Developmental Neuroscience最新文献

{"title":"A Pilot Study on Dynamic Multimodal Neuromonitoring for Predicting Neurodevelopmental Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Srinivas Kota, Lynn Bitar, Pollieanna Sepulveda, Soheila Norasteh, Hanli Liu, Lina F Chalak","doi":"10.1159/000545599","DOIUrl":"10.1159/000545599","url":null,"abstract":"<p><strong>Introduction: </strong>Multimodal neuromonitoring at the bedside is essential for understanding the pathophysiological mechanisms of brain injury and neurodevelopmental outcomes associated with neonatal hypoxic-ischemic encephalopathy (HIE). While previous research has focused on single modality neuromonitoring biomarkers to predict neurodevelopmental impairment (NDI) at 2 years of age, there remains significant gap in exploring the potential of multimodal physiological signal biomarkers to improve predictive accuracy. This study aimed to evaluate multimodal quantitative neuromonitoring biomarkers within the first day of life to improve prediction of NDI.</p><p><strong>Methods: </strong>This prospective cohort study enrolled newborns (≥36 weeks) diagnosed with HIE at Parkland Hospital in Dallas, TX. A Sarnat examination was performed to determine the severity of HIE within the first 6 h of life, and the Total Sarnat Score (TSS) was calculated. Newborns with moderate and severe HIE received therapeutic hypothermia (TH). Neuronal noninvasive biomarkers including electroencephalogram (EEG) delta power (DP, 0.5-4 Hz) and neurovascular coupling (NVC), calculated as wavelet coherence between amplitude-integrated EEG and cerebral tissue oxygen saturation (SctO2), were measured. NDI was defined as death or a cognitive score <85 on the Bayley Scales of Infant and Toddler Development. The predictive ability of individual biomarkers (TSS, DP, and NVC) and their combination for NDI was evaluated using receiver operating characteristic (ROC) curves, with the area under the ROC curve (AUC) indicating prediction accuracy. Additionally, a Net Reclassification Index (NRI) analysis was conducted to assess the predictive performance of the three baseline models (TSS, DP, and NVC).</p><p><strong>Results: </strong>Forty-six newborns with mild to severe HIE were enrolled and neuromonitoring was initiated at 12 ± 6 h of life. Death or NDI was diagnosed in 18 (6 mild, 10 moderate, 2 severe) infants. Eight out of 46 infants did not complete the 18-24 months follow-up but had a normal examination prior. The combination of all three biomarkers (TSS, DP, and NVC) yielded the highest AUC of 0.755 (95% CI: 0.569-0.941), with sensitivity of 0.750, specificity of 0.769, positive predictive value of 0.800, and negative predictive value of 0.714, outperforming individual biomarkers or two-marker combinations. Furthermore, the NRI analysis demonstrated that the combined model achieved the highest NRI value (0.5577), indicating the strongest improvement in risk classification.</p><p><strong>Conclusion: </strong>This study emphasizes the importance of implementing multimodal neuromonitoring and integrating quantitative biomarkers at the bedside during the first day of life to provide objective metrics on brain health in addition to neurological exam. These approaches demonstrate potential for enhancing the prediction of encephalopathy severity, brain injury, and NDI in th","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-12"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-Onset OCD and Juvenile Enthesitis-Related Arthritis after COVID-19 (Three Cases).","authors":"Tanya Saini, Meiqian Ma, Jesse Sandberg, Bahare Farhadian, Cindy Manko, Yuhuan Xie, Juliette Madan, Karen Bauer, Paula Tran, Jennifer Frankovich","doi":"10.1159/000545137","DOIUrl":"10.1159/000545137","url":null,"abstract":"<p><strong>Introduction: </strong>Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by obsessions and compulsions. There is a mounting body of evidence suggesting a link between OCD and inflammation. Neuropsychiatric deteriorations have been reported to follow COVID-19 infections, including OCD. Additionally, symptomatic arthritis has also been reported following COVID-19 infection. We aim to describe post-COVID-19 clinical deteriorations presenting to our multidisciplinary immune behavioral health clinic.</p><p><strong>Methods: </strong>One hundred and fifty-one prescreened patients were evaluated in our clinic between March 1, 2020 and August 1, 2024. We systematically searched charts for infection with SARS-CoV-2 and found 3 cases of confirmed COVID-19 infection that preceded an abrupt neuropsychiatric deterioration (in the absence of other detected infections). Per our clinic's latest protocol, all patients underwent a full rheumatology and arthritis evaluation (regardless of joint complaints) including ultrasound imaging, which were used to objectively assess for effusions, synovitis, and capsulitis.