Diffusion Tensor Imaging Study of White Matter Fiber Tracts in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder

doi:10.1016/j.biopsych.2008.10.015

Biological Psychiatry

Volume 65, Issue 7, 1 April 2009, Pages 586-593

https://doi.org/10.1016/j.biopsych.2008.10.015 Get rights and content

Background

To investigate microstructure of white matter fiber tracts in pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD).

Methods

A diffusion tensor imaging (DTI) study was conducted at 3 Tesla on age- and IQ-matched children and adolescents with PBD (n = 13), ADHD (n = 13), and healthy control subjects (HC) (n = 15). Three DTI parameters, fractional anisotropy (FA), apparent diffusion coefficient (ADC), and regional fiber coherence index (r-FCI), were examined in eight fiber tracts: anterior corona radiata (ACR), anterior limb of the internal capsule (ALIC), superior region of the internal capsule (SRI), posterior limb of the internal capsule (PLIC), superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF), cingulum (CG), and splenium (SP).

Results

Significantly lower FA was observed in ACR in both PBD and ADHD relative to HC. In addition, FA and r-FCI values were significantly lower in ADHD relative to PBD and HC in both the ALIC and the SRI. Further, ADC was significantly greater in ADHD relative to both the PBD and HC in ACR, ALIC, PLIC, SRI, CG, ILF, and SLF.

Conclusions

Decreased FA in ACR implies an impaired fiber density or reduced myelination in both PBD and ADHD in this prefrontal tract. These abnormalities, together with the reduced fiber coherence, extended to corticobulbar tracts in ADHD. Increased ADC across multiple white matter tracts in ADHD indicates extensive cellular abnormalities with less diffusion restriction in ADHD relative to PBD.

Section snippets

Subjects

All subjects (n = 41) in this study were recruited from the University of Illinois at Chicago Child Psychiatry Outpatient Clinic as well as the surrounding community under an approved Institutional Review Board (IRB) protocol. Informed consent was obtained from at least one parent, and assent was obtained from all subjects. Magnetic resonance imaging (MRI) studies were performed on PBD and ADHD patients and age-, gender-, and IQ-matched HC (Table 1). Images from conventional MRI scans (T1- and

Demographic and Clinical Data

Demographic and clinical data are summarized in Table 1. The groups did not differ based on mean age or IQ. Group differences were significant on the YMRS and the Child Depression Rating Scale-Revised (CDRS-R) (50) scores, with the PBD group having higher scores on the affective symptom scales than ADHD and HC subjects. Although PBD patients were euthymic for at least 3 months at the time of consent, three subjects showed worsening in clinical symptoms after withdrawing medication. This

FA Measurements

Fractional anisotropy was reduced in ACR in both the PBD group and the ADHD group compared with the HC group (F = 7.04, df = 2,38, p < .001). Fractional anisotropy was also significantly low in ALIC (F = 4.14, df = 2,38, p < .01) and SRI (F = 4.10, df = 2,38, p < .05) in ADHD group compared with the PBD group and the HC group, with no significant group differences between PBD and HC. There were no significant differences in the FA values across the three groups in PLIC (F = .14, df = 2,38, p =

Discussion

To our knowledge, this is the first study to employ DTI to compare individual color-coded WM tracts in PBD, ADHD, and HC and to utilize the new DTI parameter, r-FCI, to study these groups. Our central results indicate that FA is significantly lower in the ACR, the cortical part of the corticotectal WM fibers that project broadly to prefrontal regions that include both VLPFC and dorsolateral prefrontal cortex (DLPFC), both in PBD group and ADHD group relative to HC. Further, the ADHD group,

Conclusion

The decreased FA in the ACR and the r-FCI in the SP suggest impaired density, myelination, or fiber coherence of WM pathways that connect frontal cortex with brainstem and also fibers providing interhemispheric connections for posterior cortical regions in PBD and ADHD. Further, ADC increases across multiple corticocortical and corticobulbar WM tracts in ADHD indicate extensive microstructural abnormalities in this disorder, relative to both PBD and HC. This may represent maturational delay,

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Archival ReportDiffusion Tensor Imaging Study of White Matter Fiber Tracts in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder

Background

Methods

Results

Conclusions

Section snippets

Subjects

Demographic and Clinical Data

FA Measurements

Discussion

Conclusion

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

J Affect Disord

J Affect Disord

Biol Psychiatry

J Am Acad Child Adolesc Psychiatry

Neurosci Biobehav Rev

Psychiatry Res

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Neuroimage

J Affect Disord

Neuropsychologia

Trends Neurosci

Brain Res

Trends Neurosci

Brain Res

Psychiatry Res

Neural bases of emotion processing in pediatric bipolar disorder

Expert Rev Neurother

Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients

Am J Psychiatry

Cognitive deficits, psychopathology, and psychosocial functioning in bipolar mood disorder

Neuropsychiatry Neuropsychol Behav Neurol

Sustained attention deficit in bipolar disorder

Br J Psychiatry

The naturalistic course of pharmacologic treatment of children with maniclike symptoms: A systematic chart review

J Clin Psychiatry

Prior stimulant treatment in adolescents with bipolar disorder: Association with age at onset

Bipolar Disord

Cognitive effects of atypical antipsychotics: Focus on bipolar spectrum disorders

Bipolar Disord

Neuroimaging of inhibitory control areas in children with attention deficit hyperactivity disorder who were treatment naive or in long-term treatment

Am J Psychiatry

Task-specific hypoactivation in prefrontal and temporoparietal brain regions during motor inhibition and task switching in medication-naive children and adolescents with attention deficit hyperactivity disorder

Am J Psychiatry

Selective effects of methylphenidate in attention deficit hyperactivity disorder: A functional magnetic resonance study

Proc Natl Acad Sci U S A

Abnormal brain activation during inhibition and error detection in medication-naive adolescents with ADHD

Am J Psychiatry

Neural circuitry engaged during unsuccessful motor inhibition in pediatric bipolar disorder

Am J Psychiatry

Archival Report
Diffusion Tensor Imaging Study of White Matter Fiber Tracts in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder