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Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr 2022; 11:239-252. [PMID: 35663001 PMCID: PMC9134149 DOI: 10.5409/wjcp.v11.i3.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/09/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
There is a complex relationship between sleep disorders and childhood neurodevelopmental, emotional, behavioral and intellectual disorders (NDEBID). NDEBID include several conditions such as attention deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, epilepsy and learning (intellectual) disorders. Up to 75% of children and young people (CYP) with NDEBID are known to experience different types of insomnia, compared to 3% to 36% in normally developing population. Sleep disorders affect 15% to 19% of adolescents with no disability, in comparison with 26% to 36% among CYP with moderate learning disability (LD) and 44% among those with severe LD. Chronic sleep deprivation is associated with significant risks of behavioural problems, impaired cognitive development and learning abilities, poor memory, mood disorders and school problems. It also increases the risk of other health outcomes, such as obesity and metabolic consequences, significantly impacting on the wellbeing of other family members. This narrative review of the extant literature provides a brief overview of sleep physiology, aetiology, classification and prevalence of sleep disorders among CYP with NDEBIDs. It outlines various strategies for the management, including parenting training/psychoeducation, use of cognitive-behavioral strategies and pharmacotherapy. Practical management including assessment, investigations, care plan formulation and follow-up are outlined in a flow chart.
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Affiliation(s)
- Michael O Ogundele
- Department of Community Paediatrics, Bridgewater Community Healthcare NHS Foundation Trust, Halton District, Runcorn WA7 1TW, United Kingdom
| | - Chinnaiah Yemula
- Department of Community Paediatrics, Bedfordshire Community Health Services, Cambridgeshire Community Services NHS Trust, St Ives PE27 4LG, United Kingdom
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Interactions between nocturnal melatonin secretion, metabolism, and sleeping behavior in adolescents with obesity. Int J Obes (Lond) 2022; 46:1051-1058. [PMID: 35140394 PMCID: PMC9050511 DOI: 10.1038/s41366-022-01077-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/17/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023]
Abstract
Background/objectives Sleeping behavior and individual prospensity in sleep timing during a 24 h period, known as chronotypes, are underestimated factors, which may favor the development of obesity and metabolic diseases. Furthermore, melatonin is known to play an important role in circadian rhythm, but was also suggested to directly influence metabolism and bodyweight regulation. Since disturbed and shifted sleep rhythms have been observed in adolescents with obesity, this study aimed to investigate potential interactions between melatonin secretion, chronobiology, and metabolism. In addition, the influence of artificial light especially emitted by electronic devices on these parameters was of further interest. Subjects/methods We performed a cross-sectional study including 149 adolescents (mean age 14.7 ± 2.1 years) with obesity. Metabolic blood parameters (e.g., cholesterol, triglycerides, uric acid, and insulin) were obtained from patients and correlated with nocturnal melatonin secretion. Melatonin secretion was determined by measuring 6-sulfatoxymelatonin (MT6s), the major metabolite of melatonin in the first-morning urine, and normalized to urinary creatinine levels to account for the urinary concentration. Chronobiologic parameters were further assessed using the Munich ChronoType Questionnaire. Results Subjects with insulin resistance (n = 101) showed significantly lower nocturnal melatonin levels compared to those with unimpaired insulin secretion (p = 0.006). Furthermore, triglyceride (p = 0.012) and elevated uric acid levels (p = 0.029) showed significant associations with melatonin secretion. Patients with late chronotype showed a higher incidence of insulin resistance (p = 0.018). Moreover, late chronotype and social jetlag were associated with the time and duration of media consumption. Conclusion We identified an association of impaired energy metabolism and lower nocturnal melatonin secretion in addition to late chronotype and increased social jetlag (misalignment of biological and social clocks) in adolescents with obesity. This might point towards a crucial role of chronotype and melatonin secretion as risk factors for the development of pediatric and adolescent obesity.