</p><p><strong>Results: </strong>Two of the three patients met criteria for a PANS diagnosis. All 3 patients had new-onset OCD or reescalation of OCD with new obsessions/compulsions/rituals post-COVID-19 and all three had imaging findings of effusions +/- synovitis +/- capsulitis despite not having significant complaints of joint pain. Joint pain complaints evolved after psychiatric symptoms improved (because the capacity of the patient to articulate joint pain improved when they were less overwhelmed by intrusive thoughts). Immunomodulatory treatment began with nonsteroidal anti-inflammatory drugs (NSAIDs) and was escalated to disease-modifying antirheumatic drugs (DMARDs) in the 2 patients with synovitis +/- capsulitis. All 3 patients eventually returned to baseline neuropsychiatric health (minimal-to-no OCD and resolution of intense anxiety and mood instability) and also had improvement in arthritic findings after introduction of NSAID +/- DMARDs.</p><p><strong>Conclusion: </strong>Infections may result in systemic immune activation leading to inflammation. Thus, when patients have an acute neuropsychiatric deterioration (hypothesized to have been triggered by an infection), the situation may warrant evaluation for inflammation in other more accessible sites (e.g., joints). Use of this evidence of inflammation (as a sign of immune activation) is helpful since it is difficult to assess for brain inflammation, as clinical brain imaging has poor sensitivity for inflammation and biopsy of the striatum (and other areas involved in OCD) is difficult and limited by risk. In our cases, early joint imaging not only helped confirm signs of systemic inflammation in the setting of neuropsychiatric symptoms, but it also allowed for earlier initiation of immunomodulatory treatment.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-13"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypothermia treatment in Hypoxia-Inducible Factor-1α Knockout Mice with Hypoxia-Ischemia.","authors":"R Ann Sheldon, Xiangning Jiang, Fuxin Lu, Nicholas R Stewart, Donna M Ferriero","doi":"10.1159/000544949","DOIUrl":"10.1159/000544949","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoxia-inducible factor-1α (HIF-1α) has a wide-ranging role in the cellular responses to hypoxia. We previously found that neuron-specific HIF-1α-deficient mice (HIF-KO) that underwent neonatal hypoxia-ischemia (HI) had increased brain injury suggesting its neuroprotective function. To investigate whether HIF-1α is also involved in the mechanisms of protection by hypothermia (HT), the standard of care for hypoxic-ischemic encephalopathy, we tested the effect of HT on HIF-KO and wild-type (WT) littermates after HI in postnatal day 9 mice.</p><p><strong>Methods: </strong>Cooling at 32°C began 1 h following HI and lasted for 3.5 h. Mice were perfused 5-7 days later for histological determination of injury severity. For Western blots, mice were killed 4 h or 24 h after HI with HT or HI with normothermia (NT) and ipsilateral cortices and hippocampi were evaluated for expression of HIF-1α, spectrin, ERK1/2, phosphorylated-ERK1/2 (p-ERK), and RNA-binding motif protein 3 (RBM3), one of the main cold-inducible mRNA-binding proteins.</p><p><strong>Results: </strong>Histological evaluation showed WT mice with HT had less injury than WT with NT, but HIF-KO mice showed no reduction of injury with HT. Regionally, the reduction of injury in WT with HT is greater in the hippocampus than in the cortex. Protein expression of HIF-1α was lower in HIF-KO cortex at 4 h with NT or HT and at 24 h with NT, but HIF-1α was higher in WT with NT at 24 h. Expression of spectrin 145/150 in WT cortex with HT was not different than sham at 4 h, indicating limitation of necrosis with HT. In the HIF-KO cortex at 4 h spectrin 145/150 was higher in both NT and HT, indicating no protection with HT. In the hippocampus at 4 h and 24 h, spectrin 145/150 was elevated in all groups compared to sham. ERK activity, as represented by the ratio of p-ERK/ERK, was upregulated at 24 h in the cortex in WT with NT or HT compared to sham and in HIF-KO mice with NT or HT treatment compared to sham. RBM3 was elevated at 4 h in both WT and HIF-KO cortex with HT, but there was no change in the hippocampus.</p><p><strong>Conclusion: </strong>These results support a critical role for HIF-1α in the mechanisms of protection with HT.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aquaporins: Bridging Normal Brain Development and Neurodevelopmental Disorder Mechanisms.","authors":"Fateme Azizi, Wing Ki Chan, Maryam Ardalan","doi":"10.1159/000545512","DOIUrl":"10.1159/000545512","url":null,"abstract":"<p><strong>Background: </strong>Homeostasis of water content in the brain during fetal development is of crucial physiological importance. Aquaporins (AQPs) play a critical role in maintaining brain water balance, supporting normal brain development, and are increasingly recognized for their relevance in understanding neurodevelopmental disorders.