Bilateral Thalamus Research Articles

Effect of Professional Fighters' Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes

To evaluate the relationship between professional fighter weight class and neuropsychiatric outcomes. Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. n = 53 boxers and n = 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (=139.9 lb), middleweight (140.0-178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

Early infantile form of Krabbe disease: a case report

A 7-month-old female child, born to 2nd degree consanguineous marriage brought with complaints of gross developmental delay. Her examination revealed spasticity in all 4 limbs with brisk deep tendon reflexes with intact primitive reflexes and exaggerated startle reflex. Her MRI brain showed demyelination signs in bilateral thalami, dentate hila, and thickened optic chaisma. Age of presentation, clinico-radiological findings were suggestive of early infantile form of Krabbe disease.

Changes in the Shape and Volume of Subcortical Structures in Patients With End-Stage Renal Disease.

Introduction: End-stage renal disease (ESRD) typically causes changes in brain structure, and patients with ESRD often experience cognitive and sleep disorders. We aimed to assess the changes in the subcortical structure of patients with ESRD and how they are associated with cognitive and sleep disorders.Methods: We involved 36 adult patients for maintenance hemodialysis and 35 age- and gender-matched control individuals. All participants underwent neuropsychological examination and 3T magnetic resonance imaging (MRI) to acquire T1 anatomical images. The laboratory blood tests were performed in all patients with ESRD close to the time of the MR examination. We used volumetric and vertex-wise shape analysis approaches to investigate the volumes of 14 subcortical structural (e.g., bilateral accumbens, amygdala, hippocampus, caudate, globus pallidus, putamen, and thalamus) abnormalities in the two groups. Analyses of partial correlations and shape correlations were performed in order to identify the associations between subcortical structure, cognition, and sleep quality in patients with ESRD.Results: The volumetric analysis showed that compared with the healthy control group, patients with ESRD had less bilateral thalamus (left: p < 0.001; right: p < 0.001), bilateral accumbens (left: p < 0.001; right: p = 0.001), and right amygdala (p = 0.002) volumes. In the vertex-wise shape analysis, patients with ESRD had abnormal regional surface atrophy in the bilateral thalamus, right accumbens, left putamen, and bilateral caudate. Moreover, the Montreal Cognitive Assessment (MoCA) score was associated with volume reduction in the bilateral thalamus (left: Spearman ρ = 0.427, p = 0.009; right: ρ = 0.319, p = 0.018), and the Pittsburgh Sleep Quality Index (PSQI) score was associated with volume reduction in the bilateral accumbens (left: ρ = −0.546, p = 0.001; right: ρ = −0.544, p = 0.001). In vertex-wise shape correlation analysis, there was a positive significant correlation between regional shape deformations on the bilateral thalamus and MoCA score in patients with ESRD.Conclusion: Our study suggested that patients with ESRD have subcortical structural atrophy, which is related to impaired cognitive performance and sleep disturbances. These findings may help to further understand the underlying neural mechanisms of brain changes in patients with ESRD.

Bilateral thalamus stroke due to percheron artery

Bilateral thalamus ischemic stroke is a rare condition that carries significant morbidity and mortality in comparison to other forms of stroke. It is usually associated with an anatomical variant with the thalamic paramedian arteries arising from a common trunk from the posterior cerebellar artery, known as Percheron artery. This infarct is difficult to be recognized and early recognition of this syndrome improves survival and functional recovery. We report a case of bilateral thalamic stroke after cardiac surgery.