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Park J, Han JW, Suh SW, Byun S, Han JH, Bae JB, Kim JH, Kim KW. Pineal gland volume is associated with prevalent and incident isolated rapid eye movement sleep behavior disorder. Aging (Albany NY) 2020; 12:884-893. [PMID: 31918412 PMCID: PMC6977654 DOI: 10.18632/aging.102661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/24/2019] [Indexed: 04/25/2023]
Abstract
We aimed to investigate the association of pineal gland volume with the risk of isolated rapid eye movement (REM) sleep behavior disorder (RBD). We enrolled 245 community-dwelling cognitively normal elderly individuals without major psychiatric or neurological disorders at the baseline evaluation, of whom 146 completed the 2-year follow-up evaluation. We assessed RBD symptoms using the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and defined probable RBD (pRBD) as an RBDSQ score of ≥ 5. We manually segmented the pineal gland on 3T T1-weighted brain magnetic resonance imaging and estimated its volume. The smaller the baseline pineal gland volume, the more severe the RBD symptoms at baseline. The individuals with isolated pRBD showed smaller pineal gland volumes than those without isolated pRBD. The larger the baseline pineal gland volume, the lower the risks of prevalent isolated pRBD at the baseline evaluation and incident isolated pRBD at the 2-year follow-up evaluation. Pineal gland volume showed good diagnostic accuracy for prevalent isolated pRBD and predictive accuracy for incident isolated pRBD in the receiver operator characteristic analysis. Our findings suggest that pineal gland volume may be associated with the severity of RBD symptoms and the risk of isolated RBD in cognitively normal elderly individuals.
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Affiliation(s)
- Jeongbin Park
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Matsuda K, Park K, Tatsumi H, Kitada R, Yoshiyama M. The Use of Electronic Medical Record Data to Analyze the Association Between Atrial Fibrillation and Birth Month. Online J Public Health Inform 2017; 9:e199. [PMID: 29403578 PMCID: PMC5790432 DOI: 10.5210/ojphi.v9i3.7864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is a condition of enormous public health concern. Recently, a population study newly revealed associations between cardiovascular diseases and birth month. Here, we investigated the association between atrial fibrillation in cardiovascular disease and birth month. METHODS We retrospectively extracted birth date data from 6,016 patients with atrial fibrillation (3,876 males; 2,140 females) from our electronic medical records. The number of live births in Japan fluctuates seasonally. Therefore, we corrected the number of patients for each birth month based on a Japanese population survey report. Then, a test of the significance of the association between atrial fibrillation and birth month was performed using a chi-square test. In addition, we compared the results of an analysis of patient data with that of simulated data that showed no association with birth month. RESULTS The deviations of birth month were not significant (overall: p = 0.631, males: p = 0.842, females: p = 0.333). The number of female patients born in the first quarter of the year was slightly higher than those born in the other quarters of the year (p = 0.030). However, by comparing the magnitudes of dispersion in the simulated data, it seems that this finding was mere coincidence. CONCLUSION An association between atrial fibrillation and birth month could not be confirmed in our Japanese study. However, this might be due to differences in ethnicity. Further epidemiologic studies on this topic may result in reduction of disease risk in the general population and contribute to public health.
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Affiliation(s)
| | - Keunsik Park
- Department of Medical Informatics, Osaka City
University Hospital, Osaka, Osaka,
Japan
| | - Hiroaki Tatsumi
- Department of Cardiovascular Medicine, Osaka City
University Graduate School of Medicine, Osaka, Osaka,
Japan
| | - Ryoko Kitada
- Department of Cardiovascular Medicine, Osaka City
University Graduate School of Medicine, Osaka, Osaka,
Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City
University Graduate School of Medicine, Osaka, Osaka,
Japan
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Tsutsumi S, Ono H, Yasumoto Y. The suprapineal recess of the third ventricle: an anatomic study with magnetic resonance imaging. Surg Radiol Anat 2016; 39:725-730. [PMID: 27942944 DOI: 10.1007/s00276-016-1794-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/04/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The suprapineal recess (SPR) is a small, backward extension of the third ventricle. Few radiological studies have investigated the morphology of the SPR. Here, we explore the SPR with magnetic resonance (MR) imaging. METHODS A total of 124 patients underwent thin-slice MR imaging examinations with T2-weighted imaging and the constructive interference steady-state (CISS) sequence. Imaging data were transferred to a workstation for analysis. RESULTS The pineal gland (P) was delineated in 99% of the patients on T2-weighted imaging and 100% of the patients on the CISS sequence. In contrast, the SPR