Beruflich Dokumente
Kultur Dokumente
REVIEW ARTICLE
Keywords
Autism spectrum disorder, Cerebral cortex,
Minicolumn, Transcranial magnetic stimulation
Correspondence
M F Casanova, MD, Gottfried and Gisela Kolb
Endowed Chair in Psychiatry, Department of
Psychiatry, University of Louisville, 500 South
Preston Street, Bldg A, Rm 217, Louisville, KY
40202, USA
Tel.: +1(502)852-4077 |
Email: m0casa02@louisville.edu
ABSTRACT
Postmortem studies in autism spectrum disorder (ASD) individuals indicate the presence
of abnormalities within the peripheral neuropil space (PNS) of cortical minicolumns. The
geometrical orientation of inhibitory elements within the PNS suggests using repetitive
transcranial magnetic stimulation (rTMS) to up-regulate their activity. Several rTMS trials in
ASD have shown marked improvements in motor symptomatology, attention and
perceptual binding.
Conclusion: rTMS is the first therapeutic attempt at ASD aimed at correcting some of its
core pathology.
Received
10 December 2014; revised 15 January 2015;
accepted 20 January 2015.
DOI:10.1111/apa.12943
INTRODUCTION
Bauman and Kempers pioneering histoanatomic studies
briefly described the presence of cerebral cortex pathology
within their series of autism spectrum disorder (ASD)
individuals. Described changes included an indistinct laminar pattern and minor cortical malformations or dysplasias
(1). Nevertheless, the first group to emphasise the role of
the cerebral cortex in the neuropathology of ASD was that
of Bailey et al. (2). Since then many studies have underlined
individual aspects of this pathology including changes in
neuronal size and density (3), abnormalities of minicolumnar morphometry (4,5), heterotopias (6), the presence of
supernumerary cells in both the molecular layer and the
subplate region (7) and dysplasias (8). The prominence and
prevalence of cortical pathology along with reports of
widespread heterotopias has prompted some researchers to
suggest that, in some cases, ASD results from the heterochronic divisions of germinal cells (periventricular and
rhombic lip) giving rise to the desynchronisation in matu-
Abbreviations
ASD, Autism spectrum disorder; DLPC, Dorsolateral prefrontal
cortex; EEG, Electroencephalography; ERP, Event-related potential; GABA, Gamma-aminobutyric acid; HF, High frequency;
HRV, Heart rate variability; kA, Kilo-amps; LF, Low frequency;
M1, Primary motor cortex; MRCP, Movement related cortical
potential; PNS, Peripheral neuropil space; rTMS, Repetitive
Transcranial Magnetic Stimulation; S1, Primary somatosensory
cortex; SCL, Skin conductance level; SMA, Supplementary
motor area; TMS, Transcranial Magnetic Stimulation.
346
ration between radially derived pyramidal cells and tangentially derived interneurons (9). This abnormality of
germinal cell division and later migration appears to explain
many of the reported neuropathological and clinical aspects
of both idiopathic and syndromic autism. In this regard,
autism can be considered a neurodevelopmental disorder as
it impairs the growth and development of the brain.
The cerebral cortex provides the mainboard of crucial
circuitry that allows for the emergence of higher cognitive
functions such as attention, memory, judgment, language
and empathy. Impairments of corticogenesis usually
manifest themselves early in life as varying degrees of
cognitive dysfunction for which they are traditionally
labelled as neurodevelopmental disorders. Understanding
the mechanisms for the development of the cerebral cortex
Key notes
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Casanova et al.
CORTICAL MODULARITY
The cerebral cortex is organised into different areas that
process information in a hierarchical feedforward manner.
Although it would be profitable to differentiate these areas
in a quantitative and unbiased manner this endeavour has
been fraught with difficulties. At present, techniques for
visualising cell morphometry can only poorly demarcate
large portions of the cortex. About two-thirds of the
cerebral cortex lies buried in folds under the surface of
the brain. The curvature and repositioning of cellular
elements in these abstruse areas has confounded researchers to such an extent that their existence has been ignored
in different neuroanatomical treatises. Indeed, the limitation of cytoarchitectural techniques led neuroanatomists to
conclude that attempts at subdividing the cerebral cortex
by histological methods would prove unprofitable, if not
impossible. For many decades it has thus been recommended to complement cytoarchitectural surveys with
other techniques, notably those based on fibre connectivity.
