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Yiğit H, Güler H, Yılmaz H, Gümü ÜÖ, Karaman ZF, Güneş T. Effect of cervical and lumbosacral spina bifida cystica on volumes of intracranial structures in children. Childs Nerv Syst 2024; 40:527-535. [PMID: 37698650 DOI: 10.1007/s00381-023-06153-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Spina bifida is a major disorder that occurs when the membranes of the spinal cord and medulla fail to close during the embryonic period and affects the individual for the rest of life. Some physical, mental, and social difficulties can be observed in the lives of children with spina bifida after surgery. The aim of this study is to determine what kind of volumetric changes occur in the brain when spina bifida occurs in different regions of the cord. METHODS The volume of intracranial structures of 14 children aged 1 to 9 years (7 cervical, 7 lumbosacral) with different levels of spina bifida compared with vol2Brain. RESULTS Spina bifida occurring in the cervical region was found to cause a greater volumetric reduction in subcortical structures, cortex and gyrus than spina bifida occurring in the lumbosacral region. CONCLUSION We believe that our study will help clinicians involved in the management of this disorder.
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Affiliation(s)
- Hüseyin Yiğit
- Cappadocia Vocational School, Department of Medical Services and Techniques, Cappadocia University, Nevsehir, Turkey.
| | - Hatice Güler
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Yılmaz
- Department of Anatomy, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ümmügülsüm Özgül Gümü
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Filiz Karaman
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Tamer Güneş
- Department of Child Health and Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Ji H, Payette K, Speckert A, Tuura R, Grehten P, Kottke R, Ochseinbein-Kölble N, Hagmann C, Mazzone L, Meuli M, Padden B, Hackenberg A, Wille DA, Moehrlen U, Latal B, SPINA BIFIDA STUDY GROUP ZURICH, Jakab A. Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2 years. Cereb Cortex 2024; 34:bhad438. [PMID: 37991274 PMCID: PMC10793566 DOI: 10.1093/cercor/bhad438] [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: 07/20/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P < 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.
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Affiliation(s)
- Hui Ji
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Kelly Payette
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Anna Speckert
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
| | - Ruth Tuura
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Patrice Grehten
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Nicole Ochseinbein-Kölble
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Department of Obstetrics, University Hospital of Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Cornelia Hagmann
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Neonatology, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Luca Mazzone
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Martin Meuli
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Beth Padden
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Division of Pediatric Rehabilitation, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Annette Hackenberg
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Neurology, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - David-Alexander Wille
- Department of Pediatric Neurology, Cantonal Hospital of Baden, Baden 5404, Switzerland
| | - Ueli Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | | | - Andras Jakab
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
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Zaksaite T, Loveday C, Edginton T, Spiers HJ, Smith AD. Hydrocephalus: A neuropsychological and theoretical primer. Cortex 2023; 160:67-99. [PMID: 36773394 DOI: 10.1016/j.cortex.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.
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Affiliation(s)
- Tara Zaksaite
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Catherine Loveday
- School of Social Sciences, University of Westminster, 115 New Cavendish St, London W1W 6UW, UK
| | - Trudi Edginton
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Hugo J Spiers
- Department of Experimental Psychology, Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| | - Alastair D Smith
- School of Psychology, University of Plymouth, Plymouth, PL4 8AA, UK; Brain Research and Imaging Centre, University of Plymouth, 7 Derriford Rd, Plymouth, PL6 8BU, UK.
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Guinamard A, Clément S, Goemaere S, Mary A, Riquet A, Dellacherie D. Musical abilities in children with developmental cerebellar anomalies. Front Syst Neurosci 2022; 16:886427. [PMID: 36061946 PMCID: PMC9436271 DOI: 10.3389/fnsys.2022.886427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Developmental Cerebellar Anomalies (DCA) are rare diseases (e.g., Joubert syndrome) that affect various motor and non-motor functions during childhood. The present study examined whether music perception and production are affected in children with DCA. Sixteen children with DCA and 37 healthy matched control children were tested with the Montreal Battery for Evaluation of Musical Abilities (MBEMA) to assess musical perception. Musical production was assessed using two singing tasks: a pitch-matching task and a melodic reproduction task. Mixed model analyses showed that children with DCA were impaired on the MBEMA rhythm perception subtest, whereas there was no difference between the two groups on the melodic perception subtest. Children with DCA were also impaired in the melodic reproduction task. In both groups, singing performance was positively correlated with rhythmic and melodic perception scores, and a strong correlation was found between singing ability and oro-bucco-facial praxis in children with DCA. Overall, children with DCA showed impairments in both music perception and production, although heterogeneity in cerebellar patient’s profiles was highlighted by individual analyses. These results confirm the role of the cerebellum in rhythm processing as well as in the vocal sensorimotor loop in a developmental perspective. Rhythmic deficits in cerebellar patients are discussed in light of recent work on predictive timing networks including the cerebellum. Our results open innovative remediation perspectives aiming at improving perceptual and/or production musical abilities while considering the heterogeneity of patients’ clinical profiles to design music-based therapies.
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Affiliation(s)
- Antoine Guinamard
- Univ. Lille, ULR 4072 – PSITEC – Psychologie: Interactions, Temps, Émotions, Cognition, Lille, France
- CHU Lille, Centre de Référence Malformations et Maladies Congénitales du Cervelet, Lille, France
- *Correspondence: Antoine Guinamard,
| | - Sylvain Clément
- Univ. Lille, ULR 4072 – PSITEC – Psychologie: Interactions, Temps, Émotions, Cognition, Lille, France
| | - Sophie Goemaere
- CHU Lille, Centre de Référence Malformations et Maladies Congénitales du Cervelet, Lille, France
- CHU Lille, Centre Régional de Diagnostic des Troubles d’Apprentissage, Lille, France
| | - Alice Mary
- CHU Lille, Centre de Référence Malformations et Maladies Congénitales du Cervelet, Lille, France
| | - Audrey Riquet
- CHU Lille, Centre de Référence Malformations et Maladies Congénitales du Cervelet, Lille, France
| | - Delphine Dellacherie
- Univ. Lille, ULR 4072 – PSITEC – Psychologie: Interactions, Temps, Émotions, Cognition, Lille, France
- CHU Lille, Centre de Référence Malformations et Maladies Congénitales du Cervelet, Lille, France
- Delphine Dellacherie,
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Lindquist B, Jacobsson H, Strinnholm M, Peny‐Dahlstrand M. A scoping review of cognition in spina bifida and its consequences for activity and participation throughout life. Acta Paediatr 2022; 111:1682-1694. [PMID: 35608513 PMCID: PMC9546308 DOI: 10.1111/apa.16420] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
Aim The aim of this scoping review was to summarise findings concerning cognitive characteristics in people with spina bifida and explain how cognitive factors influence activities and participation in different areas and stages of life. Methods PubMed, Psych INFO, ERIC, Scopus, CINAHL and the Cochrane Library were searched for English language papers published in 2000–2018. A total of 92 papers were selected and quality was assessed according to the McMaster criteria. The results were presented related to body functions, activity and participation from the International Classification of Function and Health, ICF. Results People with spina bifida tended to have a lower IQ than those without. The majority also had cognitive difficulties manifested in problems with language, perception, memory, executive and attentional functions. Those difficulties affected activity and participation in all life domains in ICF. This may affect medical adherence and responsibility and by extension the prevention of secondary complications. Conclusion It is important for caregivers, professionals and especially individuals with spina bifida themselves to understand and handle both physical and cognitive consequences in all life circumstances. Having insight into one’s own assets and difficulties paves the way to managing life challenges, which could enhance health, self‐management and participation in society.