was identified in 27% of the patients on T2-weighted imaging and 82% of the patients on the CISS sequence. The location of the P relative to the lowest point of the splenium was roughly classified into two types. Of them, the anterior P location was the more frequent type and observed in 73% of the patients. The angle formed by the roof and floor of the SPR showed remarkable interindividual diversity. A membranous posterior extension with variable length, spanning between the posterosuperior margin of the P and Galenic complex was found in 55% of the identified SPRs on T2-weighted imaging and 45% on the CISS sequence. CONCLUSIONS The SPR is a distinct structure with diversity in appearance among individuals but commonly extends posterior to the P. High-resolution MR imaging is useful for delineating the SPR in vivo.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Sigurdardottir LG, Markt SC, Sigurdsson S, Aspelund T, Fall K, Schernhammer E, Rider JR, Launer L, Harris T, Stampfer MJ, Gudnason V, Czeisler CA, Lockley SW, Valdimarsdottir UA, Mucci LA. Pineal Gland Volume Assessed by MRI and Its Correlation with 6-Sulfatoxymelatonin Levels among Older Men. J Biol Rhythms 2016; 31:461-9. [PMID: 27449477 DOI: 10.1177/0748730416656948] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The pineal gland produces the hormone melatonin, and its volume may influence melatonin levels. We describe an innovative method for estimating pineal volume in humans and present the association of pineal parenchyma volume with levels of the primary melatonin metabolite, 6-sulfatoxymelatonin. We selected a random sample of 122 older Icelandic men nested within the AGES-Reykjavik cohort and measured their total pineal volume, their parenchyma volume, and the extent of calcification and cysts. For volume estimations we used manual segmentation of magnetic resonance images in the axial plane with simultaneous side-by-side view of the sagittal and coronal plane. We used multivariable adjusted linear regression models to estimate the association of pineal parenchyma volume and baseline characteristics, including 6-sulfatoxymelatonin levels. We used logistic regression to test for differences in first morning urinary 6-sulfatoxymelatonin levels among men with or without cystic or calcified glands. The pineal glands varied in volume, shape, and composition. Cysts were present in 59% of the glands and calcifications in 21%. The mean total pineal volume measured 207 mm(3) (range 65-536 mm(3)) and parenchyma volume 178 mm(3) (range 65-503 mm(3)). In multivariable-adjusted models, pineal parenchyma volume was positively correlated with 6-sulfatoxymelatonin levels (β = 0.52, p < 0.001). Levels of 6-sulfatoxymelatonin did not differ significantly by presence of cysts or calcification. By using an innovative method for pineal assessment, we found pineal parenchyma volume to be positively correlated with 6-sulfatoxymelatonin levels, in line with other recent studies.
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Affiliation(s)
- Lara G Sigurdardottir
- Icelandic Cancer Society, Reykjavik, Iceland Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sarah C Markt
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Thor Aspelund
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland Icelandic Heart Association, Kopavogur, Iceland
| | - Katja Fall
- Clinical Epidemiology and Biostatistcs, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Schernhammer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Jennifer R Rider
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland Icelandic Heart Association, Kopavogur, Iceland
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Unnur A Valdimarsdottir
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lorelei A Mucci
- Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sirin S, de Jong MC, Galluzzi P, Maeder P, Brisse HJ, Castelijns JA, de Graaf P, Goericke SL. MRI-based assessment of the pineal gland in a large population of children aged 0-5 years and comparison with pineoblastoma: part II, the cystic gland. Neuroradiology 2016; 58:713-21. [PMID: 27130617 PMCID: PMC4958131 DOI: 10.1007/s00234-016-1683-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 12/26/2022]
Abstract
Introduction Pineal cysts are a common incidental finding on brain MRI with resulting difficulties in differentiation between normal glands and pineal pathologies. The aim of this study was to assess the size and morphology of the cystic pineal gland in children (0–5 years) and compare the findings with published pineoblastoma cases. Methods In this retrospective multicenter study, 257 MR examinations (232 children, 0–5 years) were evaluated regarding pineal gland size (width, height, planimetric area, maximal cyst(s) size) and morphology. We performed linear regression analysis with 99 % prediction intervals of gland size versus age for the size parameters. Results were compared with a recent meta-analysis of pineoblastoma by de Jong et al. Results Follow-up was available in 25 children showing stable cystic findings in 48 %, cyst size increase in 36 %, and decrease in 16 %. Linear regression analysis gave 99 % upper prediction bounds of 10.8 mm, 10.9 mm, 7.7 mm and 66.9 mm2, respectively, for cyst size, width, height, and area. The slopes (size increase per month) of each parameter were 0.030, 0.046, 0.021, and 0.25, respectively. Most of the pineoblastomas showed a size larger than the 99 % upper prediction margin, but with considerable overlap between the groups. Conclusion We presented age-adapted normal values for size and morphology of the cystic pineal gland in children aged 0 to 5 years. Analysis of size is helpful in discriminating normal glands from cystic pineal pathologies such as pineoblastoma. We also presented guidelines for the approach of a solid or cystic pineal gland in hereditary retinoblastoma patients. Electronic supplementary material The online version of this article (doi:10.1007/s00234-016-1683-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Selma Sirin
