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Hsieh CCJ, Lo YC, Wang HH, Shen HY, Chen YY, Lee YC. Amelioration of the brain structural connectivity is accompanied with changes of gut microbiota in a tuberous sclerosis complex mouse model. Transl Psychiatry 2024; 14:68. [PMID: 38296969 PMCID: PMC10830571 DOI: 10.1038/s41398-024-02752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disease that causes benign tumors and dysfunctions in many organs, including the brain. Aside from the brain malformations, many individuals with TSC exhibit neuropsychiatric symptoms. Among these symptoms, autism spectrum disorder (ASD) is one of the most common co-morbidities, affecting up to 60% of the population. Past neuroimaging studies strongly suggested that the impairments in brain connectivity contribute to ASD, whether or not TSC-related. Specifically, the tract-based diffusion tensor imaging (DTI) analysis provides information on the fiber integrity and has been used to study the neuropathological changes in the white matter of TSC patients with ASD symptoms. In our previous study, curcumin, a diet-derived mTOR inhibitor has been shown to effectively mitigate learning and memory deficits and anxiety-like behavior in Tsc2+/- mice via inhibiting astroglial proliferation. Recently, gut microbiota, which is greatly influenced by the diet, has been considered to play an important role in regulating several components of the central nervous system, including glial functions. In this study, we showed that the abnormal social behavior in the Tsc2+/- mice can be ameliorated by the dietary curcumin treatment. Second, using tract-based DTI analysis, we found that the Tsc2+/- mice exhibited altered fractional anisotropy, axial and radial diffusivities of axonal bundles connecting the prefrontal cortex, nucleus accumbens, hypothalamus, and amygdala, indicating a decreased brain network. Third, the dietary curcumin treatment improved the DTI metrics, in accordance with changes in the gut microbiota composition. At the bacterial phylum level, we showed that the abundances of Actinobacteria, Verrucomicrobia, and Tenericutes were significantly correlated with the DTI metrics FA, AD, and RD, respectively. Finally, we revealed that the expression of myelin-associated proteins, myelin bassic protein (MBP) and proteolipid protein (PLP) was increased after the treatment. Overall, we showed a strong correlation between structural connectivity alterations and social behavioral deficits, as well as the diet-dependent changes in gut microbiota composition.
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Affiliation(s)
| | - Yu-Chun Lo
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Hui Wang
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Ying Shen
- Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
| | - You-Yin Chen
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yi-Chao Lee
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
- International Master Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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Karalis V, Wood D, Teaney NA, Sahin M. The role of TSC1 and TSC2 proteins in neuronal axons. Mol Psychiatry 2024:10.1038/s41380-023-02402-7. [PMID: 38212374 DOI: 10.1038/s41380-023-02402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
Tuberous Sclerosis Complex 1 and 2 proteins, TSC1 and TSC2 respectively, participate in a multiprotein complex with a crucial role for the proper development and function of the nervous system. This complex primarily acts as an inhibitor of the mechanistic target of rapamycin (mTOR) kinase, and mutations in either TSC1 or TSC2 cause a neurodevelopmental disorder called Tuberous Sclerosis Complex (TSC). Neurological manifestations of TSC include brain lesions, epilepsy, autism, and intellectual disability. On the cellular level, the TSC/mTOR signaling axis regulates multiple anabolic and catabolic processes, but it is not clear how these processes contribute to specific neurologic phenotypes. Hence, several studies have aimed to elucidate the role of this signaling pathway in neurons. Of particular interest are axons, as axonal defects are associated with severe neurocognitive impairments. Here, we review findings regarding the role of the TSC1/2 protein complex in axons. Specifically, we will discuss how TSC1/2 canonical and non-canonical functions contribute to the formation and integrity of axonal structure and function.
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Affiliation(s)
- Vasiliki Karalis
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Delaney Wood
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Human Neuron Core, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Nicole A Teaney
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, 02115, USA.
- Human Neuron Core, Boston Children's Hospital, Boston, MA, 02115, USA.
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Sforza G, Monte G, Voci A, Figà Talamanca L, Papetti L, Ferilli MAN, Proietti Checchi M, Valeriani M, Moavero R. A Case Report of Pediatric Patient with Tuberous Sclerosis and Radiologically Isolated Syndrome. J Clin Med 2023; 12:jcm12093284. [PMID: 37176724 PMCID: PMC10179347 DOI: 10.3390/jcm12093284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disease with central nervous system (CNS) involvement. Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS characterized by symptomatic episodes that occur months or years apart and affect different anatomic locations. In the absence of symptomatic episodes, radiologically isolated syndrome (RIS) could be diagnosed. Here, we report the case of a 10-year-old boy followed-up for TSC and diagnosed with RIS after a routine neuroimaging assessment. CASE DESCRIPTION The patient was diagnosed with TSC after seizure onset at the age of 4 years. The follow-up magnetic resonance imaging (MRI) showed multiple asymptomatic demyelinating lesions. Brain and spinal cord MRI was performed after 2 months and showed additional lesions in the right frontal white matter and left cerebral peduncle, the latter with contrast enhancement. Therefore, he received a diagnosis of RIS. Visual evoked potentials were normal. Cerebrospinal fluid examination showed oligoclonal bands. The search for AQP4-IgG and MOG-IgG antibodies was negative. He was treated with interferon beta-1a. Six months later, follow-up MRI revealed no new demyelinating lesions and resolution of contrast enhancement. CONCLUSION To the best of our knowledge, this is the third reported patient presenting a co-occurrence of TSC and demyelinating disease. Although we cannot state if the described comorbidity is casual or not, some clinical and preclinical data suggest that the mTOR complex might be the link between TSC and demyelinating disease.
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Affiliation(s)
- Giorgia Sforza
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Alessandra Voci
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | | | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | | | | | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Center for Sensory-Motor Interaction, Denmark Neurology Unit, Aalborg University, 922 Aalborg, Denmark
| | - Romina Moavero
- Developmental Neurology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, 00133 Rome, Italy
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Kim MJ, Hwang B, Mampre D, Negoita S, Tsehay Y, Sair H, Kang JY, Anderson WS. Ablation of apparent diffusion coefficient hyperintensity clusters in mesial temporal lobe epilepsy improves seizure outcomes after laser interstitial thermal therapy. Epilepsia 2023; 64:654-666. [PMID: 36196769 DOI: 10.1111/epi.17432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LiTT) is a minimally invasive surgical procedure for intractable mesial temporal epilepsy (mTLE). LiTT is safe and effective, but seizure outcomes are highly variable due to patient variability, suboptimal targeting, and incomplete ablation of the epileptogenic zone. Apparent diffusion coefficient (ADC) is a magnetic resonance imaging (MRI) sequence that can identify potential epileptogenic foci in the mesial temporal lobe to improve ablation and seizure outcomes. The objective of this study was to investigate whether ablation of tissue clusters with high ADC values in the mesial temporal structures is associated with seizure outcome in mTLE after LiTT. METHODS Twenty-seven patients with mTLE who underwent LiTT at our institution were analyzed. One-year seizure outcome was categorized as complete seizure freedom (International League Against Epilepsy [ILAE] Class I) and residual seizures (ILAE Class II-VI). Volumes of hippocampus and amygdala were segmented from the preoperative T1 MRI sequence. Spatially distinct hyperintensity clusters were identified in the preoperative ADC map. Proportion of cluster volume and number ablated were associated with seizure outcomes. RESULTS The mean age at surgery was 37.5 years and the mean follow-up duration was 1.9 years. Proportions of hippocampal cluster volume (p = .013) and number (p = .03) ablated were significantly higher in patients with seizure freedom. For amygdala clusters, the proportion of cluster number ablated was significantly associated with seizure outcome (p = .026). In the combined amygdalohippocampal complex, ablation of amygdalohippocampal clusters reliably predicted seizure outcome by their volume ablated (area under the curve [AUC] = 0.7670, p = .02). SIGNIFICANCE Seizure outcome after LiTT in patients with mTLE was associated significantly with the extent of cluster ablation in the amygdalohippocampal complex. The results suggest that preoperative ADC analysis may help identify high-yield pathological tissue clusters that represent epileptogenic foci. ADC-based cluster analysis can potentially assist ablation targeting and improve seizure outcome after LiTT in mTLE.
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Affiliation(s)
- Min Jae Kim
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David Mampre
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Serban Negoita
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Haris Sair
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Vanes LD, Tye C, Tournier JD, Combes AJE, Shephard E, Liang H, Barker GJ, Nosarti C, Bolton P. White matter disruptions related to inattention and autism spectrum symptoms in tuberous sclerosis complex. Neuroimage Clin 2022; 36:103163. [PMID: 36037661 PMCID: PMC9434133 DOI: 10.1016/j.nicl.2022.103163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Tuberous sclerosis complex is a rare genetic multisystem condition that is associated with a high prevalence of neurodevelopmental disorders such as autism and attention-deficit/hyperactivity disorder. The underlying neural mechanisms of the emergence of these symptom domains in tuberous sclerosis complex remain unclear. Here, we use fixel-based analysis of diffusion-weighted imaging, which allows for the differentiation between multiple fibre populations within a voxel, to compare white matter properties in 16 participants with tuberous sclerosis complex (aged 11-19) and 12 age and sex matched control participants. We further tested associations between white matter alterations and autism and inattention symptoms as well as cognitive ability in participants with tuberous sclerosis complex. Compared to controls, participants with tuberous sclerosis complex showed reduced fibre density cross-section (FDC) in the dorsal branch of right superior longitudinal fasciculus and bilateral inferior longitudinal fasciculus, reduced fibre density (FD) in bilateral tapetum, and reduced fibre cross-section (FC) in the ventral branch of right superior longitudinal fasciculus. In participants with tuberous sclerosis complex, the extent of FDC reductions in right superior longitudinal fasciculus was significantly associated with autism traits (social communication difficulties and restricted, repetitive behaviours), whereas FDC reductions in right inferior longitudinal fasciculus were associated with inattention. The observed white matter alterations were unrelated to cognitive ability. Our findings shed light on the fibre-specific biophysical properties of white matter alterations in tuberous sclerosis complex and suggest that these regional changes are selectively associated with the severity of neurodevelopmental symptoms.
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Affiliation(s)
- Lucy D Vanes
- Department of Neuroimaging, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK; Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Charlotte Tye
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Jacques-Donald Tournier
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Anna J E Combes
- Department of Neuroimaging, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Elizabeth Shephard
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK; Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Holan Liang
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Chiara Nosarti
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Patrick Bolton
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
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Cohen AL. Using causal methods to map symptoms to brain circuits in neurodevelopment disorders: moving from identifying correlates to developing treatments. J Neurodev Disord 2022; 14:19. [PMID: 35279095 PMCID: PMC8918299 DOI: 10.1186/s11689-022-09433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
A wide variety of model systems and experimental techniques can provide insight into the structure and function of the human brain in typical development and in neurodevelopmental disorders. Unfortunately, this work, whether based on manipulation of animal models or observational and correlational methods in humans, has a high attrition rate in translating scientific discovery into practicable treatments and therapies for neurodevelopmental disorders.With new computational and neuromodulatory approaches to interrogating brain networks, opportunities exist for "bedside-to bedside-translation" with a potentially shorter path to therapeutic options. Specifically, methods like lesion network mapping can identify brain networks involved in the generation of complex symptomatology, both from acute onset lesion-related symptoms and from focal developmental anomalies. Traditional neuroimaging can examine the generalizability of these findings to idiopathic populations, while non-invasive neuromodulation techniques such as transcranial magnetic stimulation provide the ability to do targeted activation or inhibition of these specific brain regions and networks. In parallel, real-time functional MRI neurofeedback also allow for endogenous neuromodulation of specific targets that may be out of reach for transcranial exogenous methods.Discovery of novel neuroanatomical circuits for transdiagnostic symptoms and neuroimaging-based endophenotypes may now be feasible for neurodevelopmental disorders using data from cohorts with focal brain anomalies. These novel circuits, after validation in large-scale highly characterized research cohorts and tested prospectively using noninvasive neuromodulation and neurofeedback techniques, may represent a new pathway for symptom-based targeted therapy.