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Affiliation(s)
- Barbro Lindquist
- Department of Habilitation Halmstad County Hospital Halmstad Sweden
| | | | - Margareta Strinnholm
- Folke Bernadotte Regional Habilitation Center University Children´s Hospital Uppsala Sweden
| | - Marie Peny‐Dahlstrand
- Regional Rehabilitation Centre Queen Silvia Children´s Hospital Sahlgrenska University Hospital Gothenburg Sweden
- Sweden Institute of Neuroscience and Physiology at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Foss S, Flanders TM, Heuer GG, Schreiber JE. Neurobehavioral outcomes in patients with myelomeningocele. Neurosurg Focus 2020; 47:E6. [PMID: 31574480 DOI: 10.3171/2019.7.focus19445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 01/26/2023]
Abstract
This paper describes some of the more common patterns in neurobehavioral deficits and their underlying neuroanatomical basis in myelomeningocele (MMC). Patients with MMC can face a lifetime of specific organ system dysfunction, chief among them spinal cord malformations, orthopedic issues, hydrocephalus, and urological disabilities. In addition, patients can experience specific patterns of neurobehavioral difficulties due to the changes in neuroanatomy associated with the open spinal defect. Although there is variability in these patterns, some trends have been described among MMC patients. It is thought that early recognition of these potential neurobehavioral deficits by treating neurosurgeons and other members of the treatment team could lead to earlier intervention and positively impact the overall outcome for patients. Neurodevelopmental and neurobehavioral follow-up assessments are recommended to help guide planning for relevant treatments or accommodations.
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Affiliation(s)
- Sophie Foss
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of
| | | | - Gregory G Heuer
- 2Neurosurgery and.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jane E Schreiber
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
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Role of Neurocognitive Factors in Academic Fluency for Children and Adults With Spina Bifida Myelomeningocele. J Int Neuropsychol Soc 2019; 25:249-265. [PMID: 30864535 DOI: 10.1017/s1355617718001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. METHODS Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. RESULTS Univariate regressions were significant and robust (R 2 =.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. CONCLUSIONS The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249-265).
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Persson M, Janeslätt G, Peny-Dahlstrand M. Daily time management in children with spina bifida. J Pediatr Rehabil Med 2017; 10:295-302. [PMID: 29125520 DOI: 10.3233/prm-170459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Spina bifida (SB) often results in a complex disability and can also cause cognitive dysfunction. No previous study has investigated the ability to adapt to time in children with SB. This ability is crucial for an individual's possibility to develop autonomy in life. The purpose of this study was to investigate whether children aged 10-17 with SB have lower time-processing abilities than typically-developing children, and to describe the profile of time-processing in children with SB. METHOD Participants comprised a consecutive sample of 21 children (drawn from a geographical cohort of 45) aged 10-17 years (mean: 14 years, SD: 2 years); 13 were boys. The instruments used were KaTid-Y, Time-S, and Time-P. RESULTS The children with SB had lower time-processing abilities than typically-developing children (52.4% under -2SD), particularly difficulties to orient to and to estimate objective time, to understand time perspectives and with time planning. They also self-rated low use of strategies to adapt to time. The parents rated their children as having extensive difficulties in daily time management. CONCLUSIONS The low time-processing ability found in children with SB is likely to be an important contributing factor to low autonomy and independence.
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Affiliation(s)
- Marika Persson
- Regional Rehabilitation Centre, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Marie Peny-Dahlstrand
- Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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De la Torre GG, Martin A, Cervantes E, Guil R, Mestre JM. Attention lapses in children with spina bifida and hydrocephalus and children with attention-deficit/hyperactivity disorder. J Clin Exp Neuropsychol 2016; 39:563-573. [DOI: 10.1080/13803395.2016.1249828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ware AL, Kulesz PA, Williams VJ, Juranek J, Cirino PT, Fletcher JM. Gray matter integrity within regions of the dorsolateral prefrontal cortical-subcortical network predicts executive function and fine motor dexterity in spina bifida. Neuropsychology 2016; 30:492-501. [PMID: 26752120 PMCID: PMC4840030 DOI: 10.1037/neu0000266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study examined microstructural properties of cortical and subcortical gray matter components of the dorsolateral prefrontal (DLPFC) cortical-subcortical circuit in relation to parent-rated executive function and fine motor dexterity performance in youth with spina bifida myelomeningocele (SBM). Aberrant gray matter integrity of the DLPFC, basal ganglia nuclei, and thalamus were hypothesized to differentially relate to neurobehavioral outcomes. METHODS Forty-nine youth between 8 and 18 years (M = 12.34) old with SBM underwent a 3T MRI including diffusion tensor imaging. Neurobehavioral measures of parent-rated executive function and fine motor dexterity were obtained from a standardized neuropsychological evaluation. Relations among indices of gray matter microstructural integrity (mean diffusivity [MD], fractional anisotropy [FA], cortical thickness) and neurobehavior were examined using 3 correlational methods to enhance reliability of brain-behavior relations. RESULTS In SBM, higher FA values in the caudate were associated with poorer behavioral regulation. Higher FA values in the putamen and greater DLPFC thickness were both associated with poorer fine motor dexterity. CONCLUSION Behavioral regulation and FA in the caudate related to behavioral inhibition in SBM. Similarly, associations between fine motor dexterity and indices of gray matter integrity in the putamen and DLPFC support fronto-striatal involvement in motor control in SBM. Examination of these neurobehavioral correlates revealed a pattern of attenuated behavioral impairments when gray matter structure was more similar to that of typically developing youth. (PsycINFO Database Record
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Affiliation(s)
- Ashley L. Ware
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, 4811 Calhoun Road, 3 Floor, Houston, TX 77204-6022
| | - Paulina A. Kulesz
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, 4811 Calhoun Road, 3 Floor, Houston, TX 77204-6022
| | - Victoria J. Williams
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, 4811 Calhoun Road, 3 Floor, Houston, TX 77204-6022
| | - Jenifer Juranek
- Department of Pediatrics, Children’s Learning Institute BRAIN Lab, University of Texas Health Science Center at Houston, 6655 Travis Street Suite 1000, Houston, Texas 77030
| | - Paul T. Cirino
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, 4811 Calhoun Road, 3 Floor, Houston, TX 77204-6022
| | - Jack M. Fletcher
- Department of Psychology and Texas Institute for Measurement, Evaluation and Statistics, University of Houston, 4811 Calhoun Road, 3 Floor, Houston, TX 77204-6022
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Poretti A, Boltshauser E, Huisman TA. Chiari Malformations and Syringohydromyelia in Children. Semin Ultrasound CT MR 2016; 37:129-42. [DOI: 10.1053/j.sult.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Koppelmans V, Hirsiger S, Mérillat S, Jäncke L, Seidler RD. Cerebellar gray and white matter volume and their relation with age and manual motor performance in healthy older adults. Hum Brain Mapp 2015; 36:2352-63. [PMID: 25704867 DOI: 10.1002/hbm.22775] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Functional neuroimaging and voxel-based morphometry studies have confirmed the important role of the cerebellum in motor behavior. However, little is known about the relationship between cerebellar gray (GMv) and white matter (WMv) volume and manual motor performance in aging individuals. This study aims to quantify the relationship between cerebellar tissue volume and manual motor performance. EXPERIMENTAL DESIGN To gain more insight into cerebellar function and how it relates to the role of the primary motor cortex (M1), we related cerebellar GMv, WMv, and M1v to manual motor performance in 217 healthy older individuals. Left and right cerebellar GMv and WMv, and M1v were obtained using FreeSurfer. The following motor measures were obtained: grip force, tapping speed, bimanual visuomotor coordination, and manual dexterity. PRINCIPAL OBSERVATIONS Significant positive relationships were observed between cerebellar GMv and WMv and grip strength, right cerebellar WMv and right-hand tapping speed, right cerebellar WMv and dexterity, M1v and grip strength, and right M1v and left-hand dexterity, though effect sizes were small. CONCLUSIONS Our results show that cerebellar GMv and WMv are differently associated with manual motor performance. These associations partly overlap with the brain-behavior associations between M1 and manual motor performance. Not all observed associations were lateralized (i.e., ipsilateral cerebellar and contralateral M1v associations with motor performance), which could point to age-related neural dedifferentiation. The current study provides new insights in the role of the cerebellum in manual motor performance. In consideration of the small effect sizes replication studies are needed to validate these results.
