Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Brain Electrophysiology In Craniosynostosis And Deformational Plagiocephaly
Jenny F. Yang, B.S., Eric D. Brooks, B.S., Peter W. Hashim, M.D., Roberto Travieso, M.D., Jordan Terner, M.D., Hannah Reuman, B.A., Karen Law, B.A., Emily Levy, B.A., Linda C. Mayes, Ph.D., James C. McPartland, Ph.D., John A. Persing, M.D..
Yale University School of Medicine, New Haven, CT, USA.

PURPOSE:
Though traditionally considered a rare form of craniosynostosis, metopic synostosis (MSO) now represents 25% of all non-syndromic cases (Kolar, 2011). MSO is associated with a prominent ridge over the pathologically fused metopic suture. However, up to 10-25% of normal infants may also display variable amounts of metopic ridging and frontal bone narrowing, albeit without the classic trigonocephaly and hypotelorism seen in MSO (Cohen, 2000). This metopic ridging (MR) may be associated with occipital skull deformity, as 39% of infants with deformational plagiocephaly (DP) display a ridge (Fisher, 2011).
Recent research has reported atypical auditory processing in a group of infants with different types of single-suture craniosynostosis (Hashim, 2014), as well as long-term language-related learning disability in adolescents with sagittal synostosis (Patel, 2014). It remains unclear whether MR, MSO, and DP pose similar risks for neural dysfunction. The present study aims to use an electrophysiological approach to evaluate the extent of impact carried by MR, MSO, and DP on early neurodevelopment. Findings will be compared to age-matched control infants and to infants with sagittal synostosis (SSO).
METHODS:
Five groups of infants (65 participants total) underwent evaluations of auditory processing: 12 patients with DP alone, 8 with DP plus MR, 13 with MSO, 8 with SSO, and 24 controls. Brain activity was recorded by electroencephalography (EEG) using a 128 channel HydroCel GSN net while the participants passively listened to auditory presentations of speech syllables. EEG data was analyzed to extract event related potentials (ERPs) evoked by the speech sounds. Analyses focused on the peak amplitudes of the P150 and N450 components of ERPs, given their reported correlation with future cortical function. The P150 component was examined over the frontal scalp areas, and the N450 component was examined over the temporal scalp areas. The analyses were carried out for left and right brain hemispheres, as language processing is a cerebrally lateralized function and atypical lateralization has been linked to language impairments (Seery, 2012).
RESULTS:
Analyses at the N450 component showed typical patterns of left-hemispheric lateralization in typically developing infants (p=0.03). Lateralization was not significant in patients with DP, DP+MR, MCSO, or SSO.
Analyses of peak amplitudes at the P150 component revealed that patients with DP, DP+MR, and MCSO had comparable responses to auditory stimuli relative to normally developing infants. SS patients, however demonstrated significantly attenuated responses at the P150 component compared to controls (p=0.01).
CONCLUSION:
Absence of hemispheric lateralization was found in all skull deformity groups while control subjects demonstrated normal patterns, suggesting deviant or delayed language processing in patients. The current study also reports for the first time that sagittal synostosis patients demonstrated a deficient response to speech in the frontal brain area that was not found in the other cranial conditions.


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