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Affiliation(s)
- Alexander Li Cohen
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Laboratory for Brain Network Imaging and Modulation, Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Anaby D, Shrot S, Belenky E, Ben-Zeev B, Tzadok M. Neurite density of white matter significantly correlates with tuberous sclerosis complex disease severity. NeuroImage: Clinical 2022; 35:103085. [PMID: 35780663 PMCID: PMC9421460 DOI: 10.1016/j.nicl.2022.103085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
Whole-brain white matter neurite density significantly reduces with TSC severity. A white matter quantification may be important for the evaluation of TSC patients. Low neurite density clusters are larger in severe TSC patients. Neurite density is an accurate MRI metric for the evaluation of TSC white-matter.
Objective To assess whether white matter (WM) diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) derived measures correlate with tuberous sclerosis complex (TSC) disease severity. Cohort and methods A multi-shell diffusion protocol was added to the clinical MRI brain scans of thirteen patients including 6 males and 7 females with a mean ± std age of 17.2 ± 5.8 years. Fractional anisotropy (FA) and mean diffusivity (MD) were generated from DTI and neurite density index (NDI), orientation dispersion index (ODI) and free water index (fiso) were generated from NODDI. A clinical score was determined for each patient according to the existence of epilepsy, developmental delay, autism or psychiatric disorders. Whole-brain segmented WM was averaged for each parametric map and 3 group k-means clustering was performed on the NDI and FA maps. MRI quantitative parameters were correlated with the clinical scores. Results Segmented whole brain WM averages of MD and NDI values showed significant negative (p = 0.0058) and positive (p = 0.0092) correlations with the clinical scores, respectively. Additionally, the contribution of the low and high NDI-based clusters to the whole brain WM significantly correlated with the clinical scores (p = 0.03 and p = 0.00047, respectively). No correlation was found when the clusters were based on the FA maps. Conclusion Advanced diffusion MRI of TSC patients revealed widespread WM alterations. Neurite density showed significant correlations with disease severity and is therefore suggested to reflect an underlying biological process in TSC WM. The quantification of WM alterations by advanced diffusion MRI may be an additional biomarker for TSC and may be advantageous as a complementary MR protocol for the evaluation of TSC patients.
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Scherrer B, Prohl AK, Taquet M, Kapur K, Peters JM, Tomas-Fernandez X, Davis PE, M Bebin E, Krueger DA, Northrup H, Y Wu J, Sahin M, Warfield SK. The Connectivity Fingerprint of the Fusiform Gyrus Captures the Risk of Developing Autism in Infants with Tuberous Sclerosis Complex. Cereb Cortex 2021; 30:2199-2214. [PMID: 31812987 DOI: 10.1093/cercor/bhz233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by benign tumors throughout the body; it is generally diagnosed early in life and has a high prevalence of autism spectrum disorder (ASD), making it uniquely valuable in studying the early development of autism, before neuropsychiatric symptoms become apparent. One well-documented deficit in ASD is an impairment in face processing. In this work, we assessed whether anatomical connectivity patterns of the fusiform gyrus, a central structure in face processing, capture the risk of developing autism early in life. We longitudinally imaged TSC patients at 1, 2, and 3 years of age with diffusion compartment imaging. We evaluated whether the anatomical connectivity fingerprint of the fusiform gyrus was associated with the risk of developing autism measured by the Autism Observation Scale for Infants (AOSI). Our findings suggest that the fusiform gyrus connectivity captures the risk of developing autism as early as 1 year of age and provides evidence that abnormal fusiform gyrus connectivity increases with age. Moreover, the identified connections that best capture the risk of developing autism involved the fusiform gyrus and limbic and paralimbic regions that were consistent with the ASD phenotype, involving an increased number of left-lateralized structures with increasing age.
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Affiliation(s)
- Benoit Scherrer
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Anna K Prohl
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Maxime Taquet
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Jurriaan M Peters
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Xavier Tomas-Fernandez
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Peter E Davis
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Elizabeth M Bebin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35233 USA
| | - Darcy A Krueger
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229 USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 77030 USA
| | - Joyce Y Wu
- Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095 USA
| | - Mustafa Sahin
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
| | - Simon K Warfield
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115 USA
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Lobanov OV, Shimony JS, Kenley J, Kaplan S, Alexopoulos D, Roland JL, Smyth MD, Smyser CD. Alterations in resting-state functional connectivity in pediatric patients with tuberous sclerosis complex. Epilepsia Open 2021; 6:579-587. [PMID: 34268913 PMCID: PMC8408601 DOI: 10.1002/epi4.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 06/27/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To investigate resting‐state functional connectivity (FC) in pediatric patients with tuberous sclerosis complex and intractable epilepsy requiring surgery. Methods Resting‐state functional MRI was utilized to investigate functional connectivity in 13 pediatric patients with tuberous sclerosis complex (TSC) and intractable epilepsy requiring surgery. Results The majority of patients demonstrated a resting‐state network architecture similar to those reported in healthy individuals. However, preoperative differences were evident between patients with high versus low tuber burden, as well as those with good versus poor neurodevelopmental outcomes, most notably in the cingulo‐opercular and visual resting‐state networks. One patient with high tuber burden and poor preoperative development and seizure control had nearly normal development and seizure resolution after surgery. This was accompanied by significant improvement in resting‐state network architecture just one day postoperatively. Significance Although many patients with tuberous sclerosis complex and medically refractory epilepsy demonstrate functional connectivity patterns similar to healthy children, relationships within and between RSNs demonstrate clear differences in patients with higher tuber burden and worse outcomes. Improvements in resting‐state network organization postoperatively may be related to epilepsy surgery outcomes, providing candidate biomarkers for clinical management in this high‐risk population.
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Affiliation(s)
- Oleg V Lobanov
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Joshua S Shimony
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Jeanette Kenley
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Sydney Kaplan
- Department of Neurology, Washington University, St. Louis, MO, USA
| | | | - Jarod L Roland
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, Washington University, St. Louis, MO, USA.,Department of Pediatrics, Washington University, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University, St. Louis, MO, USA.,Department of Radiology, Washington University, St. Louis, MO, USA.,Department of Pediatrics, Washington University, St. Louis, MO, USA
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Kim MJ, Hwang B, Mampre D, Negoita S, Tsehay Y, Sair H, Kang JY, Anderson W. Apparent diffusion coefficient is associated with seizure outcome after magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. Epilepsy Res 2021; 176:106726. [PMID: 34298428 DOI: 10.1016/j.eplepsyres.2021.106726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is becoming a first-line surgical therapy for mesial temporal lobe epilepsy (mTLE) due to good seizure control and low complication risk. However, seizure outcomes after MRgLiTT remain highly variable and there is a need to improve patient selection and post-operative prognostication. In this retrospective study, we investigated whether the pre-operative MRI-derived apparent diffusion coefficient (ADC), used as a marker of tissue pathology in the mesial temporal structures could help predict seizure outcome. METHODS Thirty-five patients who underwent MRgLiTT at our institution between 2014 and 2019 were included in the study. Demographic and clinical data were retrospectively collected. Seizure outcome was defined as good (ILAE Class I-II) and poor (ILAE Class III-VI). Volumetrics were performed on pre-ablation hippocampus and amygdala. Ablation volumes, and the proportion of ablated hippocampus and amygdala calculated via their respective mean voxel-wise ADC intensities were quantified from pre-operative and intra-operative post-ablation MRIs and statistically compared between the two outcome cohorts. Univarate and multivariate regression analysis was performed to identify demographic, clinical, and radiographic predictors of seizure outcome. RESULTS Mean age at LiTT was 36 years and 14 (40 %) were female. Mean follow-up duration was 1.90 ± 0.17 years. Twenty-seven (77 %) patients had mesial temporal sclerosis. There was no significant difference in the ablation volumes and proportion of ablated volume of hippocampus and amygdala between the two outcome groups. Patients with good seizure outcome had significantly higher normalized ADC intensities in the ablated mesial temporal structures compared to those with poor outcome (0.01 ± 0.08 vs.-0.29 ± 0.06; p = 0.015). CONCLUSIONS mTLE patients with higher ADC intensities in the ablated regions of the hippocampus and the amygdala are more likely to have good seizure outcome following MRgLiTT. Our results suggest that pre-operative ADC analysis may improve both patient selection and epileptogenic zone targeting during MRgLiTT. Further investigation with large, prospective cohorts is needed to validate the clinical utility of ADC in improving seizure outcome following MRgLiTT.
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Affiliation(s)
- Min Jae Kim
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States; Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - David Mampre
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - Serban Negoita
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - Haris Sair
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
| | - William Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States; Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
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11
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Kapfhamer D, McKenna J, Yoon CJ, Murray-Stewart T, Casero RA, Gambello MJ. Ornithine decarboxylase, the rate-limiting enzyme of polyamine synthesis, modifies brain pathology in a mouse model of tuberous sclerosis complex. Hum Mol Genet 2020; 29:2395-2407. [PMID: 32588887 PMCID: PMC7424721 DOI: 10.1093/hmg/ddaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurodevelopmental disorder characterized by variable expressivity. TSC results from inactivating variants within the TSC1 or TSC2 genes, leading to constitutive activation of mechanistic target of rapamycin complex 1 signaling. Using a mouse model of TSC (Tsc2-RG) in which the Tsc2 gene is deleted in radial glial precursors and their neuronal and glial descendants, we observed increased ornithine decarboxylase (ODC) enzymatic activity and concentration of its product, putrescine. To test if increased ODC activity and dysregulated polyamine metabolism contribute to the neurodevelopmental defects of Tsc2-RG mice, we used pharmacologic and genetic approaches to reduce ODC activity in Tsc2-RG mice, followed by histologic assessment of brain development. We observed that decreasing ODC activity and putrescine levels in Tsc2-RG mice worsened many of the neurodevelopmental phenotypes, including brain growth and neuronal migration defects, astrogliosis and oxidative stress. These data suggest a protective effect of increased ODC activity and elevated putrescine that modify the phenotype in this developmental Tsc2-RG model.
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Affiliation(s)
- David Kapfhamer
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - James McKenna
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline J Yoon
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Tracy Murray-Stewart
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert A Casero
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
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12
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Tsai JD, Ho MC, Lee HY, Shen CY, Li JY, Weng JC. Disrupted white matter connectivity and organization of brain structural connectomes in tuberous sclerosis complex patients with neuropsychiatric disorders using diffusion tensor imaging. MAGMA 2020; 34:189-200. [PMID: 32715372 DOI: 10.1007/s10334-020-00870-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tuberous sclerosis complex (TSC) is a genetic neurocutaneous syndrome with variable and unpredictable neurological comorbidity that includes epilepsy, intellectual disability (ID), autism spectrum disorder, and neurobehavioral abnormalities. The degree of white matter involvement is believed to be associated with the severity of neurological impairment. The goal of the present study was to evaluate diffusion characteristics of tubers, white matter lesions, and brain structural network alterations in TSC patients using diffusion tensor imaging (DTI), graph theoretical analysis (GTA), and network-based statistical (NBS) analysis. MATERIALS AND METHODS Forty-two patients with a definitive diagnosis of TSC were recruited for this study. All patients underwent brain DTI examination using a 3 T magnetic resonance imaging system. Mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) values, and fractional anisotropy (FA) mapping in 52 tubers and white matter lesions were measured and compared with those of contralateral normal regions. GTA was performed on the inter-regional connectivity matrix, and NBS analysis was used to identify the significance of any connected subnetworks evident in the set of altered connections. For neurological severity subgrouping, a neurological severity score was assigned to TSC patients including those with ID, seizure, autism, and other neuropsychiatric disorders (NPDs). RESULTS Significantly higher MD, AD, and RD, and lower FA values, were found in TSC lesions compared with those measured in contralateral normal regions for tubers (P < 0.05). GTA and NBS analysis provided better local segregation but worse global integration of the structural network (regular-like network) in TSC patients with ID, seizure, and higher Neurological Severity Score. Disrupted subnetworks in TSC patients with severe status included connections from the frontal lobe to the parietal lobe, temporal lobe to the caudate, and temporal lobe to the insula. DISCUSSION DTI has the potential to provide valuable information about cytoarchitectural changes in TSC lesions beyond morphological MRI findings alone. Using GTA and NBS, current results provide the information of disrupted white matter connectivity and organization in TSC patients with different neuropsychological impairments.