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Kulesz PA, Tian S, Juranek J, Fletcher JM, Francis DJ. Relations between volumetric measures of brain structure and attentional function in spina bifida: utilization of robust statistical approaches. Neuropsychology 2014; 29:212-25. [PMID: 25495830 DOI: 10.1037/neu0000166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Weak structure-function relations for brain and behavior may stem from problems in estimating these relations in small clinical samples with frequently occurring outliers. In the current project, we focused on the utility of using alternative statistics to estimate these relations. METHOD Fifty-four children with spina bifida meningomyelocele performed attention tasks and received MRI of the brain. Using a bootstrap sampling process, the Pearson product-moment correlation was compared with 4 robust correlations: the percentage bend correlation, the Winsorized correlation, the skipped correlation using the Donoho-Gasko median, and the skipped correlation using the minimum volume ellipsoid estimator. RESULTS All methods yielded similar estimates of the relations between measures of brain volume and attention performance. The similarity of estimates across correlation methods suggested that the weak structure-function relations previously found in many studies are not readily attributable to the presence of outlying observations and other factors that violate the assumptions behind the Pearson correlation. CONCLUSIONS Given the difficulty of assembling large samples for brain-behavior studies, estimating correlations using multiple, robust methods may enhance the statistical conclusion validity of studies yielding small, but often clinically significant, correlations.
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Affiliation(s)
| | - Siva Tian
- Department of Psychology, University of Houston
| | - Jenifer Juranek
- Children's Learning Institute, University of Texas-Houston Health Science
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Apkon SD, Grady R, Hart S, Lee A, McNalley T, Niswander L, Petersen J, Remley S, Rotenstein D, Shurtleff H, Warner M, Walker WO. Advances in the care of children with spina bifida. Adv Pediatr 2014; 61:33-74. [PMID: 25037124 DOI: 10.1016/j.yapd.2014.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Susan D Apkon
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Rehabilitation Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, M/S OB-8414, Seattle, WA 98105, USA.
| | - Richard Grady
- Section of Pediatric Urology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Solveig Hart
- Rehabilitation Services, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Amy Lee
- Pediatric Neurosurgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S W7729, PO Box 5371, Seattle, WA 98105, USA
| | - Thomas McNalley
- Rehabilitation Medicine, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, M/S OB-8404, Seattle, WA 98105, USA
| | - Lee Niswander
- Department of Pediatrics, Children's Hospital Colorado, Howard Hughes Medical Institute, University of Colorado School of Medicine, Mail Stop 8133, Building RC1 South, Room L18-12106, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Juliette Petersen
- Molecular Biology Program, University of Colorado Denver Anschutz Medical Campus, Mail Stop 8133, Building RC1 South, L18-12400D, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Sheridan Remley
- Rehabilitation Services, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Deborah Rotenstein
- Pediatric Endocrinology, Endocrine Division, Pediatric Alliance, 1789 South Braddock Avenue, Suite 294, Pittsburgh, PA 15218, USA
| | - Hillary Shurtleff
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA; Department of Child Psychiatry, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Molly Warner
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA; Neuropsychology Consult Service, Department of Psychiatry, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - William O Walker
- Division of Developmental Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, M/S OC.9.940, Seattle, WA 98105, USA
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Ware AL, Juranek J, Williams VJ, Cirino PT, Dennis M, Fletcher JM. Anatomical and diffusion MRI of deep gray matter in pediatric spina bifida. NEUROIMAGE-CLINICAL 2014; 5:120-7. [PMID: 25057465 PMCID: PMC4097001 DOI: 10.1016/j.nicl.2014.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 01/10/2023]
Abstract
Individuals with spina bifida myelomeningocele (SBM) exhibit brain abnormalities in cortical thickness, white matter integrity, and cerebellar structure. Little is known about deep gray matter macro- and microstructure in this population. The current study utilized volumetric and diffusion-weighted MRI techniques to examine gray matter volume and microstructure in several subcortical structures: basal ganglia nuclei, thalamus, hippocampus, and amygdala. Sixty-six children and adolescents (ages 8–18; M = 12.0, SD = 2.73) with SBM and typically developing (TD) controls underwent T1- and diffusion-weighted neuroimaging. Microstructural results indicated that hippocampal volume was disproportionately reduced, whereas the putamen volume was enlarged in the group with SBM. Microstructural analyses indicated increased mean diffusivity (MD) and fractional anisotropy (FA) in the gray matter of most examined structures (i.e., thalamus, caudate, hippocampus), with the putamen exhibiting a unique pattern of decreased MD and increased FA. These results provide further support that SBM differentially disrupts brain regions whereby some structures are volumetrically normal whereas others are reduced or enlarged. In the hippocampus, volumetric reduction coupled with increased MD may imply reduced cellular density and aberrant organization. Alternatively, the enlarged volume and significantly reduced MD in the putamen suggest increased density. Spina bifida resulted in reduced hippocampal and enlarged putamen volumes. Spina bifida resulted in reduced MD and increased FA in the putamen. Periventricular regions were differentiated by increased MD and FA in spina bifida. Spina bifida resulted in greater FA for all regions, except the hippocampus.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Jenifer Juranek
- Department of Pediatrics, Children's Learning Institute BRAIN Lab, University of Texas Health Science Center at Houston, 6655 Travis Street Suite 1000, Houston, TX 77030, USA
| | - Victoria J Williams
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Paul T Cirino
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
| | - Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
| | - Jack M Fletcher
- Department of Psychology, Texas Institute for Measurements, Evaluation and Statistics, University of Houston, 8201 Cullen St., Houston, TX 77204-6602, USA
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Taylor HB, Barnes MA, Landry SH, Swank P, Fletcher JM, Huang F. Motor contingency learning and infants with Spina Bifida. J Int Neuropsychol Soc 2013; 19:206-15. [PMID: 23298791 PMCID: PMC4067977 DOI: 10.1017/s1355617712001233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Infants with Spina Bifida (SB) were compared to typically developing infants (TD) using a conjugate reinforcement paradigm at 6 months-of-age (n = 98) to evaluate learning, and retention of a sensory-motor contingency. Analyses evaluated infant arm-waving rates at baseline (wrist not tethered to mobile), during acquisition of the sensory-motor contingency (wrist tethered), and immediately after the acquisition phase and then after a delay (wrist not tethered), controlling for arm reaching ability, gestational age, and socioeconomic status. Although both groups responded to the contingency with increased arm-waving from baseline to acquisition, 15% to 29% fewer infants with SB than TD were found to learn the contingency depending on the criterion used to determine contingency learning. In addition, infants with SB who had learned the contingency had more difficulty retaining the contingency over time when sensory feedback was absent. The findings suggest that infants with SB do not learn motor contingencies as easily or at the same rate as TD infants, and are more likely to decrease motor responses when sensory feedback is absent. Results are discussed with reference to research on contingency learning in infants with and without neurodevelopmental disorders, and with reference to motor learning in school-age children with SB.
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Affiliation(s)
- Heather B Taylor
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX 77030, USA.
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Droit-Volet S, Zélanti PS, Dellatolas G, Kieffer V, El Massioui N, Brown BL, Doyère V, Provasi J, Grill J. Time perception in children treated for a cerebellar medulloblastoma. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:480-494. [PMID: 23063729 DOI: 10.1016/j.ridd.2012.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/09/2012] [Accepted: 09/10/2012] [Indexed: 06/01/2023]
Abstract
The aim of the present study was to investigate temporal abilities in children treated by surgery for a malignant tumor in the cerebellum. Children with a diagnosed medulloblastoma and age-paired control children were given a temporal discrimination task (bisection task) and a temporal reproduction task with two duration ranges, one shorter than 1s and the other longer than 4s. The motor and cognitive capacities of these children were also assessed by a battery of age-adapted neuropsychological tests. The results did not show any significant difference in performance between the children with or without cerebellar lesions in the temporal discrimination task. It was only in the temporal reproduction task that the children with cerebellar lesions reproduced longer and more variable durations than the other children, but only for the short stimulus durations (≤ 1 s). In addition, a hierarchical regression analysis revealed that the best predictor of variance in temporal performance was a significantly lower processing speed in children with cerebellar lesions in comparison to their controls. These results indicated that the major cause of deficits in temporal judgments in children with cerebellar lesions was due to their inability to reproduce accurately short temporal intervals in association with low processing speed, rather than to a specific deficit in the perception of time.
