Language fMRI head motion, lateralisation, and training in pediatric epilepsy patients with ADHD
Poster No:
358
Submission Type:
Late-Breaking Abstract Submission
Authors:
Bonnie Alexander1,2, Kathryn Santamaria1, Sila Genc3,1, Sarah Barton1, Michael Kean1, Alison Wray1, Wirginia Maixner1, Emma Macdonald-Laurs1,2, A. Simon Harvey1, Joseph Yang4,5
Institutions:
1Royal Children's Hospital, Melbourne, Parkville, Victoria, 2Murdoch Children's Research Institute, Parkville, Australia, 3Murdoch Children's Research Institute, Melbourne, Australia, 4Neuroscience Advanced Clinical Imaging Service (NACIS), Melbourne, Australia, 5Royal Children's Hospital, Melbourne, Parkville, Australia
First Author:
Bonnie Alexander, PhD
Royal Children's Hospital, Melbourne|Murdoch Children's Research Institute
Parkville, Victoria|Parkville, Australia
Royal Children's Hospital, Melbourne|Murdoch Children's Research Institute
Parkville, Victoria|Parkville, Australia
Co-Author(s):
Sila Genc
Murdoch Children's Research Institute|Royal Children's Hospital, Melbourne
Melbourne, Australia|Parkville, Victoria
Murdoch Children's Research Institute|Royal Children's Hospital, Melbourne
Melbourne, Australia|Parkville, Victoria
Emma Macdonald-Laurs
Royal Children's Hospital, Melbourne|Murdoch Children's Research Institute
Parkville, Victoria|Parkville, Australia
Royal Children's Hospital, Melbourne|Murdoch Children's Research Institute
Parkville, Victoria|Parkville, Australia
Joseph Yang
Neuroscience Advanced Clinical Imaging Service (NACIS)|Royal Children's Hospital, Melbourne
Melbourne, Australia|Parkville, Australia
Neuroscience Advanced Clinical Imaging Service (NACIS)|Royal Children's Hospital, Melbourne
Melbourne, Australia|Parkville, Australia
Introduction:
Language fMRI is essential for presurgical planning in epilepsy. fMRI can be challenging in children, and head motion can compromise its utility. The candidacy of patients with ADHD for fMRI is sometimes queried re possible head motion. Pre-scan fMRI task training can increase scan success (Pua et al., 2020). In 2020, we implemented an fMRI task training program, via telehealth and Mock MRI. We aimed to determine whether training increased language lateralisation success and/or reduced head motion in all patients, and in those with ADHD. We also aimed to determine whether patients with ADHD had more head motion than those without ADHD.
Methods:
We retrospectively identified 225 epilepsy and neuro-oncology patients (243 scans) with language fMRI at Royal Children's Hospital, Melbourne, Australia, 2016-2024 (103 female, 122 male; age 6.1-17.9, M = 12.8, SD = 2.9). 18 individuals had ADHD, 10 had autism, and 6 had both. Language lateralisation success was determined by clinician description as left/right/bilateral in the medical record. 99 patients (101 scans) were provided the training including fMRI task practise. MRI was acquired on a 3T Siemens Prisma scanner. The language task was Noun-Verb word generation (Wood et al., 2004). Functional data were acquired with EP2D (38 slices, thickness 3.15 mm, 1.88x1.88 mm voxels, TR 3s, TE 40 ms, flip angle 90º, multiband factor 2) or CMRR sequences (60 slices, thickness 2.5 mm, 2.45 x 2.45 mm voxels, TR 3 s, TE 30 ms, flip angle 70º, multiband factor 3). fMRI was preprocessed with fMRIPREP (Esteban et al., 2019) and processed with FEAT (Jenkinson et al., 2012). Head motion was quantified by maximum Framewise Displacement (FDmax; mm). To investigate associations between training, ADHD, and language lateralisation success, Generalised Estimating Equations models were run. Linear mixed effects models were used to test associations between training, ADHD, and FDmax.
