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Gschaidmeier A, Heimgärtner M, Schnaufer L, Driever PH, Wilke M, Lidzba K, Staudt M. Cognitive development after perinatal unilateral infarctions: No evidence for preferential sparing of verbal functions. Eur J Paediatr Neurol 2022; 37:8-11. [PMID: 34999444 DOI: 10.1016/j.ejpn.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Even children with extensive perinatal left-sided lesions have been reported to show normal language functions based on right-hemispheric language reorganization. This reorganization can lead to deficits in originary right hemispheric functions ("crowding hypothesis"). In a previous study, however, we identified epilepsy (even when well-controlled), and not language reorganization, as the major risk factor for impaired nonverbal functions. Here, we asked whether verbal and nonverbal functions develop differently, and whether they share the same risk factors. METHODS We investigated 23 patients (11f, Md = 12.56 years) with perinatal strokes (16 left-sided, 8 with epilepsy), and 23 healthy age-matched controls (8 f, Md = 12.42years). Language functions were assessed using the Potsdam Illinois Test of Psycholinguistic Abilities, nonverbal intelligence with the Test of Nonverbal Intelligence, language lateralization with functional MRI, and lesion size with MRI-based volumetry. RESULTS We found no systematic difference between verbal and nonverbal skills in our patients or controls [median difference Z(PITPA)-Z(TONI): patients = -0.03, controls = -0.06]. Accordingly, verbal and nonverbal functions were strongly correlated in patients (r = 0.80) and in controls (r = 0.74). Language ability correlated significantly with epilepsy. Furthermore, in patients with epilepsies, verbal skills were significantly lower than in controls. CONCLUSION In our cohort, we found no evidence for a differential effect of perinatal strokes on the development of verbal versus nonverbal functions, and, specifically, no evidence for a preferential sparing of verbal functions. Epilepsy, even when well-controlled, was confirmed as a single key risk factor for verbal functions.
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Affiliation(s)
- Alisa Gschaidmeier
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Germany.
| | - Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Pablo Hernáiz Driever
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik, Vogtareuth, Germany
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Clinical Speech fMRI in Children and Adolescents : Development of an Optimal Protocol and Analysis Algorithm. Clin Neuroradiol 2021; 32:185-196. [PMID: 34613421 PMCID: PMC8894226 DOI: 10.1007/s00062-021-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Purpose In patients with drug-resistant focal epilepsy, surgical resection is often the only treatment option to achieve long-term seizure control. Prior to brain surgery involving potential language areas, identification of hemispheric language dominance is crucial. Our group developed and validated a functional magnetic resonance imaging (fMRI) battery of four pediatric language tasks. The present study aimed at optimizing fMRI data acquisition and analysis using these tasks. Methods We retrospectively analyzed speech fMRI examinations of 114 neuropediatric patients (age range 5.8–17.8 years) who were examined prior to possible epilepsy surgery. In order to evaluate hemispheric language dominance, 1–4 language tasks (vowel identification task VIT, word-chain task WCT, beep-story task BST, synonym task SYT) were measured. Results Language dominance was classified using fMRI activation in the 13 validly lateralizing ROIs (VLR) in frontal, temporal and parietal lobes and cerebellum of the recent validation study from our group: 47/114 patients were classified as left-dominant, 34/114 as bilateral and 6/114 as right-dominant. In an attempt to enlarge the set of VLR, we then compared for each task agreement of these ROI activations with the classified language dominance. We found four additional task-specific ROIs showing concordant activation and activation in ≥ 10 sessions, which we termed validly lateralizing (VLRnew). The new VLRs were: for VIT the temporal language area and for SYT the middle frontal gyrus, the intraparietal sulcus and cerebellum. Finally, in order to find the optimal sequence of measuring the different tasks, we analyzed the success rates of single tasks and all possible task combinations. The sequence 1) VIT 2) WCT 3) BST 4) SYT was identified as the optimal sequence, yielding the highest chance to obtain reliable results even when the fMRI examination has to be stopped, e.g., due to lack of cooperation. Conclusion Our suggested task order together with the enlarged set of VLRnew may contribute to optimize pediatric speech fMRI in a clinical setting. Supplementary Information The online version of this article (10.1007/s00062-021-01097-z) contains supplementary material, which is available to authorized users.