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Encinas JL, García-Cabezas MÁ, Barkovich J, Fontecha CG, Peiró JL, Soto GMC, Borrell V, Reillo I, López-Santamaría M, Tovar JA, Farmer DL. Maldevelopment of the cerebral cortex in the surgically induced model of myelomeningocele: implications for fetal neurosurgery. J Pediatr Surg 2011; 46:713-722. [PMID: 21496543 DOI: 10.1016/j.jpedsurg.2010.11.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 11/10/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to describe the malformations of cortical development detected in a model of cerebrospinal fluid (CSF) leakage and the influence of surgical closure technique on developmental outcome. METHODS Using a surgically induced model of myelomeningocele (MMC) in sheep, we studied the effects of different repair methods upon the development of hydrocephalus, the presence of the Arnold-Chiari II (AC-II) hindbrain malformation, and cerebral cortex developmental anomalies using gross and histologic (hematoxylin and eosin and Nissl staining) study techniques. RESULTS A malformed cerebral cortex, including 2 anomalous cortical folding patterns, and lower brain weights were observed in the untreated animals. Hydrocephalus and AC-II malformations were also found in this group. These malformations were mostly prevented with prenatal 2-layer closure. CONCLUSIONS Cerebral cortical malformations and hydrocephalus, in addition to the AC-II hindbrain malformation, are disorders caused by fetal CSF leakage. These malformations were prevented with the technique of MMC closure currently used in humans. Both observations magnify the importance of the second hit associated with chronic CSF leakage, in addition to the primary defect causing the MMC, in the development of the malformation complex.
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Affiliation(s)
- Jose L Encinas
- Department of Pediatric Surgery, Hospital Universitario "La Paz," Madrid, Spain.
| | | | - James Barkovich
- Section of Neuroradiology, Department of Radiology, UCSF, San Francisco, CA
| | - César G Fontecha
- Pediatric Orthopedic Unit, Department of Orthopedic Surgery, Hospital Universitario "Vall D'Hebron," Barcelona, Spain
| | - Jose L Peiró
- Fetal and Neonatal Surgery Unit, Pediatric Surgery Service, Hospital Universitario "Vall D'Hebron," Barcelona, Spain
| | | | - Victor Borrell
- Instituto de Neurociencias CSIC-UMH, Sant Joan d'Alacant, Alicante, Spain
| | - Isabel Reillo
- Instituto de Neurociencias CSIC-UMH, Sant Joan d'Alacant, Alicante, Spain
| | | | - Juan A Tovar
- Department of Pediatric Surgery, Hospital Universitario "La Paz," Madrid, Spain
| | - Diana L Farmer
- Pediatric Surgery Department and Fetal Treatment Laboratory, UCSF, San Francisco, CA
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Abstract
Spina bifida meningomyelocele (SBM), a congenital neurodevelopmental disorder, involves dysmorphology of the cerebellum, and its most obvious manifestations are motor deficits. This paper reviews cerebellar neuropathology and motor function across several motor systems well studied in SBM in relation to current models of cerebellar motor and timing function. Children and adults with SBM have widespread motor deficits in trunk, upper limbs, eyes, and speech articulators that are broadly congruent with those observed in adults with cerebellar lesions. The structure and function of the cerebellum are correlated with a range of motor functions. While motor learning is generally preserved in SBM, those motor functions requiring predictive signals and precise calibration of the temporal features of movement are impaired, resulting in deficits in smooth movement coordination as well as in the classical cerebellar triad of dysmetria, ataxia, and dysarthria. That motor function in individuals with SBM is disordered in a manner phenotypically similar to that in adult cerebellar lesions, and appears to involve similar deficits in predictive cerebellar motor control, suggests that age-based cerebellar motor plasticity is limited in individuals with this neurodevelopmental disorder.
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Donlau M, Imms C, Glad Mattsson G, Mattsson S, Sjörs A, Falkmer T. Children and youth with myelomeningocele's independence in managing clean intermittent catheterization in familiar settings. Acta Paediatr 2011; 100:429-38. [PMID: 20942859 DOI: 10.1111/j.1651-2227.2010.02044.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the ability of children and youth with myelomeningocele to independently manage clean intermittent catheterization. METHODS There were 50 participants with myelomeningocele (5-18 years); 13 of them had also participated in a previous hospital-based study. Their abilities and interest in completing the toilet activity were examined at home or in school using an interview and the Canadian Occupational Performance Measure (COPM). Actual performance was observed and rated. Background variables were collected from medical records and KatAD+E tests. RESULTS In total, 48% were observed to perform the toilet activity independently, in comparison with 74% who self-reported independence. Univariate analyses found KatAD+E could predict who was independent. COPM failed to do so. Ability to remain focused and ambulation were predictors of independence, but age, sex and IQ were not. Multivariable analysis found time to completion to be the strongest predictor of independence. Four children were independent in their familiar environment, but not in the hospital setting, and six of 13 children maintained focus only in their familiar environment. CONCLUSIONS Interviews were not sufficiently accurate to assess independence in the toilet activity. Instead, observations including time to completion are recommended. The execution of the toilet activity is influenced by the environmental context.
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Affiliation(s)
- Marie Donlau
- Vuxenhabiliteringen Landstinget i Östergötland, Linköping, Sweden
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Salman MS. Posterior fossa decompression and the cerebellum in Chiari type II malformation: a preliminary MRI study. Childs Nerv Syst 2011; 27:457-62. [PMID: 21221976 PMCID: PMC3074439 DOI: 10.1007/s00381-010-1359-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 12/06/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Chiari type II malformation (CII) is a congenital deformity of the hindbrain. The posterior fossa and cerebellum are small in CII. The cerebellar atrophy is associated with cognitive and motor deficits. Brainstem compression occurs in some patients with CII for whom posterior fossa decompression may be life saving. The aim was to determine whether posterior fossa decompression can prevent or reduce the cerebellar atrophy in CII. METHODS Cerebellar volumes and their tissue types (gray matter, white matter, and CSF volumes) from brain MRI were compared among four CII patients, aged 9.5 to 16.5 years, who had had posterior fossa decompression in infancy, 28 CII patients who had not had posterior fossa decompression, and ten age-matched normal controls. Parametric and non-parametric tests investigated group differences. RESULTS Compared to controls, mean cerebellar volume was significantly smaller in CII patients (p<0.0001). Mean CSF volume within the cerebellar fissures and fourth ventricle was significantly smaller in patients without posterior fossa decompression compared to the CII patients who had the decompression, p=0.043. Mean CSF volume of the latter group was similar to the controls. Other cerebellar volumetric measurements did not differ between the CII groups. CONCLUSIONS Posterior fossa decompression normalizes CSF spaces within the posterior fossa in CII but does not prevent the cerebellar atrophy. The author proposes that surgical expansion of the posterior fossa should be considered in infants with CII who have a significantly small posterior fossa, to prevent or reduce the deficits associated with the cerebellar atrophy.
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Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Children's Hospital, AE 308, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Abstract
A constellation of deficits, termed the cerebellar cognitive affective syndrome (CCAS), has been reported following acquired cerebellar lesions. We studied emotion identification and the cognitive control of emotion in children treated for acquired tumors of the cerebellum. Participants were 37 children (7-16 years) treated for cerebellar tumors (19 benign astrocytomas (AST), 18 malignant medulloblastomas (MB), and 37 matched controls (CON). The Emotion Identification Task investigated recognition of happy and sad emotions in music. In two cognitive control tasks, we investigated whether children could identify emotion in situations in which the emotion in the music and the emotion in the lyrics was either congruent or incongruent. Children with cerebellar tumors identified emotion as accurately and quickly as controls (p > .05), although there was a significant interaction of emotions and group (p < .01), with the MB group performing less accurately identifying sad emotions, and both cerebellar tumor groups were impaired in the cognitive control of emotions (p < .01). The fact that childhood acquired cerebellar tumors disrupt cognitive control of emotion rather than emotion identification provides some support for a model of the CCAS as a disorder, not so much of emotion as of the regulation of emotion by cognition.