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
| | - Paolo Galluzzi
- Unit of Diagnostic and Therapeutic Neuroradiology, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Philippe Maeder
- Department of Radiology, University Hospital, Lausanne, Switzerland
| | | | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Sophia L Goericke
- Unit of Diagnostic and Therapeutic Neuroradiology, Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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MRI-based assessment of the pineal gland in a large population of children aged 0-5 years and comparison with pineoblastoma: part I, the solid gland. Neuroradiology 2016; 58:705-12. [PMID: 27130616 PMCID: PMC4958126 DOI: 10.1007/s00234-016-1684-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 11/14/2022]
Abstract
Introduction Differentiation between normal solid (non-cystic) pineal glands and pineal pathologies on brain MRI is difficult. The aim of this study was to assess the size of the solid pineal gland in children (0–5 years) and compare the findings with published pineoblastoma cases. Methods We retrospectively analyzed the size (width, height, planimetric area) of solid pineal glands in 184 non-retinoblastoma patients (73 female, 111 male) aged 0–5 years on MRI. The effect of age and gender on gland size was evaluated. Linear regression analysis was performed to analyze the relation between size and age. Ninety-nine percent prediction intervals around the mean were added to construct a normal size range per age, with the upper bound of the predictive interval as the parameter of interest as a cutoff for normalcy. Results There was no significant interaction of gender and age for all the three pineal gland parameters (width, height, and area). Linear regression analysis gave 99 % upper prediction bounds of 7.9, 4.8, and 25.4 mm2, respectively, for width, height, and area. The slopes (size increase per month) of each parameter were 0.046, 0.023, and 0.202, respectively. Ninety-three percent (95 % CI 66–100 %) of asymptomatic solid pineoblastomas were larger in size than the 99 % upper bound. Conclusion This study establishes norms for solid pineal gland size in non-retinoblastoma children aged 0–5 years. Knowledge of the size of the normal pineal gland is helpful for detection of pineal gland abnormalities, particularly pineoblastoma. Electronic supplementary material The online version of this article (doi:10.1007/s00234-016-1684-z) contains supplementary material, which is available to authorized users.
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Whitehead MT, Oh C, Raju A, Choudhri AF. Physiologic pineal region, choroid plexus, and dural calcifications in the first decade of life. AJNR Am J Neuroradiol 2014; 36:575-80. [PMID: 25355815 DOI: 10.3174/ajnr.a4153] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Calcifications of the pineal, habenula, choroid plexus, and dura are often physiologic. In the modern CT era with thin-section images and multiplanar reformats, intracranial calcifications have become more conspicuous. We aimed to discover the CT prevalence of pineal region, choroid plexus, and dural calcifications in the first decade of life. MATERIALS AND METHODS Five hundred head CTs from different patients (age range, 0-9 years) encountered during a consecutive 6-month period at a single academic children's hospital were reviewed retrospectively after excluding examinations with artifacts and pineal region masses/hemorrhage. All studies were performed on a 320-detector CT, with 0.5-mm collimation and a 512 × 512 matrix. Five-millimeter reformatted axial, sagittal, and coronal images were analyzed for location and extent of intracranial calcifications. RESULTS The mean age was 3.5 ± 5.7 years (range, 0-9 years). There were 285 males (57%) and 215 females (43%). Pineal calcifications were present in 5% (n = 25; age range, 3.2-8.9 years; median, 7 years). Habenular calcifications were found in 10% (n = 50; age range, 2.8-8.8 years; median, 7 years). Twelve percent (n = 58) had choroid plexus calcifications, (age range, 0.1-8.8 years). Dural calcifications were rare, present in 1% (n = 6; age range, 2.9-8.7 years). CONCLUSIONS Physiologic intracranial calcifications may be found in the first decade, principally in children older than 5 years. Most epithalamic calcifications are habenular. Pineal and habenular calcifications were never present in children younger than 3 and 2 years, respectively. Choroid plexus calcifications may be present in the very young. Dural calcifications are rare.
