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Dynamic mapping of cortical development before and after the onset of pediatric bipolar illness
Nitin Gogtay1, Anna Ordonez, David H Herman
1Child Psychiatry Branch, NIMH, Bethesda, MD 20892, USA. gogtayn@intra.nimh.nih.gov
Insights
This study reveals distinct cortical development patterns in pediatric bipolar disorder (BPD) before and after illness onset. These changes may indicate general affective dysregulation, not specific to BPD.
Area of Science:
- Neuroscience
- Developmental Psychology
- Child Psychiatry
Background:
- No prior longitudinal imaging studies exist for bipolar disorder (BPD) across any age group.
- This study presents the first prospective investigation of cortical brain development in pediatric BPD.
Purpose of the Study:
- To examine cortical brain development in male children with pediatric BPD before and after illness onset.
- To compare these developmental trajectories with healthy children and those with 'multi-dimensionally impaired' (MDI) diagnoses.
Main Methods:
- Utilized novel cortical pattern matching algorithms to create dynamic brain maps.
- Compared neurodevelopmental patterns in 9 male children with pediatric BPD against matched healthy and MDI control groups.
Main Results:
- Pediatric BPD showed subtle, specific, asymmetrical cortical changes post-onset, including increased left temporal gray matter and decreased anterior cingulate gray matter.
- These neurodevelopmental trajectories were similar in children with MDI diagnoses, suggesting a link to general affective dysregulation.
- The observed pattern differed from childhood-onset schizophrenia.
Conclusions:
- Dynamic cortical development trajectories may explain varied findings in cross-sectional BPD studies.
- Highlights the necessity of including mood-disordered, non-bipolar control groups in future research.
Background:
There are, to date, no pre-post onset longitudinal imaging studies of bipolar disorder at any age. We report the first prospective study of cortical brain development in pediatric bipolar illness for 9 male children, visualized before and after illness onset.
Method:
We contrast this pattern with that observed in a matched group of healthy children as well as in a matched group of 8 children with 'atypical psychosis' who had similar initial presentation marked by mood dysregulation and transient psychosis (labeled as 'multi-dimensionally impaired' (MDI)) as in the bipolar group, but have not, to date, developed bipolar illness.
Results:
Dynamic maps, reconstructed by applying novel cortical pattern matching algorithms, for the children who became bipolar I showed subtle, regionally specific, bilaterally asymmetrical cortical changes. Cortical GM increased over the left temporal cortex and decreased bilaterally in the anterior (and sub genual) cingulate cortex. This was seen most strikingly after the illness onset, and showed a pattern distinct from that seen in childhood onset schizophrenia. The bipolar neurodevelopmental trajectory was generally shared by the children who remained with MDI diagnosis without converting to bipolar I, suggesting that this pattern of cortical development may reflect affective dysregulation (lability) in general.
Conclusions:
These dynamic trajectories of cortical development may explain age-related disparate findings from cross-sectional studies of bipolar illness, and suggest the importance of mood disordered non-bipolar control group in future studies.
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01:18Cognitive Development During Adolescence