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PubMed1997

The evolutionary origin of the language areas in the human brain. A neuroanatomical perspective.

The capacity to learn syntactic rules is a hallmark of the human species, but whether this has been acquired by the process of natural selection has been the subject of controversy. Furthermore, the cortical localization of linguistic capacities has prompted some authors to suggest a modular representation of language in the brain. In this paper, we rather propose that the neural device involved in language is embedded into a large-scale neurocognitive network comprising widespread connections between the temporal, parietal and frontal (especially prefrontal) cortices. This network is involved in the temporal organization of behavior and motor sequences, and in working (active) memory, a sort of short-term memory that participates in immediate cognitive processing. In human evolution, a precondition for language was the establishment of strong cortico-cortical interactions in the postrolandic cortex that enabled the development of multimodal associations. Wernicke's area originated as a converging place in which such associations (concepts) acquired a phonological correlate. We postulate that these phonological representations projected into inferoparietal areas, which were connected to the incipient Broca's area, thus forming a working memory circuit for processing and learning complex vocalizations. As a result of selective pressure for learning capacity and memory storage, this device yielded a sophisticated system able to generate complicated utterances (precursors of syntax) as it became increasingly connected with other brain regions, especially in the prefrontal cortex. This view argues for a gradual origin of the neural substrate for language as required by natural selection.

Animals↗

PubMed1980

Psychiatric disorders in children with speech and langauge retardation. Factors associated with development.

One hundred children (mean age, 5 to 6 years) who were seen consecutively at a suburban speech and hearing clinic were systematically evaluated for speech and language disorders and psychiatric disorders. Fifty-three were found to have a psychiatric illness. The three groups were compared with the psychiatrically well group to ascertain factors associated with the presence of a psychiatric disorder. Significantly differentiating the ill group were more academic and classroom behavior problems and the presence of both speech and language problems. The two groups were not significantly different in intellectual retardation, hearing impairment, medical factors, nonlanguage development disorders, and a variety of family and demographic factors. Common in both groups were psychiatric illness in parents and first-degree relatives. The data indicate that children with speech and langauge disorders are highly at risk for the development of significant psychiatric problems, which suggests the need for proper screening and multimodal treatment planning.

Adolescent↗

PubMed1995

Learning difficulties in children with Tourette syndrome.

Children with Tourette syndrome have been shown to have a variety of school difficulties. These difficulties, however, may be related to a single factor or to a combination of problems including tic severity, the use of tic-suppressing medication, executive dysfunction, a direct consequence of having a stigmatizing disorder, and coexisting attention deficit disorder, hyperactivity, obsessive-compulsive behaviors, or other psychopathologies. The goals for the treating health care team are to identify the presence of these factors, to clarify which are the major source of distress, and to develop an individualized multimodal treatment program. The prompt diagnosis of underlying problems and the prescription of appropriate therapy can play an important role in preventing school failure in children with Tourette syndrome.

Adrenergic alpha-Agonists↗

PubMedDate not supplied

When the problem is not the problem: understanding attention deficit disorder with and without hyperactivity.

Attention Deficit Disorder with, and Attention Deficit Disorder without, Hyperactivity, are common neurobiological conditions that cause or exacerbate many learning, social, and emotional problems. Understanding the significant interactions of biological, cognitive, and psychological factors in AD(H)D and informing clients of all treatment options, including pharmacological intervention, are essential to treatment. Counseling alone, without providing multimodal treatments that acknowledge the core medical problem, has limited positive effect.

Adolescent↗

PubMed2006

Binding crossmodal object features in perirhinal cortex.

