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Jussila MP, Olsén P, Niinimäki J, Suo-Palosaari M. Is Brain MRI Needed in Diagnostic Evaluation of Mild Intellectual Disability? Neuropediatrics 2021; 52:27-33. [PMID: 33111301 DOI: 10.1055/s-0040-1716902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The purpose of our study was to suggest an imaging strategy and guidelines for the selection of the children with mild intellectual disability (ID) for magnetic resonance imaging (MRI), to avoid unnecessary imaging. METHODS The brain MRIs and patient reports of 471 children were reviewed for the imaging findings and ID severity. The correlation between the clinical and brain MRI findings was analyzed in the 305 children with mild ID. RESULTS Thirty-eight (12.5%) of the children with mild ID had significant abnormal brain MRI findings. Thirty-five of these had other neurological symptoms or diseases in addition to ID, which were an indication for brain MRI. In the logistic regression analysis, seizures (in patients without an epilepsy diagnosis), epilepsy, movement disorders, dysmorphia, encephalitis, traumatic brain injury, and abnormal head size were statistically significant symptoms or comorbidities associated with abnormal MRI findings. Only three children (1.0%) with mild ID had a significant MRI finding without any other clinical symptoms or disease. CONCLUSION Routine MRI in children with mild ID without specific neurological symptoms, dysmorphic features, or related diseases is not suggested for revealing an etiology of mild ID. Since children with ID usually need to be sedated for MRI, routine imaging in the diagnostic evaluation of mild ID should be carefully considered. Clinical examination, other symptoms, and related diseases should be carefully assessed to decide the need for MRI.
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Affiliation(s)
- Miro Pekka Jussila
- Department of Diagnostic Radiology, Oulu University Hospital and Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Päivi Olsén
- Department of Pediatrics and Adolescence, Oulu University Hospital and PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital and Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Suo-Palosaari
- Department of Diagnostic Radiology, Oulu University Hospital and Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital and University of Oulu, Oulu, Finland
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Soysal H, Doğan Z, Kamışlı Ö. Effects of phenytoin and lamotrigine treatment on serum BDNF levels in offsprings of epileptic rats. Neuropeptides 2016; 56:1-8. [PMID: 26706181 DOI: 10.1016/j.npep.2015.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 12/01/2015] [Accepted: 12/06/2015] [Indexed: 12/01/2022]
Abstract
The role of brain-derived neurotrophic factor (BDNF) is to promote and modulate neuronal responses across neurotransmitter systems in the brain. Therefore, abnormal BDNF signaling may be associated with the pathophysiology of schizophrenia. Low BDNF levels have been reported in brains and serums of patients with psychotic disorders. In the present study, we investigated the effects of antiepileptic drugs on BDNF in developing rats. Pregnant rats were treated with phenytoin (PHT), lamotrigine (LTG) and folic acid for long-term, all through their gestational periods. Experimental epilepsy (EE) model was applied in pregnant rats. Epileptic seizures were determined with electroencephalography. After birth, serum BDNF levels were measured in 136 newborn rats on postnatal day (PND) 21 and postnatal day 38. In postnatal day 21, serum BDNF levels of experimental epilepsy group were significantly lower compared with PHT group. This decrease is statistically significant. Serum BDNF levels increased in the group LTG. This increase compared with LTG+EE group was statistically significant. In the folic acid (FA) group, levels of serum BDNF decreased statistically significantly compared to the PHT group. On postnatal day 38, no significant differences were found among the groups for serum BDNF levels. We concluded that, the passed seizures during pregnancy adversely affect fetal brain development, lowering of serum BDNF levels. PHT use during pregnancy prevents seizure-induced injury by increasing the levels of BDNF. About the increase level of BDNF, LTG is much less effective than PHT, the positive effect of folic acid on serum BDNF levels was not observed. LTG increase in BDNF is much less effective than PHT, folic acid did not show a positive effect on serum BDNF levels. Epilepsy affects fetal brain development during gestation in pregnant rats, therefore anti-epileptic therapy should be continued during pregnancy.
