Brainstem tumors may increase the impairment of behavioral emotional cognition in children

Abstract

Purpose It remains unclear as to whether patients with brainstem tumor experience complex neuropsychiatric problems. In this cohort study, we specifically investigated behavioral, emotional and cognitive symptoms in pediatric patients with brainstem glioma and healthy individuals. Methods A total of 146 patients with pediatric brainstem tumors (aged 4–18 years old) and 46 age-matched healthy children were recruited to assess their behaviors and emotions examined by the Child Behavior Checklist. A variety of clinical factors were also analyzed. Results There were significant differences in most behavioral and emotional symptoms between pediatric patients and healthy subjects. Moreover, patients with pons tumors exhibited significantly higher scores than patients with medulla oblongata tumors (p = 0.012), particularly in concerning the syndrome categories of Withdrawn (p = 0.043), Anxious/depressed symptoms (p = 0.046), Thought Problems (p = 0.004), Attention deficits (p = 0.008), Externalizing problems (p = 0.013), and Aggressive behavior (p = 0.004). A tumor body located in the pontine (p = 0.01, OR = 4.5, 95% CI = 1.4–14.059) or DIPG in the midbrain (p = 0.002, OR = 3.818, 95% CI = 1.629–8.948) appears to act as a risk factor that is associated with more problems in patients with neuropsychiatric symptoms. Conclusions Pediatric patients with brainstem tumors exhibit severe behavioral and emotional problems. Tumor invades the pontine and midbrain act a risk factor with more problems. It suggests that structural and functional abnormalities in the brainstem will cause prolonged behavioral problems and emotional-cognitive dysfunctions in young children.

Individualized Cerebellar Damage Predicts the Behavioral Disorders in Children with Brainstem Tumors

“…These symptoms can persist long after surgical intervention 4 . Recent neuropsychological research has demonstrated widespread behavioral impairments in children with brainstem tumors 5 , aligns with previous reports on symptoms caused by posterior fossa tumors 6,7 . Researchers believe these behaviors may result mainly from cerebellar damage 8 .…”

Individualized Cerebellar Damage Predicts the Behavioral Disorders in Children with Brainstem Tumors

“…These symptoms can persist long after surgical intervention 4 . Recent neuropsychological research has demonstrated widespread behavioral impairments in children with brainstem tumors 5 , aligns with previous reports on symptoms caused by posterior fossa tumors 6,7 . Researchers believe these behaviors may result mainly from cerebellar damage 8 .…”

Cholinergic Neuronal Activity Promotes Diffuse Midline Glioma Growth through Muscarinic Signaling

“…We observed an effect of DMG on the baseline neuronal activity of cholinergic midbrain neurons. Given the important neuromodulatory effects of cholinergic signaling on cognition and other brain functions (for review, see 43 ), this raises the possibility that tumor-induced dysregulation of cholinergic neurons – and possibly other neuromodulatory neuron types - in the brainstem may contribute to the cognitive, behavioral and emotional symptoms that DMG patients frequently experience 63 . Further work on interactions between neuromodulatory brainstem neurons and DMG tumor cells is needed.…”

Brain Tumors, AI and Psychiatry: Predicting Tumor-Associated Psychiatric Syndromes with Machine Learning and Biomarkers

“…Thalamic hypometabolism observed based upon PET imaging studies correlates with cognitive slowing, disorganized thought patterns, and decreased emotional responsiveness, symptoms prominent in both thalamic stroke syndromes as well as in many end-stage neurodegenerative disease states [ 50 ]. Lesions of the basal ganglia, particularly those involving the striatum and pallidum, perturb dopaminergic and GABAergic pathways and yield psychomotor slowing, anhedonia, and tumors with Parkinsonian-like features located in the brainstem, particularly the periaqueductal gray and pontine tegmentum, can give rise to catatonic syndromes and autonomic instability as well as dissociative-like states, mirroring their role in emotion–motor integration and autonomic regulation [ 51 ].…”