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Gschaidmeier A, Heimgärtner M, Schnaufer L, Hernáiz Driever P, Wilke M, Lidzba K, Staudt M. Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies. Front Pediatr 2021; 9:660096. [PMID: 34136439 PMCID: PMC8200455 DOI: 10.3389/fped.2021.660096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The risk factors for impaired cognitive development after unilateral perinatal stroke are poorly understood. Non-verbal intelligence seems to be at particular risk, since language can shift to the right hemisphere and may thereby reduce the capacity of the right hemisphere for its originary functions. Pharmaco-refractory epilepsies, a frequent complication of perinatal strokes, often lead to impaired intelligence. Yet, the role of well-controlled epilepsies is less well-understood. Here, we investigated whether well-controlled epilepsies, motor impairment, lesion size, lesion side, and lateralization of language functions influence non-verbal functions. Methods: We recruited 8 patients with well-controlled epilepsies (9-26 years), 15 patients without epilepsies (8-23 years), and 23 healthy controls (8-27 years). All underwent the Test of Non-verbal Intelligence, a motor-independent test, which excludes biased results due to motor impairment. Language lateralization was determined with functional MRI, lesion size with MRI-based volumetry, and hand motor impairment with the Jebson-Taylor Hand Function-Test. Results: Patients with epilepsies showed significantly impaired non-verbal intelligence [Md = 89.5, interquartile range (IQR) = 13.5] compared with controls (Md = 103, IQR = 17). In contrast, patients without epilepsies (Md = 97, IQR = 15.0) performed within the range of typically developing children. A multiple regression analysis revealed only epilepsy as a significant risk factor for impaired non-verbal functions. Conclusion: In patients with unilateral perinatal strokes without epilepsies, the neuroplastic potential of one healthy hemisphere is able to support the development of normal non-verbal cognitive abilities, regardless of lesion size, lesion side, or language lateralization. In contrast, epilepsy substantially reduces this neuroplastic potential; even seizure-free patients exhibit below-average non-verbal cognitive functions.
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Affiliation(s)
- Alisa Gschaidmeier
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Magdalena Heimgärtner
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Lukas Schnaufer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital, Tübingen, Germany
| | - Karen Lidzba
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Division of Neuropediatrics, Development, and Rehabilitation, University Children's Hospital Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.,Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
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Meinhold T, Hofer W, Pieper T, Kudernatsch M, Staudt M. Presurgical Language fMRI in Children, Adolescents and Young Adults : A Validation Study. Clin Neuroradiol 2020; 30:691-704. [PMID: 31960077 DOI: 10.1007/s00062-019-00852-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To validate four established, child-friendly functional magnetic resonance imaging (fMRI) language tasks (word chain task [WCT], vowel identification task [VIT], synonym task [SYT] and beep story task [BST]) in a predominantly pediatric cohort. METHODS Intracarotid amobarbital procedures (IAP) (n = 17) and unchanged language after hemispherotomy (n = 6) were used as gold standards. The fMRI activations of nine regions of interest (ROI) in the frontal, temporal and parietal lobes as well as in the cerebellum were visually assessed in 23 fMRI examinations (in total 117 fMRI task sessions) of 23 patients (age range 10.0-23.0 years) with drug-refractory epilepsies. RESULTS The ROIs were considered valid when they showed activation in more than 25% of all sessions for the respective task and never showed false lateralization (in comparison to gold standards). Thus, 13 valid, task-specific ROIs were identified: 5 ROIs for the WCT (frontal operculum, inferior frontal gyrus, middle frontal gyrus, intraparietal sulcus, cerebellum), 3 ROIs for the VIT (frontal operculum, inferior frontal gyrus, middle frontal gyrus), 3 ROIs for the SYT (frontal operculum, inferior frontal gyrus, temporal language area) and 2 ROIs for the BST (inferior frontal gyrus, middle frontal gyrus). CONCLUSION Clinical fMRI using the battery of four tasks is a valid tool for lateralizing language in children, adolescents and young adults. Each task proved to be specifically useful, which confirms that applying different tasks increases the probability of diagnosing language dominance in presurgical candidates.
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Affiliation(s)
- Theresa Meinhold
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Germany. .,Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tübingen, Tübingen, Germany.
| | - Wiebke Hofer
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Germany
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Center for Neurosurgery and Epilepsy Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany.,Research Institute "Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Martin Staudt
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Germany.,Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tübingen, Tübingen, Germany
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Wilke M, Baldeweg T. A multidimensional artefact-reduction approach to increase robustness of first-level fMRI analyses: Censoring vs. interpolating. J Neurosci Methods 2019; 318:56-68. [PMID: 30779930 DOI: 10.1016/j.jneumeth.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND This manuscript describes a new, multidimensional and data-driven approach to identify outlying datapoints from a first-level fMRI dataset. NEW METHOD Using three different indicators of data corruption (the fast variance component of DVARS [Δ%D-var], scan-to-scan total displacement [STS], and each scan's overall explained variance [R2]), it identifies outlying datapoints while being balanced using Akaike'c corrected criterion (AIC C) to avoid overcorrection. We then explore the impact of censoring, interpolating, or both, to remove a bad scan's contribution to the final timeseries. RESULTS AND COMPARISON WITH EXISTING METHODS Our results (using three real-life datasets and extensive simulations) show that motion-corrupted datapoints as well as non-motion related image artefacts are detected reliably. Using several indicators is shown to be an advantage over existing single-indicator solutions in different settings. As a result of using our algorithm, stronger activation (as detected by both T-value and number of activated voxels) and an increase in the temporal signal-to-noise ratio can be seen. The effects of censoring and interpolation are distinct and complex. CONCLUSIONS The multidimensional approach described here is able to identify outlying datapoints in fMRI timeseries, with demonstrable positive effects on several outcome measures. While censoring datapoints may be preferable in many settings, the ultimate choice on which approach to choose may depend on the data at hand. Recommendations are provided for different scenarios.