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Affiliation(s)
- Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Chou Ho
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hom-Yi Lee
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Yu Shen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jheng-Yan Li
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital At Linkou, Taoyuan, Taiwan.
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.
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13
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Sundberg M, Sahin M. Modeling Neurodevelopmental Deficits in Tuberous Sclerosis Complex with Stem Cell Derived Neural Precursors and Neurons. Adv Neurobiol 2020; 25:1-31. [PMID: 32578142 DOI: 10.1007/978-3-030-45493-7_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic disorder that is caused by mutations in TSC1 or TSC2. TSC is a multi-organ disorder characterized by development of non-malignant cellular overgrowths, called hamartomas, in different organs of the body. TSC is also characterized as a neurodevelopmental disorder presenting with epilepsy and autism, and formation of cortical malformations ("tubers"), subependymal giant cell astrocytomas (SEGAs), and subependymal nodules (SENs) in the patient's brain. In this chapter, we are going to give an overview of neural stem cell and neuronal development in TSC. In addition, we will also describe previously developed animal models of TSC that display seizures, autistic-like behaviors, and neuronal cell abnormalities in vivo, and we will compare them to disease phenotypes detected with human stem cell derived neuronal cells in vitro. We will describe the effects of TSC-mutations in different neural cell subtypes, and discuss the mitochondrial function, autophagy, and synaptic development and functional deficits in the neurons. Finally, we will review utilization of these human TSC-patient derived neuronal models for drug screening to develop new treatment options for the neurological phenotypes seen in TSC patients.
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14
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Hsieh CCJ, Lo YC, Li SJ, Lin TC, Chang CW, Chen TC, Yang SH, Lee YC, Chen YY. Detection of endophenotypes associated with neuropsychiatric deficiencies in a mouse model of tuberous sclerosis complex using diffusion tensor imaging. Brain Pathol 2020; 31:4-19. [PMID: 32530070 PMCID: PMC8018051 DOI: 10.1111/bpa.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/09/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare hereditary disease, which results from the mutation of either TSC1 or TSC2, and its clinical features include benign tumors and dysfunctions in numerous organs, including the brain. Many individuals with TSC manifest neuropsychiatric symptoms, such as learning impairments, cognitive deficits and anxiety. Current pharmacological treatment for TSC is the use of mTOR inhibitors. However, they are not effective in treating neuropsychiatric symptoms. We previously used curcumin, a diet-derived mTOR inhibitor, which possesses both anti-inflammatory and antiproliferative properties, to improve learning and memory deficits in Tsc2+/- mice. Diffusion tensor imaging (DTI) provides microstructural information in brain tissue and has been used to study the neuropathological changes in TSC. In this study, we confirmed that the impaired recognition memory and increased anxiety-like behavior in Tsc2+/- mice can be reversed by curcumin treatment. Second, we found altered fractional anisotropy and mean diffusivity in the anterior cingulate cortex and the hippocampus of the Tsc2+/- mice, which may indicate altered circuitry. Finally, the mTOR complex 1 hyperactivity was found in the cortex and hippocampus, coinciding with abnormal cortical myelination and increased glial fibrillary acidic protein expression in the hippocampal CA1 of Tsc2+/- mice, both of which can be rescued with curcumin treatment. Overall, DTI is sensitive to the subtle alterations that cannot be detected by conventional imaging, suggesting that noninvasive DTI may be suitable for longitudinally monitoring the in vivo neuropathology associated with the neuropsychiatric symptoms in TSC, thereby facilitating future clinical trials of pharmacological treatments.
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Affiliation(s)
- Christine Chin-Jung Hsieh
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang-Ming University and Academia Sinica, Taipei, 11574, Taiwan.,Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Yu-Chun Lo
- PhD Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan
| | - Ssu-Ju Li
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Ting-Chun Lin
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Ching-Wen Chang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Ting-Chieh Chen
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Shih-Hung Yang
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yi-Chao Lee
- PhD Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan
| | - You-Yin Chen
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Yang-Ming University and Academia Sinica, Taipei, 11574, Taiwan.,Department of Biomedical Engineering, National Yang-Ming University, Taipei, 11221, Taiwan.,PhD Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan
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15
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White T, Langen C, Schmidt M, Hough M, James A. Comparative Neuropsychiatry: White Matter Abnormalities in Children and Adolescents with Schizophrenia, Bipolar Affective Disorder, and Obsessive-Compulsive Disorder. Eur Psychiatry 2020; 30:205-13. [DOI: 10.1016/j.eurpsy.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 12/14/2022] Open
Abstract
AbstractBackground:There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.Methods:A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.Results:Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.Conclusions:White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.
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16
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Taoka T, Aida N, Fujii Y, Ichikawa K, Kawai H, Nakane T, Ito R, Naganawa S. White matter microstructural changes in tuberous sclerosis: Evaluation by neurite orientation dispersion and density imaging (NODDI) and diffusion tensor images. Sci Rep 2020; 10:436. [PMID: 31949187 DOI: 10.1038/s41598-019-57306-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 12/28/2019] [Indexed: 12/03/2022] Open
Abstract
Neurite orientation dispersion and density imaging (NODDI) is a novel diffusion method for evaluating tissue microstructure, and may provide additional information over conventional diffusion tensor imaging (DTI). We evaluated NODDI and DTI parameters in cases of tuberous sclerosis (TS) to assess microstructural changes in the white matter. Eleven cases of tuberous sclerosis and eight age-matched controls underwent NODDI and DTI. We performed qualitative analysis and tract-based spatial statistics (TBSS) analysis of the NODDI parameters (Ficv: intracellular volume fraction, Fiso: isotropic fraction, ODI: orientation dispersion index) as well as DTI parameters (MD: mean diffusivity, FA: fractional anisotropy). We also performed a correlation analysis between clinical symptoms and parameters. The qualitative analysis indicated that the Ficv had a lower value in TS cases particularly in the tubers adjacent to the white matter. The TBSS analysis showed that the TS cases had decreased Ficv in a greater area compared to the other parameters including MD. In particular, the Ficv was decreased in deep white matter, such as the superior longitudinal fascicles (SLF). The application of NODDI to TS cases revealed tissue microstructural changes, and particularly the Ficv could detect more widespread abnormalities in white matter structure compared to DTI parameters.
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17
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Wong M. The role of glia in epilepsy, intellectual disability, and other neurodevelopmental disorders in tuberous sclerosis complex. J Neurodev Disord 2019; 11:30. [PMID: 31838997 PMCID: PMC6913020 DOI: 10.1186/s11689-019-9289-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 11/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a genetic disorder characterized by severe neurological manifestations, including epilepsy, intellectual disability, autism, and a range of other behavioral and psychiatric symptoms, collectively referred to as TSC-associated neuropsychiatric disorders (TAND). Various tumors and hamartomas affecting different organs are the pathological hallmarks of the disease, especially cortical tubers of the brain, but specific cellular and molecular abnormalities, such as involving the mechanistic target of rapamycin (mTOR) pathway, have been identified that also cause or contribute to neurological manifestations of TSC independent of gross structural lesions. In particular, while neurons are immediate mediators of neurological symptoms, different types of glial cells have been increasingly recognized to play important roles in the phenotypes of TSC. Main body This review summarizes the literature supporting glial dysfunction from both mouse models and clinical studies of TSC. In particular, evidence for the role of astrocytes, microglia, and oligodendrocytes in the pathophysiology of epilepsy and TAND in TSC is analyzed. Therapeutic implications of targeting glia cells in developing novel treatments for the neurological manifestations of TSC are also considered. Conclusions Different types of glial cells have both cell autonomous effects and interactions with neurons and other cells that are involved in the pathophysiology of the neurological phenotype of TSC. Targeting glial-mediated mechanisms may represent a novel therapeutic approach for epilepsy and TAND in TSC patients.
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Affiliation(s)
- Michael Wong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, 660 South Euclid Avenue, Box 8111, St. Louis, MO, 63110, USA.
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18
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Peters JM, Struyven RR, Prohl AK, Vasung L, Stajduhar A, Taquet M, Bushman JJ, Lidov H, Singh JM, Scherrer B, Madsen JR, Prabhu SP, Sahin M, Afacan O, Warfield SK. White matter mean diffusivity correlates with myelination in tuberous sclerosis complex. Ann Clin Transl Neurol 2019; 6:1178-1190. [PMID: 31353853 PMCID: PMC6649396 DOI: 10.1002/acn3.793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Diffusion tensor imaging (DTI) of the white matter is a biomarker for neurological disease burden in tuberous sclerosis complex (TSC). To clarify the basis of abnormal diffusion in TSC, we correlated ex vivo high‐resolution diffusion imaging with histopathology in four tissue types: cortex, tuber, perituber, and white matter. Methods Surgical specimens of three children with TSC were scanned in a 3T or 7T MRI with a structural image isotropic resolution of 137–300 micron, and diffusion image isotropic resolution of 270‐1,000 micron. We stained for myelin (luxol fast blue, LFB), gliosis (glial fibrillary acidic protein, GFAP), and neurons (NeuN) and registered the digitized histopathology slides (0.686 micron resolution) to MRI for visual comparison. We then performed colocalization analysis in four tissue types in each specimen. Finally, we applied a linear mixed model (LMM) for pooled analysis across the three specimens. Results In white matter and perituber regions, LFB optical density measures correlated with fractional anisotropy (FA) and inversely with mean diffusivity (MD). In white matter only, GFAP correlated with MD, and inversely with FA. In tubers and in the cortex, there was little variation in mean LFB and GFAP signal intensity, and no correlation with MRI metrics. Neuronal density correlated with MD. In the analysis of the combined specimens, the most robust correlation was between white matter MD and LFB metrics. Interpretation In TSC, diffusion imaging abnormalities in microscopic tissue types correspond to specific histopathological markers. Across all specimens, white matter diffusivity correlates with myelination.
