Dynamic mapping of cortical development before and after the onset of pediatric bipolar illness.
BACKGROUND
There are, to date, no pre-post onset longitudinal imaging studies of bipolar disorder at any age. We report the first prospective study of cortical brain development in pediatric bipolar illness for 9 male children, visualized before and after illness onset.


METHODS
We contrast this pattern with that observed in a matched group of healthy children as well as in a matched group of 8 children with 'atypical psychosis' who had similar initial presentation marked by mood dysregulation and transient psychosis (labeled as 'multi-dimensionally impaired' (MDI)) as in the bipolar group, but have not, to date, developed bipolar illness.


RESULTS
Dynamic maps, reconstructed by applying novel cortical pattern matching algorithms, for the children who became bipolar I showed subtle, regionally specific, bilaterally asymmetrical cortical changes. Cortical GM increased over the left temporal cortex and decreased bilaterally in the anterior (and sub genual) cingulate cortex. This was seen most strikingly after the illness onset, and showed a pattern distinct from that seen in childhood onset schizophrenia. The bipolar neurodevelopmental trajectory was generally shared by the children who remained with MDI diagnosis without converting to bipolar I, suggesting that this pattern of cortical development may reflect affective dysregulation (lability) in general.


CONCLUSIONS
These dynamic trajectories of cortical development may explain age-related disparate findings from cross-sectional studies of bipolar illness, and suggest the importance of mood disordered non-bipolar control group in future studies.
Gogtay
Nitin
N
Child Psychiatry Branch, NIMH, Bethesda, MD 20892, USA. gogtayn@intra.nimh.nih.gov
Ordonez
Anna
A
Herman
David H
DH
Hayashi
Kiralee M
KM
Greenstein
Deanna
D
Vaituzis
Cathy
C
Lenane
Marge
M
Clasen
Liv
L
Sharp
Wendy
W
Giedd
Jay N
JN
Jung
David
D
Nugent
Tom F
TF
Toga
Arthur W
AW
Leibenluft
Ellen
E
Thompson
Paul M
PM
Rapoport
Judith L
JL
D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening; D012720:Severity of Illness Index