Bożena Kubas

Metabolite alterations in autistic children: a 1H MR spectroscopy study

PURPOSE The purpose of this study was to assess the role of proton magnetic resonance spectroscopy (1H MRS) in the detection of changes in cerebral metabolite levels in autistic children. MATERIAL AND METHODS Study group consisted of 12 children, aged 8-15 years, who were under the care of Pediatric Neurology Department and Pediatric Rehabilitation Department of Medical University of Bialystok. The diagnosis of autism was established by neurologist, psychiatrist and psychologist in every case. All patients matched the clinical criteria of the disease according to International Statistical Classification of Diseases and Related Health Problems (ICD-10). The control group included 16 healthy children aged 7-17. 1H MRS was performed with a single-voxel method (TE-36, TR-1500, NEX-192). The volume of interest (VOI) was located in the frontal lobe regions, separately on each side. RESULTS We showed lower N-acetylaspartate/creatine (NAA/Cr), γ-aminobutyric acid /creatine (GABA/Cr) and glutamate/creatine (Glx/Cr) in the frontal lobes in the study group comparing with healthy controls. The ratio of myoinositol/creatine (mI/Cr) was increased in autistic children. No differences in choline/creatine (Cho/Cr) ratio in study group and controls were found. There was a correlation between age and NAA/Cr in autistic children (R=0.593 p=0.041). No significant differences in metabolite ratios between right and left hemisphere in ASD and controls were found. CONCLUSIONS (1)H MRS can provide important information regarding abnormal brain metabolism. Differences in NAA/Cr, GABA/Cr, Glx/Cr and mI/Cr may contribute to the pathogenesis of autism.

Spastic Cerebral Palsy: Clinical Magnetic Resonance Imaging Correlation of 129 Children

A prospective study was undertaken of 129 children with spastic cerebral palsy to clarify the relationship between magnetic resonance imaging (MRI) findings and clinical features of cerebral palsy. Low birth weight, asphyxia, prematurity, seizures, mental development, Gross Motor Function Classification System, and MRI findings were analyzed. Significant abnormalities relevant to the cerebral palsy were evident on imaging in 123 (95.3%). A similar percentage of MRI abnormalities were detected in the groups, 45 (100%) in patients with tetraplegic cerebral palsy, 37 (92.5%) in children with diplegic cerebral palsy, and 42 (95.4%) with hemiplegic cerebral palsy. Periventricular leukomalacia was detected more frequently in the children with spastic diplegia than in the patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more frequently in children with spastic hemiplegia. Congenital brain anomalies were found in a higher proportion in tetraplegic children. Significant correlations between the MRI findings and Gross Motor Function Classification System in the diplegic and tetraplegic patients were found. No correlations between the MRI results and risk factors for cerebral palsy in the tetraplegic patients were noted. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the initiation of appropriate therapy

Assessment of fetal distress based on magnetic resonance examinations

RATIONALE AND OBJECTIVES Hypoxia is the main cause of injuries and intrauterine death of the fetus. Therefore, the main aim of monitoring and assessment of the fetus should be diagnosis of fetal distress before irreversible changes occur. Besides the fetal condition assessment methods used so far, in recent years in obstetrics new non-invasive imaging methods were introduced such as magnetic resonance (MR). This method enables morphologic evaluation of brain and brain tissue metabolism using magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS Twenty pregnant women with pregnancy-induced hypertension (11 cases, including 3 with coexisting diabetes mellitus and 2 with intrauterine growth retardation), chronic hypertension (2 cases), gestational diabetes mellitus (6 cases), and suspected intrauterine fetal growth retardation (IUGR) participated in the study. Cardiotocography (CTG) and Doppler ultrasound examination of the blood flow in the umbilical artery and in the middle cerebral artery were performed. RESULTS In case of abnormal CTG and Doppler study records that indicated fetal hypoxia, MR studies showed the existence of ischemic focus in 5 patients and abnormal spectral images in 6 patients. CONCLUSION The results of the preliminary study suggests that the use of MR in prenatal diagnosis may revolutionize the early detection of fetal injury in fetal distress. It is a valuable component of the diagnostic process, supplementing other examinations. The use of MR to assess fetal condition gives additional information and helps to make decisions about therapeutic actions.