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Affiliation(s)
- Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robbert R Struyven
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anna K Prohl
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lana Vasung
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrija Stajduhar
- Croatian Institute for Brain Research and Center of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, Zagreb, Croatia
| | - Maxime Taquet
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John J Bushman
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hart Lidov
- Division of Neuropathology, Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jolene M Singh
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Benoit Scherrer
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjay P Prabhu
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mustafa Sahin
- Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Onur Afacan
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Simon K Warfield
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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19
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Peters JM, Prohl A, Kapur K, Nath A, Scherrer B, Clancy S, Prabhu SP, Sahin M, Franz DN, Warfield SK, Krueger DA. Longitudinal Effects of Everolimus on White Matter Diffusion in Tuberous Sclerosis Complex. Pediatr Neurol 2019; 90:24-30. [PMID: 30424962 DOI: 10.1016/j.pediatrneurol.2018.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We studied the longitudinal effects of everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), on callosal white matter diffusion tensor imaging (DTI) in patients with tuberous sclerosis complex (TSC). METHODS Serial imaging data spanning nine years were used from the open label, Phase I/II trial (NCT00411619) and open-ended extension phase of everolimus for the treatment of subependymal giant cell astrocytoma associated with TSC. From 28 patients treated with everolimus and 25 untreated control patients, 481 MRI scans were available. Rigorous quality control resulted in omission of all scans with diffusion weighted imaging data in less than 15 directions or more than eight artifacted volumes, and all postsurgical scans. We applied a linear mixed-effects model to the remaining 125 scans (17 treated, 24 controls) for longitudinal analysis of each DTI metric of manually drawn callosal regions of interest. RESULTS On a population level, mTOR inhibition was associated with a decrease in mean diffusivity. In addition, in treated patients only, a decrease of radial diffusivity was observed; in untreated patients only, an increase of axial diffusivity was seen. In patients below age 10, effect-sizes were consistently greater, and longer treatment was associated with greater rate of diffusion change. There was no correlation between DTI metrics and reduction of subependymal giant cell astrocytoma volume, or everolimus serum levels. CONCLUSIONS Effects from mTOR overactivity on white matter microstructural integrity in TSC were modified through pharmacologic inhibition of mTOR. These changes sustained over time, were greater with longer treatment and in younger patients during a time of rapid white matter maturation.
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20
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Sundberg M, Tochitsky I, Buchholz DE, Winden K, Kujala V, Kapur K, Cataltepe D, Turner D, Han MJ, Woolf CJ, Hatten ME, Sahin M. Purkinje cells derived from TSC patients display hypoexcitability and synaptic deficits associated with reduced FMRP levels and reversed by rapamycin. Mol Psychiatry 2018; 23:2167-2183. [PMID: 29449635 PMCID: PMC6093816 DOI: 10.1038/s41380-018-0018-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
Accumulating evidence suggests that cerebellar dysfunction early in life is associated with autism spectrum disorder (ASD), but the molecular mechanisms underlying the cerebellar deficits at the cellular level are unclear. Tuberous sclerosis complex (TSC) is a neurocutaneous disorder that often presents with ASD. Here, we developed a cerebellar Purkinje cell (PC) model of TSC with patient-derived human induced pluripotent stem cells (hiPSCs) to characterize the molecular mechanisms underlying cerebellar abnormalities in ASD and TSC. Our results show that hiPSC-derived PCs from patients with pathogenic TSC2 mutations displayed mTORC1 pathway hyperactivation, defects in neuronal differentiation and RNA regulation, hypoexcitability and reduced synaptic activity when compared with those derived from controls. Our gene expression analyses revealed downregulation of several components of fragile X mental retardation protein (FMRP) targets in TSC2-deficient hiPSC-PCs. We detected decreased expression of FMRP, glutamate receptor δ2 (GRID2), and pre- and post-synaptic markers such as synaptophysin and PSD95 in the TSC2-deficient hiPSC-PCs. The mTOR inhibitor rapamycin rescued the deficits in differentiation, synaptic dysfunction, and hypoexcitability of TSC2 mutant hiPSC-PCs in vitro. Our findings suggest that these gene expression changes and cellular abnormalities contribute to aberrant PC function during development in TSC affected individuals.
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Affiliation(s)
- Maria Sundberg
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA,Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA
| | - Ivan Tochitsky
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - David E. Buchholz
- Laboratory of Developmental Neurobiology, The Rockefeller University, New York, NY, USA
| | - Kellen Winden
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Ville Kujala
- Harvard John A. Paulson School of Engineering and Applied Sciences, Boston, MA, USA
| | - Kush Kapur
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Deniz Cataltepe
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Daria Turner
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Min-Joon Han
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Clifford J. Woolf
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA,Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA
| | - Mary E. Hatten
- Laboratory of Developmental Neurobiology, The Rockefeller University, New York, NY, USA
| | - Mustafa Sahin
- Department of Neurology, F.M. Kirby Center for Neurobiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA.
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Abstract
PURPOSE OF REVIEW Studies investigating postnatal brain growth disorders inform the biology underlying the development of human brain circuitry. This research is becoming increasingly important for the diagnosis and treatment of childhood neurodevelopmental disorders, including autism and related disorders. Here, we review recent research on typical and abnormal postnatal brain growth and examine potential biological mechanisms. RECENT FINDINGS Clinically, brain growth disorders are heralded by diverging head size for a given age and sex, but are more precisely characterized by brain imaging, post-mortem analysis, and animal model studies. Recent neuroimaging and molecular biological studies on postnatal brain growth disorders have broadened our view of both typical and pathological postnatal neurodevelopment. Correlating gene and protein function with brain growth trajectories uncovers postnatal biological mechanisms, including neuronal arborization, synaptogenesis and pruning, and gliogenesis and myelination. Recent investigations of childhood neurodevelopmental and neurodegenerative disorders highlight the underlying genetic programming and experience-dependent remodeling of neural circuitry. SUMMARY To understand typical and abnormal postnatal brain development, clinicians and researchers should characterize brain growth trajectories in the context of neurogenetic syndromes. Understanding mechanisms and trajectories of postnatal brain growth will aid in differentiating, diagnosing, and potentially treating neurodevelopmental disorders.
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Leng X, Fang P, Lin H, An J, Tan X, Zhang C, Wu D, Shen W, Qiu S. Structural MRI research in patients with nasopharyngeal carcinoma following radiotherapy: A DTI and VBM study. Oncol Lett 2017; 14:6091-6096. [PMID: 29113251 DOI: 10.3892/ol.2017.6968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/26/2017] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the microstructural characteristics of the brain lobes following radiotherapy (RT) for patients with nasopharyngeal carcinoma (NPC) at distinct times. Diffusion tensor imaging (DTI) and 3D-T1-weighted imaging was performed in 70 age- and sex-matched subjects, 24 of whom were pre-treatment patients. The patients were divided into three groups, according to the time following completion of RT. Fractional anisotropy (FA) and gray matter (GM) volume were determined. The DTI data were analyzed using tract-based spatial statistics and the GM volume was analyzed using voxel-based morphometry (VBM). Compared with the pre-RT group, the mean FA values in the left parietal lobe white matter (WM) and right cerebellum decreased significantly in the post-RT 0-6 month group (P<0.05). In addition, the mean FA values in the right parietal lobe WM decreased significantly in the post-RT 6-12 month group (P<0.05), compared with the pre-RT group. The FA level in the right temporal lobe remained significantly decreased, compared with that in the pre-RT group (P<0.05) for 1 year after RT. Furthermore, compared with pre-RT group, the GM volume in the bilateral frontal lobe, right occipital lobe, left parietal lobe, right temporal lobe and left cerebellum decreased significantly in the post-RT 0-6 month group (P<0.05), and in the bilateral temporal lobe, parietal lobe, right frontal lobe and left cerebellum, the GM volume decreased significantly in the post-RT 6-12 month group (P<0.05). The GM volume in the right temporal lobe, bilateral frontal lobe and bilateral cerebellum remained significantly decreased compared with that in the pre-RT group (P<0.05) for 1 year after RT. A combination of DTI and VBM may be used to determine radiation-induced brain injury in patients treated for NPC.
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Affiliation(s)
- Xi Leng
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Peng Fang
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, P.R. China
| | - Huan Lin
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Jie An
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Xin Tan
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Chi Zhang
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Donglin Wu
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Wen Shen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shijun Qiu
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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23
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McDonald NM, Varcin KJ, Bhatt R, Wu JY, Sahin M, Nelson CA, Jeste SS. Early autism symptoms in infants with tuberous sclerosis complex. Autism Res 2017; 10:1981-1990. [PMID: 28801991 DOI: 10.1002/aur.1846] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/14/2017] [Accepted: 07/16/2017] [Indexed: 11/08/2022]
Abstract
Tuberous sclerosis complex (TSC) is a rare, autosomal dominant genetic syndrome that confers significantly increased risk for autism spectrum disorder (ASD), with 50-60% of infants with TSC meeting criteria for ASD by 3 years of age. In a previous study of the current longitudinal cohort, we found that infants with TSC who develop ASD (TSC/ASD) evidence decreased cognitive abilities that diverge from infants with TSC and no ASD (TSC/no ASD). We extended this work by asking whether TSC/ASD infants (n = 13) differed from TSC/no ASD infants (n = 10) and infants with low developmental risk and no ASD (LR; n = 21) in their social communication functioning during the first year of life. We measured early ASD symptoms with the Autism Observation Scale for Infants (AOSI) at 9 and 12 months of age. At both ages, infants in the TSC/ASD group had significantly higher AOSI total scores than infants in the TSC/no ASD and LR groups, which were not fully explained by differences in cognitive abilities. Several items on the AOSI at both ages were predictive of ASD outcome, particularly those representing core social communication deficits (e.g., social referencing). Our findings signal the need for further study of this population within the first year and provide strong justification for early identification and early intervention targeting social communication skills in infants with TSC. Autism Res 2017, 10: 1981-1990. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY We examined early signs of autism spectrum disorder (ASD) in infants with tuberous sclerosis complex (TSC), approximately 50% of whom will meet criteria for ASD by age 3. Infants with TSC and ASD showed deficits in social communication behaviors by 9 months of age that were clearly distinguishable from behaviors in infants with TSC who do not develop ASD and low risk infants. Results support the importance of early ASD screening and intervention for infants with TSC.
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Affiliation(s)
- Nicole M McDonald
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90095
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA, 6008, Australia
| | - Rujuta Bhatt
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90095
| | - Joyce Y Wu
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital, David Geffen School of Medicine, 10833 Le Conte Ave, MDCC Room 22-474, Los Angeles, CA, 90095
| | - Mustafa Sahin
- Department of Neurology, Boston Children's Hospital, Translational Neuroscience Center, 300 Longwood Avenue, Boston, MA, 02115
| | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School & Harvard Graduate School of Education, Harvard University, 1 Autumn Street, Boston, MA, 02215
| | - Shafali S Jeste
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90095
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Randell E, McNamara R, Davies DM, Owen-Jones E, Kirby N, Angel L, Drew C, Cannings-John R, Smalley M, Saxena A, McDermott E, Stockwell L, de Vries PJ, Hood K, Sampson JR. The use of everolimus in the treatment of neurocognitive problems in tuberous sclerosis (TRON): study protocol for a randomised controlled trial. Trials 2016; 17:398. [PMID: 27515417 DOI: 10.1186/s13063-016-1446-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/18/2016] [Indexed: 12/25/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a genetic disorder affecting about 1 in 6000 people and is characterised by the development of tumours in many organs, including the skin and kidneys, and by a range of neurological and neuropsychiatric manifestations. TSC-associated neuropsychiatric disorders (TAND) occur in the majority of those with TSC, and they have a significant impact on patients and their families, given the everyday impact of TAND on education, employment, family and social life. The potential benefits of better treatment for TAND therefore include reduction in health care demands and wider benefits for patients and their carers. Methods/design We have planned a single-centre, two-arm, individually randomised, phase II, double-blind, placebo-controlled trial of everolimus versus placebo in the treatment of neurocognitive problems in patients with tuberous sclerosis. Everolimus is a licensed medicine in this patient group, but for a different target of effect. The present trial is a proof-of-principle study developed to provide effect size estimates which may be used to inform the design of subsequent trials. Forty-eight patients aged 16–60 years with tuberous sclerosis who have an IQ >60 and a significant deficit (at least −2 SD) in one or more primary outcome measures will be randomly allocated in a ratio of 2:1 to receive everolimus or placebo, respectively. Participants will be assessed for eligibility and then be started on study medication 4 weeks later. They will then be randomised and receive placebo or everolimus for 24 weeks. Neurocognitive and safety assessments will be carried out at baseline and weeks 4, 12, 24 and 36. Discussion This study is designed to determine the effect sizes of treatment with everolimus or placebo for 6 months on specific neurocognitive functions—recall memory (verbal and non-verbal) and executive function—in people affected by TSC who have significant deficits in these functions. These data will provide new evidence to determine whether larger-scale trials are indicated and to explore suitable outcome measures and analytical methods for neurocognitive trial design. Trial registration ISRCTN09739757. Registered on 28 Dec 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1446-6) contains supplementary material, which is available to authorized users.