Knowledge of objects in the world is stored in our brains as rich, multimodal representations. Because the neural pathways that process this diverse sensory information are largely anatomically distinct, a fundamental challenge to cognitive neuroscience is to explain how the brain binds the different sensory features that comprise an object to form meaningful, multimodal object representations. Studies with nonhuman primates suggest that a structure at the culmination of the object recognition system (the perirhinal cortex) performs this critical function. In contrast, human neuroimaging studies implicate the posterior superior temporal sulcus (pSTS). The results of the functional MRI study reported here resolve this apparent discrepancy by demonstrating that both pSTS and the perirhinal cortex contribute to crossmodal binding in humans, but in different ways. Significantly, only perirhinal cortex activity is modulated by meaning variables (e.g., semantic congruency and semantic category), suggesting that these two regions play complementary functional roles, with pSTS acting as a presemantic, heteromodal region for crossmodal perceptual features, and perirhinal cortex integrating these features into higher-level conceptual representations. This interpretation is supported by the results of our behavioral study: Patients with lesions, including the perirhinal cortex, but not patients with damage restricted to frontal cortex, were impaired on the same crossmodal integration task, and their performance was significantly influenced by the same semantic factors, mirroring the functional MRI findings. These results integrate nonhuman and human primate research by providing converging evidence that human perirhinal cortex is also critically involved in processing meaningful aspects of multimodal object representations.

Adolescent↗

PubMed2006

Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler--a systematic review of the literature.

BACKGROUND: Transcranial Doppler Ultrasound (TCD) is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV). This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB). METHODOLOGY: We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring". DISCUSSION: Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA) blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF) during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption. CONCLUSION: In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography) that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.

Aorta, Thoracic↗

PubMed2025

Triage and workflow optimization with artificial intelligence in pediatric imaging.

Artificial intelligence (AI) is being increasingly utilized in various aspects by the radiology department. With an ever-increasing burden on the healthcare system, particularly in emergency units, the need to incorporate AI in patient triage and workflow optimization cannot be overstated. Machine learning (ML)-based algorithms form the core of AI-based software, aiding healthcare professionals at nearly every step in delivering appropriate patient care. Regarding the radiology section of the hospital, AI-based algorithms have proven exceptionally useful in assisting radiologists and technicians with image acquisition. From accurate clinical referrals to scheduling computed tomography/magnetic resonance imaging scan appointments, from ensuring the lowest radiation exposure to offering timely follow-up reminders, ML-based software has indeed revolutionized the concept of modern image acquisition, especially in the pediatric radiology section. Although the implementation of these algorithms is swift, several technical challenges and the limited availability of pediatric datasets preclude their widespread use. The utility of multimodal pediatric datasets, which combine imaging, genomics, and clinical data, for comprehensive AI triage models can help AI systems evolve toward greater adaptability and integration, resulting in enhanced efficiency, reduced turnaround times, and improved patient outcomes in pediatric radiology departments in the future. In this article, we highlight and review the utility of AI and machine learning-based algorithms in efficiently aiding triage and streamlining the workflow in the pediatric radiology section, thereby ensuring an overall improvement in the departmental workflow.

Triage↗

PubMed2004

Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.

OBJECTIVE: To test the hypotheses that in children with attention-deficit/hyperactivity disorder (ADHD) (1) symptoms of ADHD, oppositional defiant disorder, and overall functioning are significantly improved by methylphenidate combined with intensive multimodal psychosocial treatment compared with methylphenidate alone and with methylphenidate plus attention control and (2) more children receiving combined treatment can be taken off methylphenidate. METHOD: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to (1) methylphenidate alone; (2) methylphenidate plus psychosocial treatment that included parent training and counseling, social skills training, psychotherapy, and academic assistance, or (3) methylphenidate plus attention psychosocial control treatment. Assessments included parent, teacher, and psychiatrist ratings, and observations in academic and gym classes. RESULTS: Combination treatment did not lead to superior functioning and did not facilitate methylphenidate discontinuation. Significant improvement occurred across all treatments and continued over 2 years. CONCLUSIONS: In stimulant-responsive children with ADHD, there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms. Significant benefits from methylphenidate were stable over 2 years.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

[Management of learning disorders and attention deficit in children]

