MD, USA.
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Janssen N, Mendieta CCR. The Dynamics of Speech Motor Control Revealed with Time-Resolved fMRI. Cereb Cortex 2021; 30:241-255. [PMID: 31070731 DOI: 10.1093/cercor/bhz084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/08/2019] [Accepted: 03/15/2019] [Indexed: 12/30/2022] Open
Abstract
Holding a conversation means that speech must be started, maintained, and stopped continuously. The brain networks that underlie these aspects of speech motor control remain poorly understood. Here we collected functional magnetic resonance imaging (fMRI) data while participants produced normal and fast rate speech in response to sequences of visually presented objects. We took a non-conventional approach to fMRI data analysis that allowed us to study speech motor behavior as it unfolded over time. To this end, whole-brain fMRI signals were extracted in stimulus-locked epochs using slice-based fMRI. These data were then subjected to group independent component analysis to discover spatially independent networks that were associated with different temporal activation profiles. The results revealed two basic brain networks with different temporal dynamics: a cortical network that was activated continuously during speech production, and a second cortico-subcortical network that increased in activity during the initiation and suppression of speech production. Additional analyses explored whether key areas involved in motor suppression such as the right inferior frontal gyrus, sub-thalamic nucleus and pre-supplementary motor area provide first-order signals to stop speech. The results reveal for the first time the brain networks associated with the initiation, maintenance, and suppression of speech motor behavior.
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Affiliation(s)
- Niels Janssen
- Psychology Department, Universidad de la Laguna, La Laguna, Spain.,Instituto de Tecnologías Biomédicas, Universidad de La Laguna, La Laguna, Spain.,Instituto de Neurociencias, Universidad de la Laguna, La Laguna, Spain
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de Lima Xavier L, Hanekamp S, Simonyan K. Sexual Dimorphism Within Brain Regions Controlling Speech Production. Front Neurosci 2019; 13:795. [PMID: 31417351 PMCID: PMC6682624 DOI: 10.3389/fnins.2019.00795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022] Open
Abstract
Neural processing of speech production has been traditionally attributed to the left hemisphere. However, it remains unclear if there are structural bases for speech functional lateralization and if these may be partially explained by sexual dimorphism of cortical morphology. We used a combination of high-resolution MRI and speech-production functional MRI to examine cortical thickness of brain regions involved in speech control in healthy males and females. We identified greater cortical thickness of the left Heschl's gyrus in females compared to males. Additionally, rightward asymmetry of the supramarginal gyrus and leftward asymmetry of the precentral gyrus were found within both male and female groups. Sexual dimorphism of the Heschl's gyrus may underlie known differences in auditory processing for speech production between males and females, whereas findings of asymmetries within cortical areas involved in speech motor execution and planning may contribute to the hemispheric localization of functional activity and connectivity of these regions within the speech production network. Our findings highlight the importance of consideration of sex as a biological variable in studies on neural correlates of speech control.
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Affiliation(s)
- Laura de Lima Xavier
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sandra Hanekamp
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kristina Simonyan
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Avecillas-Chasin JM, Poologaindran A, Morrison MD, Rammage LA, Honey CR. Unilateral Thalamic Deep Brain Stimulation for Voice Tremor. Stereotact Funct Neurosurg 2019; 96:392-399. [PMID: 30625492 DOI: 10.1159/000495413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Voice tremor (VT) is the involuntary and rhythmical phonatory instability of the voice. Recent findings suggest that unilateral deep brain stimulation of the ventral intermediate nucleus (Vim-DBS) can sometimes be effective for VT. In this exploratory analysis, we investigated the effect of Vim-DBS on VT and tested the hypothesis that unilateral thalamic stimulation is effective for patients with VT. METHODS Seven patients with VT and previously implanted bilateral Vim-DBS were enrolled in the study. Each patient was randomized and recorded performing sustained phonation during the following conditions: left thalamic stimulation, right thalamic stimulation, bilateral thalamic stimulation (Bil-ON), and no stimulation (Bil-OFF). Perceptual VT ratings and an acoustic analysis to find the rate of variation of the fundamental frequency measured by the standard deviation of the pitch (f0SD) were performed in a blinded manner. For the purposes of this study, a "dominant" side was defined as one with more than twice as much reduction in VT following Vim-DBS compared to the contralateral side. The Wilcoxon signed-rank test was performed to compare the effect of the dominant side stimulation in the reduction of VT scores and f0SD. The volume of activated tissue (VAT) of the dominant stimulation side was modelled against the degree of improvement in VT to correlate the significant stimulation cluster with thalamic anatomy. Finally, tractography analysis was performed to analyze the connectivity of the significant stimulation cluster. RESULTS Unilateral stimulation was beneficial in all 7 patients. Five patients clearly had a "dominant" side with either benefit only seen following stimulation of one side or more than twice as much benefit from one side compared to the other. Two patients had similar benefit with unilateral stimulation from either side. The Wilcoxon paired test showed significant differences between unilateral dominant and unilateral nondominant stimulation for VT scores (p = 0.04), between unilateral dominant and Bil-OFF (p = 0.04), and between Bil-ON and unilateral nondominant stimulation (p = 0.04). No significant differences were found between Bil-ON and unilateral dominant condition (p = 0.27), or between Bil-OFF and unilateral nondominant (p = 0.23). The dominant VAT showed that the significant voxels associated with the best VT control were located in the most ventral and medial part of the Vim nucleus and the ventralis caudalis anterior internus nucleus. The connectivity analysis showed significant connectivity with the cortical areas of the speech circuit. CONCLUSIONS Unilateral dominant-side thalamic stimulation and bilateral thalamic stimulation were equally effective in reducing VT. Nondominant unilateral stimulation alone did not significantly improve VT.
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Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anujan Poologaindran
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Morrison
- Department of Surgery, Division of Otolaryngology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda A Rammage
- Department of Surgery, Division of Otolaryngology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada,
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