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Abnormal early brain development in autism

2002, Molecular Psychiatry

Molecular Psychiatry (2002) 7, S21–S23  2002 Nature Publishing Group All rights reserved 1359-4184/02 $25.00 www.nature.com/mp ANATOMY AND NEUROBIOLOGY OF AUTISM Abnormal early brain development in autism Molecular Psychiatry (2002) doi:10.1038/sj.mp.4001169 7, S21–S23. A pivotal period in human brain and behavioral development occurs in the first years of life. These years are normally characterized by a degree and variety of neuroanatomical change unmatched by any subsequent developmental or aging period in human life. From birth through to the fourth year of life, brain volume quadruples, cortical synapse counts double, dendritic arbors of many neurons quadruple in extent, volume of cortical pyramidal cells may double or quadruple depending on region and layer, the corpus callosum nearly triples in size, and cerebral axonal myelination increases rapidly. The epigenetic nature of development combines intrinsic forces that drive neuronal growth and elaboration with extrinsic forces that adaptively modify structure and function according to experience. These two complementary forces underlie the remarkable changes in multiple domains of neurobehavioral capacity from birth through early childhood. Behaviorally, this developmental period from infancy to the early preschool period is a time when humans first use cognitive, social, linguistic and motor skills to understand and actively engage others socially and the development of these skills represents a huge leap in social and intellectual development. Autism is first manifested during this very early, pivotal period of life. Parents become concerned that their toddler is not developing speech, not showing normal social and emotional reactions, or not paying attention to and exploring their environment as normal babies do. Thus, early abnormal development is apparent in autism in several neurobehavioral domains including cognitive, emotional, social, speech, language, and motor. What deviant neuroanatomical changes occur in autism at this critical period in development? Given the epigenetic nature of neural development and the malleability of the neural matrix during the early years of life, what abnormal alterations in functional organization ensue and can such abnormal neurofunctional maps be detected by modern neuroimaging techniques? Until the advent of magnetic resonance imaging (MRI), answers to such questions have been unobtainable, but recent MRI studies of early brain structure and of later functional organization have provided evidence addressing these questions. Correspondence: E Courchesne, Center for Research on Autism, 8110 La Jolla Shores Drive, La Jolla, CA 92037, USA. E-mail: [email protected] Brain size in autism at the beginning of this period of life— birth—appears to be normal.1 This conclusion is based on measures of head circumference,1 an index which has been shown to be highly predictive of CT2 or MRI-based1,2 brain volume. However, according to new MRI studies,1,3 by 2–4 years of age, 90% of autistic patients have brain volumes that are larger than normal average (Figure 1). Moreover, 37% of 2–4 year-old autistic toddlers met criteria for developmental macroencephaly (Figure 1). One autistic 3-year-old (Figure 1) had a brain volume of 1816 ml (normal mean for age is 1179 ml) giving an in vivo-estimated brain weight of 2000 g, which exceeds every one of nearly 8000 normal child and adult males and females from six studies published over the last 35 years (for summary of brain weights from these normative studies as well as brain weights at autopsy in autism, see Courchesne et al4). Determining the brain regions that contribute to this pattern of overall brain enlargement during early life in autism is a question that has been addressed by a series of MRI studies. First, we found that autistic 2–3 year-olds had more cerebral cortical gray matter (12%), and more cerebral (18%) and cerebellar (39%) white matter than normal, whereas older autistic children and adolescents did not have such enlarged gray and white matter volumes (eg, see cerebellar white matter, Figure 2).3 Next, we found that the excessive cerebral size in young autistic children showed an anterior to posterior gradient with frontal lobes being the most abnormally enlarged and occipital lobes showing the smallest effect (Figure 3).5 Lastly, within frontal lobes, abnormal overgrowth was regionally localized to dorsolateral and medial prefrontal cortex; orbital frontal cortex was not different from normal.6 Interestingly, after this period of accelerated growth, cross-sectional MRI data show slowed growth throughout cerebral and cerebellar (eg, Figure 2) regions, in contrast to normal.1,3,5 For example, in normal children, frontal lobe gray and white matter volumes increased by 19% and 46%, respectively, from 2–4 years of age to 9–12 years, but they increased by only 1% and 14%, respectively, in autistic children during this same age span.5 It is important to note, however, that excessive enlargement does not appear to be a global phenomena in the developing autistic brain and has not been detected in all regions studied. In the cerebellum, for example, the 2–3 year-old autistic children have similar overall gray matter volumes to normal while older autistic boys and adolescents have less gray matter; additionally, at all ages from 2 years and up, autistic children have a smaller ratio of gray to white matter and smaller vermis