Indeed the lack of cookie cutter borders between cytoarchitecturally defined parcellations of the cerebral cortex has
led to an alternate affiliation system based on functional
connections.
Attempts at parsing the cerebral cortex by means of
functional connections have yielded a limited number of
discrete areas (1012) where Information travels in a
stereotyped manner going from the extrapersonal space to
idiotypic cortex (primary sensory and motor areas) and
from there to homotypical (unimodal and heteromodal),
paralimbic and limbic cortices. As there is an infinite
number and variety of inputs the proposed computation
system begs the question as to how intrinsic cortical circuits
are adapted to so many different tasks. According to
Creutzeldt (13) the cerebral cortex overcomes this obstacle
by instantiating a canonical circuit that provides for similar
transformations throughout the cerebral cortex (Fig. 1).
This view upholds that functional differences among brain
regions depend on variations in input sources, output
targets, interconnectivity and the modulatory effect of
inhibitory influences.
Common patterns in the organisation of nerve cells and
their connections (i.e. microcircuits) have been described in
the cerebral cortex of all examined mammalian species.
was the first to discuss the physiological role
Lorente de No
of vertical cylinders of cells when he famously said: All the
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Casanova et al.
Figure 2 Interlaminar recording and MIMO stimulation model: (left panel) rasters and peri-event histograms depict the activity of supra-granular (blue) and infragranular (red) cell layers. Overlay cross-correlograms show inter-laminar firing increase following the presentation of targets compared to pre-target epoch. Recording
array with the MIMO model for recording in layer 2/3 and stimulation in layer 5. Stimulation effect (on the right panel) compares the cumulative effect in single session
and population tuning for MIMO stimulation (red) vs. layer 5 prefrontal cortical activity (dark blue dotted line). Overall MIMO stimulation effect (red) is significantly
greater than no-stimulation and the chance level. Asterisks **p < 0.001, ANOVA.
umns, is the first reported intervention where a neuroprosthesis has been used to successfully restore diminished
cognitive function (19).
Construct validity for the minicolumn, and the appropriateness of inferences based on their existence, is derived
from multiple sources. Population analysis of neurons
within the same receptive field in primary somatosensory
cortex (SI) shows that diversity within segregates is
attributable to variability among minicolumns rather than
within minicolumns (20,21). Metabolic studies (2-deoxyglucose) of the receptive fields of monkeys SI evoked by
skin stimuli show column-shaped patches of label comprised of active minicolumns interspersed with less active
minicolumns (22). Two-photon imaging of calcium influxes
evidences an organisation of cortical response fields comprised of columns 12 cell wide (23). Similarly, studies
using labelled retroviruses and multiple cell recordings
illustrate a propensity for pyramidal cells to develop
connections with sister cells rather than to neighbouring
non-siblings (24). This affinity may be the result of the
close apposition of neuroblasts as they migrate radially
towards the cortical plate. Indeed, early during brain
development these cells are connected to each other via
gap junctions thus procreating a suitable scenario for
Hebbian reciprocity. Minicolumns are therefore highly
integrated structures where connections within the modules
far exceed those between modules. In this regard, minicolumns are modules within a hierarchical system whose
parts are interconnected by anatomical and physiological
relationships fulfilling the function of an informationprocessing unit.
348
It is important to note that although different minicolumns appear to convey the same canonical circuit that they
are not clonal elements. Anatomical studies have found
significant minicolumnar variability within and across areas
in individual brains as well as between mammalian species.
This variability (e.g. number of neurons and synaptic
elements) between minicolumns may be an adaptive feature
that is responsible for both fault tolerances within larger
networks (e.g. macrocolumns) as well as for the competition among modules that is necessary for circuit optimisation (25).
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50
0
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0
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150
200
Time (msec)
B
A 100
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Time (msec)
C
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Figure 5 Stochastic resonance illustrated in a model neuron, SRM0 (35). The
model was stimulated with a combination of subthreshold pulses at 25 ms
intervals or 40 Hz, within the gamma band, and a background of random
postsynaptic potentials (PSP) distributed as a Poisson process. In the absence of
background, the subthreshold pulses fail to produce action potentials in the
model neuron. When noise is present at a rate of 500 PSP per second (A), the
neuron spikes occasionally with the gamma-band pulses. At a higher noise rate
of 1000 PSP per second (B), the neuron fires in synchrony with the 40 Hz input
signal. At still greater noise, 2000 PSP per second (C), random firing drowns out
the signal. Vertical bars in each panel indicate the timing of the input pulses.