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Affiliation(s)
- Handan Soysal
- Faculty of Medicine, Department of Anatomy, Başkent University, Ankara, Turkey.
| | - Zümrüt Doğan
- Faculty of Medicine, Department of Anatomy, Adıyaman University, Adıyaman, Turkey
| | - Özden Kamışlı
- Faculty of Medicine, Department of Nörology, Inönü University, Malatya, Turkey
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Sathiya S, Ganesh M, Kalaivani P, Ranju V, Janani S, Pramila B, Saravana Babu C. Prenatal exposure to lamotrigine: effects on postnatal development and behaviour in rat offspring. ISRN NEUROSCIENCE 2014; 2014:163459. [PMID: 24967313 PMCID: PMC4045557 DOI: 10.1155/2014/163459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
Use of antiepileptic drugs (AEDs) in pregnancy warrants various side effects and also deleterious effects on fetal development. The present study was carried out to assess the effects of prenatal exposure to lamotrigine (LTG) on postnatal development and behavioural alterations of offspring. Adult male and female Sprague Dawley rats weighing 150-180 g b. wt. were allowed to copulate and pregnancy was confirmed by vaginal cytology. Pregnant rats were treated with LTG (11.5, 23, and 46 mg/kg, p.o) from gestational day 3 (GND 3) and this treatment continued till postnatal day 11 (PND 11). Offspring were separated from their dam on day 21 following parturition. LTG, at 46 mg/kg, p.o, produced severe clinical signs of toxicity leading to death of dam between GND 15 and 17. LTG, at 11.5 and 23 mg/kg, p.o, showed significant alterations in offspring's incisors eruption and vaginal opening when compared to age matched controls. LTG (23 mg/kg, p.o) exposed female offspring expressed hyperactive behaviour and decreased GABA-A receptor expression when compared to control rats. These results reveal that prenatal exposure to LTG may impart differential postnatal behavioural alterations between male and female rats which paves way for further investigations.
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Affiliation(s)
- Sekar Sathiya
- Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
| | - Murugan Ganesh
- Department of Biochemistry, Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
| | - Periyathambi Kalaivani
- Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
| | - Vijayan Ranju
- Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
| | - Srinivasan Janani
- School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy (SASTRA University), Thanjavur, Tamil Nadu 613402, India
| | - Bakthavachalam Pramila
- Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
| | - Chidambaram Saravana Babu
- Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai, Tamil Nadu 600116, India
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Lapray D, Popova IY, Kindler J, Jorquera I, Becq H, Manent JB, Luhmann HJ, Represa A. Spontaneous Epileptic Manifestations in a DCX Knockdown Model of Human Double Cortex. Cereb Cortex 2010; 20:2694-701. [DOI: 10.1093/cercor/bhq014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Chou A, Boerkoel C, du Souich C, Rupps R. Phenotypic and molecular characterization of a novelDCXdeletion and a review of the literature. Clin Genet 2009; 76:214-8. [DOI: 10.1111/j.1399-0004.2009.01206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manent JB, Jorquera I, Franco V, Ben-Ari Y, Perucca E, Represa A. Antiepileptic drugs and brain maturation: Fetal exposure to lamotrigine generates cortical malformations in rats. Epilepsy Res 2008; 78:131-9. [DOI: 10.1016/j.eplepsyres.2007.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 10/24/2007] [Accepted: 10/28/2007] [Indexed: 02/05/2023]
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Poirier K, Keays DA, Francis F, Saillour Y, Bahi N, Manouvrier S, Fallet-Bianco C, Pasquier L, Toutain A, Tuy FPD, Bienvenu T, Joriot S, Odent S, Ville D, Desguerre I, Goldenberg A, Moutard ML, Fryns JP, van Esch H, Harvey RJ, Siebold C, Flint J, Beldjord C, Chelly J. Large spectrum of lissencephaly and pachygyria phenotypes resulting from de novo missense mutations in tubulin alpha 1A (TUBA1A). Hum Mutat 2007; 28:1055-64. [PMID: 17584854 DOI: 10.1002/humu.20572] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We have recently reported a missense mutation in exon 4 of the tubulin alpha 1A (Tuba1a) gene in a hyperactive N-ethyl-N-nitrosourea (ENU) induced mouse mutant with abnormal lamination of the hippocampus. Neuroanatomical similarities between the Tuba1a mutant mouse and mice deficient for Doublecortin (Dcx) and Lis1 genes, and the well-established functional interaction between DCX and microtubules (MTs), led us to hypothesize that mutations in TUBA1A (TUBA3, previous symbol), the human homolog of Tuba1a, might give rise to cortical malformations. This hypothesis was subsequently confirmed by the identification of TUBA1A mutations in two patients with lissencephaly and pachygyria, respectively. Here we report additional TUBA1A mutations identified in six unrelated patients with a large spectrum of brain dysgeneses. The de novo occurrence was shown for all mutations, including one recurrent mutation (c.790C>T, p.R264C) detected in two patients, and two mutations that affect the same amino acid (c.1205G>A, p.R402H; c.1204C>T, p.R402C) detected in two other patients. Retrospective examination of MR images suggests that patients with TUBA1A mutations share not only cortical dysgenesis, but also cerebellar, hippocampal, corpus callosum, and brainstem abnormalities. Interestingly, the specific high level of Tuba1a expression throughout the period of central nervous system (CNS) development, shown by in situ hybridization using mouse embryos, is in accordance with the brain-restricted developmental phenotype caused by TUBA1A mutations. All together, these results, in combination with previously reported data, strengthen the relevance of the known interaction between MTs and DCX, and highlight the importance of the MTs/DCX complex in the neuronal migration process.
