Serial MRI findings in brain anoxia leading to Lance–Adams syndrome: a case report

Although in literature almost 150 patients with Lance-Adams Syndrome (LAS) have been reported, neuroradiological evaluations were often performed in late stages and there is no serial study evaluating LAS from early stages. We herein report a serial neuroimaging study demonstrating early and transient involvement of cerebellum and thalami in a LAS patient. We may hypothesize that a transient cerebral hypoxia provoked a permanent synaptic rearrangements of the neuronal networks involved in the pathogenesis of post-hypoxic myoclonus in our patient.     

Experimental Study of the Course of Threshold Current,Voltage and Electrode Impedance During Stepwise Stimulation From the Skin Surface to the Human Cortex

BackgroundTranscranial electric stimulation as used during intraoperative neurostimulation is dependent on electrode and skull impedances.ObjectiveThreshold currents, voltages and electrode impedances were evaluated with electrical stimulation at 8 successive layers between the skin and the cerebral cortex.Patients and MethodsData of 10 patients (6f, 53 ± 11 years) were analyzed. Motor evoked potentials were elicited by constant current stimulation with corkscrew type electrodes (CS) at C3 and C4 in line with standard transcranial electric stimulation. A monopolar anodal ball tip shaped probe was used for all other measurements being performed at the level of the skin, dura and cortex, as well as within the skull by stepwise performed burr holes close to C3 resp. C4.ResultsAverage stimulation intensity, corresponding voltage and impedance for muscle MEPs at current motor threshold (CMT) were recorded: CS 54 ± 23 mA (mean ± SD), 38 ± 21 V, 686 ± 146 Ω; with the monopolar probe on skin 55 ± 28 mA, 100 ± 44 V, 1911 ± 683 Ω and scalp 59 ± 32 mA, 56 ± 28 V, 1010 ± 402 Ω; within the skull bone: outer compact layer 33 ± 23 mA, 91 ± 53 V, 3734 ± 2793 Ω; spongiform layer 33 ± 23 mA, 70 ± 44 V, 2347 ± 1327 Ω; inner compact layer (ICL) 28 ± 19 mA, 48 ± 23 V, 2103 ± 1498 Ω; on dura 25 ± 12 mA, 17 ± 12 V, 643 ± 244 Ω and cortex 14 ± 6 mA, 11 ± 5 V, 859 ± 300 Ω. CMTs were only significantly different for CS (P = 0.02) and for the monopolar probe between the cortex and ICL (P = 0.03), scalp (P = 0.01) or skin (P = 0.01) and between ICL and CS (P ≤ 0.01) or skin (P ≤ 0.01).ConclusionThe mean stimulation current of the CMT along the extracranial to intracranial anodal trajectory followed a stepwise reduction. VMT was strongly dependent on electrode impedance. CMT within the skull layers was noted to have relative strong shunting currents in scalp layers.     

MRI Predicts Efficacy of Constraint-Induced Movement Therapy in Children With Brain Injury

Using resting state (RS) functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we identified the predictors of clinical improvement following constraint-induced movement therapy (CIMT) in pediatric patients with chronic hemiplegia.From 14 children with congenital or acquired brain injury and 10 sex- and age-matched healthy controls, brain dual-echo, DTI and RS fMRI sequences were acquired before CIMT. The Quality of Upper Extremities Skills Test and the Gross Motor Function Measure (GMFM) were administered at baseline, at the end of CIMT (10 weeks), and after 6 months. Mean diffusivity and fractional anisotropy (FA) were measured in the lesion responsible for the clinical symptomatology, the affected and unaffected corticospinal tract (CST), motor transcallosal fibers, and uncinate fasciculus (as an internal control). Independent component analysis was used to identify the sensorimotor RS network. The ability of baseline MRI variables to predict clinical changes over time was assessed using multivariate linear models. At baseline, patients had increased mean diffusivity in the symptomatic lesion and decreased FA in the symptomatic lesion, affected corticospinal tract, and motor transcallosal fibers. A reduced RS functional connectivity was found in the bilateral cerebellum, left precentral gyrus, and right secondary sensorimotor cortex. At follow up, Quality of Upper Extremities Skills Test and GMFM scales improved significantly. Baseline average lesion FA predicted clinical improvement at week 10, and baseline functional connectivity of the right secondary sensorimotor cortex and cerebellum predicted GMFM improvement at month 6. DTI and RS fMRI offer promising and objective markers to predict clinical outcomes following CIMT in pediatric patients with congenital or acquired hemiplegia.     

On occasionally being able to paint

Many of us find that our own work suffers when we practise as art therapists. Yet training courses stress the importance of maintaining our personal artwork alongside therapy practice, and this is widely accepted as a valuable part of a balanced approach to art therapy. Andrea Gilroy has examined this, sometimes difficult, relationship. She outlines her own experiences and reports on her research findings. This article is a reprint of an article originally published in Inscape Spring 1989. It should be noted that at the time the research was being carried out, art therapy training courses ran for only one year full-time or two years part-time.     

The “vegetarian brain”: chatting with monkeys and pigs?