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Affiliation(s)
- M T Whitehead
- From the Departments of Radiology (M.T.W., C.O., A.R., A.F.C.) Department of Radiology (M.T.W., A.R., A.F.C.), Le Bonheur Children's Hospital, Memphis, Tennessee Department of Radiology (M.T.W.), Children's National Medical Center, Washington, DC
| | - C Oh
- From the Departments of Radiology (M.T.W., C.O., A.R., A.F.C.)
| | - A Raju
- From the Departments of Radiology (M.T.W., C.O., A.R., A.F.C.) Department of Radiology (M.T.W., A.R., A.F.C.), Le Bonheur Children's Hospital, Memphis, Tennessee
| | - A F Choudhri
- From the Departments of Radiology (M.T.W., C.O., A.R., A.F.C.) Neurosurgery (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee Department of Radiology (M.T.W., A.R., A.F.C.), Le Bonheur Children's Hospital, Memphis, Tennessee
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Lee J, Yoon J, Lee JA, Lee SY, Shin CH, Yang SW. Urinary 6-sulfatoxymelatonin level in girls and its relationship with obesity. KOREAN JOURNAL OF PEDIATRICS 2012; 55:344-9. [PMID: 23049592 PMCID: PMC3454577 DOI: 10.3345/kjp.2012.55.9.344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 02/06/2012] [Accepted: 06/14/2012] [Indexed: 11/27/2022]
Abstract
Purpose Short sleep duration is associated with obesity. Urinary 6-sulfatoxymelatonin (6-OHMS), the principal metabolite of melatonin, is closely related with sleep. We evaluated the difference in urinary 6-OHMS levels between obese girls and normal weight girls, and the relationship of urinary 6-OHMS with other hormones regulating body weight and metabolism. Methods A total of 79 girls (6.3 to 12.4 years) were included in this study, of whom 34 were obese; 15, overweight; and 30, normal-weight. We examined their pubertal status and bone age. Fasting serum levels of total ghrelin, leptin, insulin, and first morning urinary 6-OHMS were measured. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated from the fasting insulin and glucose levels. Results There was no significant difference in the creatinine adjusted 6-OHMS levels between the obese girls and the control group. Urinary 6-OHMS did not show any correlations with body mass index (BMI), BMI percentile, total ghrelin, leptin, and HOMA-IR. Negative correlations were found between urinary 6-OHMS levels and chronological and bone ages. Conclusion Our results suggest that melatonin production is not reduced consistently in obese girls.
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Affiliation(s)
- Jieun Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Bumb JM, Brockmann MA, Groden C, Al-Zghloul M, Nölte I. TrueFISP of the pediatric pineal gland: volumetric and microstructural analysis. Clin Neuroradiol 2011; 22:69-77. [PMID: 22101692 DOI: 10.1007/s00062-011-0110-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/24/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE Although high-resolution 3D-imaging has markedly improved the imaging of the pediatric pineal gland, the prevalences of typical and atypical cysts as well as in vivo volumes are unknown. The purpose of this study was to compare the frequency of typical and atypical cysts using high-resolution 3D-sequence true fast imaging with steady state precession (trueFISP) and standard sequences and to directly measure the pineal volume in a large pediatric population. METHODS In 54 consecutively examined children (age 0-17 years, mean age 5.4 ± 5.6 years, 44% female, 56% male) the prevalence of typical and atypical cysts (thickened rim, trabeculations, asymmetry) was determined using trueFISP (isotropic, 0.8 mm) and standard sequences, 1.5-T, T1-weighted spin echo (T1-SE), T2-weighted turbo spin echo (T2-TSE) and fluid attenuated inversion recovery (FLAIR). Indistinct findings were noted separately. Volumetry was based on the trueFISP datasets. Solid and cystic compartments were approached separately. The pineal volume was correlated to gender and age. RESULTS The detected frequency of pineal cysts was higher in trueFISP (57.4%) than in standard sequences (T1-SE 7.4%, T2-TSE 14.8%, and FLAIR 13.0%). In trueFISP 66.3% of the detected cysts were classified as atypical (standard sequences 0%). Indistinct findings were lowest in trueFISP. The mean pineal volume was 94.3 ± 159.1 mm³ and no gender related differences were found. Age and volume showed a moderate correlation (r = 0.382) which was remarkably higher in completely solid glands (r = 0.659). CONCLUSIONS TrueFISP imaging improves the detection of pineal cysts in children. A typical cysts are frequently detected as an incidental finding. Volumetric analysis of the pediatric pineal gland is feasible and reveals enormous variation. Whereas gender effects are negligible, the pineal volume in children is dependant on age.