OBJECTIVE: This review aims at providing pediatricians with an update on the main causes involved in low school achievement. A more detailed approach is given for the management and treatment of attention deficit hyperactive disorder. SOURCES: Data was obtained by a systematic review of published literature in Medline, through a search on Pubmed in the last five years. The key words used were learning disability, attention deficit, dyslexia (reading disorder) and dyscalculia (mathematical disorder). Studies focusing evaluation and management were retrieved. Governmental population educational data on literacy was also included. SUMMARY OF THE FINDINGS: Statistical medical Brazilian data on the subject is scarce. Hearing, visual and mental deficiency, together with attention deficit hyperactive disorder and specific learning disorders should be part of the differential diagnosis of children with poor school achievement. Development should be carefully followed until school entrance, particularly in children at risk. CONCLUSIONS: Therapy with stimulants, anti-depressive drugs or cloninidine with multimodal treatment improves school achievement in children with attention deficit hyperactive disorder.

Journal Article↗

PubMed2006

Improving the accuracy of the diagnosis of schizophrenia by means of virtual reality.

OBJECTIVE: The authors' goal was to improve the diagnosis of schizophrenia by using virtual reality technology to build a complex, multimodal environment in which cognitive functions can be studied (and measured) in parallel. METHOD: The authors studied sensory integration within working memory by means of computer navigation through a virtual maze. The simulated journey consisted of a series of rooms, each of which included three doors. Each door was characterized by three features (color, shape, and sound), and a single combination of features--the door-opening rule--was correct. Subjects had to learn the rule and use it. The participants were 39 schizophrenic patients and 21 healthy comparison subjects. RESULTS: Upon completion, each subject was assigned a performance profile, including various error scores, response time, navigation ability, and strategy. A classification procedure based on the subjects' performance profile correctly predicted 85% of the schizophrenic patients (and all of the comparison subjects). Several performance variables showed significant correlations with scores on a standard diagnostic measure (Positive and Negative Syndrome Scale), suggesting potential use of these measurements for the diagnosis of schizophrenia. On the other hand, the patients did not show unusual repetition of response despite stimulus cessation (called "perseveration" in classical studies of schizophrenia), which is a common symptom of the disease. This deficit appeared only when the subjects did not receive proper explanation of the task. CONCLUSIONS: The ability to study multimodal performance simultaneously by using virtual reality technology opens new possibilities for the diagnosis of schizophrenia with objective procedures.

Adult↗

PubMed2005

The contribution of novel brain imaging techniques to understanding the neurobiology of mental retardation and developmental disabilities.

Studying the biological mechanisms underlying mental retardation and developmental disabilities (MR/DD) is a very complex task. This is due to the wide heterogeneity of etiologies and pathways that lead to MR/DD. Breakthroughs in genetics and molecular biology and the development of sophisticated brain imaging techniques during the last decades have facilitated the emergence of a field called Behavioral Neurogenetics. Behavioral Neurogenetics focuses on studying genetic diseases with known etiologies that are manifested by unique cognitive and behavioral phenotypes. In this review, we describe the principles of magnetic resonance imaging (MRI) techniques, including structural MRI, functional MRI, and diffusion tensor imaging (DTI), and how they are implemented in the study of Williams (WS), velocardiofacial (VCFS), and fragile X (FXS) syndromes. From WS we learn that dorsal stream abnormalities can be associated with visuospatial deficits; VCFS is a model for exploring the molecular and brain pathways that lead to psychiatric disorders for which subjects with MR/DD are at increased risk; and finally, findings from multimodal imaging techniques show that aberrant frontal-striatal connections are implicated in the executive function and attentional deficits of subjects with FXS. By deciphering the molecular pathways and brain structure and function associated with cognitive deficits, we will gain a better understanding of the pathophysiology of MR/DD, which will eventually make possible more specific treatments for this population.

Brain↗

PubMed2003

Assessment and treatment of attention deficit hyperactivity disorder in children with comorbid psychiatric illness.