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Jiang M, Liu L, He X, Wang H, Lin W, Wang H, Yoon SO, Wood TL, Lu QR. Regulation of PERK-eIF2α signalling by tuberous sclerosis complex-1 controls homoeostasis and survival of myelinating oligodendrocytes. Nat Commun 2016; 7:12185. [PMID: 27416896 DOI: 10.1038/ncomms12185] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/08/2016] [Indexed: 12/20/2022] Open
Abstract
Tuberous sclerosis complex-1 or 2 (TSC1/2) mutations cause white matter abnormalities, including myelin deficits in the CNS; however, underlying mechanisms are not fully understood. TSC1/2 negatively regulate the function of mTOR, which is required for oligodendrocyte differentiation. Here we report that, unexpectedly, constitutive activation of mTOR signalling by Tsc1 deletion in the oligodendrocyte lineage results in severe myelination defects and oligodendrocyte cell death in mice, despite an initial increase of oligodendrocyte precursors during early development. Expression profiling analysis reveals that Tsc1 ablation induces prominent endoplasmic reticulum (ER) stress responses by activating a PERK–eIF2α signalling axis and Fas–JNK apoptotic pathways. Enhancement of the phospho-eIF2α adaptation pathway by inhibition of Gadd34-PP1 phosphatase with guanabenz protects oligodendrocytes and partially rescues myelination defects in Tsc1 mutants. Thus, TSC1-mTOR signalling acts as an important checkpoint for maintaining oligodendrocyte homoeostasis, pointing to a previously uncharacterized ER stress mechanism that contributes to hypomyelination in tuberous sclerosis. The molecular mechanisms regulating myelination are only partially understood. Here authors show that Tsc1 ablation in oligodendrocyte lineage activates ER stress and apoptotic programs in mice, and that enhancing PERK-eIF2α signalling partially rescues the myelination defects in Tsc1 mutants.
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Zikou AK, Xydis VG, Astrakas LG, Nakou I, Tzarouchi LC, Tzoufi M, Argyropoulou MI. Diffusion tensor imaging in children with tuberous sclerosis complex: tract-based spatial statistics assessment of brain microstructural changes. Pediatr Radiol 2016; 46:1158-64. [PMID: 27085522 DOI: 10.1007/s00247-016-3582-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is evidence of microstructural changes in normal-appearing white matter of patients with tuberous sclerosis complex. OBJECTIVE To evaluate major white matter tracts in children with tuberous sclerosis complex using tract-based spatial statistics diffusion tensor imaging (DTI) analysis. MATERIALS AND METHODS Eight children (mean age ± standard deviation: 8.5 ± 5.5 years) with an established diagnosis of tuberous sclerosis complex and 8 age-matched controls were studied. The imaging protocol consisted of T1-weighted high-resolution 3-D spoiled gradient-echo sequence and a spin-echo, echo-planar diffusion-weighted sequence. Differences in the diffusion indices were evaluated using tract-based spatial statistics. RESULTS Tract-based spatial statistics showed increased axial diffusivity in the children with tuberous sclerosis complex in the superior and anterior corona radiata, the superior longitudinal fascicle, the inferior fronto-occipital fascicle, the uncinate fascicle and the anterior thalamic radiation. No significant differences were observed in fractional anisotropy, mean diffusivity and radial diffusivity between patients and control subjects. No difference was found in the diffusion indices between the baseline and follow-up examination in the patient group. CONCLUSION Patients with tuberous sclerosis complex have increased axial diffusivity in major white matter tracts, probably related to reduced axonal integrity.
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Moavero R, Napolitano A, Cusmai R, Vigevano F, Figà-Talamanca L, Calbi G, Curatolo P, Bernardi B. White matter disruption is associated with persistent seizures in tuberous sclerosis complex. Epilepsy Behav 2016; 60:63-67. [PMID: 27179194 DOI: 10.1016/j.yebeh.2016.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS White matter is diffusely altered in tuberous sclerosis complex (TSC), and these alterations appear to be more evident in subjects with a more severe neurologic phenotype. However, little is known on the correlation between white matter alterations and epilepsy in TSC. The aims of this study were to evaluate the effects of early onset and refractory seizures on white matter by using diffusion tensor imaging (DTI). METHODS We enrolled 20 children with TSC and epilepsy onset in the first 3years of life and grouped them according to seizure persistence or freedom. All patients underwent brain MRI with DTI. Specific ROIs have were placed to generate tracks to calculate fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Statistical analysis was performed by ANOVA. RESULTS Children with persistent seizures presented an overall reduced FA, with statistically significant differences on the cingulum (right p=0.003, left p=0.016), the left cerebral peduncle (p=0.020), the superior cerebellar peduncles (right p=0.008, left p=0.002), the posterior limbs of internal capsule (right p=0.037, left p=0.015), the external capsule (right p=0.018, left p=0.031), the inferior frontooccipital fasciculus (right p=0.010, left p=0.026), and the temporal trunk (right p=0.017, left p=0.001). CONCLUSIONS Our study demonstrated that children with persistent seizures present more significant alterations of brain connectivity in areas crucial for global cognitive maturation, executive functions, and verbal abilities, implying a higher risk of cognitive impairment, attention-deficit hyperactivity disorder, and autism.
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Affiliation(s)
- Romina Moavero
- Systems Medicine Department, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Viale Oxford 81, 00133 Rome, Italy; Neuroscience Department, Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy.
| | - Antonio Napolitano
- Enterprise Risk Management, Medical Physics Department, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Raffaella Cusmai
- Neuroscience Department, Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Federico Vigevano
- Neuroscience Department, Neurology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Lorenzo Figà-Talamanca
- Neuroradiology Unit, Imaging Department, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Giuseppe Calbi
- Anesthesiology Unit, DEA-ARCO "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Paolo Curatolo
- Systems Medicine Department, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Bruno Bernardi
- Neuroradiology Unit, Imaging Department, "Bambino Gesù" Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
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Abstract
Purpose of review Tuberous sclerosis complex (TSC) is a variably expressed neurocutaneous genetic disorder characterized by hamartomatous growths in multiple organ systems. Neurologic involvement often confers the most severe symptoms, and can include epilepsy, increased intracranial pressure from hydrocephalus, intellectual deficits, and autism. The purpose of this review is to provide a neurologically focused update in the diagnosis and treatment of these complications in patients with TSC. Recent findings We highlight 5 new areas of understanding in TSC: the neurobiology of TSC and its translation into clinical practice, vigabatrin in the treatment of infantile spasms, the role of tubers and epilepsy surgery, the treatment of subependymal giant cell astrocytomas, and TSC-related neuropsychiatric disorders. Summary These recent advances in diagnosis and treatment give our patients with TSC and their families hope for the future for improved care and possible preventive cures, to the end goal of improving quality of life.
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Affiliation(s)
- David T Hsieh
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Susan L Whiteway
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Luis O Rohena
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Elizabeth A Thiele
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
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Kaden E, Kelm ND, Carson RP, Does MD, Alexander DC. Multi-compartment microscopic diffusion imaging. Neuroimage 2016; 139:346-59. [PMID: 27282476 DOI: 10.1016/j.neuroimage.2016.06.002] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/30/2016] [Accepted: 06/02/2016] [Indexed: 12/03/2022] Open
Abstract
This paper introduces a multi-compartment model for microscopic diffusion anisotropy imaging. The aim is to estimate microscopic features specific to the intra- and extra-neurite compartments in nervous tissue unconfounded by the effects of fibre crossings and orientation dispersion, which are ubiquitous in the brain. The proposed MRI method is based on the Spherical Mean Technique (SMT), which factors out the neurite orientation distribution and thus provides direct estimates of the microscopic tissue structure. This technique can be immediately used in the clinic for the assessment of various neurological conditions, as it requires only a widely available off-the-shelf sequence with two b-shells and high-angular gradient resolution achievable within clinically feasible scan times. To demonstrate the developed method, we use high-quality diffusion data acquired with a bespoke scanner system from the Human Connectome Project. This study establishes the normative values of the new biomarkers for a large cohort of healthy young adults, which may then support clinical diagnostics in patients. Moreover, we show that the microscopic diffusion indices offer direct sensitivity to pathological tissue alterations, exemplified in a preclinical animal model of Tuberous Sclerosis Complex (TSC), a genetic multi-organ disorder which impacts brain microstructure and hence may lead to neurological manifestations such as autism, epilepsy and developmental delay.
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30
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Dogan M, Gumus K, Koc G, Doganay S, Per H, Gorkem S, Canpolat M, Bayram A, Coskun A. Brain diffusion tensor imaging in children with tuberous sclerosis. Diagn Interv Imaging 2016; 97:171-6. [DOI: 10.1016/j.diii.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/15/2015] [Accepted: 04/02/2015] [Indexed: 11/25/2022]
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Yogi A, Hirata Y, Karavaeva E, Harris RJ, Wu JY, Yudovin SL, Linetsky M, Mathern GW, Ellingson BM, Salamon N. DTI of tuber and perituberal tissue can predict epileptogenicity in tuberous sclerosis complex. Neurology 2015; 85:2011-5. [PMID: 26546629 DOI: 10.1212/wnl.0000000000002202] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/17/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether diffusion tensor imaging (DTI) can predict epileptogenic tubers by measuring apparent diffusion coefficient (ADC), fractional anisotropy, axial diffusivity, and radial diffusivity in both tubers and perituberal tissue in pediatric patients with tuberous sclerosis complex (TSC) undergoing epilepsy surgery. METHODS We retrospectively selected 23 consecutive patients (aged 0.4-19.6 years, mean age of 5.2; 13 female, 10 male) who underwent presurgical DTI and subsequent surgical resection between 2004 and 2013 from the University of California-Los Angeles TSC Clinic. We evaluated presurgical examinations including video-EEG, brain MRI, (18)F-fluorodeoxyglucose-PET, magnetic source imaging, and intraoperative electrocorticography for determining epileptogenic tubers. A total of 545 tubers, 33 epileptogenic and 512 nonepileptogenic, were identified. Two observers generated the regions of interest (ROIs) of tubers (ROI(tuber)), the 4-mm-thick ring-shaped ROIs surrounding the tubers (ROI(perituber)), and the combined ROIs (ROI(tuber+perituber)) in consensus and calculated maximum, minimum, mean, and median values of each DTI measure in each ROI for all tubers. RESULTS The Mann-Whitney U test demonstrated that the epileptogenic group showed higher maximum ADC and radial diffusivity values in all ROIs, and that maximum ADC in ROI(tuber+perituber) showed the strongest difference (p = 0.001). Receiver operating characteristic analysis demonstrated that maximum ADC measurements in ROI(tuber+perituber) (area under curve = 0.68 ± 0.05, p < 0.001) had 81% sensitivity and 44% specificity for correctly identifying epileptogenic tubers with a cutoff value of 1.32 μm(2)/ms. CONCLUSIONS DTI analysis of tubers and perituberal tissue may help to identify epileptogenic tubers in presurgical patients with TSC more easily and effectively than current invasive methods.
