title: Whole-brain voxel-based morphometry in Kallmann syndrome associated with mirror movements.
abstract: OBJECTIVE
  There are 2 main hypotheses concerning the cause of mirror movements (MM) in Kallmann syndrome (KS): abnormal development of the primary motor system, involving the ipsilateral corticospinal tract; and lack of contralateral motor cortex inhibitory mechanisms, mainly through the corpus callosum. The purpose of our study was to determine white and gray matter volume changes in a KS population by using optimized voxel-based morphometry (VBM) and to investigate the relationship between the abnormalities and the presence of MM, addressing the 2 mentioned hypotheses.
  
  
  METHODS
  T1-weighted volumetric images from 21 patients with KS and 16 matched control subjects were analyzed with optimized VBM. Images were segmented and spatially normalized, and these deformation parameters were then applied to the original images before the second segmentation. Patients were divided into groups with and without MM, and a t test statistic was then applied on a voxel-by-voxel basis between the groups and controls to evaluate significant differences.
  
  
  RESULTS
  When considering our hypothesis a priori, we found that 2 areas of increased gray matter volume, in the left primary motor and sensorimotor cortex, were demonstrated only in patients with MM, when compared with healthy controls. Regarding white matter alterations, no areas of altered volume involving the corpus callosum or the projection of the corticospinal tract were demonstrated.
  
  
  CONCLUSIONS
  The VBM study did not show significant white matter changes in patients with KS but showed gray matter alterations in keeping with a hypertrophic response to a deficient pyramidal decussation in patients with MM. In addition, gray matter alterations were observed in patients without MM, which can represent more complex mechanisms determining the presence or absence of this symptom.
authors.affiliation: Division of Radiology, School of Medicine of Ribeirao Preto-University of Sao Paulo, Ribeirao Preto, SP, Brazil. marcelk46@yahoo.com.br
authors.forename: M
authors.initials: M
authors.lastname: Koenigkam-Santos
authors.forename: A C
authors.initials: AC
authors.lastname: Santos
authors.forename: T
authors.initials: T
authors.lastname: Borduqui
authors.forename: B R
authors.initials: BR
authors.lastname: Versiani
authors.forename: J E C
authors.initials: JE
authors.lastname: Hallak
authors.forename: J A S
authors.initials: JA
authors.lastname: Crippa
authors.forename: M
authors.initials: M
authors.lastname: Castro