lobules VI–VII than normal con- Abnormal brain development in autism E Courchesne S22 Figure 1 Brain size in 2–4 year-old autistic children. Two to four-year-old autistic and normal boys are plotted showing overall whole brain enlargement of the youngest autistic children. Ninety per cent of autistic boys have brain volumes larger than the normal mean.3 3-D MR image of 3-year-old autistic subject JW (left) as compared to that of a normal boy whose brain volume was scaled to equal normal average size (right). JW’s brain volume (1816 ml) was more than 6 SDs above normal average for his age.3 Figure 2 Cerebellar abnormality in young autistic children. Developmental changes in cerebellar white matter volume in normal and autistic 2 to 16-year-old boys. Volumes in 2–3 year-old autistic boys exceed normal by 39%, but thereafter growth slows.3 trols.3 Further, in the largest autism and normal control samples studied, Hashimoto et al7 showed that from infancy through adolescence, the cerebellar vermis and the brainstem are abnormally reduced in size. There are 16 MRI studies reporting evidence of significantly reduced size of cerebellar hemispheres or one or another subregion of the vermis in patients with autism as compared to normal, making the cerebellum the most widely replicated site of MRI abnormality in the autism literature (reviewed in Ref 3). In postmortem examinations, 95% of autistic cases have loss of cerMolecular Psychiatry ebellar Purkinje neurons with pathology observed in the vermis and hemispheres.3 Developmental defect in the limbic system has been hypothesized because it mediates memory, social, and affective functions typically disturbed in autism. In a new developmental MRI study of 29-month-olds to 42-year-olds, the cross-sectional area of the area dentata—a component of the hippocampal memory circuitry—was smaller than normal in autism with the largest deviation from normal size (−13.5%) found in autistic children 29 months to 4 years old.9 This MRI study is the first direct evidence that anatomic abnormality within the limbic system exists from the earliest years of the disorder, and persists throughout development and up through middle age. Lastly, posterior regions of the corpus callosum are also reduced in size in autism in a study of 3 to 42year-olds.10 In conclusion, these recent MRI observations suggest abnormal regulation of brain growth in autism: overgrowth early in life followed by abnormally slowed growth in some regions, but premature arrest of growth in others. This evidence raises a growth dysregulation hypothesis of autism in which there is a pathologic dysregulation in the timing and amount of growth as well as in the cessation of growth. The evidence raises the further hypothesis that brain development in autism occurs with an abnormal anatomical heterochronicity, that is, different brain structures follow different schedules of pathological overgrowth and premature cessation of growth. Lastly, it is a reasonable assumption that pathological growth regulation during this critical period of early life could lead to widespread and pervasive consequences for the functional differentiation of systems mediating many neuro- Abnormal brain development in autism E Courchesne phins and neuropeptides (BDNF, NT-4, VIP, and CGRP) have been found in neonatal blood spots of individuals who later developed autism and mental retardation.16 These and other growth factors play roles in neural proliferation, migration, differentiation, growth and circuit organization. Future studies should examine possible relationships between brain growth factors and abnormal brain growth patterns such as those described in recent MRI studies of autism.1,3 Also, future studies may test for associations between preand perinatal risk factors17 and growth defects in this disorder. Understanding the developmental anatomical phenotype of autism will facilitate the development of animal models of autism which will be crucial for validating claims of suspected causes or the effectiveness of treatments. This is important since a number of the core behavioral features of autism—speech delay and deviance, impaired use of language for communication, and impaired higher order social behaviors— are not amenable to animal modeling, while patterns of anatomic maldevelopment are. If the causes of abnormal regulation of brain growth in early life are discovered, then in vivo anatomical MRI studies of infants and toddlers might be able to detect the onset and trajectory of the growth pathology, and biomedical interventions prior to the full expression of these abnormalities may be a possibility. S23 Acknowledgements Supported by funds from NINDS (2-RO1-NS-19855) and NIMH (RO1-MH36840) awarded to Eric Courchesne. Thanks to Karen Pierce and Ruth Carper for comments on the manuscript. E Courchesne1,2 Department of Neuroscience, School of Medicine, University of California, San Diego, La Jolla, CA, USA; 2 Center for Research on Autism, Children’s Hospital Research Center, San Diego, CA, USA 1 Figure 3 Cerebral abnormality in young autistic children. Excessive cerebral gray and white matter volumes 2–4 yearold autistic children showed an anterior to posterior gradient with frontal lobes being the most abnormally enlarged (cross hatched bars) and occipital lobes showing the smallest effect (bars with diagonals).5 The ‘0’ on the y-axis indicates the normal mean (see arrows) and ‘1’ and ‘2’ indicate standard deviations above the mean. behavioral domains. 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