Abnormal resting-state brain activity and connectivity of brain-bladder control network in overactive bladder syndrome

Neuroimaging studies have shown that the brain is involved in the mechanism of overactive bladder disease (OAB). To explorer spatial patterns of spontaneous neural activities and functional integration in patients with OAB. In total, 28 patients with OAB and 28 matched healthy controls (HC) underwent resting-state functional magnetic resonance imaging and completed questionnaires to assess clinical symptoms. The amplitude of low-frequency fluctuation (ALFF) and ROI-based functional connectivity (FC) within the brain-bladder control network (BBCN) were calculated and compared between the two groups using a two-sample t-test. Pearson correlation analysis was performed to investigate the relationship between ALFF and the clinical score of patients with OAB. Compared with HCs, patients with OAB exhibited significantly decreased ALFF in the left superior medial middle gyrus (SFGmed) and superior dorsal frontal gyrus (SFGdor), and increased ALFF in the right hippocampus. Furthermore, ALFF values in the left SFGmed were negatively correlated with OABSS scores. FC in patients with OAB was significantly increased between the bilateral caudate nucleus (CAU) and bilateral SFGdor, the bilateral CAU and bilateral supplementary motor area (SMA), the bilateral thalamus and SMA; the left CAU and bilateral SFGmed, the left CAU and bilateral anterior cingulate gyrus, and the left CAU and left insula. Additionally, decreased FC was found between the bilateral amygdala and bilateral SFGmed and the left SMA and left insula. These abnormal activities and connectivities of BBCN may indicate impaired cortical control of micturition in OAB, suggesting a possible neural mechanism of OAB.

Real-time shear wave elastography evaluation of the correlation between brain tissue stiffness and body mass index in premature neonates.

BackgroundReal-time shear wave elastography (SWE) is non-invasive and reliable for quantitatively evaluate stiffness of tissues and organs. Until now, little researches have applied SWE to evaluate brain tissue of premature neonates. This study sought to compare differences in the average brain tissue elasticity modulus (Emean) values of neonates, and explore the factors affecting these differences.MethodsIn total, 159 neonates admitted from December 2019 to February 2021 were taken as the study subjects and divided into 2 groups based on their time of birth. Premature neonates, full-term neonates, and neonates with neonatal pneumonia were included in this study. Of the 159 neonates, 76 were premature and 83 were full-term. SWE was used to quantitatively evaluate the Emean of bilateral paraventricular white matter, thalamus, and choroid, and to analyze the relationship between body mass index (BMI) and Emeans in both groups of neonates.ResultsThe Emeans of the paraventricular white matter, thalamus, and choroid of the premature neonates were lower than those of the full-term neonates (P<0.001). The BMI of the premature and full-term neonates was positively correlated to the bilateral paraventricular white matter, thalamus, and choroid Emean.ConclusionsSWE can be used to quantitatively evaluate the brain tissue stiffness of neonates, and as a reference for neonatal brain-related diseases.

Cerebral Structural Abnormalities and Their Associations With Peripheral Cytokine Levels in a Group of Untreated Patients With Nasopharyngeal Carcinoma.

The current study is to characterize the alterations of peripheral cytokines and anatomical brain changes, and their relationships in untreated nasopharyngeal carcinoma (NPC) patients with depressive symptoms. Twenty-nine newly diagnosed NPC patients without any treatment and 46 matched healthy comparisons were recruited, scanned with high-resolution T1 images and assessed psychologically using Hamilton Rating Scale for Depression (HAMD). Serum levels of interleukin-1 beta (IL-1β), IL-2, IL-6, IL-8, IL-10, interferon-gamma (IFN-γ) and transforming growth factor-beta (TGF-β) were measured by quantitative chemiluminescence assay. Inter-group comparisons of anatomical brain measures were performed, and regions with significant inter-group differences were correlated to HAMD scores and cytokines in NPC patients. A subgroup analysis especially within NPC patients with depression was conducted to precisely characterize the associations among serum cytokines, brain changes and depressive symptoms. Relative to healthy subjects, NPC patients showed significantly decreased cortical thickness in the left parahippocampal gyrus, increased surface area in the right superior parietal lobule and precentral gyrus, and increased gray matter volume in the right postcentral gyrus, bilateral caudate nucleus and right thalamus, as well as significantly elevated IL-1β, IL-2 and IL-10. The elevated IL-2 and IL-10 were negatively correlated with surface area in right superior parietal lobule, whilst IL-1β level was positively correlated to HAMD scores. In patients with depression, specific brain changes and evaluated IL-1β were identified, and the IL-1β interacted with right precentral gyrus to significantly affect the depressive symptoms. Our findings provide novel evidence indicating potential effects of inflammation on brain structure and behavior in NPC patients.

Artery of Percheron Occlusion: A Diagnostic Challenge.

Artery of Percheron occlusion is a rare cause of ischaemic stroke characterized by bilateral thalamus infarction. Presentation is varied and non-specific, with the most frequent manifestations being altered level of consciousness, hypersomnolence or altered oculomotor movements. We describe the case of a 37-year-old man hospitalized for hypersomnia and hypomnesia with 3 days of evolution, who was diagnosed with a bilateral thalamus stroke due to artery of Percheron occlusion.LEARNING POINTSStroke is frequently encountered but can present a diagnostic challenge when presentation is non-specific or a lesion is not identified.Artery of Percheron stenosis has a varied and often non-specific presentation, which can lead to delayed diagnosis and treatment of these patients.It is important that doctors recognize this entity for timely diagnosis and treatment, and for the best prognosis.

Intravenous thrombolytic therapy for cerebral infarction due to the Persheron artery occlusion. Case report

Occlusion of the artery of Percheron is the cause of bilateral thalamic infarctions, sometimes involving structures of the midbrain. A clinical case of intravenous thrombolytic therapy for ischemic stroke due to the occlusion of the Percheron artery in a 72-year-old female patient who developed depression of consciousness, oculomotor disorders, dysarthria, ataxia, pyramidal disorders, and cognitive disorders is presented. Magnetic resonance imaging, which detected bilateral thalamus paramedian infarction in the acute stage, made it possible to diagnose the occlusion of the Percheron artery. Intravenous thrombolysis led to a rapid regression of symptoms; at the end of the acute period of the disease, the patient was discharged from the hospital with a slight neurological deficit and with a good functional outcome. After a one year the dynamic observation revealed persistent mild cognitive disorders; magnetic resonance imaging showed small symmetric cystic-gliosis changes in the medial parts of the thalamus on both sides. Timely diagnosis and intravenous thrombolytic therapy contribute to a good outcome of cerebral infarction due to the Percheron's artery occlusion.

ONC 201 PRACTICE IN DIFFUSE MIDLINE GLIOMA (H3K27M MUTANT)

Diffuse Midline Gliomas (DMG), H3 K27M-mutant have the poorest prognosis among all pediatric high-grade gliomas, with a median survival of 9-11 months. Although radiotherapy (RT) is standard treatment for these tumors, unfortunately there has been no approved and effective treatment which completely diminishes the tumor yet. In our clinic, we started an up-to-date approach to manage DMG, which is adjuvant fractionated external beam radiotherapy along with ONC 201 after tissue diagnosis. Between January 2016 and June 2021, a total of 11 patients with H3 K27M-mutant diffuse midline glioma, diagnosis confirmed by Next-Generation Sequencing (NGS) were enrolled in study. All patients received ONC201 orally once a week following radiotherapy. Safety, and radiological evaluations were regularly assessed every 12 weeks. Among the 11 patients, the median age of diagnosis was 5. Seven (63.6%) patients were male and 4 (36.4%) were female. Primary lesions were localized in the pons in 5 (45.5%) patients, unilateral thalamus (2 on the left, 1 on the right) in 3 (27.3%) patients, bilateral thalamus in 2 (18.2%) patients, and temporo-insular in 1 patient (9.1%). Median progression-free interval was 10 months and median overall survival was 16 months. Diffuse midline glioma has dismal prognosis. None of the treatment options made any dramatic changes in disease course during last 30 years. In our series, diffuse midline glioma patients who had ONC201 tend to have few months more progression free and overall survival (16 vs 11 months) in comparison to patients who had classical treatment in literature. As a neurooncology team, we strongly advocate to obtain tissue samples from diffuse tumors, to establish definite diagnosis and to perform NGS