PURPOSE OF REVIEW: Attention deficit hyperactivity disorder (ADHD) frequently occurs with a wide variety of comorbid psychiatric disorders such as conduct disorder, depression, mania, anxiety, and learning disabilities. Because the vast majority of children with ADHD are treated in primary care settings, it is important that primary medical doctors be proficient in the diagnosis and initial treatment of children with ADHD and its commonly occurring comorbid disorders. ADHD research is beginning to focus on the treatment of these comorbidly ill children. This review will summarize the recent findings from the psychiatric literature in an attempt to provide the clinician with some initial diagnostic and treatment guidelines for ADHD and its comorbidities. RECENT FINDINGS: The NIMH Multimodal Treatment Study of ADHD found that children with other disruptive behavior disorders plus ADHD respond well to stimulant medications, with behavioral interventions reducing academic and social impairment. Children with anxiety and ADHD are very responsive across multiple dimensions to behavioral and pharmacological ADHD treatments. Much less is known about the impact of depression on ADHD, and significant debate exists surrounding the identification and treatment of bipolar disorder in children with ADHD. Children with learning disabilities respond well to stimulants but often require additional educational supports. New findings suggest that treating ADHD may prevent the development of future psychiatric disorders. SUMMARY: The presence of comorbid illness is associated with significant additional morbidity and complicates the diagnosis, treatment, and prognosis of ADHD. Therefore, it is important to identify and treat any comorbid psychiatric conditions in a child with ADHD.

Antidepressive Agents, Second-Generation↗

PubMed1998

Central auditory processing disorder in school-aged children: a critical review.

The rationale to evaluate for central auditory processing disorder (CAPD) in school-aged children is based on the assumption that an auditory-specific perceptual deficit underlies many learning problems including specific reading and language disabilities. A fundamental issue in this area is whether convincing empirical evidence exists to validate this proposition. Herein, we consider the issue of modality specificity by examining the extent to which reading, language, and attention disorders in school-aged children involve perceptual dysfunctions limited to a single sensory modality. Difficulty in validating CAPD as a diagnostic label is due in large part to use of the unimodal inclusive framework, which has biased the diagnosis to favor sensitivity of test results over documenting the specificity of the deficit. Indeed, empirical research documenting modality-specific auditory-perceptual dysfunction in this population is scarce. Therefore, the existing literature on this topic has not clarified the "true" nature of the problem, and has left many questions about this disorder unanswered. It is argued that demonstrating modality specificity is one way to rule out supramodal disorders as explanations for observed dysfunction. Multimodal perceptual testing is one logical approach to help clarify this area of investigation.

Attention Deficit Disorder with Hyperactivity↗

PubMed2026

A Knowledge-Enhanced Multimodal Framework with Genomic Reconstruction for DLBCL Drug Response Prediction.

Diffuse large B-cell lymphoma (DLBCL) exhibits substantial biological heterogeneity, leading to pronounced variability in patient response to therapy. Accurate drug response prediction is therefore critical for precision treatment but remains challenging in clinical settings where genomic sequencing, a highly informative modality, is frequently incomplete. Existing methods, often developed from cell-line pharmacogenomic datasets or single-modality data, typically assume fully observed molecular profiles and thus show limited robustness under missing genomic data. To address this limitation, a knowledge-enhanced multimodal framework with genomic reconstruction (KeM-DRP) is proposed for individualized drug response prediction in DLBCL. The framework models the central role of genomics by integrating biological prior knowledge through a gene-pathway-biological process hierarchy, enabling robust representation learning from sparse observations. To compensate for missing genomic measurements, a cross-modal genomic compensation module reconstructs genomically informed latent features from routinely available clinical modalities. Furthermore, a genomics-guided adaptive fusion strategy dynamically integrates heterogeneous modalities conditioned on observed or reconstructed genomic representation. Experiments on a real-world DLBCL cohort demonstrate that KeM-DRP consistently outperforms competitive baselines. The reconstructed genomic representation represents most predictive utility, highlighting the robustness and practical value of the framework under incomplete genomic data.

Journal Article↗

PubMed2000

The functional anatomy of visual-tactile integration in man: a study using positron emission tomography.

