Double Dissociation of Auditory Attention and Visual Scanning in Long Term Survivors of Childhood Cerebellar Tumor: A Deterministic Tractography and Volumetric Study of the Cerebellar-Frontal and the Superior Longitudinal Fasciculus Pathways

Background. Right cerebellar-left frontal (RC-LF) white matter integrity (WMI) has been associated with working memory. Right Superior Longitudinal Fasciculus II (SLF II) WMI has been associated with visual attention. These relationships have held true for neurotypical controls and brain tumor survivors. The current study examined the relationships between RC-LF WMI and processing speed, attention, and working memory. SLF II WMI and visual attention were included as a control tract and task to demonstrate a correlational double dissociation. This study also examined the relationship between the volume of brain regions within the RC-LF network and RC-LF WMI. Methods. Adult survivors of childhood brain tumors (n= 29, age: M=22 years (SD= 5), 45% female) were treated with neurosurgery, and combinations of radiation therapy and chemotherapy. Age- and gender-matched controls (n=29) were also included. Tests of auditory attention span, working memory, visual attention, and processing speed served as cognitive measures. Participants completed a 3T MRI diffusion imaging scan. WMI (FA, RD) and volume served as neuroimaging measures. In the survivor group, partial correlations between WMI and cognitive scores included controlling for type of treatment. Results. A correlational double dissociation was found. RC-LF WMI was associated with auditory attention span (FA: r=.42, p=.03; RD: r=-.50, p=.01), and was not associated with visual attention (FA: r=-.11, p=.59; RD: r=-.11, p=.57). SLF II FA WMI was associated with visual attention (FA: r=.44, p=.02; RD: r=-.17, p=.40), and was not associated with auditory attention span (FA: r=.24, p=.22; RD: r=-.10, p=.62). The relationship between RC-LF WMI and auditory attention span robustly dissociated from working memory and visual attention. In the radiation group, thalamic-frontal segment of RC-LF WMI associated with the volumetric measures of each structure of the RC-LF pathway, whereas in the no radiation group cerebellar-rubral segment of RC-LF WMI associated with the volumetric measures. Conclusions. The current study advances the understanding of structural brain changes following cerebellar tumor resection and treatment because the results show that RC-LF WMI is associated with auditory attention span rather that working memory, provide evidence for a correlational double dissociation, and suggest distinct relationships between WMI and volume based on treatment

Survivors of Childhood Cerebellar Tumors: Atrophy, Lack of Lesion Specificity, and the Impact on Behavioral Performance

Research suggests that the cerebellum is involved in cognition, but its exact role is unclear. The efficiency theory posits that the cerebellum supports processing speed. Other researchers argue that the cerebellum is functionally heterogeneous, and damage to lobes of the cerebellum causes selective loss of cognitive functions. This study sought to determine whether selective impairment in motor, verbal fluency, or processing speed occurred depending on the lobe of the cerebellum that was lesioned. Lesion mapping was used to measure lesion size and volumetric methods were used to measure atrophy in 25 adult survivors of cerebellar tumors. Participants had too a high degree of heterogeneous cerebellar lesions and accompanying atrophy to explore specialization. However, total cerebellar atrophy negatively impacted written and oral processing speed to a greater degree than total cerebellar lesion size. Younger ages at diagnosis and radiation therapy were associated with greater cerebellar atrophy

Longitudinal Analysis of Risk Factors Affecting Reading Trajectories in Children Diagnosed with Pediatric Brain Tumors

Prior research suggests aggressive cancer treatments contribute to cognitive impairments in children diagnosed with pediatric brain tumors. The literature also suggests that younger age at diagnosis (AAD) and treatment may result in disrupted cognitive trajectories due to limited brain plasticity. In line with this research, we hypothesized an interaction between radiation therapy (RT) and young AAD of brain tumors, where young AAD and RT results in lower standard scores on the WRAT-R Reading Comprehension Subtest. Analyses included archival data; the sample consists of 134 children diagnosed with pediatric brain tumors with multiple assessments resulting in 487 cases for analysis. Participants were diagnosed with mixed tumor types and locations. A two level multilevel model was used to analyze reading trajectories while taking into account AAD, time since diagnosis, socioeconomic status (SES), and RT. Results detected a positive interaction between AAD and RT (γ =2.08, p=.02). For participants with RT, younger AAD was associated with lower reading scores, whereas AAD had no effect for participants without RT. Results also detected a negative interaction between radiation and time (γ =-2.29, p=.00) indicating that children treated with RT have reading scores that decrease over time. These data suggested that children diagnosed with pediatric brain tumors treated with RT are at higher risk of reading impairment as reflected in their reading scores

Time Varying Predictor Model of Socialization Behavior in Children Diagnosed with Pediatric Brain Tumors