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Affiliation(s)
- Akira Yogi
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles.
| | - Yoko Hirata
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Elena Karavaeva
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Robert J Harris
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Joyce Y Wu
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Sue L Yudovin
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Michael Linetsky
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Gary W Mathern
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Benjamin M Ellingson
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
| | - Noriko Salamon
- From the Department of Neuroradiology (A.Y., Y.H., E.K., R.J.H., M.L., B.M.E., N.S.), Department of Pediatrics, Division of Pediatric Neurology (J.Y.W., S.L.Y.), and Department of Neurosurgery (G.W.M.), David Geffen School of Medicine, University of California, Los Angeles
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Peters JM, Prohl AK, Tomas-Fernandez XK, Taquet M, Scherrer B, Prabhu SP, Lidov HG, Singh JM, Jansen FE, Braun KPJ, Sahin M, Warfield SK, Stamm A. Tubers are neither static nor discrete: Evidence from serial diffusion tensor imaging. Neurology 2015; 85:1536-45. [PMID: 26432846 DOI: 10.1212/wnl.0000000000002055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/18/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the extent and evolution of tissue abnormality of tubers, perituber tissue, and normal-appearing white matter (NAWM) in patients with tuberous sclerosis complex using serial diffusion tensor imaging. METHODS We applied automatic segmentation based on a combined global-local intensity mixture model of 3T structural and 35 direction diffusion tensor MRIs (diffusion tensor imaging) to define 3 regions: tuber tissue, an equal volume perituber rim, and the remaining NAWM. For each patient, scan, lobe, and tissue type, we analyzed the averages of mean diffusivity (MD) and fractional anisotropy (FA) in a generalized additive mixed model. RESULTS Twenty-five patients (mean age 5.9 years; range 0.5-24.5 years) underwent 2 to 6 scans each, totaling 70 scans. Average time between scans was 1.2 years (range 0.4-2.9). Patient scans were compared with those of 73 healthy controls. FA values were lowest, and MD values were highest in tubers, next in perituber tissue, then in NAWM. Longitudinal analysis showed a positive (FA) and negative (MD) correlation with age in tubers, perituber tissue, and NAWM. All 3 tissue types followed a biexponential developmental trajectory, similar to the white matter of controls. An additional qualitative analysis showed a gradual transition of diffusion values across the tissue type boundaries. CONCLUSIONS Similar to NAWM, tuber and perituber tissues in tuberous sclerosis complex undergo microstructural evolution with age. The extent of diffusion abnormality decreases with distance to the tuber, in line with known extension of histologic, immunohistochemical, and molecular abnormalities beyond tuber pathology.
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Affiliation(s)
- Jurriaan M Peters
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Anna K Prohl
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Xavier K Tomas-Fernandez
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Maxime Taquet
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Benoit Scherrer
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Sanjay P Prabhu
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Hart G Lidov
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Jolene M Singh
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Floor E Jansen
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Kees P J Braun
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Mustafa Sahin
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
| | - Simon K Warfield
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands.
| | - Aymeric Stamm
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (J.M.P., M.S.), Computational Radiology Laboratory, Department of Radiology (J.M.P., A.K.P., X.K.T.-F., M.T., B.S., S.P.P., J.M.S., S.K.W., A.S.), and Department of Pathology (H.G.L.), Boston Children's Hospital and Harvard Medical School, MA; ICTEAM Institute (M.T.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; and Brain Center Rudolf Magnus (F.E.J., K.P.J.B.), Department of Pediatric Neurology, University Medical Center Utrecht, the Netherlands
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Baumer FM, Song JW, Mitchell PD, Pienaar R, Sahin M, Grant PE, Takahashi E. Longitudinal changes in diffusion properties in white matter pathways of children with tuberous sclerosis complex. Pediatr Neurol 2015; 52:615-23. [PMID: 25817702 PMCID: PMC4442035 DOI: 10.1016/j.pediatrneurol.2015.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormal white matter development in patients with tuberous sclerosis complex, a multisystem hamartomatous disorder caused by aberrant neural proliferation and axonal maturation, may be associated with poorer neurocognitive outcomes. The purpose of this study is to identify predictors of longitudinal changes in diffusion properties of white matter tracts in patients with tuberous sclerosis complex. METHODS Diffusion magnetic resonance imaging was carried out in 17 subjects with tuberous sclerosis complex (mean age, 7.2 ± 4.4 years) with at least two magnetic resonance imaging scans (mean number of days between scans, 419.4 ± 105.4). There were 10 males; 5 of 17 had autism spectrum disorder and 10 of 17 had epilepsy. Regions of interest were placed to delineate the internal capsule/corona radiata, cingulum, and corpus callosum. The outcomes were mean change in apparent diffusion coefficient and fractional anisotropy. Data were analyzed using Pearson's correlation and multiple linear regression analyses. RESULTS Gender was a significant predictor of mean change in apparent diffusion coefficient in the left internal capsule, right and left cingulum bundles, and corpus callosum and a significant predictor of mean change in fractional anisotropy in the corpus callosum. Epilepsy was a significant predictor of mean change in apparent diffusion coefficient in the left internal capsule. Autism spectrum disorder was not predictive of diffusion changes in any of the studied pathways. CONCLUSION Clinical variables, including gender and epilepsy, have an effect on the development of white matter pathways. These variables should be taken into consideration when counseling tuberous sclerosis complex patients and in future imaging studies in this population.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA,Correspondence should be addressed to: Emi Takahashi, Ph.D., Division of Newborn Medicine, Boston Children's Hospital, 1 Autumn St. #456, Boston, MA 02115, phone (617) 999-0433
- fax (617) 730-4671, , , Fiona Baumer, M.D., Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood, Avenue, Boston, MA, 02115, USA,
| | - Jae W Song
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Paul D Mitchell
- Clinical Research Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Rudolph Pienaar
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston MA, 02115, USA
| | - Mustafa Sahin
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - P Ellen Grant
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA,Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston MA, 02115, USA
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Gialloreti LE, Moavero R, Marciano S, Pardini M, Benassi F, Mutolo MG, Curatolo P. Reduction in retinal nerve fiber layer thickness in tuberous sclerosis complex. Childs Nerv Syst 2015; 31:857-61. [PMID: 25910752 DOI: 10.1007/s00381-015-2702-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/05/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of our study was to non-invasively investigate central nervous system axonal integrity in patients with tuberous sclerosis complex (TSC). Diffuse microstructural white matter abnormalities reflecting axonal disorganization, reduced/altered myelination, or gliosis have been described in individuals with TSC. Optical coherence tomography (OCT) is a fast, easy-to-perform, non-invasive, and cost-efficient method to assess retinal morphology in vivo and to measure the thickness of the retinal nerve fiber layer (RNFL). METHODS In order to assess central nervous system axonal integrity, eight subjects with TSC have been investigated by OCT to evaluate RNFL and they have been compared with matched healthy controls. RESULTS When comparing mean overall RNFL thicknesses of the TSC group with those of the control group, the TSC group presented with significantly lower RNFL values, compared to the control group, in the temporal quadrant (62.5 ± 6.9 vs. 76.9 ± 5.4; t = 14.438; p < 0.0001). CONCLUSIONS Since a reduced RNFL thickness might be seen as an indicator of chronic axonal degeneration or lack of appropriate neuronal development, our results support the presence of axonal alterations in TSC and also that white matter disorganization could be much more diffuse than originally thought. Since axonal alterations directly derive from mammalian target of rapamycin (mTOR) overactivation, which occurs early during fetus development, the RNFL thinning we observed could represent one of the facets of such early neurodevelopmental abnormalities.
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Im K, Ahtam B, Haehn D, Peters JM, Warfield SK, Sahin M, Ellen Grant P. Altered Structural Brain Networks in Tuberous Sclerosis Complex. Cereb Cortex 2015; 26:2046-58. [PMID: 25750257 DOI: 10.1093/cercor/bhv026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is characterized by benign hamartomas in multiple organs including the brain and its clinical phenotypes may be associated with abnormal neural connections. We aimed to provide the first detailed findings on disrupted structural brain networks in TSC patients. Structural whole-brain connectivity maps were constructed using structural and diffusion MRI in 20 TSC (age range: 3-24 years) and 20 typically developing (TD; 3-23 years) subjects. We assessed global (short- and long-association and interhemispheric fibers) and regional white matter connectivity, and performed graph theoretical analysis using gyral pattern- and atlas-based node parcellations. Significantly higher mean diffusivity (MD) was shown in TSC patients than in TD controls throughout the whole brain and positively correlated with tuber load severity. A significant increase in MD was mainly influenced by an increase in radial diffusivity. Furthermore, interhemispheric connectivity was particularly reduced in TSC, which leads to increased network segregation within hemispheres. TSC patients with developmental delay (DD) showed significantly higher MD than those without DD primarily in intrahemispheric connections. Our analysis allows non-biased determination of differential white matter involvement, which may provide better measures of "lesion load" and lead to a better understanding of disease mechanisms.
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Affiliation(s)
- Kiho Im
- Division of Newborn Medicine Fetal Neonatal Neuroimaging and Developmental Science Center
| | - Banu Ahtam
- Division of Newborn Medicine Fetal Neonatal Neuroimaging and Developmental Science Center
| | - Daniel Haehn
- Fetal Neonatal Neuroimaging and Developmental Science Center Department of Radiology
| | - Jurriaan M Peters
- Department of Neurology Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Simon K Warfield
- Department of Radiology Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - P Ellen Grant
- Division of Newborn Medicine Fetal Neonatal Neuroimaging and Developmental Science Center Department of Radiology Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02119, USA
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Mietzsch U, McKenna J, Reith RM, Way SW, Gambello MJ. Comparative analysis of Tsc1 and Tsc2 single and double radial glial cell mutants. J Comp Neurol 2014; 521:3817-31. [PMID: 23749404 DOI: 10.1002/cne.23380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 02/27/2013] [Accepted: 05/24/2013] [Indexed: 11/08/2022]
Abstract
Tuberous sclerosis complex (TSC) is a neurodevelopmental disorder with variable expressivity. Heterozygous mutations in either of two genes, TSC1 (hamartin) or TSC2 (tuberin), are responsible for most cases. Hamartin and tuberin form a heterodimer that functions as a major cellular inhibitor of the mammalian target of rapamycin complex 1 (mTORC1) kinase. Genotype-phenotype studies suggest that TSC2 mutations are associated with a more severe neurologic phenotype, although the biologic basis for the difference between TSC1- and TSC2-based disease is unclear. Here we performed a study to compare and contrast the brain phenotypes of Tsc1 and Tsc2 single and double mutants. Using Tsc1 and Tsc2 floxed alleles and a radial glial transgenic Cre driver (FVB-Tg(GFAP-cre)25Mes/J), we deleted Tsc1 and/or Tsc2 in radial glial progenitor cells. Single and double mutants had remarkably similar phenotypes: early postnatal mortality, brain overgrowth, laminar disruption, astrogliosis, a paucity of oligodendroglia, and myelination defects. Double Tsc1/Tsc2 mutants died earlier than single mutants, and single mutants showed differences in the location of heterotopias and the organization of the hippocampal stratum pyramidale. The differences were not due to differential mTORC1 activation or feedback inhibition on Akt. These data provide further genetic evidence for individual hamartin and tuberin functions that may explain some of the genotype-phenotype differences seen in the human disease.
