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Focus on: structural and functional brain abnormalities in fetal alcohol spectrum disorders.

Nunez CC, Roussotte F, Sowell ER - Alcohol Res Health (2011)

Bottom Line: Children exposed to alcohol prenatally can experience significant deficits in cognitive and psychosocial functioning as well as alterations in brain structure and function related to alcohol's teratogenic effects.These impairments are present both in children with fetal alcohol syndrome (FAS) and in children with heavy in utero alcohol exposure who do not have facial dysmorphology required for the FAS diagnosis.Several studies have found relationships between these morphological differences and cognitive function, suggesting some clinical significance to the structural brain abnormalities.

View Article: PubMed Central - PubMed

Affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

ABSTRACT
Children exposed to alcohol prenatally can experience significant deficits in cognitive and psychosocial functioning as well as alterations in brain structure and function related to alcohol's teratogenic effects. These impairments are present both in children with fetal alcohol syndrome (FAS) and in children with heavy in utero alcohol exposure who do not have facial dysmorphology required for the FAS diagnosis. Neuropsychological and behavioral studies have revealed deficits in most cognitive domains measured, including overall intellectual functioning, attention/working memory, executive skills, speed of processing, and academic skills in children and adolescents across the range of fetal alcohol spectrum disorders (FASD). As with neuro-psychological studies, brain-imaging studies have detected differences in brain structure related to alcohol exposure in multiple brain systems and abnormalities in the white matter that connects these brain regions. Several studies have found relationships between these morphological differences and cognitive function, suggesting some clinical significance to the structural brain abnormalities. Concentrations of neurotransmitter metabolites within the brains of prenatally exposed children also appear to be altered, and functional imaging studies have identified significant differences in brain activation related to working memory, learning, and inhibitory control in children and adolescents with FASD.

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(A) (Sowell et al. 2001a): Corpus callosum divided into five equal lengths along the horizontal axis. The splenium is blue, isthmus is green, posterior midbody is yellow, anterior midbody is purple, and the genu is red superimposed over the grayscale midsagittal slice. (B) Average callosal lines in ICBM-305 standard space shows the distinctions between FAS, PEA, and control groups but with similar pattern of displacement. Note the placement of the corpus callosum in the PEA group somewhere between that of the control and FAS groups. (C) Map (in ICBM-305 space) shows average displacement vectors in millimeters between the PEA and control groups and between FAS and control groups (D). Again, the pattern of displacement is the same in the PEA subjects, but the displacement is somewhat less severe than that observed for the FAS subjects.
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f4-arh-34-1-121: (A) (Sowell et al. 2001a): Corpus callosum divided into five equal lengths along the horizontal axis. The splenium is blue, isthmus is green, posterior midbody is yellow, anterior midbody is purple, and the genu is red superimposed over the grayscale midsagittal slice. (B) Average callosal lines in ICBM-305 standard space shows the distinctions between FAS, PEA, and control groups but with similar pattern of displacement. Note the placement of the corpus callosum in the PEA group somewhere between that of the control and FAS groups. (C) Map (in ICBM-305 space) shows average displacement vectors in millimeters between the PEA and control groups and between FAS and control groups (D). Again, the pattern of displacement is the same in the PEA subjects, but the displacement is somewhat less severe than that observed for the FAS subjects.

Mentions: Many alcohol-exposed children do not meet the full criteria for a diagnosis of FAS; this is usually because they are lacking the facial dysmorphology required for the diagnosis. Please refer to the article by Warren and colleagues in this issue (pp. 1–14) for a thorough review of FAS diagnostic criteria. These children have been found to have differences in brain structure (Astley et al. 2009a; Sowell et al. 2001a, b, 2002a, b, 2008b) (see figures 1, 2A, 3, and 4), and they experience significant and debilitating cognitive and behavioral impairments that impact their daily functioning (Mattson and Riley 1998; Mattson et al. 2001). The U.S. Surgeon General estimates that for every child born with FAS, three additional children are born without physical dysmorphology but still experience neurobehavioral deficits as a result of prenatal alcohol exposure (U.S. Department of Health and Human Services 2005). This estimate is likely to be revised as the technologies for assessing fetal alcohol spectrum disorders (FASD) are improved. Over the last decade, appreciation of the wide range of symptom severities has led to the development of a more inclusive term to describe these sequelae—FASD. FASD is not a diagnosis but rather an umbrella term with several more specific diagnoses. Terms used to describe individuals within the overarching category have included FAS, partial FAS (pFAS), alcohol-related neurodevelopmental disorder (ARND), fetal alcohol effects (FAE), and alcohol-related birth defects (ARBD) (Centers for Disease Control and Prevention 2009b). This article will refer to children with ARND, FAE, or ARBD, collectively, as having prenatal exposure to alcohol (PEA).