</p><p><strong>Summary: </strong>This review provides a comprehensive overview of AQPs and their essential roles in the central nervous system (CNS), specifically AQP4, AQP11, and AQP9, which play a crucial role in water transport in the brain, maintaining water homeostasis and facilitating water movement across cell membranes. The review also highlights how disruptions in AQP expression and function may contribute to the pathology of neurodevelopmental disorders such as autism and Fragile X syndrome.</p><p><strong>Key messages: </strong>AQPs are vital for brain water regulation and normal neural development. Altered expression or function of AQPs can impact blood-brain barrier integrity, neuroinflammation, and synaptic activity. AQP dysfunctions are linked to neurodevelopmental disorders and may represent promising therapeutic targets.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-15"},"PeriodicalIF":2.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective Injury of Thalamocortical Tract in Neonatal Rats Impairs Forelimb Use: Model Validation and Behavioral Effects.","authors":"Tong Chun Wen, Michelle Corkrum, Jason B Carmel","doi":"10.1159/000544990","DOIUrl":"10.1159/000544990","url":null,"abstract":"<p><strong>Introduction: </strong>Unilateral brain injury in neonates results in largely contralateral hand function impairment in children. Most research investigating neurorehabilitation targets for movement recovery has focused on the effects of brain injury on descending motor systems, especially the corticospinal tract. However, a recent human study demonstrated that sensory tract injury may have larger effects on dexterity than motor tract injury. To test this, we first developed a model of sensory tract injury in neonatal rats by targeting the thalamocortical tract (TCT), and then we used this model to assess the effects of sensory lesions on paw use.</p><p><strong>Methods: </strong>In the postnatal day 7 rats, we used three types of lesions to the TCT: periventricular blood injection, photothrombotic lesion, and electrolytic lesion. To test the sensitivity and specificity of these techniques, viral tracers were injected into the primary sensory or motor cortex immediately after injury. To test the forelimb use, the cylinder exploration and pasta handling tests were used.</p><p><strong>Results: </strong>Electrolytic lesions were the most specific and reproducible for inducing a lesion compared to the other two methods. Electrolytic lesions disrupted 63% of the TCT while sparing the adjacent corticospinal tract in the internal capsule. Given that electrolytic lesions were the most specific and sensitive for targeting the TCT, this model was used for behavioral experiments to measure the impact of sensory tract lesion on dexterity. Lesions to the TCT were associated with a significant decrease in the use of the contralateral forelimb in the cylinder task, and the degree of impairment positively correlated with the degree of injury.</p><p><strong>Conclusion: </strong>Overall, specific sensory system lesions of the TCT impair forelimb use, suggesting a key role for skilled movement.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-12"},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Onset Neuropsychiatric Conditions in Children and Adolescents following SARS-CoV-2 Infection: A Case Series.","authors":"Mohamed T Jasser, Thomas Ferland, Thomas Bocian, Matthew Goff, Abigail Gauch, Michael V Heinz, Elizabeth Joffrey, Richard Morse, Daniel Albert, Jennifer Frankovich, Juliette C Madan","doi":"10.1159/000545349","DOIUrl":"10.1159/000545349","url":null,"abstract":"<p><strong>Introduction: </strong>Neuropsychiatric symptoms following SARS-CoV-2 infection have been described in a substantial proportion of patients, acute, subacute, and chronic. Understanding of the neurological and neuropsychiatric sequelae of this virus is an emerging field of study with rapidly evolving descriptions of its impact on the central and peripheral nervous system.</p><p><strong>Case presentation: </strong>Here, we report a series of 8 pediatric patients presenting with acute onset neuropsychiatric symptoms following SARS-CoV-2 infection who received comprehensive medical and psychiatric evaluation and treatment in our research-based Neuroimmune Psychiatric Disorders Program. We provide a review of the research available to date regarding potential mechanisms underlying neuroinflammatory consequences of this endemic infection. Opportunities for further investigations of mechanisms, evaluations and impactful treatments following SARS-CoV-2 infection are described.</p><p><strong>Conclusion: </strong>The pediatric cases presented share acute onset of obsessive-compulsive disorder, psychosis, tics, neurobehavioral and physiological symptoms, with significant response to treatments targeting inflammation in combination with psychiatric and psychological interventions. Ongoing study and identification of this phenomenon of abrupt neuropsychiatric changes following SARS-CoV-2 infection may lead to more effective treatments with potential application to broader populations.