Interhemispheric cooperation in global-local visual processing in pediatric multiple sclerosis.

Impairments in visuospatial abilities are commonly reported in children and adolescents with multiple sclerosis (MS). Corpus callosum (CC) pathology occurs in patients with MS and may contribute to impairment in visuospatial perception, particularly when interhemispheric information transfer is required. This study used a global-local hierarchical letter paradigm to examine the relationship between interhemispheric information transfer and white matter integrity in the CC assessed using diffusion tensor imaging. Thirteen cognitively preserved pediatric-onset MS patients and 15 age-matched healthy controls were asked to determine whether a target letter E appeared at the attended level of the stimulus. As expected, both groups processed global and local information more slowly under divided than selective attention conditions. The MS group performed similarly to the control group with respect to reaction time and accuracy on selective and divided attention conditions, with one exception. Specifically, the presence of a global target when attending to a local target caused greater response conflict in the MS group than in controls (p = .01). Pooling both the patient and control data, greater response conflict was associated with reduced white matter integrity as indicated by lower fractional anisotropy in the anterior body of the CC (r = -.33, p < .05). Results suggest that reduced white matter integrity in anterior regions of the CC may lead to less efficient inhibition of task-irrelevant global information in the hierarchal processing of visual information.

Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study.

OBJECTIVES: Second-generation antipsychotics (SGAs), in conjunction with other psychotropic medications, are increasingly used to treat psychiatric disorders in pregnancy. The few available studies investigating the reproductive safety of SGAs did not reach conclusive results, and none have compared monotherapy with polytherapy involving other psychotropic medications. DESIGN: Descriptive cohort study using a prospectively collected database. SETTING: Motherisk Program, The Hospital for Sick Children, Toronto, Canada. PARTICIPANTS: 133 women exposed to SGAs and other psychotropic drugs and 133 matched healthy controls were assessed and analysed. Outcomes of mother-child pairs exposed to SGAs in monotherapy (N=37) were compared with those exposed to SGAs with other psychotropic medications (in polytherapy; N=96). MAIN OUTCOME MEASURES: Maternal, pregnancy, delivery and neonatal outcomes. RESULTS: 72% of exposed women received SGAs in polytherapy, and 101 women took their medications throughout pregnancy. These women had significantly higher pre-pregnancy weight, experienced more associated comorbidities and instrumental deliveries, and delivered a greater proportion of large for gestational age neonates. There were no differences in maternal weight gain in pregnancy between the exposed and comparison groups and between the monotherapy-exposed and polytherapy-exposed subgroups. The exposed neonates were more likely to be born premature, were admitted more often to the neonatal intensive care unit, presented with poor neonatal adaptation signs and had higher rates of congenital malformations. All the aforementioned neonatal outcomes were found mainly in the polytherapy subgroup. CONCLUSIONS: The use of SGAs in polytherapy was prevalent in the assessed cohort and was associated with adverse pregnancy outcomes for both the mother and the child. In utero exposure to SGA monotherapy appears to be associated with less risk to the fetus. Future research should focus on polytherapy in pregnancy in order to define its reproductive safety and to separate the effects of medication exposure, underlying psychopathology and associated comorbidities.

Cognitive aspects of fetal alcohol spectrum disorder.

Nearly four decades have passed since a link was first established between alcohol consumption during pregnancy and a particular pattern of birth defects. Since then, autopsy, longitudinal, structural imaging, and functional imaging studies have revealed a great deal about the teratogenic effects of alcohol. This paper provides a comprehensive summary of the findings from the neurocognitive and behavioral literature on fetal alcohol spectrum disorder (FASD) and outlines the unique profile of cognitive deficits associated with it. We describe diagnostic issues as well as factors contributing to the heterogeneity of the FASD cognitive presentation. Next, we review research on the impact of prenatal alcohol exposure on intellectual functioning, attention, executive functioning, learning and memory, language, quantitative reasoning, and social cognition. In our opinion, future research can now begin to focus on FASD-specific interventions directly informed by the rich body of neurocognitive findings accumulated thus far. WIREs Cogn Sci 2013, 4:81-92. doi: 10.1002/wcs.1202 For further resources related to this article, please visit the WIREs website.

Ethical considerations when communicating a diagnosis of a fetal alcohol spectrum disorder to a child.

Maternal alcohol consumption during pregnancy may result in Fetal Alcohol Spectrum Disorder (FASD), which is an umbrella term used to describe a range of conditions that are associated with significant neurodevelopmental impairments. Communicating an FASD diagnosis to a child is a complex and difficult task that requires a great deal of care, particularly due to the sensitive nature of the etiology of these disorders. To the best of our knowledge, there are no formal guidelines or published materials that outline the ethical considerations specifically associated with disclosing an FASD diagnosis to a child. This paper discusses a number of ethical principles and situational factors that should be considered when communicating an FASD diagnosis, as well as some of the potential risks and benefits associated with disclosure. We also provide recommendations to assist clinicians in communicating the diagnosis in a manner that increases understanding and minimizes harm to the child. Future recommendations include the development of formalized guidelines in order to aid clinicians in carrying out this sensitive task.

Investigating the effects of low to moderate levels of prenatal alcohol exposure on child behaviour: a critical review.

Conflicting findings exist regarding the risks of low to moderate levels of alcohol use during pregnancy. A recent study from Australia has suggested that mild gestational drinking is not associated with adverse fetal effects, and may even be associated with favorable outcomes as compared to "no drinking".The study may lead women to continue consuming alcohol throughout pregnancy, despite methodological limitations that render its conclusions uncertain. This review discusses the challenges of assessing long-term effects of moderate drinking during pregnancy. Recommendations are provided for researchers investigating the effects of prenatal alcohol consumption on subsequent developmental outcomes in children.