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Affiliation(s)
- Ulrike Mietzsch
- Department of Pediatrics/Neonatology, Indiana School of Medicine, Indianapolis, Indiana, 46202
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Choudhri AF, Chin EM, Blitz AM, Gandhi D. Diffusion tensor imaging of cerebral white matter: technique, anatomy, and pathologic patterns. Radiol Clin North Am 2014; 52:413-25. [PMID: 24582347 DOI: 10.1016/j.rcl.2013.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diffusion tensor imaging is a magnetic resonance imaging technique that provides insight into the anatomy and integrity of white matter pathways in the brain. Further processing of these data can help map individual tracts, which can aid in surgical planning. Understanding the basics of this technique can improve characterization of white matter development and disorders.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, G216, Memphis, TN 38103, USA.
| | - Eric M Chin
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA
| | - Ari M Blitz
- Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe Street, B100, Baltimore, MD 21287, USA
| | - Dheeraj Gandhi
- Division of Neuroradiology, Department of Radiology, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA; Department of Neurology, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA; Department of Neurosurgery, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA
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Hunold A, Haueisen J, Ahtam B, Doshi C, Harini C, Camposano S, Warfield SK, Grant PE, Okada Y, Papadelis C. Localization of the epileptogenic foci in tuberous sclerosis complex: a pediatric case report. Front Hum Neurosci 2014; 8:175. [PMID: 24723876 PMCID: PMC3972469 DOI: 10.3389/fnhum.2014.00175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/10/2014] [Indexed: 12/20/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare disorder of tissue growth and differentiation, characterized by benign hamartomas in the brain and other organs. Up to 90% of TSC patients develop epilepsy and 50% become medically intractable requiring resective surgery. The surgical outcome of TSC patients depends on the accurate identification of the epileptogenic zone consisting of tubers and the surrounding epileptogenic tissue. There is conflicting evidence whether the epileptogenic zone is in the tuber itself or in abnormally developed surrounding cortex. Here, we report the localization of the epileptiform activity among the many cortical tubers in a 4-year-old patient with TSC-related refractory epilepsy undergoing magnetoencephalography (MEG), electroencephalography (EEG), and diffusion tensor imaging (DTI). For MEG, we used a prototype system that offers higher spatial resolution and sensitivity compared to the conventional adult systems. The generators of interictal activity were localized using both EEG and MEG with equivalent current dipole (ECD) and minimum norm estimation (MNE) methods according to the current clinical standards. For DTI, we calculated four diffusion scalar parameters for the fibers passing through four ROIs defined: (i) at a large cortical tuber identified at the right quadrant, (ii) at the normal appearing tissue contralateral to the tuber, (iii) at the cluster formed by ECDs fitted at the peak of interictal spikes, and (iv) at the normal appearing tissue contralateral to the cluster. ECDs were consistently clustered at the vicinity of the large calcified cortical tuber. MNE and ECDs indicated epileptiform activity in the same areas. DTI analysis showed differences between the scalar values of the tracks passing through the tuber and the ECD cluster. In this illustrative case, we provide evidence from different neuroimaging modalities, which support the view that epileptiform activity may derive from abnormally developed tissue surrounding the tuber rather than the tuber itself.
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Affiliation(s)
- Alexander Hunold
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology , Ilmenau , Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology , Ilmenau , Germany
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Newborn Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Chiran Doshi
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Chellamani Harini
- Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Susana Camposano
- Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Patricia Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Newborn Medicine, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Radiology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Yoshio Okada
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Christos Papadelis
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA ; Department of Neurology, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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Picchioni D, Reith RM, Nadel JL, Smith CB. Sleep, plasticity and the pathophysiology of neurodevelopmental disorders: the potential roles of protein synthesis and other cellular processes. Brain Sci 2014; 4:150-201. [PMID: 24839550 PMCID: PMC4020186 DOI: 10.3390/brainsci4010150] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/26/2014] [Accepted: 03/07/2014] [Indexed: 12/28/2022] Open
Abstract
Sleep is important for neural plasticity, and plasticity underlies sleep-dependent memory consolidation. It is widely appreciated that protein synthesis plays an essential role in neural plasticity. Studies of sleep-dependent memory and sleep-dependent plasticity have begun to examine alterations in these functions in populations with neurological and psychiatric disorders. Such an approach acknowledges that disordered sleep may have functional consequences during wakefulness. Although neurodevelopmental disorders are not considered to be sleep disorders per se, recent data has revealed that sleep abnormalities are among the most prevalent and common symptoms and may contribute to the progression of these disorders. The main goal of this review is to highlight the role of disordered sleep in the pathology of neurodevelopmental disorders and to examine some potential mechanisms by which sleep-dependent plasticity may be altered. We will also briefly attempt to extend the same logic to the other end of the developmental spectrum and describe a potential role of disordered sleep in the pathology of neurodegenerative diseases. We conclude by discussing ongoing studies that might provide a more integrative approach to the study of sleep, plasticity, and neurodevelopmental disorders.
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Affiliation(s)
- Dante Picchioni
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; E-Mail:
- Advanced MRI Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - R. Michelle Reith
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - Jeffrey L. Nadel
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
| | - Carolyn B. Smith
- Section on Neuroadaptation and Protein Metabolism, National Institute of Mental Health, Bethesda, MD 20892, USA; E-Mails: (R.M.R.); (J.L.N.)
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Ruppe V, Dilsiz P, Reiss CS, Carlson C, Devinsky O, Zagzag D, Weiner HL, Talos DM. Developmental brain abnormalities in tuberous sclerosis complex: A comparative tissue analysis of cortical tubers and perituberal cortex. Epilepsia 2014; 55:539-50. [DOI: 10.1111/epi.12545] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2013] [Indexed: 12/25/2022]
Affiliation(s)
- Véronique Ruppe
- Department of Neurology; School of Medicine; New York University; New York New York U.S.A
| | - Pelin Dilsiz
- Department of Neurology; School of Medicine; New York University; New York New York U.S.A
| | - Carol Shoshkes Reiss
- Department of Biology and Neural Science; New York University; New York New York U.S.A
| | - Chad Carlson
- Department of Neurology; School of Medicine; New York University; New York New York U.S.A
| | - Orrin Devinsky
- Department of Neurology; School of Medicine; New York University; New York New York U.S.A
- Department of Neurosurgery; School of Medicine; New York University; New York New York U.S.A
- Department of Psychiatry; School of Medicine; New York University; New York New York U.S.A
| | - David Zagzag
- Department of Neurosurgery; School of Medicine; New York University; New York New York U.S.A
- Department of Pathology; School of Medicine; New York University; New York New York U.S.A
| | - Howard L. Weiner
- Department of Neurosurgery; School of Medicine; New York University; New York New York U.S.A
| | - Delia M. Talos
- Department of Neurology; School of Medicine; New York University; New York New York U.S.A
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Jeste SS, Hirsch S, Vogel-Farley V, Norona A, Navalta MC, Gregas MC, Prabhu SP, Sahin M, Nelson CA. Atypical face processing in children with tuberous sclerosis complex. J Child Neurol 2013; 28:1569-76. [PMID: 23143725 PMCID: PMC4422391 DOI: 10.1177/0883073812465122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is a high incidence of autism in tuberous sclerosis complex. Given the evidence of impaired face processing in autism, the authors sought to investigate electrophysiological markers of face processing in children with tuberous sclerosis complex. The authors studied 19 children with tuberous sclerosis complex under age 4, and 20 age-matched controls, using a familiar-unfamiliar faces paradigm. Of the children, 6 with tuberous sclerosis complex (32%) had autism. Children with tuberous sclerosis complex showed a longer N290 latency than controls (276 ms vs 259 ms, P = .05) and also failed to show the expected hemispheric differences in face processing. The longest N290 latency was seen in (1) children with autism and tuberous sclerosis complex and (2) children with temporal lobe tubers. This study is the first to quantify atypical face processing in children with tuberous sclerosis complex. This functional impairment may provide insight into a mechanism underlying a pathway to autism in tuberous sclerosis complex.
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Affiliation(s)
- Shafali Spurling Jeste
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,Department of Neurology, Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Suzanna Hirsch
- Laboratories of Cognitive Neuroscience, Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Vanessa Vogel-Farley
- Laboratories of Cognitive Neuroscience, Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Norona
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Mary-Clare Navalta
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Matt C. Gregas
- Department of Neurology, Children’s Hospital, Harvard Medical School, Boston, MA, USA,Clinical Research Program, Children’s Hospital, Boston, MA, USA
| | - Sanjay P. Prabhu
- Department of Neuroradiology, Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mustafa Sahin
- Department of Neurology, Children’s Hospital, Harvard Medical School, Boston, MA, USA,F. M. Kirby Neurobiology Center, Children’s Hospital, Boston, MA, USA
| | - Charles A. Nelson
- Laboratories of Cognitive Neuroscience, Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Peters JM, Taquet M, Prohl AK, Scherrer B, van Eeghen AM, Prabhu SP, Sahin M, Warfield SK. Diffusion tensor imaging and related techniques in tuberous sclerosis complex: review and future directions. Future Neurol 2013; 8:583-597. [PMID: 24489482 DOI: 10.2217/fnl.13.37] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this article, the authors aim to introduce the nonradiologist to diffusion tensor imaging (DTI) and its applications to both clinical and research aspects of tuberous sclerosis complex. Tuberous sclerosis complex is a genetic neurocutaneous syndrome with variable and unpredictable neurological comorbidity that includes refractory epilepsy, intellectual disability, behavioral abnormalities and autism spectrum disorder. DTI is a method for modeling water diffusion in tissue and can noninvasively characterize microstructural properties of the brain. In tuberous sclerosis complex, DTI measures reflect well-known pathological changes. Clinically, DTI can assist with detecting the epileptogenic tuber. For research, DTI has a putative role in identifying potential disease biomarkers, as DTI abnormalities of the white matter are associated with neurocognitive morbidity including autism. If indeed DTI changes parallel phenotypical changes related to the investigational treatment of epilepsy, cognition and behavior with mTOR inhibitors, it will facilitate future clinical trials.
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Affiliation(s)
- Jurriaan M Peters
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA ; Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Maxime Taquet
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA ; ICTEAM Institute, Université catholique de Louvain, Place du Levant 2 bte L5.04.04, 1348 Louvain-La-Neuve, Belgium
| | - Anna K Prohl
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA ; Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Benoit Scherrer
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Agnies M van Eeghen
- Department of Neuroscience, ENCORE, Expertise Centre for Neurodevelopmental Disorders, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sanjay P Prabhu
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
| | - Mustafa Sahin
- Department of Neurology & the Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, 300 Longwood Avenue, Fegan 9, Boston, MA 02115, USA
| | - Simon K Warfield
- Department of Radiology & the Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA 02115, USA
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Filippi CG, Maxwell AW, Watts R. Magnetic resonance diffusion tensor imaging metrics in perilesional white matter among children with periventricular nodular gray matter heterotopia. Pediatr Radiol 2013; 43:1196-203. [PMID: 23529629 DOI: 10.1007/s00247-013-2677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite pharmacological and surgical interventions, some children with periventricular nodular heterotopia (PNH) remain refractory to treatment, which suggests more diffuse pathology potentially involving perilesional white matter. OBJECTIVE The purpose of this study was to evaluate MR diffusion tensor imaging (MRDTI) metrics within perilesional white matter in children with PNH. MATERIALS AND METHODS Six children with PNH (four boys; average age 3.2 years, range 2 months to 6 years) were studied with MRDTI at 3 T. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were quantified within perilesional white matter at distances of 5 mm, 10 mm, 15 mm, and 20 mm from focal areas of PNH and compared to location-matched ROIs in six healthy control patients (two boys, average age 3.3 years, range 2-6 years). Statistical significance was set at an overall level of α = 0.05, corrected for multiple comparisons. RESULTS Perilesional white matter showed significantly decreased fractional anisotropy and elevated mean and radial diffusivity at all evaluated distances. No significant differences in axial diffusivity were detected at any distance. CONCLUSION PNH is associated with microstructural white matter abnormalities as indicated by abnormal perilesional MRDTI metrics detectable at least 20 mm from visible nodular lesions.