Proton magnetic resonance spectroscopy in children with spastic diplegia.

The objective of this prospective study was the application of proton magnetic resonance spectroscopy in children with spastic diplegia (SD) to determine the metabolite profile of SD children in the left basal ganglia, and to assess the relationship of this profile with motor and mental development. Patients with SD showed reduced ratios of N-acetylaspartate (NAA)/creatine (Cr), NAA/choline (Cho), NAA/myo-inositol (mI), Cho/NAA, Cho/Cr and Cho/mI in the basal ganglia compared to a well-matched control group. On the other hand, we noted increased Cr/NAA, Cr/Cho and mI/NAA ratios in the SD patients as compared with controls. NAA/mI ratios were positively correlated with the severity scale of cerebral palsy in SD children. There was also a significant correlation between Cr/NAA and mental retardation. Increased Cr/NAA, Cr/Cho and mI/NAA ratios in SD children may suggest the existence of the compensatory mechanisms in these patients. The NAA/mI ratio could be used as an additional marker of SD severity and Cr/NAA as a marker of the mental retardation.

Corpus Callosum Size in Children With Spastic Cerebral Palsy: Relationship to Clinical Outcome

This study examines corpus callosum pathology in children with spastic cerebral palsy aged 7 to 15 years and to investigates the relation between corpus callosum areas and clinical picture. Magnetic resonance images of 46 patients were reviewed prospectively. Twenty-two patients with cerebral palsy were age and gender matched with the control patients. The cerebral palsy group had a significantly smaller mean corpus callosum surface area than did the control group. The cerebral palsy group also had a significantly smaller mean internal skull surface area measurement than did the control group. The corpus callosum/internal skull surface area ratio was also smaller for those with cerebral palsy. Wechsler Intelligence Scale Verbal IQ scores were associated with the surface area of the corpus callosum in cerebral palsy patients. A significant relationship between corpus callosum surface area and IQ scores in children with cerebral palsy was found. A positive correlation between internal skull surface area and IQ scores in children with cerebral palsy was noted. A significant correlation between Apgar score and corpus callosum surface area in the cerebral palsy group was found. A negative correlation between corpus callosum surface area and the Gross Motor Function Classification System in patients with cerebral palsy was noted.

Cerebrovascular Manifestations of Lyme Neuroborreliosis—A Systematic Review of Published Cases

Background Lyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA). Materials and methods We conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB. Results This study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%. Conclusion Cerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.

Schizencephaly as a cause of spastic cerebral palsy

PURPOSE The objective was to investigate the clinical features of schizencephaly in children with spastic cerebral palsy. MATERIAL AND METHODS The present study included 180 children with cerebral palsy, spastic tetraplegia, diplegia, and hemiplegia. All magnetic resonance (MR) scans were obtained using a 1.5 T MR scanner with the use of a standard circularly polarized head coil. RESULTS Significant abnormalities relevant to cerebral palsy were evident on MRI in 95%. Periventicular leukomalacia was detected more frequently in children with spastic diplegia than in other patients. Cerebral atrophy was found more often in tetraplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 20 (11.1%) children with spastic cerebral palsy. Twelve patients had schizencephaly with cerebral palsy. Children with spastic diplegia and tetraplegia had bilateral schizencephaly; patients with spastic hemiplegia only had unilateral schizencephaly. Most patients with schizencephaly had epilepsy. CONCLUSIONS Schizencephaly occurred more often in patients with spastic hemiplegia. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the introduction of appropriate therapy.