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Essner BS, Holmbeck GN. The impact of family, peer, and school contexts on depressive symptoms in adolescents with spina bifida. Rehabil Psychol 2010; 55:340-50. [PMID: 21171793 PMCID: PMC3075551 DOI: 10.1037/a0021664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Based on social ecological theory, this study examined the joint relations among adolescents' family, peer, and school contexts and depressive symptoms in youth with spina bifida using cumulative, protective, and specific effects models. METHOD Sixty families of adolescents with spina bifida and 65 comparison families reported on adolescents' positive experiences within these contexts and on depressive symptoms when youth were 14-15 and 16-17 years old. RESULTS Adolescents with spina bifida had fewer total positive contexts and less positive experience within peer and school contexts, as compared to typically developing adolescents. Greater total number of positive contexts and higher levels of positive experiences within family and school contexts were associated with fewer depressive symptoms for both groups; peer positive experiences were related to lower depressive symptoms for typically developing adolescents only. CONCLUSION Adolescents with spina bifida have fewer positive contexts, which may place them at risk for higher levels of depressive symptoms.
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Affiliation(s)
- Bonnie S Essner
- Department of Psychology, Loyola University Chicago, 6525 N. Sheridan Road, Chicago, IL 60626, USA
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Dennis M, Barnes MA. The cognitive phenotype of spina bifida meningomyelocele. ACTA ACUST UNITED AC 2010; 16:31-9. [PMID: 20419769 DOI: 10.1002/ddrr.89] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A cognitive phenotype is a product of both assets and deficits that specifies what individuals with spina bifida meningomyelocele (SBM) can and cannot do and why they can or cannot do it. In this article, we review the cognitive phenotype of SBM and describe the processing assets and deficits that cut within and across content domains, sensory modality, and material, including studies from our laboratory and other investigations. We discuss some implications of the SBM cognitive phenotype for assessment, rehabilitation, and research.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.
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Central Nervous System Findings on Fetal Magnetic Resonance Imaging and Outcomes in Children With Spina Bifida. Obstet Gynecol 2010; 116:323-329. [DOI: 10.1097/aog.0b013e3181e666e8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preschool neurodevelopmental outcome of children following fetal myelomeningocele closure. Am J Obstet Gynecol 2010; 202:450.e1-9. [PMID: 20347433 DOI: 10.1016/j.ajog.2010.02.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/25/2010] [Accepted: 02/02/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to investigate the preschool neurodevelopmental outcomes of children following fetal myelomeningocele (fMMC) surgery. STUDY DESIGN Prior to the Management of Myelomeningocele Study trial, 54 children underwent fMMC closure at our institution. Thirty (56%) returned at 5 years of age for standardized neurocognitive examination. Scores were grouped as high-average, average, mildly delayed, and severely delayed by SD intervals. RESULTS Mean verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full intelligence quotient (FIQ) scores were within normal population range. High-average or average scores for VIQ, PIQ, FIQ, and processing speed were found in 93%, 90%, 90%, and 60%, respectively. Mean FIQ and processing speed of nonshunted children were significantly higher than for those who required shunt placement (P=.02 and P=.01, respectively). Mean VIQ and PIQ tended to be higher in nonshunted fMMC children (P=.05). CONCLUSION The majority of fMMC children in this highly selective population had average preschool neurodevelopmental scores. fMMC children who did not require shunt placement were more likely to have better scores.
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Reduced Anisotropy in the Middle Cerebellar Peduncle in Chiari-II Malformation. THE CEREBELLUM 2010; 9:303-9. [DOI: 10.1007/s12311-010-0162-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Juranek J, Salman MS. Anomalous development of brain structure and function in spina bifida myelomeningocele. DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2010; 16:23-30. [PMID: 20419768 PMCID: PMC2917986 DOI: 10.1002/ddrr.88] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spina bifida myelomeningocele (SBM) is a specific type of neural tube defect whereby the open neural tube at the level of the spinal cord alters brain development during early stages of gestation. Some structural anomalies are virtually unique to individuals with SBM, including a complex pattern of cerebellar dysplasia known as the Chiari II malformation. Other structural anomalies are not necessarily unique to SBM, including altered development of the corpus callosum and posterior fossa. Within SBM, tremendous heterogeneity is reflected in the degree to which brain structures are atypical in qualitative appearance and quantitative measures of morphometry. Hallmark structural features of SBM include overall reductions in posterior fossa and cerebellum size and volume. Studies of the corpus callosum have shown complex patterns of agenesis or hypoplasia along its rostral-caudal axis, with rostrum and splenium regions particularly susceptible to agenesis. Studies of cortical regions have demonstrated complex patterns of thickening, thinning, and gyrification. Diffusion tensor imaging studies have reported compromised integrity of some specific white matter pathways. Given equally complex ocular motor, motor, and cognitive phenotypes consisting of relative strengths and weaknesses that seem to align with altered structural development, studies of SBM provide new insights to our current understanding of brain structure-function associations.
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Affiliation(s)
- Jenifer Juranek
- Department of Pediatrics, Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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Jewell D, Fletcher JM, Mahy CEV, Hetherington R, MacGregor D, Drake JM, Salman MS, Dennis M. Upper limb cerebellar motor function in children with spina bifida. Childs Nerv Syst 2010; 26:67-73. [PMID: 19823846 PMCID: PMC3075013 DOI: 10.1007/s00381-009-0991-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate upper limb cerebellar motor function in children with spina bifida myelomeningocele (SBM) and in typically developing controls. METHODS Participants with SBM, who had either upper level spinal lesions (n = 23) or lower level spinal lesions (n = 65), and controls (n = 37) completed four upper limb motor function tasks (posture, rebound, limb dysmetria, and diadochokinesis) under four different physical and cognitive challenge conditions. Functional independence was assessed by parental questionnaire. RESULTS Fewer SBM participants were able to complete the posture task, and they were less likely than controls to obtain a perfect rebound score. Participants with SBM showed impaired performance in either time, accuracy, or both, on the limb dysmetria and diadochokinesis tasks but responded like controls to physical and cognitive challenges. CONCLUSIONS Because upper limb motor performance predicted aspects of functional independence, we conclude that upper limb impairments in children with SBM are significant and have direct implications for the level of independent functioning in children with SBM.
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Affiliation(s)
- Derryn Jewell
- Program in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jack M. Fletcher
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Ross Hetherington
- AboutKidsHealth, The Hospital for Sick Children, Toronto, ON, Canada, Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Daune MacGregor
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, Canada, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - James M. Drake
- Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael S. Salman
- Section of Pediatric Neurology, Children’s Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Maureen Dennis
- Program in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, ON, Canada, Department of Psychology, University of Toronto, Toronto, ON, Canada, Department of Surgery, University of Toronto, Toronto, ON, Canada, Program in Neurosciences & Mental Health, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Abstract
INTRODUCTION Chiari type II malformation (CII) is a developmental deformity of the hindbrain. We have previously reported that many patients with CII have impaired smooth pursuit, while few make inaccurate saccades or have an abnormal vestibuloocular reflex. In contrast, saccadic adaptation and visual fixation are normal. In this report, we correlate results from several eye movement studies with neuroimaging in CII. We present a model for structural changes within the cerebellum in CII. METHODS Saccades, smooth pursuit, the vestibulo-ocular reflex, and visual fixation were recorded in 21 patients with CII, aged 8-19 years and 39 age-matched controls, using an infrared eye tracker. Qualitative and quantitative MRI data were correlated with eye movements in 19 CII patients and 28 controls. RESULTS Nine patients with CII had abnormal eye movements. Smooth pursuit gain was subnormal in eight, saccadic accuracy abnormal in four, and vestibulo-ocular reflex gain abnormal in three. None had fixation instability. Patients with CII had a significantly smaller cerebellar volume than controls, and those with normal eye motion had an expanded midsagittal vermis compared to controls. However, patients with abnormal eye movements had a smaller (non-expanded) midsagittal vermis area, posterior fossa area and medial cerebellar volumes than CII patients with normal eye movements. CONCLUSIONS The deformity of CII affects the structure and function of the cerebellum selectively and differently in those with abnormal eye movements. We propose that the vermis can expand when compressed within a small posterior fossa in some CII patients, thus sparing its ocular motor functions.