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-15"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Branched Chain Amino Acid Metabolism in Developmental Brain Injury: Putative Mechanisms and Therapeutic Potential.","authors":"Margaret M Cassidy, Marc Yudkoff, Rebecca C Ahrens-Nicklas, Ana G Cristancho","doi":"10.1159/000545099","DOIUrl":"10.1159/000545099","url":null,"abstract":"<p><strong>Background: </strong>Branched chain amino acid (BCAA) metabolism plays roles in various cellular processes, including energy homeostasis, anabolic signaling, and production of glutamate, the primary excitatory neurotransmitter. Emerging evidence also suggests BCAA metabolism has relationships to inflammatory and hypoxic cellular responses. Recent work in adult and adolescent clinical populations has suggested that BCAA dietary supplementation may improve outcomes associated with traumatic brain injury. Given these links, examining the putative mechanisms and potential therapeutic applications of modulating dietary BCAA content in the context of inflammatory and hypoxic developmental brain injury may reveal mechanisms for intervention in affected infants.</p><p><strong>Summary: </strong>Inflammatory and hypoxic brain injuries influence the dynamics of BCAA metabolism in the fetal brain. Inflammatory insults to the developing brain may increase BCAA catabolism downstream of the branched chain ketoacids (BCKAs). The effect of altered BCAA metabolism on the pathophysiology of inflammatory developmental brain injury is currently unclear but may play a role in microglial response. Hypoxic brain injury seems to increase BCAA concentration in the fetal brain, possibly because of re-amination of BCKAs to the parent BCAAs, or via increased protein breakdown during hypoxia.</p><p><strong>Key messages: </strong>The apparent relationship between aberrant BCAA metabolism and inflammation or hypoxia warrants consideration of BCAA supplementation or restriction as a strategy for attenuating developmental brain injury that is associated with these pathologic events. This approach could entail alterations of maternal diet during pregnancy or the feeding of infant formula that is fortified with or restricted in BCAA. These types of interventions have been safely and effectively employed in cases of inborn errors of BCAA metabolism, suggesting feasibility in infant populations. Both in vitro and preclinical work is necessary to elucidate how BCAA supplementation or restriction may affect the sequelae of inflammatory and hypoxic developmental brain injury.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-15"},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auditory Deficits in a Mouse Model of First-Trimester Prenatal Alcohol Exposure.","authors":"Mark Jessup, Abigail L Tice, Addison McNeill, Avery Tangen, Maya L Liu, Deirdre M McCarthy, Pradeep G Bhide, Jennifer L Steiner, Yuan Wang","doi":"10.1159/000545065","DOIUrl":"10.1159/000545065","url":null,"abstract":"<p><strong>Introduction: </strong>Prenatal alcohol exposure (PAE) can lead to a wide spectrum of deficits in growth and neurological function, and there is an established link between PAE and auditory dysfunction. However, the effects of PAE on auditory development are complex and vary depending on the age and pattern of alcohol exposure.</p><p><strong>Methods: </strong>In this study, we developed a mouse model of PAE during the first half of the gestational period, mimicking alcohol consumption during the first trimester of pregnancy in humans.</p><p><strong>Results: </strong>This exposure did not affect overall growth or induce anxiety-related symptoms in the offspring, as indicated by normal body weight change and largely unchanged behaviors in the open field and elevated zero maze tests. However, several aspects of auditory function were affected by PAE. Offspring born from prenatal alcohol-exposed dams displayed smaller auditory brainstem responses (ABRs) at 2-month-old as compared to those from control dams, suggesting weakened neuron synchronization within auditory brainstem circuits. Additionally, a reduction in the reproducibility of ABR peaks III/IV was observed in PAE offspring. In contrast, the overall hearing sensitivity and neuron transmission was not affected by PAE, as evaluated by ABR thresholds or peak latencies. In an acoustic startle test, PAE offspring failed to display prepulse inhibition to low levels of prepulses more frequently than control offspring at both 2 weeks old and 2 months old, suggesting an early-onset and lasting deficit in auditory gating or sound level differentiation.</p><p><strong>Conclusion: </strong>These results demonstrate that mice exposed to alcohol during early gestation have largely preserved auditory responses but show significant alterations in specific features of auditory processing.