Thalamocortical Dysconnectivity In Lifelong Premature Ejaculation: A Functional MRI Study

ObjectivesTo detect seed-based functional connectivity (FC) between various cortical sub-regions and the thalamus in lifelong premature ejaculation (LPE) patients and explore whether specific thalamocortical networks are significantly altered in PE patients compared to healthy controls (HCs) MethodsFifty non-medicated LPE patients and 40 age-matched HCs underwent a resting-state functional MRI. FC was adopted to identify specific thalamocortical connectivity between the thalamus and 6 cortical regions of interest (i.e., the motor cortex/supplementary motor, the prefrontal cortex, the temporal lobe, the posterior parietal cortex, the somatosensory cortex and the occipital lobe). In LPE patients, regression analysis was subsequently conducted to assess relationships of thalamocortical connectivity with the Premature Ejaculation Diagnostic Tool (PEDT) score and the Intravaginal Ejaculatory Latency Time (IELT). ResultsLPE patients had significantly decreased FC between the motor cortex and bilateral ventral thalamus, between the prefrontal cortex and left dorsomedial thalamus, as well as between the temporal cortex and bilateral ventromedial thalamus. In LPE patients, PEDT score was significantly positively associated with the thalamus-posterior parietal cortex FC, and negatively associated with the thalamus-temporal cortex FC, while IELT was positively associated with the thalamus-temporal cortex and thalamus-motor cortex FC. ConclusionThese results enrich the imaging evidence for the understanding of the neurobiological mechanisms and/or consequences of LPE.

Altered Hypothalamic Functional Connectivity Following Total Sleep Deprivation in Young Adult Males.

Background: Sleep deprivation can markedly influence vigilant attention that is essential to complex cognitive processes. The hypothalamus plays a critical role in arousal and attention regulation. However, the functional involvement of the hypothalamus in attentional impairments after total sleep deprivation (TSD) remains unclear. The purpose of this study is to investigate the alterations in hypothalamic functional connectivity and its association with the attentional performance following TSD.Methods: Thirty healthy adult males were recruited in the study. Participants underwent two resting-state functional magnetic resonance imaging (rs-fMRI) scans, once in rested wakefulness (RW) and once after 36 h of TSD. Seed-based functional connectivity analysis was performed using rs-fMRI for the left and right hypothalamus. Vigilant attention was measured using a psychomotor vigilance test (PVT). Furthermore, Pearson correlation analysis was conducted to investigate the relationship between altered hypothalamic functional connectivity and PVT performance after TSD.Results: After TSD, enhanced functional connectivity was observed between the left hypothalamus and bilateral thalamus, bilateral anterior cingulate cortex, right amygdala, and right insula, while reduced functional connectivity was observed between the left hypothalamus and bilateral middle frontal gyrus (AlphaSim corrected, P < 0.01). However, significant correlation between altered hypothalamic functional connectivity and PVT performance was not observed after Bonferroni correction (P > 0.05).Conclusion: Our results suggest that TSD can lead to disrupted hypothalamic circuits, which may provide new insight into neural mechanisms of attention impairments following sleep deprivation.

Hypertensive disorders of pregnancy and alterations in brain metabolites in preterm infants: A multi-voxel proton MR spectroscopy study