An Age and Gender Dependency of Metabolite Concentrations in Basal Ganglia in Children with Spastic Diplegia: Proton Magnetic Resonance Spectroscopy Study

We determined metabolite profile in spastic diplegic children compared to controls in left basal ganglia of brain in using proton magnetic resonance spectroscopy in correlation with age and gender. Twenty-four patients with spastic diplegia and twenty-six healthy children were examined. The relative concentrations of N-acetylaspartate, choline, and myoinositol were measured in relation to creatine and different combinations of metabolites within 8-cm3 brain voxel. Children with spastic diplegia showed reduced ratios of N-acetylaspartate/creatine, N-acetylaspartate/ choline, and N-acetylaspartate/myoinositol in the basal ganglia compared to the control group. Patients and controls subjects demonstrated a significant age-dependent increase in N-acetylaspartate/creatine, N-acetylaspartate/choline in the basal ganglia. No gender-dependent difference was shown in children with cerebral palsy for all tested metabolite ratios. Gender-related differences because of increased ratio N-acetylaspartate/choline in girls in controls were detected. These results indicate that maturation of brain exists in cerebral palsy and healthy children to a higher degree in healthy children.

Metabolite profile in the basal ganglia of children with cerebral palsy: a proton magnetic resonance spectroscopy study

This prospective study determined metabolite profile in the left and right basal ganglia of children with spastic cerebral palsy (CP) compared with children without disabilities, by using proton magnetic resonance spectroscopy (1HMRS). Twenty‐three patients with spastic CP (12 males, 11 females; mean age 11y 9mo [SD 4y 2mo], range 4–17y) were examined. Twenty children had spastic diplegia and three had quadriplegia. Twenty‐four normally developing children (13 females, 11 males; mean age 10y 3mo [SD 4y 8mo], range 4–17y) served as a comparison group. The relative concentrations of N‐acetylaspartate (NAA), choline (Cho), myo‐inositol (mI), and gamma‐aminobutyric acid (GABA) were measured relative to creatine (Cr) and different combinations of metabolites within 8cm3 brain voxels. Children with CP showed reduced ratios of NAA:Cr, NAA:Cho, NAA:mI, and GABA:Cr in the basal ganglia relative to a matched comparison group. Patients demonstrated a significant age‐dependent increase in NAA:Cr and NAA:Cho in the basal ganglia. No sex‐dependent difference was shown in children with CP nor in the comparison group for all tested metabolite ratios. Significant correlation between Apgar score and ratio of mI:Cr in the group with CP was found. None of the tested metabolite ratios were correlated with the severity scale of CP in children with CP. NAA:Cr ratios were negatively correlated with learning disability* in patients with CP. Results indicate the association of the metabolite ratios in basal ganglia with learning disability.

Neurochemical alterations in anterior cingulate cortex in bipolar disorder: a proton magnetic resonance spectroscopy study (1H-MRS).

OBJECTIVES The aim of this study was to determine neurochemical alterations in bipolar disorder using proton magnetic resonance spectroscopy (1H-MRS). METHODS We investigated a group of 27 patients diagnosed with bipolar disorder (with manic and mixed episodes, depression and after remission of symptoms) and 10 healthy subjects. MR imaging and 1H-MRS were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the anterior cingulate, left frontal lobe and left temporal lobe. Spectral peaks of NAA (N-acetylaspartate), Glx (glutamate/glutamine/GABA complex), Cho (choline), Cr (creatine/phosphocreatine) and mI (myo-inositol) were analyzed and the ratios of these metabolites to creatine (Cr) and non-suppressed water signal were determined. RESULTS In the anterior cingulate cortex of patients with bipolar disorder a significantly higher Cho/H2O ratio (p = 0.029) and a trend toward higher Cho/Cr ratio values (p = 0.096) were observed as compared to healthy controls. CONCLUSIONS The findings of our study prove that neurochemical changes occurring in the anterior cingulate cortex of bipolar patients are related to altered choline levels.