Neuroanatomical correlates of childhood apraxia of speech: A connectomic approach

Simona Fiori, Andrea Guzzetta, Jhimli Mitra, Kerstin Pannek, Rosa Pasquariello, Paola Cipriani, Michela Tosetti, Giovanni Cioni, Stephen E Rose, Anna Chilosi, Simona Fiori, Andrea Guzzetta, Jhimli Mitra, Kerstin Pannek, Rosa Pasquariello, Paola Cipriani, Michela Tosetti, Giovanni Cioni, Stephen E Rose, Anna Chilosi

Abstract

Childhood apraxia of speech (CAS) is a paediatric speech sound disorder in which precision and consistency of speech movements are impaired. Most children with idiopathic CAS have normal structural brain MRI. We hypothesize that children with CAS have altered structural connectivity in speech/language networks compared to controls and that these altered connections are related to functional speech/language measures. Whole brain probabilistic tractography, using constrained spherical deconvolution, was performed for connectome generation in 17 children with CAS and 10 age-matched controls. Fractional anisotropy (FA) was used as a measure of connectivity and the connections with altered FA between CAS and controls were identified. Further, the relationship between altered FA and speech/language scores was determined. Three intra-hemispheric/interhemispheric subnetworks showed reduction of FA in CAS compared to controls, including left inferior (opercular part) and superior (dorsolateral, medial and orbital part) frontal gyrus, left superior and middle temporal gyrus and left post-central gyrus (subnetwork 1); right supplementary motor area, left middle and inferior (orbital part) frontal gyrus, left precuneus and cuneus, right superior occipital gyrus and right cerebellum (subnetwork 2); right angular gyrus, right superior temporal gyrus and right inferior occipital gyrus (subnetwork 3). Reduced FA of some connections correlated with diadochokinesis, oromotor skills, expressive grammar and poor lexical production in CAS. These findings provide evidence of structural connectivity anomalies in children with CAS across specific brain regions involved in speech/language function. We propose altered connectivity as a possible epiphenomenon of complex pathogenic mechanisms in CAS which need further investigation.

Keywords: Childhood apraxia of speech; Connectivity; Diadochokinesis; Diffusion magnetic resonance; Fractional anisotropy.

Figures

Fig. 1
Fig. 1
Subnetworks with reduced fractional anisotropy (FA) in children with CAS compared to controls represented on brain renderings. Spheres correspond to significant nodes in the analysis. Sphere size is proportional to the number of altered connections originating from that node. The top panel represents subnetwork 1, the middle panel represents subnetwork 2, and the bottom panel represents subnetwork 3. All subnetworks from the left to the right are represented on axial, coronal and sagittal planes, respectively. Sagittal plane is viewed from the left.
Fig. 2
Fig. 2
Subnetworks that were significantly different between CAS and controls overlaid on a single image, shown on axial, coronal and sagittal planes (sagittal plane shows view from the left). Thin black lines represent edges (connections) whose average FA value does not correlate with any clinical measure. Brown edges represents: a) the connection between the opercular part of the left inferior frontal gyrus and the left middle temporal gyrus (subnetwork 1), whose average FA value correlates with low diadochokinesis rate (p = 0.01, R = 0.57), poor expressive grammar (p = 0.02, R = 0.53) and poor lexical production (p = 0.003, R = 0.67); b) the connection between the medial part of superior frontal gyrus and middle temporal gyrus (subnetwork 1), whose average FA value correlates with oromotor skills (p = 0.02, R = 0.56); c) the connection between the right superior occipital gyrus and left precuneus (subnetwork 2) whose average FA value correlates with low diadochokinesis rate (p = 0.01, R = 0.57).

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