BackgroundInfants born to mothers with hypertensive disorders of pregnancy (HDP) have adverse neurodevelopmental consequences in later life. Magnetic resonance spectroscopy (MRS) is used to predict subsequent neurodevelopment in the field of perinatology. AimWe aimed to determine whether exposure to HDP in utero leads to alterations in brain metabolites in preterm infants using multi-voxel proton MRS at term-equivalent age. Study designRetrospective cohort study. SubjectsA total of 103 preterm infants born before 34 weeks of gestation at Nagoya University Hospital between 2010 and 2018 were eligible. Twenty-seven infants were born to mothers with HDP (HDP group), and 76 were born to mothers without HDP (non-HDP group). Outcome measuresThe peak area ratios of N-acetylaspartate (NAA)/choline (Cho), NAA/creatine (Cr), and Cho/Cr were evaluated at 10 designated regions of interest (bilateral frontal lobes, basal ganglia, thalami, temporal lobes, and occipital lobes). ResultsThe peak area ratios of NAA/Cho and NAA/Cr in the bilateral thalami were significantly higher in the HDP group than in the non-HDP group after adjustment for covariates (postmenstrual age at MRS assessment and infant sex). No significant differences were observed in other regions. Preeclampsia, abnormal umbilical artery blood flow, and fetal growth restrictions were significantly associated with increased NAA/Cho and NAA/Cr ratios in the thalami. ConclusionsBased on the evidence that NAA/Cho and NAA/Cr ratios constantly increase with postmenstrual age in normal brain development, exposure to maternal HDP in utero may accelerate brain maturation and increase neuronal activity in preterm infants.

A multiparametric MRI study of structural brain damage in dementia with lewy bodies: A comparison with Alzheimer's disease

IntroductionDifferential diagnosis between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) is crucial for an adequate patients' management but might be challenging. We investigated with advanced MRI techniques gray (GM) and white matter (WM) damage in DLB patients compared to those with AD. Methods24 DLB patients, 26 age- and disease severity-matched AD patients, and 20 age and sex-matched controls performed clinical and neuropsychological assessment, and brain structural and diffusion-tensor MRI. We measured GM atrophy using voxel-based morphometry, WM hyperintensities (WMH) using a local thresholding segmentation technique, and normal-appearing WM (NAWM) damage using tract-based spatial statistic. ResultsDLB and AD patients exhibited mild-to-moderate-stage dementia. Compared to controls, GM damage was diffuse in AD, while limited to bilateral thalamus and temporal regions in DLB. Compared to DLB, AD patients exhibited GM atrophy in bilateral fronto-temporal and occipital regions. DLB and AD patients showed higher WMH load than controls, with no differences among each other. WMH in DLB were diffuse with relative prevalence in posterior parietal-occipital regions. Compared to controls, both DLB and AD patients showed reduced microstructural integrity of the main supratentorial and infratentorial NAWM tracts. AD patients exhibited greater posterior NAWM damage than DLB. ConclusionsDLB showed prominent WM degeneration compared to the limited GM atrophy, while in AD both tissue compartments were severely involved. In DLB, NAWM microstructural degeneration was independent of WMH, thus revealing two possible underlying processes. Different pathophysiological mechanisms are likely to drive GM and WM damage distribution in DLB and AD.

Detection of visual and frontoparietal network perfusion deficits in Parkinson’s disease dementia

Mild cognitive impairment of Parkinson's disease (PD) may be an early manifestation that may progressively worsen to dementia. Cognitive decline has been associated with changes in the brain perfusion pattern. This study aimed to evaluate cerebral blood flow (CBF) deficits specific to different stages of cognitive decline.Seventeen patients with cognitively normal PD (PD-CN), 18 patients with PD with mild cognitive impairment (PD-MCI), and 16 patients with PD with dementia (PDD) were included in this study. The participants were scanned using a 3 T Philips MRI scanner. Arterial spin labelling magnetic resonance (ASL-MR) images were acquired, followed by calculation of the CBF maps, and registration onto the MNI152 brain atlas. A whole-brain voxel-based CBF comparison was performed among the patient groups using age as a covariate. The mean age of patients with PDD was significantly higher than that of patients with PD-MCI (P = 0.015) and PD-CN (P = 0.001). The CBF values of the three groups were significantly different in the left cuneus of the visual network (VN), left inferior frontal gyrus of the frontoparietal network (FPN), and left dorsomedial nucleus of the thalamus. PDD had lower perfusion values than PD-MCI group in the same regions detected in the main group analysis. Additionally, comparison of PDD with PD-CN and non-demented groups revealed that the perfusion reduction extended into the bilateral cuneus of the VN, bilateral thalami, and left inferior frontal gyrus of the FPN.PDD could be separated from PD-MCI and PD-CN stages with CBF deficits in non-dopaminergically mediated posterior and dopaminergically mediated frontal networks.