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Höglund A, Norrlin S. Influence of dual tasks on sitting postural sway in children and adolescents with myelomeningocele. Gait Posture 2009; 30:424-30. [PMID: 19695879 DOI: 10.1016/j.gaitpost.2009.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 05/06/2009] [Accepted: 06/16/2009] [Indexed: 02/02/2023]
Abstract
Performing dual tasks, e.g. cognitive and motor tasks simultaneously, may be especially challenging to children with motor disorders. Changes in postural sway have been used to evaluate the effect of dual tasks. Increases in postural sway frequency and concurrent decrease in sway amplitude have been interpreted as tighter control of postural sway. The purpose of this study was to analyze postural sway under single and dual task conditions, while sitting. Thirteen children and adolescents with myelomeningocele and a matched control group were included in the study. The participants performed two single and two dual tasks each. The single task was a sitting still task. The dual tasks were one visual-spatial task and one executive task while simultaneously sitting still. Amplitude, velocity and frequency of center of pressure displacement of postural sway were analyzed between tasks and between groups. The results of the cognitive tasks were analyzed as well. The results revealed different patterns in the groups. During single tasks, the MMC group displayed significantly lower frequencies and velocities of center of pressure displacement compared to the control group. Adding the visual-spatial task influenced postural sway significantly in the control group, while adding the executive task influence the postural sway significantly in the MMC group. The myelomeningocele group confirmed our clinical experience by performing the cognitive tasks slowly but accurately. Further studies are needed to evaluate whether motor function, sensory function, structural anomalies in the brain or any other causes, separately or together, may explain the observed differences in the groups.
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Affiliation(s)
- Anette Höglund
- Department of Woman's and Children's Health, Uppsala University Hospital, Folke Bernadotte Regional Habilitation Centre, SE-751 85 Uppsala, Sweden.
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Dennis M, Hopyan T, Juranek J, Cirino PT, Hasan KM, Fletcher J. Strong-meter and weak-meter rhythm identification in spina bifida meningomyelocele and volumetric parcellation of rhythm-relevant cerebellar regions. Ann N Y Acad Sci 2009; 1169:84-8. [PMID: 19673758 DOI: 10.1111/j.1749-6632.2009.04863.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with spina bifida meningomyelocele (SBM) are impaired relative to controls in terms of discriminating strong-meter and weak-meter rhythms, so congenital cerebellar dysmorphologies that affect rhythmic movements also disrupt rhythm perception. Cerebellar parcellations in children with SBM showed an abnormal configuration of volume fractions in cerebellar regions important for rhythm function: a smaller inferior-posterior lobe, and larger anterior and superior-posterior lobes.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Hopyan T, Schellenberg EG, Dennis M. Perception of strong-meter and weak-meter rhythms in children with spina bifida meningomyelocele. J Int Neuropsychol Soc 2009; 15:521-8. [PMID: 19573270 PMCID: PMC3044483 DOI: 10.1017/s1355617709090845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neurodevelopmental disorders such as spina bifida meningomyelocele (SBM) are often associated with dysrhythmic movement. We studied rhythm discrimination in 21 children with SBM and in 21 age-matched controls, with the research question being whether both groups showed a strong-meter advantage whereby rhythm discrimination is better for rhythms with a strong-meter, in which onsets of longer intervals occurred on the beat, than those with a weak-meter, in which onsets of longer intervals occurred off the beat. Compared to controls, the SBM group was less able to discriminate strong-meter rhythms, although they performed comparably in discriminating weak-meter rhythms. The attenuated strong-meter advantage in children with SBM shows that their rhythm deficits occur at the level of both perception and action, and may represent a central processing disruption of the brain mechanisms for rhythm.
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Affiliation(s)
- Talar Hopyan
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
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Abstract
IQ scores are volatile indices of global functional outcome, the final common path of an individual's genes, biology, cognition, education, and experiences. In studying neurocognitive outcomes in children with neurodevelopmental disorders, it is commonly assumed that IQ can and should be partialed out of statistical relations or used as a covariate for specific measures of cognitive outcome. We propose that it is misguided and generally unjustified to attempt to control for IQ differences by matching procedures or, more commonly, by using IQ scores as covariates. We offer logical, statistical, and methodological arguments, with examples from three neurodevelopmental disorders (spina bifida meningomyelocele, learning disabilities, and attention deficit hyperactivity disorder) that: (1) a historical reification of general intelligence, g, as a causal construct that measures aptitude and potential rather than achievement and performance has fostered the idea that IQ has special status and that in studying neurocognitive function in neurodevelopmental disorders; (2) IQ does not meet the requirements for a covariate; and (3) using IQ as a matching variable or covariate has produced overcorrected, anomalous, and counterintuitive findings about neurocognitive function.
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Abstract
We sought to identify whether deficits in selective attention are present in pediatric brain tumor patients. Selective attention was assessed with covert-orienting, filtering, and visual-search tasks in 54 patients with either (1) posterior fossa (PF) tumors treated with cranial radiation and surgery (n = 22); (2) PF tumors treated with surgery alone (n = 17); or (3) non-CNS tumors (n = 15), who served as a patient control group. To account for normal development, patient performance was also compared with that of healthy age-matched controls (n = 10). We found that in PF tumor patients selective attention was impaired, regardless of whether they were treated with cranial radiation and surgery or surgery alone. However, patients treated with cranial radiation were most impaired. These patients may have greater damage to posterior brain regions know to mediate selective attention as the result of tumor location, effects of surgery, and higher doses of radiation to the posterior regions of the brain. These findings help to elucidate the potential impact of pediatric brain tumors and their treatment on discrete attentional skills.
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Encinas Hernández JL, Soto C, García-Cabezas MA, Pederiva F, Garriboli M, Rodríguez R, Peiró JL, Carceller F, López-Santamaría M, Tovar JA. Brain malformations in the sheep model of myelomeningocele are similar to those found in human disease: preliminary report. Pediatr Surg Int 2008; 24:1335-40. [PMID: 18989683 DOI: 10.1007/s00383-008-2276-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine if brain malformations, similar to those which account for cognitive disorders seen in human disease, are present in an ovine model of myelomeningocele (MMC). METHODS An MMC-like lesion was surgically created in 16 fetal lambs between 60 and 80 days of gestation. Ten did not undergo fetal repair (group A), 2 were repaired with an open two-layer closure (group B), 2 with open bioglue coverage (group C) and 2 with fetoscopic coverage (group D). Lambs were killed and their brains were examined. Two brains from normal unoperated lambs served as controls. RESULTS Thirteen lambs died in utero (81%). Two lambs in group A and 1 in group B were delivered at term. Group A brains showed hydrocephalus and extensive areas of polymicrogyria. There was also an extensive denudation of the ependymal lining under the polymicrogyric areas and the corpus callosum was thinner than normal. No hindbrain herniation was observed. Brains from group B and the control did not show any of these abnormalities. CONCLUSIONS Some of the central nervous system abnormalities associated to MMC in human patients are also found in the uncorrected fetal lamb model of MMC but not in the only survivor to intrauterine coverage. Further studies are necessary to ascertain if these abnormalities can be prevented by coverage of the defect.
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Affiliation(s)
- Jose Luis Encinas Hernández
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Au KS, Tran PX, Tsai CC, O’Byrne MR, Lin JI, Morrison AC, Hampson AW, Cirino P, Fletcher JM, Ostermaier KK, Tyerman GH, Doebel S, Northrup H. Characteristics of a spina bifida population including North American Caucasian and Hispanic individuals. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2008; 82:692-700. [PMID: 18937358 PMCID: PMC2597629 DOI: 10.1002/bdra.20499] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes. METHODS A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and association testing using the transmission disequilibrium test. RESULTS A total of 509 affected child/parent trios and 309 affected child/parent duos have been enrolled to date for genetic association studies. Subsets of the patients have also been enrolled for studies assessing development, brain imaging, and neurocognitive outcomes. The study recruited two major ethnic groups, with 45.9% Hispanics of Mexican descent and 36.2% North American Caucasians of European descent. The remaining patients are African-American, South and Central American, Native American, and Asian. Studies of this group of patients have already discovered distinct corpus callosum morphology and neurocognitive deficits that associate with MM. We have identified maternal MTHFR 667T allele as a risk factor for MM. In addition, we also found that several genes for glucose transport and metabolism are potential risk factors for MM. CONCLUSIONS The enrolled patient population provides a valuable resource for elucidating the disease characteristics and mechanisms for MM development.
