Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Dec 9, 2023; 12(5): 310-318
Published online Dec 9, 2023. doi: 10.5409/wjcp.v12.i5.310
Brain metabolic profile assessed by magnetic resonance spectroscopy in ‎‎children with Down syndrome: Relation to intelligence quotient
Nesreen Safwat El Feil, Heba S Elmahdy, Rasha Ahmed Elmahdy, Ahmed Abd-Elbasset Aboelezz‎, Heba S Dawoud, Mohammed Al-Beltagi
Nesreen Safwat El Feil, Heba S Elmahdy, Ahmed Abd-Elbasset Aboelezz‎, Heba S Dawoud, Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Al ‎Gharbia, Egypt
Rasha Ahmed Elmahdy, Department of Radiology, University Medical Center, Dr. Sulaiman Al-Habib Medical Group‎, Manama 26671, Manama, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, ‎Arabian Gulf University, Manama 26671, Manama, Bahrain
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group‎, Manama 26671, Manama, Bahrain
Author contributions: Dawoud HS provided the research idea and initiated the study design; El-Feil SE and El Mahdy HS collected the patients and their information; Aboelezz AA was responsible for statistical analysis; Elshafey RA was responsible for the technical part of the study; Also, Elshafey RA oversaw imaging and data analysis; Al-Biltagi M analyzed the data and revised the manuscript. All the authors revised and agreed on the final version of the manuscript.
Institutional review board statement: We performed the study according to the latest version of Helsinki's Declaration. The Institutional Ethical and Research Review Board of Faculty of Medicine, Tanta University, approved the study.
Informed consent statement: All parents, guardians, or next of kin signed informed consent for the minors to participate in this study.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Academic Editor, Chairman, Consultant Physician-Scientist, Professor, Researcher, Department of Pediatrics, Faculty of Medicine, Tanta University, Al bahr street, Tanta 31527, Al ‎Gharbia, Egypt. mbelrem@hotmail.com
Received: July 17, 2023
Peer-review started: July 17, 2023
First decision: August 31, 2023
Revised: September 18, 2023
Accepted: September 28, 2023
Article in press: September 28, 2023
Published online: December 9, 2023
ARTICLE HIGHLIGHTS
Research background

Down syndrome (DS) is the most prevalent chromosomal disorder in humans and one of the leading causes of intellectual disability. Magnetic resonance (MR) spectroscopy (MRS) is an analytical technique used to quantify metabolites. Proton MRS (1 H-MRS) is widely employed to characterize brain neurochemical changes associated with health and disease. N-acetyl aspartic acid (NAA) is a derivative of aspartic acid primarily synthesized and stored in neurons. Therefore, it is a marker for neuronal density and viability.

Research motivation

Establishing a connection between the brain's metabolic profiles and intelligence quotient (IQ) in children with DS could provide insights into the underlying reasons for this relationship and aid in developing strategies to improve their IQ.

Research objectives

We aimed to evaluate the brain's metabolic profile using MRS in children with DS, comparing it with that of normal controls and examining the correlation between this metabolic profile and IQ.

Research methods

The study was a case-control study that included sixty children with DS and forty healthy controls. IQ was assessed using Stanford-Binet Intelligence Scales, Fifth Edition. A conventional MR imaging scan followed by point-resolved spectroscopy was performed for all the participants.

Research results

Children with DS showed significant reductions in NAA/creatine (Cr) and myoinositol (MI)/Cr and a non-significant reduction in choline (Cho)/Cr in frontal lobes compared to controls. Additionally, we observed significant decreases in NAA/Cr, MI/Cr, and Cho/Cr in the temporal and occipital lobes and basal ganglia in children with DS compared to controls. Furthermore, there was a significant correlation between IQ and metabolic ratios in the brains of children with DS.

Research conclusions

Brain metabolic profile could be a good predictor of IQ in children with DS.

Research perspectives

To generalize our results, the authors must include a larger sample size and perform a multicentre study. We also need to include another group with low IQ for different reasons to investigate the unique features of brain metabolic profiles in children with DS.