Altered thalamic gray matter volume in firefighters with heavy alcohol use

BackgroundAlcohol, a known addictive substance, affects the structural properties of the brain. In this study, we explored associations between alcohol use and gray matter properties among firefighters, who are often exposed to significant occupational stress. MethodsGray matter volume (GMV) was evaluated using voxel-based morphometry in 287 male firefighters (mean age: 48.8 ± 7.7 years). Firefighters were classified into 32 never-drinkers, 162 non-heavy alcohol users, and 93 heavy alcohol users according to their alcohol consumption. GMV was compared between groups, and the correlations between GMV and alcohol use were investigated. A voxel-wise height threshold of p < 0.001 (uncorrected) was used, with small volume correction applied on cluster level. ResultsHeavy alcohol users had lower GMV in the bilateral thalamus than non-heavy alcohol users or never-drinkers. Heavy alcohol users also showed lower GMV in the left insula, compared to other groups. The higher the alcohol consumption among firefighters, the lower the GMV of the right thalamus. ConclusionsThe results of this study show that heavy alcohol use has an association with lower GMV in several core regions, including the thalamus. When considering the impact of these brain regions on cognitive and behavioral control, our findings suggest a need for concern about heavy alcohol use among firefighters.

Investigation of Patients With Eye Closure Sensitive Epilepsy With Magnetic Resonance Spectroscopy.

Introduction and aim: A proportion of patients diagnosed with genetic generalized epilepsy (GGE) experience eye-closure sensitivity (ECS), the underlying pathogenesis of which is unknown. In this study, we compare magnetic resonance spectroscopy (MRS) findings of healthy volunteers with patients diagnosed with GGE, with and without ECS, to detect possible explanatory differences between groups. Materials and methods: A total of 33 patients diagnosed with GGE: 17 with ECS and 16 without, and 12 healthy volunteers are included. MRS measurements of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were made of bilateral occipital lobes and thalamus, and values of patients with GGE were compared with those of normal controls, and within subgroups with different clinical variables, using appropriate statistical tests. Results: Left occipital NAA and NAA/Cr levels were found to be significantly higher in the ECS group than in the control group. In the ECS epilepsy group, a significant moderate positive correlation was noted between left thalamic Cr and duration of drug therapy (r = .539, P = .047) and left thalamic Cr and age at epilepsy onset (r = .564, P = .036). Additionally, left thalamic NAA and NAA/Cr levels were observed to be lower in GGE patients compared to healthy subjects, although not to a statistically significant degree. Conclusion:The differences in MRS-measurable metabolites in the left occipital lobe in those with ECS epilepsy suggest an association between the ECS mechanism and the left occipital lobe. Our results also support the multifocal thalamocortical pathway disorder in the pathophysiology of GGE based on the observation of cellular dysfunction in the thalamus.

Complex Regional Pain Syndrome: Thalamic GMV Atrophy and Associations of Lower GMV With Clinical and Sensorimotor Performance Data.

Results on gray matter alterations in complex regional pain syndrome (CRPS) showed heterogeneous findings. Since CRPS is a rare disease, most studies included only small and heterogeneous samples resulting in a low reliability of findings between studies. We investigated 24 CRPS patients with right upper limb affection in the chronic stage of disease using structural MRI and clinical testing. We focused on gray matter volume (GMV) alterations of the brain in comparison to 33 age matched healthy controls, their association to clinical characteristics (duration of pain syndrome and pain intensity ratings) and sensorimotor performance (finger dexterity and spatiotactile resolution). When applying an explorative whole brain analysis CRPS patients showed lower GMV in the bilateral medial thalamus. No other areas showed a relevant GMV difference for the group comparisons. When applying a region of interest driven approach using anatomical masks of the thalamus, ACC/mPFC, putamen, and insula we found relevant associations of clinical and behavioral data in ACC and insula. Whereas, the GMV in ACC showed negative associations with pain intensity and CRPS duration, the GMV of the left posterior insula was negatively associated with sensorimotor performance of the affected hand side. Overall, our results are in accordance to results of others describing a thalamic reduction of GMV in patients with neuropathic pain and are also in accordance with associations of pain intensity and duration with reduced ACC in general in patients with chronic pain syndromes. Sensorimotor performance seems to be related to posterior insula GMV reduction, which has not been described yet for other patient groups.