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Affiliation(s)
- Kit Sing Au
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Phong X. Tran
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Chester C. Tsai
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Michelle R. O’Byrne
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
| | - Jone-Ing Lin
- Human Genetics Center, The University of Texas School of Public Health, Houston, TX
| | - Alanna C. Morrison
- Human Genetics Center, The University of Texas School of Public Health, Houston, TX
| | - Amy W. Hampson
- Department of Psychology, University of Houston, Houston, TX
| | - Paul Cirino
- Department of Psychology, University of Houston, Houston, TX
| | | | | | | | - Sabine Doebel
- The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Hope Northrup
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, TX
- Shriners Hospital for Children, Houston, TX
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Dennis M, Sinopoli KJ, Fletcher JM, Schachar R. Puppets, robots, critics, and actors within a taxonomy of attention for developmental disorders. J Int Neuropsychol Soc 2008; 14:673-90. [PMID: 18764966 PMCID: PMC2593155 DOI: 10.1017/s1355617708080983] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review proposes a new taxonomy of automatic and controlled attention. The taxonomy distinguishes among the role of the attendee (puppet and robot, critic and actor), the attention process (stimulus orienting vs. response control), and the attention operation (activation vs. inhibition vs. adjustment), and identifies cognitive phenotypes by which attention is overtly expressed. We apply the taxonomy to four childhood attention disorders: attention deficit hyperactivity disorder, spina bifida meningomyelocele, traumatic brain injury, and acute lymphoblastic leukemia. Variations in attention are related to specific brain regions that support normal attention processes when intact, and produce disordered attention when impaired. The taxonomy explains group differences in behavioral inattention, hyperactivity, and impulsiveness, as well as medication response. We also discuss issues relevant to theories of the cognitive and neural architecture of attention: functional dissociations within and between automatic and controlled attention; the relative importance of type of brain damage and developmental timing to attention profile; cognitive-energetic models of attention and white matter damage; temporal processing deficits, attention deficits and cerebellar damage; and the issue of cognitive phenotypes as candidate endophenotypes.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada.
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Hasan KM, Eluvathingal TJ, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM. White matter microstructural abnormalities in children with spina bifida myelomeningocele and hydrocephalus: a diffusion tensor tractography study of the association pathways. J Magn Reson Imaging 2008; 27:700-9. [PMID: 18302204 DOI: 10.1002/jmri.21297] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To quantify microstructural abnormalities in the major association pathways of children affected by spina bifida myelomeningocele (SBM) and shunted hydrocephalus using whole-brain diffusion tensor imaging (DTI). MATERIALS AND METHODS The institutional review board approved this Health Insurance Portability and Accountability Act (HIPAA)-compliant study and written informed consent/assent were obtained prior to the study. The 69 participants included 38 children with SBM and shunted hydrocephalus (age mean +/- SD = 12.30 +/- 2.10 years; 22 boys; 10 left-handed) and 31 age- and sex-matched normally-developing children (11.56 +/- 2.72 years; 15 boys, four left-handed). Diffusion tensor tractography (DTT) was performed to delineate and quantify bilaterally four major association pathways (arcuate, inferior longitudinal, inferior fronto-occipital, and uncinate fasciculi). RESULTS The group with SBM did not exhibit the pattern of age-related decreases in the diffusivities observed in the controls. The transverse and axial diffusivities were significantly elevated in most of the white matter pathways of the participants with SBM. The fractional anisotropy (FA) was significantly lower in most of the association pathways. Many of the association pathways were not traceable in some participants with SBM compared to the controls at the selected FA thresholds. CONCLUSION DTT revealed diffusion tensor characteristics of abnormal development (nonvisualization/poor visualization of tracts, downward arrow FA, upward arrow diffusivities), impairment in myelination (upward arrow transverse diffusivity) as well as abnormalities in intrinsic axonal characteristics and extraaxonal/extracellular space (upward arrow axial diffusivity) in the association pathways of the SBM children. The differences in the diffusion metrics observed in the children with SBM are suggestive of abnormal white matter development and persistent degeneration with increased age.
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Affiliation(s)
- Khader M Hasan
- Department of Diagnostic and Interventional Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Hasan KM, Sankar A, Halphen C, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM. Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida: laboratory investigation. J Neurosurg Pediatr 2008; 2:75-82. [PMID: 18590401 PMCID: PMC3046025 DOI: 10.3171/ped/2008/2/7/075] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Patients with spina bifida (SB) have variable intellectual outcomes. The authors used diffusion tensor (DT) imaging to quantify whole-brain volumes of gray matter, white matter, and cerebrospinal fluid (CSF), and perform regional quantitative microstructural assessments of gray matter nuclei and white matter tracts in relation to intellectual outcomes in patients with SB. METHODS Twenty-nine children with myelomeningoceles and 20 age- and sex-matched children with normal neural tube development underwent MR imaging with DT image acquisition and assessments of intelligence. The DT imaging-derived metrics were the fractional anisotropy (FA), axial (parallel), and transverse (perpendicular) diffusivities. These metrics were also used to segment the brain into white matter, gray matter, and CSF. A region-of-interest analysis was conducted of the white and gray matter structures implicated in hydrocephalus. RESULTS The amount of whole-brain gray matter was decreased in patients with SB, with a corresponding increase in CSF (p < 0.0001). Regional transverse diffusivity in the caudate nucleus was decreased (p < 0.0001), and the corresponding FA was increased (p < 0.0001), suggesting reduced dendritic branching and connectivity. Fractional anisotropy in the posterior limb of the internal capsule increased in the myelomeningocele group (p = 0.02), suggesting elimination of some divergent fascicles; in contrast, the FA in several white matter structures (such as the corpus callosum genu [p < 0.001] and arcuate fasciculus) was reduced, suggesting disruption of myelination. Diffusion tensor imaging-metrics involving gray matter volume and the caudate nucleus, but not other structures, predicted variations in IQ (r = 0.37-0.50; p < 0.05). CONCLUSIONS Diffusion tensor imaging-derived metrics provide noninvasive neuronal surrogate markers of the pathogenesis of SB and predict variations in general intellectual outcomes in children with this condition.
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Affiliation(s)
- Khader M. Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Ambika Sankar
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Christopher Halphen
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
| | - Larry A. Kramer
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston
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Verb generation in children with spina bifida. J Int Neuropsychol Soc 2008; 14:181-91. [PMID: 18282316 PMCID: PMC2592551 DOI: 10.1017/s1355617708080181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/06/2022]
Abstract
We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance was associated with brain volume measures in participants with SBM. Congenital cerebellar dysmorphology is associated with impaired performance in verb generation accuracy, although not with increased response times to produce verbs
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Peter B, Stoel-Gammon C. Central timing deficits in subtypes of primary speech disorders. CLINICAL LINGUISTICS & PHONETICS 2008; 22:171-198. [PMID: 18307084 DOI: 10.1080/02699200701799825] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Childhood apraxia of speech (CAS) is a proposed speech disorder subtype that interferes with motor planning and/or programming, affecting prosody in many cases. Pilot data (Peter & Stoel-Gammon, 2005) were consistent with the notion that deficits in timing accuracy in speech and music-related tasks may be associated with CAS. This study replicated and expanded earlier findings. Eleven children with speech disorders and age-and gender-matched controls participated in non-word imitation, clapped rhythm imitation, and paced repetitive tapping tasks. Results suggest a central timing deficit, expressed in both the oral and the limb modality, and observable in two different types of timing measures, overall rhythmic structures and small-scale durations. Associations among timing measures were strongest in the participants with speech disorders, who also showed lower timing accuracy than the controls in all measures. The number of observed CAS characteristics was associated with timing deficits.
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Affiliation(s)
- Beate Peter
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA 98105, USA.