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Affiliation(s)
- Karine Poirier
- Institut Cochin, Université Paris Descartes, Centre national de la recherche scientifique Unité Mixte de Recherche 8104, Paris, France
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Ledergerber D, Fritschy JM, Kralic JE. Impairment of dentate gyrus neuronal progenitor cell differentiation in a mouse model of temporal lobe epilepsy. Exp Neurol 2006; 199:130-42. [PMID: 16624297 DOI: 10.1016/j.expneurol.2006.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 01/31/2006] [Accepted: 02/01/2006] [Indexed: 11/25/2022]
Abstract
Unilateral intrahippocampal injection of kainic acid (KA) in adult mice induces an epileptic focus replicating major histopathological features of temporal lobe epilepsy (TLE). In this model, neurogenesis is impaired in the lesioned dentate gyrus, although cell proliferation transiently is increased bilaterally in the subgranular zone (SGZ). To investigate further the relationship between epileptogenesis and neurogenesis, we compared the differentiation of cells born shortly before and after KA injection. Immunohistochemical staining for doublecortin and PSA-NCAM, two markers of young neurons, revealed a rapid downregulation of both markers ipsilaterally, whereas they were increased transiently on the contralateral side. To determine whether KA treatment directly affects neural progenitors in the SGZ, dividing cells were prelabeled with 5'-bromo-2'deoxyuridine (BrdU) treatment before unilateral injection of KA. Double staining with the proliferation marker PCNA showed that prelabeled BrdU cells survived KA exposure and proliferated bilaterally. Unexpectedly, the neuronal differentiation of these cells, as assessed after 2 weeks with doublecortin and NeuN triple-staining, occurred to the same extent as on the contralateral side. Only 5% of pre-labeled BrdU cells were GFAP-positive within the lesion. Therefore, SGZ progenitor cells committed to a neuronal phenotype before KA treatment complete their differentiation despite the rapid down-regulation of doublecortin and PSA-NCAM. These findings suggest impaired fate commitment and/or early differentiation of proliferating cells in the lesioned dentate gyrus. Loss of neurogenesis in this TLE model likely reflects an irreversible alteration of the SGZ germinal niche during development of the epileptic focus and may therefore be relevant for human TLE.
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Affiliation(s)
- Debora Ledergerber
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
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Francis F, Meyer G, Fallet-Bianco C, Moreno S, Kappeler C, Socorro AC, Tuy FPD, Beldjord C, Chelly J. Human disorders of cortical development: from past to present. Eur J Neurosci 2006; 23:877-93. [PMID: 16519653 DOI: 10.1111/j.1460-9568.2006.04649.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Epilepsy and mental retardation, originally of unknown cause, are now known to result from many defects including cortical malformations, neuronal circuitry disorders and perturbations of neuronal communication and synapse function. Genetic approaches in combination with MRI and related imaging techniques continually allow a re-evaluation and better classification of these disorders. Here we review our current understanding of some of the primary defects involved, with insight from recent molecular biology advances, the study of mouse models and the results of neuropathology analyses. Through these studies the molecular determinants involved in the control of neuron number, neuronal migration, generation of cortical laminations and convolutions, integrity of the basement membrane at the pial surface, and the establishment of neuronal circuitry are being elucidated. We have attempted to integrate these results with the available data concerning, in particular, human brain development, and to emphasize the limitations in some cases of extrapolating from rodent models. Taking such species differences into account is clearly critical for understanding the pathophysiological mechanisms associated with these disorders.
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Affiliation(s)
- Fiona Francis
- Institut Cochin, Département de Génétique et Développement, Paris, F-75014 France.