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Wong AM, Wang HS, Schwartz ES, Toh CH, Zimmerman RA, Liu PL, Wu YM, Ng SH, Wang JJ. Cerebral diffusion tensor MR tractography in tuberous sclerosis complex: correlation with neurologic severity and tract-based spatial statistical analysis. AJNR Am J Neuroradiol 2013; 34:1829-35. [PMID: 23578671 DOI: 10.3174/ajnr.a3507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE The neurologic significance of residual cerebral white matter tracts, identified on diffusion tensor tractography, has not been well studied in tuberous sclerosis complex. We aimed to correlate the quantity of reconstructed white matter tracts with the degree of neurologic impairment of subjects with the use of DTI and determined differences in white matter integrity between patients with tuberous sclerosis complex and controls with the use of voxelwise analysis. MATERIALS AND METHODS In this case-control study, 16 patients with tuberous sclerosis complex and 12 control subjects underwent DTI. Major white matter tracts, comprising bilateral PF and CF, were reconstructed and assessed for quantity, represented by NOP and NOF. A neurologic severity score, based on the presence of developmental disability, seizure, autism, and other neuropsychiatric disorders, was calculated for each subject. We then correlated this score with white matter quantity. Voxelwise tract-based spatial statistics was used to determine differences in FA, axial, and radial diffusivity values between the tuberous sclerosis complex group and the control subjects. RESULTS NOP and NOF of CF, bilateral PF, and MWT in the tuberous sclerosis complex group were all significantly lower than those in the control subjects (P < .05). The neurologic severity score was moderately negatively correlated with NOF and NOP regarding CF (r = -.70; r = -.75), bilateral PF (r = -.66; r = -.68), and MWT (r = -.71; r = -.74). Tract-based spatial statistics revealed that patients with tuberous sclerosis complex showed a widespread reduction (P < .05) in FA and axial diffusivity in most cerebral white matter regions. CONCLUSIONS Patients with tuberous sclerosis complex with reduced residual white matter were neurologically more severely affected. Tract-based spatial statistics revealed decreased FA and axial diffusivity of the cerebral white matter in the tuberous sclerosis complex group, suggesting reduced axonal integrity.
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Affiliation(s)
- A M Wong
- Department of Medical Imaging and Intervention Chang Gung Memorial Hospital and Chang Gung University, Keelung, Linkou, Taiwan, Republic of China
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van Eeghen AM, Terán LO, Johnson J, Pulsifer MB, Thiele EA, Caruso P. The neuroanatomical phenotype of tuberous sclerosis complex: focus on radial migration lines. Neuroradiology 2013; 55:1007-1014. [PMID: 23644537 DOI: 10.1007/s00234-013-1184-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/27/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The contribution of radial migration lines (RMLs) to the neuroanatomical and neurocognitive phenotype of tuberous sclerosis complex (TSC) is unclear. The aim of this study was to perform a comprehensive evaluation of the neuroradiological phenotype of TSC, distinguishing RMLs from normal-appearing white matter (NAWM) using diffusion tensor imaging (DTI) and volumetric fluid-attenuated inversion recovery imaging. METHODS Magnetic resonance images of 30 patients with TSC were evaluated. The frequencies of RMLs, tubers, and subependymal nodules (SENs) were determined for every hemispheric lobe. Cerebellar lesions and subependymal giant cell tumors were counted. DTI metrics were obtained from the NAWM of every hemispheric lobe and from the largest RML and tuber. Analyses of variance and correlations were performed to investigate the associations between neuroanatomical characteristics and relationships between RML frequency and neurocognitive outcomes. NAWM DTI metrics were compared with measurements of 16 control patients. RESULTS A mean of 47 RMLs, 27 tubers, and 10 SENs were found per patient, and the frequencies of these lesions were strongly correlated (p < 0.001). RML fractional anisotropy and mean diffusivity were strongly inversely correlated (p = 0.003). NAWM DTI metrics were similar to the controls (p = 0.26). RML frequency was strongly associated with age of seizure onset (p = 0.003), intelligence outcomes (p = 0.01), and level of autistic features (p = 0.007). CONCLUSION A detailed neuroradiological phenotype is presented, showing that RMLs are the most frequent neuroanatomical lesion, are responsible for white matter DTI abnormalities, and are strongly associated with age of seizure onset, intelligence outcomes, and level of autistic features.
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Affiliation(s)
- Agnies M van Eeghen
- Department of Neurology, Carol and James Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA, 02114, USA.
- ENCORE, Expertise Centre for Neurodevelopmental Disorders, Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Laura Ortiz Terán
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jason Johnson
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret B Pulsifer
- Department of Psychiatry, Psychological Assessment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth A Thiele
- Department of Neurology, Carol and James Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA, 02114, USA
| | - Paul Caruso
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Wood TL, Bercury KK, Cifelli SE, Mursch LE, Min J, Dai J, Macklin WB. mTOR: a link from the extracellular milieu to transcriptional regulation of oligodendrocyte development. ASN Neuro 2013; 5:e00108. [PMID: 23421405 DOI: 10.1042/AN20120092] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Oligodendrocyte development is controlled by numerous extracellular signals that regulate a series of transcription factors that promote the differentiation of oligodendrocyte progenitor cells to myelinating cells in the central nervous system. A major element of this regulatory system that has only recently been studied is the intracellular signalling from surface receptors to transcription factors to down-regulate inhibitors and up-regulate inducers of oligodendrocyte differentiation and myelination. The current review focuses on one such pathway: the mTOR (mammalian target of rapamycin) pathway, which integrates signals in many cell systems and induces cell responses including cell proliferation and cell differentiation. This review describes the known functions of mTOR as they relate to oligodendrocyte development, and its recently discovered impact on oligodendrocyte differentiation and myelination. A potential model for its role in oligodendrocyte development is proposed.
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Ohki M, Kikuchi S. Bilateral objective tinnitus in an infant with tuberous sclerosis. Int J Pediatr Otorhinolaryngol 2013; 77:290-3. [PMID: 23164500 DOI: 10.1016/j.ijporl.2012.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/24/2012] [Accepted: 10/26/2012] [Indexed: 11/26/2022]
Abstract
This is the first report of objective tinnitus presenting as audible spontaneous otoacoustic emission in a patient with tuberous sclerosis. The tinnitus was loud, continuous, and high pitched: 7757.8 and 6257.8 Hz. The auditory system may be dysfunctional in patients with tuberous sclerosis. Possible causes of tinnitus in these patients are abnormal myelination and dysfunctional axons and neurons associated with tuberous sclerosis. A disturbance of the outer hair cells or the MOC efferent fibers innervating the outer hair cells is considered to be the source of the loud spontaneous otoacoustic emission.
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Affiliation(s)
- Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Kawagoe-shi, Saitama, Japan.
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Lewis WW, Sahin M, Scherrer B, Peters JM, Suarez RO, Vogel-Farley VK, Jeste SS, Gregas MC, Prabhu SP, Nelson CA, Warfield SK. Impaired language pathways in tuberous sclerosis complex patients with autism spectrum disorders. Cereb Cortex 2012; 23:1526-32. [PMID: 22661408 DOI: 10.1093/cercor/bhs135] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to examine the relationship between language pathways and autism spectrum disorders (ASDs) in patients with tuberous sclerosis complex (TSC). An advanced diffusion-weighted magnetic resonance imaging (MRI) was performed on 42 patients with TSC and 42 age-matched controls. Using a validated automatic method, white matter language pathways were identified and microstructural characteristics were extracted, including fractional anisotropy (FA) and mean diffusivity (MD). Among 42 patients with TSC, 12 had ASD (29%). After controlling for age, TSC patients without ASD had a lower FA than controls in the arcuate fasciculus (AF); TSC patients with ASD had even a smaller FA, lower than the FA for those without ASD. Similarly, TSC patients without ASD had a greater MD than controls in the AF; TSC patients with ASD had even a higher MD, greater than the MD in those without ASD. It remains unclear why some patients with TSC develop ASD, while others have better language and socio-behavioral outcomes. Our results suggest that language pathway microstructure may serve as a marker of the risk of ASD in TSC patients. Impaired microstructure in language pathways of TSC patients may indicate the development of ASD, although prospective studies of language pathway development and ASD diagnosis in TSC remain essential.
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Affiliation(s)
- William W Lewis
- Department of Neurology, Children’s Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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Chokshi FH, Poretti A, Meoded A, Huisman TAGM. Normal and abnormal development of the cerebellum and brainstem as depicted by diffusion tensor imaging. Semin Ultrasound CT MR 2012; 32:539-54. [PMID: 22108217 DOI: 10.1053/j.sult.2011.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diffusion tensor imaging (DTI) is an advanced MRI technique that measures the microscopic molecular motion of water to gain information about the brain structure. This modality and its application to fiber tractography have been increasingly used in the last years to study the neuroanatomical background of brain malformations. This article aims to give an overview of the application of DTI and fiber tractography on pediatric posterior fossa including malformations, acquired disorders affecting the white matter, and posterior fossa involvement in phacomatoses. For every disorder, we show the additional information that DTI and fiber tractography are providing compared to conventional MR sequences and discuss their significance. Additionally, we show at the beginning normal DTI and fiber tractography findings of the pediatric posterior fossa. Finally, we briefly discuss potential future uses for DTI and fiber tractography to further understand the pathogenesis of posterior fossa malformations and the neuronal plasticity and connectivity of acquired lesions affecting the posterior fossa.
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Affiliation(s)
- Falgun H Chokshi
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Peters JM, Sahin M, Vogel-Farley VK, Jeste SS, Nelson CA, Gregas MC, Prabhu SP, Scherrer B, Warfield SK. Loss of white matter microstructural integrity is associated with adverse neurological outcome in tuberous sclerosis complex. Acad Radiol 2012; 19:17-25. [PMID: 22142677 DOI: 10.1016/j.acra.2011.08.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES Tuberous sclerosis complex (TSC) is a genetic neurocutaneous syndrome in which cognitive and social-behavioral outcomes for patients vary widely in an unpredictable manner. The cause of adverse neurologic outcome remains unclear. The aim of this study was to investigate the hypothesis that disordered white matter and abnormal neural connectivity are associated with adverse neurologic outcomes. MATERIALS AND METHODS Structural and diffusion magnetic resonance imaging was carried out in 40 subjects with TSC (age range, 0.5-25 years; mean age, 7.2 years; median age, 5 years), 12 of whom had autism spectrum disorders (ASD), and in 29 age-matched controls. Tractography of the corpus callosum was used to define a three-dimensional volume of interest. Regional averages of four diffusion scalar parameters of the callosal projections were calculated for each subject. These were the average fractional anisotropy (AFA) and the average mean, radial, and axial diffusivity. RESULTS Subjects with TSC had significantly lower AFA and higher average mean, radial, and axial diffusivity values compared to controls. Subjects with TSC and ASD had significantly lower AFA values compared to those without ASD and compared to controls. Subjects with TSC without ASD had similar AFA values compared to controls. CONCLUSION Diffusion tensor scalar parameters provided measures of properties of the three-dimensional callosal projections. In TSC, changes in these parameters may reflect microstructural changes in myelination, axonal integrity, or extracellular environment. Alterations in white matter microstructural properties were associated with TSC, and larger changes were associated with TSC and ASD, thus establishing a relationship between altered white matter microstructural integrity and brain function.
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Affiliation(s)
- Jurriaan M Peters
- Department of Neurology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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