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Landry SH, Taylor HB, Guttentag C, Smith KE. Chapter 2 Responsive Parenting. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0074-7750(08)00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Lee KH, Egleston PN, Brown WH, Gregory AN, Barker AT, Woodruff PWR. The role of the cerebellum in subsecond time perception: evidence from repetitive transcranial magnetic stimulation. J Cogn Neurosci 2007; 19:147-57. [PMID: 17214571 DOI: 10.1162/jocn.2007.19.1.147] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In three experiments, we investigated the role of the cerebellum in sub- and suprasecond time perception by using repetitive transcranial magnetic stimulation (rTMS). In Experiment 1, subjects underwent four 8-min 1-Hz rTMS sessions in a within-subject design. rTMS sites were the medial cerebellum (real and sham rTMS), left lateral cerebellum, and right lateral cerebellum. Following each rTMS session, subjects completed a subsecond temporal bisection task (stimuli in the range 400-800 msec). Compared with sham rTMS, rTMS applied over the right lateral or medial cerebellum induced a leftward shift of the psychophysical function (perceived lengthening of time). In Experiment 2, a separate sample of subjects underwent the identical rTMS procedure and completed a suprasecond bisection task (stimuli in the 1000-2000 msec range). In this experiment, rTMS to the cerebellar sites did not produce any significant changes compared with sham rTMS. Experiment 3 employed a within-subject design to replicate findings from Experiments 1 and 2. Subjects underwent four rTMS conditions (sub- and suprabisection tasks following medial cerebellar and sham rTMS). rTMS induced a significant leftward shift of psychophysical function in the subsecond bisection, but not in the suprasecond bisection. In this study, we have demonstrated that transient cerebellar stimulation can differently affect the ability to estimate time intervals below and above a duration of 1 sec. The results of this study provide direct evidence for the role of the cerebellum in processing subsecond time intervals. This study further suggests that the perception of sub- and suprasecond intervals is likely to depend upon distinct neural systems.
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Salman MS, Sharpe JA, Eizenman M, Lillakas L, To T, Westall C, Steinbach MJ, Dennis M. Saccadic adaptation in Chiari type II malformation. Can J Neurol Sci 2007; 33:372-8. [PMID: 17168162 DOI: 10.1017/s0317167100005321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Saccadic adaptation corrects errors in saccadic amplitude. Experimentally-induced saccadic adaptation provides a method for studying motor learning. The cerebellum is a major participant in saccadic adaptation. Chiari type II malformation (CII) is a developmental deformity of the cerebellum and brainstem that is associated with spina bifida. We investigated the effects of CII on saccadic adaptation. METHOD We measured eye movements using an infrared eye tracker in 21 subjects with CII (CII group) and 39 typically developing children (control group), aged 8-19 years. Saccadic adaptation was induced experimentally using targets that stepped horizontally 120 to the right and then stepped backward 3 degrees during saccades. RESULTS Saccadic adaptation was achieved at the end of the adaptation phase in participants in each group. Saccadic amplitude gain decreased by 6.9% in the CII group and 9.3% in the control group. The groups did not differ significantly (p = 0.27). Amplitude gain reduction was significantly less in the CII participants who had multiple shunt revisions. Regression analyses revealed no effects of spinal lesion level, presence of nystagmus, or cerebellar vermis dysmorphology on saccadic adaptation. CONCLUSION The neural circuits involved in saccadic adaptation appear to be functionally intact in CII.
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Affiliation(s)
- Michael S Salman
- Division of Neurology, The Hospital for Sick Children, Toronto, ON
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Lomax-Bream LE, Barnes M, Copeland K, Taylor HB, Landry SH. The Impact of Spina Bifida on Development Across the First 3 Years. Dev Neuropsychol 2007; 31:1-20. [PMID: 17305435 DOI: 10.1207/s15326942dn3101_1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Early cognitive, motor, and language skills were evaluated in 165 children, 91 with Spina Bifida (SB) and 74 developing typically. Assessments were given at 5 time points (6, 12, 18, 24, and 36 months of age). Three latent growth curve models were conducted to evaluate the development of these early skills, with social economic status and etiology as predictors of growth. Lesion level and shunting effects were included for group comparison. Children with SB exhibited lower levels of functioning in all areas, with slower rates of growth in cognition and language, but more acceleration in growth of motor skills. The impact of lesion level and shunting significantly related to growth in cognition and motor skills but not in language.
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Affiliation(s)
- Laura E Lomax-Bream
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Dennis M, Jewell D, Edelstein K, Brandt ME, Hetherington R, Blaser SE, Fletcher JM. Motor learning in children with spina bifida: intact learning and performance on a ballistic task. J Int Neuropsychol Soc 2006; 12:598-608. [PMID: 16961941 DOI: 10.1017/s1355617706060772] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 05/26/2006] [Accepted: 05/30/2006] [Indexed: 11/06/2022]
Abstract
Learning and performance on a ballistic task were investigated in children with spina bifida meningomyelocele (SBM), with either upper level spinal lesions (n = 21) or lower level spinal lesions (n = 81), and in typically developing controls (n = 35). Participants completed three phases (20 trials each) of an elbow goniometer task that required a ballistic arm movement to move a cursor to one of two target positions on a screen, including (1) an initial learning phase, (2) an adaptation phase with a gain change such that recalibration of the ballistic arm movement was required, and (3) a learning reactivation phase under the original gain condition. Initial error rate, asymptotic error rate, and learning rate did not differ significantly between the SBM and control groups. Relative to controls, the SBM group had reduced volumes in the cerebellar hemispheres and pericallosal gray matter (the region including the basal ganglia), although only the pericallosal gray matter was significantly correlated with motor adaptation. Congenital cerebellar dysmorphology is associated with preserved motor skill learning on voluntary, nonreflexive tasks in children with SBM, in whom the relative roles of the cerebellum and basal ganglia may differ from those in the adult brain.
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Affiliation(s)
- Maureen Dennis
- Brain and Behaviour Program, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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Vinck A, Maassen B, Mullaart R, Rotteveel J. Arnold-Chiari-II malformation and cognitive functioning in spina bifida. J Neurol Neurosurg Psychiatry 2006; 77:1083-6. [PMID: 16690692 PMCID: PMC2077736 DOI: 10.1136/jnnp.2005.075887] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Spina bifida is a multifaceted neurological condition with complex neuropsychological sequelae. The cognitive outcome in spina bifida has frequently been attributed to the severity of the hydrocephalus. However, because of complex neuropathology, the influence of hydrocephalus alone does not sufficiently explain the deficits in the cognitive profile in spina bifida. To date, little is known of the role of Arnold-Chiari-II malformation (ACM) in the cognitive profile of these patients. Aim of the current study is to delineate the specific contribution of the ACM in spina bifida by comparing children with ACM and those without ACM. 46 children between 6 and 15 years of age underwent a neuropsychological assessment covering intelligence and a wide range of cognitive functions, such as visuo-motor processing, attention, memory, word fluency and speed of information processing. Comparisons were made between patients with ACM (ACM+) and those without ACM (ACM-); all children with ACM+ also had hydrocephalus. Confounding effects of global cognitive impairment were excluded, such that groups were matched on verbal IQ. Because of complex neuropathology, which is inherent to spina bifida, the method applied was based on a comparison of cognitive profiles of the study group with profiles of patients with cerebellar damage and hydrocephalus found in the literature. Impaired visual analysis and synthesis, verbal memory, and verbal fluency, even after correction for global cognitive impairment, were observed in children with ACM. The hypothesis that in addition to impairment in visual analysis and synthesis, which are related to both hydrocephalus and ACM, specific deficiencies in verbal memory and fluency may be attributed to ACM is supported.
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Affiliation(s)
- A Vinck
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Salman MS, Blaser SE, Sharpe JA, Dennis M. Cerebellar vermis morphology in children with spina bifida and Chiari type II malformation. Childs Nerv Syst 2006; 22:385-93. [PMID: 16374591 DOI: 10.1007/s00381-005-1180-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 02/23/2005] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Posterior fossa size and cerebellar weight and volume are reduced in Chiari type II malformation (CII). This is assumed to affect the cerebellum uniformly. We quantified the presumed reduction in vermis size on magnetic resonance imaging (MRI). METHODS A midsagittal brain MRI slice was selected from each of 68 participants with CII (mean age 13 years). Control participants were 28 typically developing children (mean age 14.1 years). Midsagittal surface areas occupied by the intracranial fossa, posterior fossa, vermis, and its lobules were measured. CONCLUSIONS Mean posterior fossa area was significantly smaller (P<0.003), although mean vermis area was significantly larger (P<0.0001), in participants with CII than in control participants. This expansion involved vermis lobules I-V and VI-VII areas (P<0.0001). The midsagittal vermis was expanded and not reduced in size in participants with CII. This is attributed to compressive displacement of midline structures within the confines of a small posterior fossa.
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Affiliation(s)
- Michael S Salman
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
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