Focus on: structural and functional brain abnormalities in fetal alcohol spectrum disorders.

Nunez CC, Roussotte F, Sowell ER - Alcohol Res Health (2011)

(A) (Sowell et al. 2001a): Corpus callosum divided into five equal lengths along the horizontal axis. The splenium is blue, isthmus is green, posterior midbody is yellow, anterior midbody is purple, and the genu is red superimposed over the grayscale midsagittal slice. (B) Average callosal lines in ICBM-305 standard space shows the distinctions between FAS, PEA, and control groups but with similar pattern of displacement. Note the placement of the corpus callosum in the PEA group somewhere between that of the control and FAS groups. (C) Map (in ICBM-305 space) shows average displacement vectors in millimeters between the PEA and control groups and between FAS and control groups (D). Again, the pattern of displacement is the same in the PEA subjects, but the displacement is somewhat less severe than that observed for the FAS subjects.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860550&req=5

f4-arh-34-1-121: (A) (Sowell et al. 2001a): Corpus callosum divided into five equal lengths along the horizontal axis. The splenium is blue, isthmus is green, posterior midbody is yellow, anterior midbody is purple, and the genu is red superimposed over the grayscale midsagittal slice. (B) Average callosal lines in ICBM-305 standard space shows the distinctions between FAS, PEA, and control groups but with similar pattern of displacement. Note the placement of the corpus callosum in the PEA group somewhere between that of the control and FAS groups. (C) Map (in ICBM-305 space) shows average displacement vectors in millimeters between the PEA and control groups and between FAS and control groups (D). Again, the pattern of displacement is the same in the PEA subjects, but the displacement is somewhat less severe than that observed for the FAS subjects.
Mentions: Many alcohol-exposed children do not meet the full criteria for a diagnosis of FAS; this is usually because they are lacking the facial dysmorphology required for the diagnosis. Please refer to the article by Warren and colleagues in this issue (pp. 1–14) for a thorough review of FAS diagnostic criteria. These children have been found to have differences in brain structure (Astley et al. 2009a; Sowell et al. 2001a, b, 2002a, b, 2008b) (see figures 1, 2A, 3, and 4), and they experience significant and debilitating cognitive and behavioral impairments that impact their daily functioning (Mattson and Riley 1998; Mattson et al. 2001). The U.S. Surgeon General estimates that for every child born with FAS, three additional children are born without physical dysmorphology but still experience neurobehavioral deficits as a result of prenatal alcohol exposure (U.S. Department of Health and Human Services 2005). This estimate is likely to be revised as the technologies for assessing fetal alcohol spectrum disorders (FASD) are improved. Over the last decade, appreciation of the wide range of symptom severities has led to the development of a more inclusive term to describe these sequelae—FASD. FASD is not a diagnosis but rather an umbrella term with several more specific diagnoses. Terms used to describe individuals within the overarching category have included FAS, partial FAS (pFAS), alcohol-related neurodevelopmental disorder (ARND), fetal alcohol effects (FAE), and alcohol-related birth defects (ARBD) (Centers for Disease Control and Prevention 2009b). This article will refer to children with ARND, FAE, or ARBD, collectively, as having prenatal exposure to alcohol (PEA).

Bottom Line: Children exposed to alcohol prenatally can experience significant deficits in cognitive and psychosocial functioning as well as alterations in brain structure and function related to alcohol's teratogenic effects.These impairments are present both in children with fetal alcohol syndrome (FAS) and in children with heavy in utero alcohol exposure who do not have facial dysmorphology required for the FAS diagnosis.Several studies have found relationships between these morphological differences and cognitive function, suggesting some clinical significance to the structural brain abnormalities.

View Article: PubMed Central - PubMed

Affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

ABSTRACT
Children exposed to alcohol prenatally can experience significant deficits in cognitive and psychosocial functioning as well as alterations in brain structure and function related to alcohol's teratogenic effects. These impairments are present both in children with fetal alcohol syndrome (FAS) and in children with heavy in utero alcohol exposure who do not have facial dysmorphology required for the FAS diagnosis. Neuropsychological and behavioral studies have revealed deficits in most cognitive domains measured, including overall intellectual functioning, attention/working memory, executive skills, speed of processing, and academic skills in children and adolescents across the range of fetal alcohol spectrum disorders (FASD). As with neuro-psychological studies, brain-imaging studies have detected differences in brain structure related to alcohol exposure in multiple brain systems and abnormalities in the white matter that connects these brain regions. Several studies have found relationships between these morphological differences and cognitive function, suggesting some clinical significance to the structural brain abnormalities. Concentrations of neurotransmitter metabolites within the brains of prenatally exposed children also appear to be altered, and functional imaging studies have identified significant differences in brain activation related to working memory, learning, and inhibitory control in children and adolescents with FASD.

Show MeSH
Related in: MedlinePlus