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Casanova et al.
Poor
lateral
inhibition
Poor
lateral
inhibition
Enhanced
lateral
inhibition
Enhanced
lateral
inhibition
Figure 6 The principle of rTMS is that a magnetic field (B), varying in strength
over time, induces electric currents (j) parallel to the direction of B. The greatest
effect will be seen in superficial layers of the cortex and outside of sulci, since B
loses strength rapidly with increasing distance from the scalp. This part of the
cerebral cortex includes double bouquet cells, whose long, straight axon bundles
synapse on the basal dendrites of pyramidal cells, creating the inhibitory
surround that isolates a particular minicolumn from its neighbours. Reprinted
from Cutting-edge therapies for autism 20102011 by permission of Skyhorse
Publishing, Inc.
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Casanova et al.
PrerTMS
PostrTMS
1.5
Gamma amplitude ( V)
1.5
Gamma amplitude ( V)
1.0
0.5
0
0.5
1.0
1.5
1.0
Nontarget
Target
0.5
0
0.5
1.0
1.5
50
100
Time (msec)
150
200
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200
Time (msec)
Figure 7 rTMS modulates evoked EEG gamma frequency oscillations to target and non-target illusory figures at frontal site F7. Following a 12 session-long TMS course,
early gamma response to non-target decreased, whereas gamma oscillation power to target illusory figures increased. Reprinted, with permission, from Frontiers in
autism research, ed. Valerie W. Hu, copyright 2014 World Scientific Publishing.
352
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ACKNOWLEDGEMENTS
This article is based on several studies partially supported
by a grant from the National Institutes of Health
(MH86784) awarded to Manuel F. Casanova.
References
1. Kemper TL, Bauman M. Neuropathology of infantile autism.
J Neuropathol Exp Neurol 1998; 57: 64552.
2. Bailey A, Luthert PJ, Dean AF, Harding B, Janota I,
Montgomery M, et al. A clinicopathological study of autism.
Brain 1998; 121: 889905.
3. Casanova MF, Buxhoeveden DP, Switala AE, Roy E. Neuronal
density and architecture (grey level index) in the brains of ASD
patient. J Child Neurol 2002; 17: 51521.
4. Casanova MF, Buxhoeveden DP, Switala AE, Roy E.
Minicolumnar pathology in autism. Neurology 2002; 58: 428
32.
5. Casanova MF, Van Kooten IAJ, Switala AE, Van Engeland H,
Heinsen H, Steinbusch HWM, et al. Minicolumnar
abnormalities in autism. Acta Neuropathol 2006; 112: 287303.
6. Casanova MF. The neuropathology of autism. In: Volkmar FR,
Rogers SJ, Paul R, Pephrey KA, editors. Handbook of pervasive
developmental disorders. 4th ed. New York: Wiley, 2014: 497
531.
7. Avino TA, Hutsler JJ. Abnormal cell patterning at the cortical
gray-white matter boundary in autism spectrum disorders.
Brain Res 2010; 1360: 13846.
8. Wegiel J, Kuchna I, Nowicki K, Imaki H, Wegiel J, Marchi E,
et al. The neuropathology of autism: defects of neurogenesis
and neuronal migration, and dysplastic changes. Acta
Neuropathol 2010; 119: 75570.
9. Casanova MF. The minicolumnopathy of autism. In: Buxbaum
J, Hof P, editors. The neuroscience of autism spectrum
disorders. Oxford: Academic Press, 2013: 32733.
10. Yakovlev PI. Pathoarchitectonic studies of cerebral
malformations. III. Arrhinencephalies (Holotelencephalies).
J Neuropathol Exp Neurol 1959; 18: 2255.
11. Sanides F. Functional architecture of motor and sensory
cortices in primates in the light of a new concept of
neocortex evolution. In: Noback CR, Motagna W, editors.
The primate brain. New York: Appleton-Century-Crofts,
1970: 137208.
12. Jones EG, Powell TP. An anatomical study of converging
sensory pathways within the cerebral cortex of the monkey.
Brain 1970; 93: 793820.
13. Creutzfeldt OD. The neocortical link: thoughts on the
generality of structure and function in the neocortex. In:
2015 Foundation Acta Pdiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 346355
353
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
354
Casanova et al.
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