An array of brain regions in the fronto-parietal and temporal lobes cooperates to process observation and execution of actions performed by other individuals. Using functional MRI, we hypothesized that vegetarians and vegans might show brain responses to mouth actions performed by humans, monkeys, and pigs different from omnivores. We scanned 20 omnivores, 19 vegetarians, and 21 vegans while watching a series of silent videos, which presented a single mouth action performed by a human, a monkey, and a pig. Compared to omnivores, vegetarians and vegans have increased functional connectivity between regions of the fronto-parietal and temporal lobes versus the cerebellum during observation of mouth actions performed by humans and, to the same degree, animals. Vegans also had increased connectivity with the supplementary motor area. During human mouth actions, increased amygdala activity in vegetarians and vegans was found. More critically, vegetarians recruited the right middle frontal gyrus and insula, which are involved in social mirroring, whereas vegans activated the left inferior frontal gyrus and middle temporal gyrus, which are part of the mirror neuron system. Monkey mouth actions triggered language network activity in both groups, which might be due to the attempt to decode monkey mouth gesture, with an additional recruitment of associative temporo-occipital areas in vegans, whereas pig mouth actions activated empathy-related regions, including the anterior cingulum. These results support the role of the action observation–execution matching system in social cognition, which enables us to interact not only with our conspecifics but also with species in phylogenetic proximity to humans.     

Retention of Stem Cell Plasticity in Avian Primitive Streak Cells and the Effects of Local Microenvironment

Primitive streak (PS) is the first structure occurring in embryonic gastrulation, in which the epiblast cells undergo the epithelial‐mesenchymal transition to become the loose mesoderm cells subsequently. Because the mesoderm cells departing from different portions of PS are blessed with disparate migration trajectory and differentiation fate, one question is when the cell fate is determinated. To understand whether the cell fate and cell migration pattern will be alternated along with the microenvironment transformation, the traditional transplantation technology was used to replace the anterior PS cells in HH4 host embryo using posterior PS tissue labeled by green fluorescent protein (GFP) in the same stage donor embryo, and then, we tracked the migration trajectory of the GFP‐positive cells with fluorescence stereomicroscope after incubation, and eventually verified the cell contribution from the transplants with in situ hybridization and immunocytochemistry. The same experimental strategy applied for posterior PS site replacement in host embryo. We found that the transplanted posterior PS cells to anterior part of streak followed the anterior PS cell migration pattern rather than kept its posterior streak cell migration trajectory, and so did vice versa. In addition, the transplants were involved in the contribution to the subsequent organogenesis as the local PS tissues affirmed by specific expression of myocardial or hematopoietic markers. Therefore, our data strongly suggest that the PS cells still keep stem cell plasticity during gastrulation and the eventual cell fate will depend on the spatial gene expression within local microenvironment along with development. Anat Rec, 296:533–543, 2012. © 2012 Wiley Periodicals, Inc.     

Positive effects of short course androgen therapy on the neurodevelopmental outcome in boys with 47,XXY syndrome at 36 and 72 months of age

The effects of early androgen treatment on neurodevelopmental performance in pre‐pubertal boys with 47,XXY have not been well investigated. The influence of hormones on brain development in humans suggests that a positive effect on neurodevelopmental outcome in young boys with XXY may be plausible with hormone replacement therapy. The aim of the study was to investigate retrospectively if an early course of androgen treatment (three injections of testosterone enanthate, 25 mg, each) had an impact on specific domains of neurodevelopmental function in boys with 47,XXY at 36 and 72 months of age. One hundred one boys with a karyotype of 47,XXY had neurodevelopmental assessments. The retrospective chart review resulted in one group (n = 34) who had received androgen treatment during infancy and the second group was untreated (N = 67). Statistical analysis was completed to determine if there was a positive effect from treatment observed at 36 and at 72 months on multiple domains of development. There were significant differences in multiple cognitive domains in the group who received androgen treatment, including multiple measures of language, intellectual, and neuromotor skills. Improved function was observed in neurodevelopmental outcome in boys with 47,XXY at 36 and 72 months who had been treated with a short course of androgen treatment in infancy. Continued research is underway to expand our understanding of the relationship of androgen, brain function, and neurobehavioral and neurodevelopmental outcome in boys with 47,XXY. © 2013 Wiley Periodicals, Inc.     

Actions of 17β-estradiol and testosterone in the mitochondria and their implications in aging

A decline in the mitochondrial functions and aging are two closely related processes. The presence of estrogen and androgen receptors and hormone-responsive elements in the mitochondria represents the starting point for the investigation of the effects of 17β-estradiol and testosterone on the mitochondrial functions and their relationships with aging. Both steroids trigger a complex molecular mechanism that involves crosstalk between the mitochondria, nucleus, and plasma membrane, and the cytoskeleton plays a key role in these interactions. The result of this signaling is mitochondrial protection. Therefore, the molecular components of the pathways activated by the sexual steroids could represent targets for anti-aging therapies. In this review, we discuss previous studies that describe the estrogen- and testosterone-dependent actions on the mitochondrial processes implicated in aging.