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-18"},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caffeine as a Treatment for Perinatal Hypoxic-Ischemic Brain Injury: The Potential Risks and Benefits.","authors":"Kelly Qishan Zhou, Flora Lam, Laura Bennet, Alistair Jan Gunn, Joanne O Davidson","doi":"10.1159/000545126","DOIUrl":"10.1159/000545126","url":null,"abstract":"<p><strong>Background: </strong>It is well established that therapeutic hypothermia improves outcomes for infants with moderate-severe hypoxic-ischemic encephalopathy (HIE) in high-income counties. However, ∼29% of the infants treated with therapeutic hypothermia still have adverse outcome. Additionally, therapeutic hypothermia is not recommended as a treatment for infants with HIE in low- and middle-income countries. Therefore, there is an urgent need to develop alternative treatments for infants with HIE in low- and middle-income countries, as well as additive treatments to therapeutic hypothermia in high-income countries.</p><p><strong>Summary: </strong>Caffeine is widely used as an agent to prevent apnea in preterm infants, and more recently, it has been investigated as a potential neuroprotective treatment for perinatal hypoxic-ischemic (HI) brain injury, but the preclinical evidence so far has been mixed. Furthermore, there are concerns that caffeine, which is an adenosine receptor antagonist, could abolish the endogenous neuroprotective effects of adenosine, during and after HI.</p><p><strong>Key messages: </strong>Further studies using caffeine particularly in large animal translational models of HI brain injury are required to establish the safety and efficacy of caffeine for HIE before conducting large randomized controlled trials.</p>","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obsessive-Compulsive Disorder Associated with Autoimmunity in Youth: Clinical Course before and after Rituximab +/- Adjunctive Immunomodulation.","authors":"Jennifer Frankovich, Denise Calaprice, Meiqian Ma, Olivia Knight, Kate Miles, Cindy Manko, Joseph D Hernandez, Jesse Sandberg, Bahare Farhadian, Yuhuan Xie, Melissa Silverman, Juliette Madan, Vibeke Strand, Kiki Chang, Margo Thienemann","doi":"10.1159/000544993","DOIUrl":"10.1159/000544993","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Multiple lines of evidence suggest that some cases of obsessive-compulsive disorder (OCD) are underlain by autoimmune and/or inflammatory processes that act on the brain to create neuropsychiatric symptomatology. However, studies of immunomodulatory treatments for such cases are sparse. Here we present consecutive cases of presumed-neuroimmune OCD in youth that have been treated with rituximab +/- adjunctive immunomodulatory treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Of the 458 cases evaluated by our clinic between September 15, 2012, and January 6, 2023, 23 patients were treated with rituximab +/- adjunctive immunomodulation orchestrated by our team (based on evidence of autoimmunity) and were followed routinely by the outpatient clinic team. Patients who presented for a second opinion and were not diagnosed, treated, and/or followed by our outpatient clinic (n = 5) or did not have OCD (n = 1) are not included. We present the immunological and psychiatric profiles (prior to treatment), selection criteria for the use of rituximab, rituximab treatment protocol, recovery status, and reasons for discontinuation (if applicable). Data were obtained from chart review of clinical records. Determination of recovery status was confirmed by the clinical team caring for the patients; patients were classified as did not recover, partial recovery (PR), or full recovery (FR). Since multiple treatments (psychotherapy, psychiatric medication, and immunomodulation) together contributed to recovery, the team additionally assessed the attribution of response to rituximab and details are documented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients were between the ages of 4 and 20 at initiation of rituximab treatment. All suffered from severe, debilitating neuropsychiatric symptoms prior to rituximab initiation in the context of evidence for systemic autoimmunity. Approximately 70% had an unequivocal recovery following treatment with rituximab (+/- induction and adjunctive immunomodulation) which in most cases allowed the patients to achieve normal levels of function and cease psychotropic medications. Interpretation of attribution in many cases is complicated by the use of induction and adjunct immunomodulation. Most patients experienced transient increases in symptoms before improving; 11 experienced mild self-limited infusion-related reactions, and 14 experienced hypogammaglobulinemia. No patient had an organ or life-threatening reaction or infection following rituximab. One patient developed recurrent sinusitis following rituximab, and thus, rituximab was stopped despite neuropsychiatric improvements, then rituximab was restarted later due to recrudescence of psychiatric symptoms; the approval to use rituximab with intravenous immune globulin (IVIG) permitted its use. Patients who received adjunctive immunomodulation (IVIG, methotrexate, leflunomide, etc.) had a higher likelihood of achieving recovery (FR or PR) after rituximab (Fisher","PeriodicalId":50585,"journal":{"name":"Developmental Neuroscience","volume":" ","pages":"1-19"},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}