Results:
Across all patients, language lateralisation was successful in 78.3% of scans without training and 96.0% of scans with training (Fig. 1a) and training was associated with successful language lateralisation (p < .001; OR 7.48, 95%CI 2.4-23.4). For patients with ADHD, language lateralisation was successful in 53.3% of scans without training and 92.9% of scans with training (Fig. 1b). Training was associated with lateralisation (p = .036, OR = 11.4, 95%CI 1.17-110).
Regarding training and head motion, across all patients, FDmax was significantly lower for scans with training (M = 1.95, SD = 4.27, Mdn = 0.55) than without (M = 3.19, SD = 6.18, Mdn = 0.96), p = .016, 95%CI -2.86 - -0.31. In patients with ADHD, FDmax was on average lower for scans with training (M = 4.87, SD = 9.84, Mdn = 0.85) than without (M = 9.33, SD = 12.70, Mdn = 1.87), however training was not associated with FDmax (p = 0.323, 95%CI -10.90 – 3.47).
Regarding ADHD and head motion, outliers in FDmax (>20mm) were seen (Fig. 2a,b), e.g., in 5 patients < 11 years old with ADHD. Data were trimmed to FDmax <20 to allow separate investigation of FDmax for the sample with and without extremes of head motion. In untrimmed data, FDmax was significantly higher in patients with ADHD (M = 7.18, SD = 11.5, Mdn = 1.18) than in those without (M = 1.93, SD = 3.30, Mdn = 0.76), p < .001, 95%CI 1.66-5.68. In trimmed data, FDmax was on average lower in patients with ADHD (M = 1.60, SD = 1.88, Mdn = 0.82) than those without (M = 1.70, SD = 2.41, Mdn = 0.730). However, ADHD was not associated with FDmax (p = 0.267, 95%CI -1.60-0.44).
Regarding training and head motion, across all patients, FDmax was significantly lower for scans with training (M = 1.95, SD = 4.27, Mdn = 0.55) than without (M = 3.19, SD = 6.18, Mdn = 0.96), p = .016, 95%CI -2.86 - -0.31. In patients with ADHD, FDmax was on average lower for scans with training (M = 4.87, SD = 9.84, Mdn = 0.85) than without (M = 9.33, SD = 12.70, Mdn = 1.87), however training was not associated with FDmax (p = 0.323, 95%CI -10.90 – 3.47).
Regarding ADHD and head motion, outliers in FDmax (>20mm) were seen (Fig. 2a,b), e.g., in 5 patients < 11 years old with ADHD. Data were trimmed to FDmax <20 to allow separate investigation of FDmax for the sample with and without extremes of head motion. In untrimmed data, FDmax was significantly higher in patients with ADHD (M = 7.18, SD = 11.5, Mdn = 1.18) than in those without (M = 1.93, SD = 3.30, Mdn = 0.76), p < .001, 95%CI 1.66-5.68. In trimmed data, FDmax was on average lower in patients with ADHD (M = 1.60, SD = 1.88, Mdn = 0.82) than those without (M = 1.70, SD = 2.41, Mdn = 0.730). However, ADHD was not associated with FDmax (p = 0.267, 95%CI -1.60-0.44).
Conclusions:
Language fMRI training was effective in increasing language lateralization success, particularly in patients with ADHD. Training reduced head motion across all patients. Although some young patients with ADHD had substantial head motion, most did not move more than those without ADHD. We conclude that the training program increases success of language fMRI, and that an ADHD diagnosis should not be a contraindication to Language fMRI.
Disorders of the Nervous System:
Neurodevelopmental/ Early Life (eg. ADHD, autism) 1
Language:
Language Other 2
Keywords:
Attention Deficit Disorder
Epilepsy
FUNCTIONAL MRI
Language
PEDIATRIC
1|2Indicates the priority used for review
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Provide references using APA citation style.
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Pua, E. P. K., Barton, S., Williams, K., Craig, J. M., & Seal, M. L. (2020). Individualised MRI training for paediatric neuroimaging: A child-focused approach. Developmental Cognitive Neuroscience, 41, 100750. https://doi.org/10.1016/j.dcn.2019.100750
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