Individualized Cerebellar Damage Predicts the Behavioral Disorders in Children with Brainstem Tumors

“…These symptoms can persist long after surgical intervention 4 . Recent neuropsychological research has demonstrated widespread behavioral impairments in children with brainstem tumors 5 , aligns with previous reports on symptoms caused by posterior fossa tumors 6,7 . Researchers believe these behaviors may result mainly from cerebellar damage 8 .…”

Cholinergic Neuronal Activity Promotes Diffuse Midline Glioma Growth through Muscarinic Signaling

“…We observed an effect of DMG on the baseline neuronal activity of cholinergic midbrain neurons. Given the important neuromodulatory effects of cholinergic signaling on cognition and other brain functions (for review, see 43 ), this raises the possibility that tumor-induced dysregulation of cholinergic neurons – and possibly other neuromodulatory neuron types - in the brainstem may contribute to the cognitive, behavioral and emotional symptoms that DMG patients frequently experience 63 . Further work on interactions between neuromodulatory brainstem neurons and DMG tumor cells is needed.…”

Brain Tumors, AI and Psychiatry: Predicting Tumor-Associated Psychiatric Syndromes with Machine Learning and Biomarkers

“…Thalamic hypometabolism observed based upon PET imaging studies correlates with cognitive slowing, disorganized thought patterns, and decreased emotional responsiveness, symptoms prominent in both thalamic stroke syndromes as well as in many end-stage neurodegenerative disease states [ 50 ]. Lesions of the basal ganglia, particularly those involving the striatum and pallidum, perturb dopaminergic and GABAergic pathways and yield psychomotor slowing, anhedonia, and tumors with Parkinsonian-like features located in the brainstem, particularly the periaqueductal gray and pontine tegmentum, can give rise to catatonic syndromes and autonomic instability as well as dissociative-like states, mirroring their role in emotion–motor integration and autonomic regulation [ 51 ].…”

Individualized Cerebellar Damage Predicts the Behavioral Disorders in Children with Brainstem Tumors

“…These symptoms can persist long after surgical intervention 4 . Recent neuropsychological research has demonstrated widespread behavioral impairments in children with brainstem tumors 5 , aligns with previous reports on symptoms caused by posterior fossa tumors 6,7 . Researchers believe these behaviors may result mainly from cerebellar damage 8 .…”

Cholinergic Neuronal Activity Promotes Diffuse Midline Glioma Growth through Muscarinic Signaling

“…We observed an effect of DMG on the baseline neuronal activity of cholinergic midbrain neurons. Given the important neuromodulatory effects of cholinergic signaling on cognition and other brain functions (for review, see 43 ), this raises the possibility that tumor-induced dysregulation of cholinergic neurons – and possibly other neuromodulatory neuron types - in the brainstem may contribute to the cognitive, behavioral and emotional symptoms that DMG patients frequently experience 63 . Further work on interactions between neuromodulatory brainstem neurons and DMG tumor cells is needed.…”

Brain Tumors, AI and Psychiatry: Predicting Tumor-Associated Psychiatric Syndromes with Machine Learning and Biomarkers

“…Thalamic hypometabolism observed based upon PET imaging studies correlates with cognitive slowing, disorganized thought patterns, and decreased emotional responsiveness, symptoms prominent in both thalamic stroke syndromes as well as in many end-stage neurodegenerative disease states [ 50 ]. Lesions of the basal ganglia, particularly those involving the striatum and pallidum, perturb dopaminergic and GABAergic pathways and yield psychomotor slowing, anhedonia, and tumors with Parkinsonian-like features located in the brainstem, particularly the periaqueductal gray and pontine tegmentum, can give rise to catatonic syndromes and autonomic instability as well as dissociative-like states, mirroring their role in emotion–motor integration and autonomic regulation [ 51 ].…”