Brain and Muscle Metabolic Changes by FDG-PET in Stiff Person Syndrome Spectrum Disorders.

Objective: To report clinical characteristics and fluorodeoxyglucose positron emission tomography (FDG-PET) findings in the brain and muscles of individuals with stiff person syndrome (SPS) spectrum disorders (SPSSDs).Methods: Retrospective cohort study from 1997 to 2018 at Johns Hopkins Hospital identified 170 individuals with SPS or cerebellar ataxia (CA) associated with anti-glutamic acid decarboxylase (anti-GAD)-65 antibodies. Fifty-one underwent FDG-PET, with 50 involving the body and 30 with dedicated brain acquisition. The clinical and immunological profiles were extracted via medical record review. The brain scans were analyzed quantitatively using the NeuroQ software, with comparison with an averaged normal database. The body scans were reviewed qualitatively by a blinded nuclear medicine radiologist.Results: Mean age of symptom onset was 41.5 years (range 12–75 years). Majority were female (68%) and White (64%). Of the patients, 82% had SPS (majority being classic phenotype), and 18% had CA. Three had a paraneoplastic process. Forty-seven had serum anti-GAD, two with anti-amphiphysin, and one with anti-glycine receptor antibodies. Brain metabolic abnormalities were seen in both SPS and CA, with significant differences between the groups noted in the right superior frontal cortex, right sensorimotor cortex, left inferior parietal cortex, bilateral thalami, vermis, and left cerebellum. Of the patients, 62% demonstrated muscle hypermetabolism, most commonly bilateral, involving the upper extremities or axial muscles. Neither brain nor muscle metabolism was correlated with functional outcomes nor treatments.Conclusions: Metabolic changes as seen by FDG-PET are present in the brain and muscle in many individuals with SPSSD. Future studies are needed to assess whether FDG-PET can help aid in the diagnosis and/or monitoring of individuals with SPSSD.

Decline in executive function in patients with white matter hyperintensities from the static and dynamic perspectives of amplitude of low-frequency fluctuations.

Cognitive impairments are characteristics of patients with white matter hyperintensities (WMHs), and hypoperfusion is currently a relatively recognized mechanism of WMHs. Brain activity is closely coupled to the regulation of local blood flow. This study aimed to investigate the abnormal local brain activity of patients with WMHs from the viewpoint of the static amplitude of low-frequency fluctuations (sALFF) and dynamic amplitude of low-frequency fluctuations (dALFF). Seventy-four patients with WMHs and 35 healthy controls (HCs) were included. Based on the Fazekas scale, patients with WMHs were further divided into a mild WMH group (n=33, Fazekas score 1-2) and moderate-severe WMH group (n=41, Fazekas score 3-6). The sALFF and dALFF values were calculated separately and neuropsychological tests including the Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Trail Making Test (TMT), and Boston Naming Test (BNT) were completed by all participants. Patients with WMHs showed increased sALFF and dALFF values in the bilateral thalamus and decreased performance in the MoCA test, AVLT-immediate, AVLT-delay, AVLT-recognition, TMT-A, and BNT. The dALFF values in the bilateral thalamus was correlated with the MoCA in HCs. The sALFF values in the bilateral thalamus correlated with TMT-B in patients with WMHs. Patients with WMHs showed abnormal brain activity and decreased functional stability of the bilateral thalamus, which may be a potential mechanism of decreased executive function.