A Wallace

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

OBJECTIVE Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems. METHOD The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors. RESULTS Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality. CONCLUSIONS Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.

Ongoing Developments in Sporadic Inclusion Body Myositis

Sporadic inclusion body myositis (IBM) is an acquired muscle disorder associated with ageing, for which there is no effective treatment. Ongoing developments include: genetic studies that may provide insights regarding the pathogenesis of IBM, improved histopathological markers, the description of a new IBM autoantibody, scrutiny of the diagnostic utility of clinical features and biomarkers, the refinement of diagnostic criteria, the emerging use of MRI as a diagnostic and monitoring tool, and new pathogenic insights that have led to novel therapeutic approaches being trialled for IBM, including treatments with the objective of restoring protein homeostasis and myostatin blockers. The effect of exercise in IBM continues to be investigated. However, despite these ongoing developments, the aetiopathogenesis of IBM remains uncertain. A translational and multidisciplinary collaborative approach is critical to improve the diagnosis, treatment, and care of patients with IBM.

A protocol to develop clinical guidelines for inclusion-body myositis

Inclusion‐body myositis (IBM) is a late‐onset idiopathic inflammatory myopathy associated with selective and progressive muscle weakness and atrophy. Current clinical management of IBM is largely supportive due to its uncertain etiology and lack of effective treatment. Establishing a consensus of opinion on questions relating to diagnosis and management of IBM is expected to help reduce inconsistencies in the care and resources allocated to those living with this condition.

EVALUATING THE BENEFITS OF COMMUNITY BASED AEROBIC TRAINING ON THE PHYSICAL HEALTH AND WELL-BEING OF PEOPLE WITH NEUROMUSCULAR DISEASE

Introduction: Postural stability is the distance one can lean without losing balance. Movement beyond this limit requires a stabilization reaction to avoid falls. Individuals with Myotonic Dystrophy type-1 (DM1) often experience falls, possibly influenced by reduced limits of stability (LOS). Objectives: Compare LOS via maximum excursion (MXE) scores for DM1 versus normative values. Evaluate MXE at baseline and 3-months. Methods: Dynamic posturography assessed the MXE(%) for eighteen adults with DM1 at baseline and 3-months. Singlegroup and paired t-test analyses were conducted. Results: Individuals with DM1 had significantly lower mean MXE when compared to normative values for ages 20-39 (66.33(4.21), p< 0.01) and 40-59 (48.67(4.94), p< 0.01). Comparing mean MXE among DM1 participants at baseline (57.50(3.81)) versus 3-months (57.78(4.01)) found no difference (p50.41). Conclusion: Adults with DM1 had a significantly reduced LOS when compared to normative values. This reduced maximum excursion capacity indicates an increased fall risk. Additional reductions in stability limits from baseline to 3-months were not detected.