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儿童口吃的神经解剖学关联:区分持续性口吃与恢复性口吃的白质和灰质发育的MRI指标

Neuroanatomical Correlates of Childhood Stuttering: MRI Indices of White and Gray Matter Development That Differentiate Persistence Versus Recovery.

作者信息

Garnett Emily O, Chow Ho Ming, Chang Soo-Eun

机构信息

Department of Psychiatry, University of Michigan, Ann Arbor.

Katzin Diagnostic & Research PET/MRI Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

出版信息

J Speech Lang Hear Res. 2019 Aug 29;62(8S):2986-2998. doi: 10.1044/2019_JSLHR-S-CSMC7-18-0356.

Abstract

Purpose We review two recent neuroanatomical studies of children who stutter (CWS), one that examines white matter integrity and the other that focuses on cortical gray matter morphology. In both studies, we sought to examine differences between children whose stuttering persists ("persistent"), children who recovered from stuttering ("recovered"), and their nonstuttering peers ("controls"). Method Both of the reviewed studies use data from a large pediatric sample spanning preschool- to school-age children (3-10 years old at initial testing). Study 1 focused on surface-based measures of cortical size (thickness) and shape (gyrification) using structural magnetic resonance imaging, whereas Study 2 utilized diffusion tensor imaging to examine white matter integrity. Results In both studies, the main difference that emerged between CWS and fluent peers encompassed left hemisphere speech motor areas that are interconnected via the arcuate fasciculus. In the case of white matter integrity, the temporoparietal junction and posterior superior temporal gyrus, both connected via the left arcuate fasciculus, and regions along the corpus callosum that contain fibers connecting bilateral motor regions were significantly decreased in white matter integrity in CWS compared to controls. In the morphometric study, children who would go on to have persistent stuttering specifically had lower cortical thickness in ventral motor and premotor areas of the left hemisphere. Conclusion These results point to aberrant development of cortical areas involved in integrating sensory feedback with speech movements in CWS and differences in interhemispheric connectivity between the two motor cortices. Furthermore, developmental trajectories in these areas seem to diverge between persistent and recovered cases.

摘要

目的 我们回顾了两项近期针对口吃儿童(CWS)的神经解剖学研究,一项研究考察了白质完整性,另一项则聚焦于皮质灰质形态。在这两项研究中,我们试图探究口吃持续存在的儿童(“持续性口吃儿童”)、从口吃中恢复的儿童(“恢复性口吃儿童”)以及他们的非口吃同龄人(“对照组”)之间的差异。方法 两项被回顾的研究均使用了来自一个大型儿科样本的数据,该样本涵盖了学龄前至学龄儿童(初次测试时年龄为3 - 10岁)。研究1使用结构磁共振成像,重点关注基于表面的皮质大小(厚度)和形状(脑回化)测量,而研究2利用扩散张量成像来检查白质完整性。结果 在两项研究中,口吃儿童与流利儿童之间出现的主要差异都包括通过弓状束相互连接的左半球言语运动区域。在白质完整性方面,与对照组相比,口吃儿童中通过左弓状束连接的颞顶叶交界处和后颞上回以及胼胝体沿线包含连接双侧运动区域纤维的区域,其白质完整性显著降低。在形态学研究中,那些后来会持续性口吃的儿童,其左半球腹侧运动区和运动前区的皮质厚度特别低。结论 这些结果表明,口吃儿童中参与整合感觉反馈与言语运动的皮质区域发育异常,且两个运动皮质之间的半球间连接存在差异。此外,这些区域的发育轨迹在持续性口吃和恢复性口吃病例之间似乎有所不同。

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