The integration of neural signals from different sensory modalities is a prerequisite for many cognitive and behavioural functions. In this study, we have mapped the functional anatomy of the integration of sensory signals across the tactile and visual modalities. Using the PET radiotracer H2(15)O, regional cerebral blood flow (rCBF) changes were measured in eight normal volunteers performing crossmodal recognition of simultaneously presented visual and tactile stimuli using a modified version of the 'arc-circle test'. Whilst intramodal matching within the visual modality led to relative rCBF increases in the visual association cortex, crossmodal matching (visual-tactile), when compared to intramodal matching, was accompanied by relative rCBF increases in the anterior cingulate cortex, inferior parietal lobules, the left dorsolateral prefrontal cortex (DLPFC) and the left claustrum/insular cortex. The pattern of brain activation is congruent with areas of heteromodal and supramodal cortex and indicates that activation of multimodal areas is required to solve the crossmodal problem.

Adult↗

PubMed2007

[Coping with pain].

Chronic pain is to be understood as a complex syndrome influenced by its intensity, character, localisation and time aspects as well as the subjective feeling of impairment and the accompanying emotions and cognitions. Based on the biopsychosocial concept of pain, therapies have to be multimodal to take into account the various dimensions of pain. One element of multimodal pain therapy is pain coping skills training, aimed at giving pain patients increasingly greater control over their pain by following the didactic guideline of small steps at a time. In addition to giving them disease-specific information, patients are supposed to learn to recognize dysfunctional components of their pain disorder and to alter them. Improved health and increased joy of living as well as a decrease of stressor-related activation (pain being the stressor) are the objectives of the training. Coping with pain as a programme aims at helping patients to help themselves. Pain coping skills training is indicated for patients already suffering from chronic pain or running a risk of pain chronicity.

Adaptation, Psychological↗

PubMed1984

Severe tactual as well as visual memory deficits follow combined removal of the amygdala and hippocampus in monkeys.

To determine whether medial temporal limbic structures are essential for memory in more than one modality, we trained monkeys preoperatively on both visual and tactual versions of a sensory memory task and then retested them after they had been given bilateral ablations of either the amygdaloid complex, the hippocampal formation, or both. Monkeys with the combined ablations were severely impaired in both modalities. By contrast, the amygdalectomized monkeys were only moderately impaired in the two modalities, while the hippocampectomized monkeys were impaired in neither. Further examination revealed that the source of the impairment in the monkeys with amygdalectomy alone, unlike that in the animals with combined lesions, was the small size of the pool from which the test objects were drawn. The latter result suggests that, whereas the sensory memory impairment following the combined lesions is basically a recognition loss, the more selective impairment following amygdalectomy alone reflects special difficulty in determining whether a recognized object was presented recently. By demonstrating that the profound sensory memory impairment that follows combined ablation of the amygdala and hippocampus extends beyond a single modality, the present results strengthen the proposals that these two structures are important for sensory memory in all modalities and the multimodal or global amnesia observed in patients with medial temporal lobe damage is likewise due to combined amygdaloid and hippocampal lesions.

Amygdala↗

PubMed1999

Palliative education: a didactic and experiential approach to teaching end-of-life care.

BACKGROUND: The training in palliative care that health professionals receive is inadequate. An aging population, changing systems of health care delivery, and the debate about euthanasia and physician-assisted suicide increase the importance of ongoing education about palliative care. METHODS: Three modules are offered by the University of California, Davis, West Coast Center for Palliative Education (WCCPE). Module 1, offered on-site, blends didactic and field learning using lectures, case studies, patient contact, and role modeling. Module 2 programs, held off-site, are customized in collaboration with the sponsor to address local needs and concerns. This module emphasizes group discussion and problem solving. Module 3 trains health care and custody staff and volunteer inmates at correctional facilities. Inmate training focuses on developing communication skills and a capacity to empathize through experiential exercises, dialog, and role-playing. RESULTS: Off-site training significantly improved self-assessed knowledge about pain management and attitudes towards end-of-life care. Qualitative measures showed enhanced care-delivery skills for participants in all three modules. CONCLUSIONS: Palliative care education can be enhanced when delivered close to the point of care using multimodal techniques that influence attitudes as well as knowledge.

Attitude to Death↗