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Affiliation(s)
- J M Bumb
- University Hospital Mannheim, Department of Neuroradiology, Theodor-Kutzer-Ufer 1–3, Mannheim, Germany
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van Geijlswijk IM, van der Heijden KB, Egberts ACG, Korzilius HPLM, Smits MG. Dose finding of melatonin for chronic idiopathic childhood sleep onset insomnia: an RCT. Psychopharmacology (Berl) 2010; 212:379-91. [PMID: 20668840 PMCID: PMC2952772 DOI: 10.1007/s00213-010-1962-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 07/12/2010] [Indexed: 11/28/2022]
Abstract
RATIONALE Pharmacokinetics of melatonin in children might differ from that in adults. OBJECTIVES This study aims to establish a dose-response relationship for melatonin in advancing dim light melatonin onset (DLMO), sleep onset (SO), and reducing sleep onset latency (SOL) in children between 6 and 12 years with chronic sleep onset insomnia (CSOI). METHODS The method used for this study is the randomized, placebo-controlled double-blind trial. Children with CSOI (n = 72) received either melatonin 0.05, 0.1, and 0.15 mg/kg or placebo during 1 week. Sleep was assessed with log and actigraphy during this week and the week before. Outcomes were the shifts in DLMO, SO, and SOL. RESULTS Treatment with melatonin significantly advanced SO and DLMO by approximately 1 h and decreased SOL by 35 min. Within the three melatonin groups, effect size was not different, but the circadian time of administration (TOA) correlated significantly with treatment effect on DLMO (r (s) = -0.33, p = 0.022) and SO (r (s) = -0.38, p = 0.004), whereas clock TOA was correlated with SO shift (r = -0.35, p = 0.006) and not with DLMO shift. CONCLUSIONS No dose-response relationship of melatonin with SO, SOL, and DLMO is found within a dosage range of 0.05-0.15 mg/kg. The effect of exogenous melatonin on SO, SOL, and DLMO increases with an earlier circadian TOA. The soporific effects of melatonin enhance the SO shift. This study demonstrates that melatonin for treatment of CSOI in children is effective in a dosage of 0.05 mg/kg given at least 1 to 2 h before DLMO and before desired bedtime.
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Affiliation(s)
- Ingeborg M. van Geijlswijk
- Department of Pharmacy, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 106, 3584 CM Utrecht, The Netherlands ,Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Kristiaan B. van der Heijden
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, University of Leiden, Leiden, The Netherlands
| | - A. C. G. Egberts
- Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands ,Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Marcel G. Smits
- Department of Sleep-Wake Disorders and Chronobiology, Gelderse Vallei Hospital Ede, Ede, The Netherlands
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Abstract
INTRODUCTION Little is known about the incidence and symptomatology of pineal cysts in children. Until now, the proper management of this group of patients has not been established. PURPOSE The purpose of this study was to evaluate the epidemiological and clinical features of pineal cysts in children and adolescents and to try to find guidelines for their management. METHODS AND RESULTS We analyzed 24 patients (17 girls, mean age 9, and 7 boys, mean age 14) with pineal cysts found as the only pathology on MRI. Six patients were treated surgically (excision of the cysts via a supracerebellar-infratentorial approach) because of the progression of neurological symptoms or the enlargement of the cyst at follow-up. In this group of patients, no surgery-related complications were noted, nor was residual cyst observed on postoperative MRI. In 4 cases, histological examination revealed simple cysts, but in 2 cases pineocytomas were diagnosed. Preoperative symptoms disappeared except light headache in 2 cases and in 1 case no improvement was obtained. The remaining 18 patients had a mean follow-up of 38 months (range 24-60 months). None of the cysts diminished or collapsed. We also measured the circadian pattern of melatonin secretion as well as beta-HCG and AFP levels in serum before surgery. We found very high night levels of melatonin in both of the patients with pineocytomas, while the patients with pineal cysts showed normal or depressed melatonin secretion profile. CONCLUSION We concluded that though most pineal cysts were clinically benign they should be followed up for many years. If the cyst grows larger in follow-up MRI study and neurological symptoms are progressive, surgical treatment should be performed. In the authors' opinion, one of the markers discriminating benign and neoplastic lesions may be melatonin.
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Affiliation(s)
- Marek Mandera
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, Silesian University School of Medicine, ul. Medyków 16, 40-752 Katowice, Poland.
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