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Affiliation(s)
- Marko Wilke
- Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, Germany; Experimental Pediatric Neuroimaging, Children's Hospital and Department of Neuroradiology, University Hospital Tübingen, Germany.
| | - Torsten Baldeweg
- Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, United Kingdom; Great Ormond Street Hospital NHS Trust, London, United Kingdom
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Assessing motor, visual and language function using a single 5-minute fMRI paradigm: three birds with one stone. Brain Imaging Behav 2019; 12:1775-1785. [PMID: 29480439 DOI: 10.1007/s11682-018-9848-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Clinical functional Magnetic Resonance Imaging (fMRI) requires inferences on localization of major brain functions at the individual subject level. We hypothesized that a single "triple use" task would satisfy sensitivity and reliability requirements for successfully assessing the motor, visual and language domain in this context. This was tested here by the application in a group of healthy adults, assessing sensitivity and reliability at the individual subject level, separately for each domain.Our "triple use" task consisted of 2 conditions (condition 1, assessing motor and visual domain, and condition 2, assessing the language domain), serving mutually as active/control. We included 20 healthy adult subjects. Random effect analyses showed activation in primary motor, visual and language regions, as expected. Less expected regions were activated both for the motor and visual domains. Further, reliability of primary activation patterns was very high across individual subjects, with activation seen in 70-100% of subjects in primary motor, visual, and left-lateralized language regions.These findings suggest the "triple use" task to be reliable at the individual subject's level to assess motor, visual and language domains in the clinical fMRI context. Benefits of such an approach include shortening of acquisition time, simplicity of the task for each domain, and using a visual stimulus. Following establishment of reliability in adults, the task may also be a valuable addition in the pediatric clinical fMRI context, where each of these factors is of high relevance.
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Role of presurgical functional MRI and diffusion MR tractography in pediatric low-grade brain tumor surgery: a single-center study. Childs Nerv Syst 2018; 34:2241-2248. [PMID: 29802593 DOI: 10.1007/s00381-018-3828-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/13/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Presurgical functional MRI (fMRI) and diffusion MRI tractography (dMRI tractography) are widely employed to delineate eloquent brain regions and their connections prior to brain tumor resection in adults. However, such studies are harder to perform in children, resulting in suboptimal neurosurgical care in pediatric brain tumor surgery as compared to adults. Thus, our objective was to assess the feasibility and the influence of presurgical advanced MR imaging on neurosurgical care in pediatric brain tumor surgery. METHODS Retrospective analyses of 31 presurgical fMRI/dMRI tractography studies were performed in children with low-grade tumors near eloquent brain regions at our site between 2005 and 2017. RESULTS In only 3/31 cases, imaging results were not interpretable (10%). All 28 successful imaging sessions were used for neurosurgical risk assessment. Based on this, surgery was canceled in 2/28 patients, and intention to treat was changed in 5/28 patients. In 4/28 cases, the surgical approach was changed and in 10/28, electrode placement for intraoperative neurophysiological monitoring was guided by imaging results. Gross total resection (GTR) was planned in 21/28 cases and could be achieved in 15/21 (71%). Despite highly eloquent tumor location, only four children suffered from a mild permanent neurological deficit after the operation. CONCLUSIONS We demonstrate that presurgical fMRI/dMRI tractography can have a profound impact on pediatric brain tumor management, optimizing preoperative risk-assessment and pre- as well as intraoperative decision-making. We believe that these tools should be offered to children suffering from eloquent brain tumors as part of a comprehensive operative work-up.
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Wilke M, Groeschel S, Lorenzen A, Rona S, Schuhmann MU, Ernemann U, Krägeloh‐Mann I. Clinical application of advanced MR methods in children: points to consider. Ann Clin Transl Neurol 2018; 5:1434-1455. [PMID: 30480038 PMCID: PMC6243383 DOI: 10.1002/acn3.658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision-making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically-indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.
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Affiliation(s)
- Marko Wilke
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Samuel Groeschel
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Anna Lorenzen
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
- Children's Hospital and Department of NeuroradiologyExperimental Pediatric NeuroimagingTuebingenGermany
| | - Sabine Rona
- Department of NeurosurgeryUniversity HospitalTuebingenGermany
| | | | - Ulrike Ernemann
- Department of Diagnostic and Interventional NeuroradiologyUniversity HospitalUniversity of TübingenTuebingenGermany
| | - Ingeborg Krägeloh‐Mann
- Department of Pediatric Neurology and Developmental MedicineChildren's HospitalTuebingenGermany
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