Medical advances have improved the survival rate of children with brain tumors, allowing research on long-term outcomes. Prior research suggests that social functioning is often negatively affected by brain insults, and social functioning may be related to childhood receptive vocabulary in children with traumatic brain injuries (Greenham et al., 2010). The current study addressed this hypothesis with children diagnosed with pediatric brain tumors longitudinally using latent growth curve modeling (LGCM). Our sample consisted of 154 children with 544 evaluations from 2 to 7 years post diagnosis. All children completed the Peabody Picture Vocabulary Test Revised (PPVT-R) and Vineland Socialization Scale. Participants were diagnosed with mixed tumor types and diverse tumor locations. The average time since diagnosis was used to determine the latent growth curve factor loading (2, 2.5, 3, 4, 5, 6, 7 years post diagnosis). Results indicated that the predictors (PPVT-R and radiation therapy) accounted for 41% of the variance of the slope of socialization behavior and 38% of the variance of the intercept. Socialization and PPVT-R scores were significantly positively correlated (intercept γ=.47,

FCHC Final Scripts

Scripts to process and calculate language Functional Connectivity Hemispheric Contrast Map to delineate 3D language connectivity ma

Behavioral phenotypes of pediatric temporal lobe epilepsy

Objective: A broad spectrum of emotional-behavioral problems have been reported in pediatric temporal lobe epilepsy (TLE), but with considerable variability in their presence and nature of expression, which hampers precise identification and treatment. The present study aimed to empirically identify latent patterns or behavioral phenotypes and their correlates. Methods: Data included parental ratings of emotional-behavioral status on the Behavior Assessment System for Children, 2nd Edition (BASC-2) of 81 children (mean age = 11.79, standard deviation [SD] = 3.93) with TLE. The nine clinical subscales were subjected to unsupervised machine learning to identify behavioral subgroups. To explore concurrent validity and the underlying composition of the identified clusters, we examined demographic factors, seizure characteristics, psychosocial factors, neuropsychological performance, psychiatric status, and health-related quality of life (HRQoL). Results: Three behavioral phenotypes were identified, which included no behavioral concerns (Cluster 1, 43% of sample), externalizing problems (Cluster 2, 41% of sample), and internalizing problems (Cluster 3, 16% of sample). Behavioral phenotypes were characterized by important differences across clinical seizure variables, psychosocial/familial factors, everyday executive functioning, and HRQoL. Cluster 2 was associated with younger child age, lower maternal education, and higher rate of single-parent households. Cluster 3 was associated with older age at epilepsy onset and higher rates of hippocampal sclerosis and parental psychiatric history. Both Cluster 2 and 3 demonstrated elevated family stress. Concurrent validity was demonstrated through the association of psychiatric (i.e., rate of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) disorders and psychotropic medication) and parent-rated HRQoL variables. Significance: Youth with TLE present with three distinct behavioral phenotypes that correspond with important clinical and sociodemographic markers. The current findings demonstrate the variability of behavioral presentations in youth with TLE and provide a preliminary framework for screening and targeting intervention to enhance support for youth with TLE and their families

Comparison of fMRI language laterality with and without sedation in pediatric epilepsy

Functional MRI is an essential component of presurgical language mapping. In clinical settings, young children may be sedated for the MRI with the functional stimuli presented passively. Research has found that sedation changes language activation in healthy adults and children. However, there is limited research comparing sedated and unsedated functional MRI in pediatric epilepsy patients. We compared language activation patterns in children with epilepsy who received sedation for functional MRI to the ones who did not.We retrospectively identified the patients with focal epilepsy who underwent presurgical functional MRI including Auditory Descriptive Decision Task at Boston Children's Hospital from 2014 to 2022. Patients were divided into sedated and awake groups, based on their sedation status during functional MRI. Auditory Descriptive Decision Task stimuli were presented passively to the sedated group per clinical protocol. We extracted language activation maps contrasted against a control task (reverse speech) in the Frontal and Temporal language regions and calculated separate language laterality indexes for each region. We considered positive laterality indexes as left dominant, negative laterality indexes as right dominant, and absolute laterality indexes <0.2 as bilateral. We defined 2 language patterns: typical (i.e., primarily left-sided) and atypical. Typical pattern required at least one left dominant region (either frontal or temporal) and no right dominant region. We then compared the language patterns between the sedated and awake groups.Seventy patients met the inclusion criteria, 25 sedated, and 45 awake. Using the Auditory Descriptive Decision Task paradigm, when adjusted for age, handedness, gender, and laterality of lesion in a weighted logistic regression model, the odds of the atypical pattern were 13.2 times higher in the sedated group compared to the awake group (Confidence Interval: 2.55–68.41, p-value < 0.01).Sedation may alter language activation patterns in pediatric epilepsy patients. Language patterns on sedated functional MRI with passive tasks may not represent language networks during wakefulness, sedation may differentially suppress some networks, or require a different task or method of analysis to capture the awake language network. Given the critical surgical implication of these findings, additional studies are needed to better understand how sedation impacts the functional MRI blood oxygenation level-dependent signal. Consistent with current practice, sedated functional MRI should be interpreted with greater caution and requires additional validation as well as research on post-surgical language outcomes