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Tang-Wai R, Oskoui M, Webster R, Shevell M. Outcomes in pediatric epilepsy: seeing through the fog. Pediatr Neurol 2005; 33:244-50. [PMID: 16194721 DOI: 10.1016/j.pediatrneurol.2005.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 03/17/2005] [Accepted: 04/18/2005] [Indexed: 11/29/2022]
Abstract
To identify clinical and predictive features of outcome in cryptogenic epilepsy in pediatric neurology practice, the medical records of all patients with cryptogenic epilepsy (as defined by the International League Against Epilepsy) in a single pediatric neurology practice over a 12-year interval with at least 2 years of follow-up were systematically and retrospectively reviewed. Review revealed 60 children with cryptogenic epilepsy: 32 (53.3%) males, 11 (18.3%) prior febrile seizure, 9 (15.0%) developmental delay at onset, and 38 (63.3%) placement in regular classes. Twenty-two (35.7%) had generalized seizures. Mean follow-up after initiating antiepileptic medication was 53 months (range 24-128 months). Four (6.7%) were intractable; 4 (6.7%) had very poor outcomes; 8 (13.3%) had poor outcomes; 44 (73.3%) were well controlled. Sixteen (26.7%) and 31 (51.7%) had seizure recurrence within the last 12 and 24 months, respectively. Twenty-nine (48.3%) were seizure-free for at least 24 months. Factors associated with a poor outcome include seizure recurrence in the 6- to 12-month interval after therapy initiation (P = 0.006) and developmental delay at onset (P = 0.023). This case series suggests that children with cryptogenic epilepsy tend to have a favorable outcome. Seizure recurrence in the first months after therapy initiation and developmental delay apparent at onset are predictive of poor outcome.
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MESH Headings
- Adolescent
- Anticonvulsants/therapeutic use
- Chi-Square Distribution
- Child
- Child, Preschool
- Developmental Disabilities/etiology
- Epilepsies, Partial/complications
- Epilepsies, Partial/drug therapy
- Epilepsies, Partial/mortality
- Epilepsy/complications
- Epilepsy/drug therapy
- Epilepsy/mortality
- Epilepsy, Generalized/complications
- Epilepsy, Generalized/drug therapy
- Epilepsy, Generalized/mortality
- Female
- Follow-Up Studies
- Humans
- Male
- Prognosis
- Recurrence
- Regression Analysis
- Retrospective Studies
- Seizures, Febrile/complications
- Seizures, Febrile/drug therapy
- Seizures, Febrile/mortality
- Treatment Outcome
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Affiliation(s)
- Richard Tang-Wai
- Department of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada
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Decobert F, Grabar S, Merzoug V, Kalifa G, Ponsot G, Adamsbaum C, des Portes V. Unexplained mental retardation: is brain MRI useful? Pediatr Radiol 2005; 35:587-96. [PMID: 15739114 DOI: 10.1007/s00247-005-1406-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mental retardation (MR), defined as an IQ below 70, is a frequent cause of consultation in paediatrics. OBJECTIVE To evaluate the yield of brain MRI in the diagnostic work-up of unexplained MR in children. PATIENTS AND METHODS The MRI features and clinical data of 100 patients (age 1-18 years) affected with non-progressive MR of unknown origin were compared to an age-matched control group (n=100). Two radiologists conducted an independent review of the MRI scans. RESULTS Univariate and multivariate analyses showed a higher incidence of brain anomalies in the MR group than in the control group (53 vs 17, OR=5.7 [2.9-11.1]), for signal abnormalities within the periventricular white matter (OR=20.3 [2.6-155.3]), lateral ventricular dilatation (OR=15.6 [2.0-124]), mild corpus callosum abnormalities (shortness, atrophy) (OR=6.8 [1.8-25.6]) and subtle cerebellar abnormalities, including fissure enlargement (OR=5.2 [1.1-26.2]). The diagnostic value of MRI abnormalities was considered good in 5% of patients (Alexander disease n=1, diffuse cortical malformation n=1, leukomalacia n=1, vermian agenesis n=1, commissural agenesis n=1), and weak in 48% of patients, in whom non-specific abnormalities did not lead to a diagnosis. Some clinical features resulted in a significantly higher percentage of abnormal MRI scans: abnormal neurological examination (82% vs 47%, P=0.008), abnormal skull circumference (66% vs 49%, P=0.04). Motor delay was associated with cerebellar abnormalities (P=0.01). CONCLUSIONS This study confirms the weak diagnostic yield of MRI in mentally retarded children. The use of a control group has enabled us to identify the neuroimaging markers frequently associated with MR. Subgrouping patients according to neuroimaging markers and clinical signs should help identify those who would benefit from molecular studies.
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Affiliation(s)
- Fabrice Decobert
- Department of Radiology, Saint Vincent de Paul Hospital, 82 Avenue Denfert Rochereau, 75674 Paris Cedex 14, France
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