Papers by Piyadasa Kodituwakku
he adverse effects of alcohol on the developing human represent a spectrum of structural anomalie... more he adverse effects of alcohol on the developing human represent a spectrum of structural anomalies, behavioral and neurocognitive disabilities, most accurately termed Fetal Alcohol Spectrum Disorder (FASD). Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD: the 1996 Institute of Medicine (IOM) criteria and the Washington University criteria. Although both approaches have improved the clinical delineation of FASD, both have significant drawbacks in their application in pediatric practice. The IOM criteria are vague, with no specific parameters set forth for diagnosis in each category. First, neither the degree of growth deficiency nor the exact facial dysmorphic features required for each category have been defined. In addition, the specific behavioral/cognitive phenotype is not characterized. Second, assessment of the family and genetic history of each affected child is not addressed adequately. Finally, alcohol-...
Pediatrics, 2005
Background. The adverse effects of alcohol on the developing human represent a spectrum of struct... more Background. The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice. Objective. The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice. Methods. A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information.
Sri Lanka Journal of Neurology
Neuroscience in the 21st Century
Sensors
Prior studies indicate differences in brain volume and neurophysiological responses of musicians ... more Prior studies indicate differences in brain volume and neurophysiological responses of musicians relative to non-musicians. These differences are observed in the sensory, motor, parietal, and frontal cortex. Children with a fetal alcohol spectrum disorder (FASD) experience deficits in auditory, motor, and executive function domains. Therefore, we hypothesized that short-term music training in children with an FASD due to prenatal alcohol exposure may improve brain function. Children (N = 20) with an FASD were randomized to participate in either five weeks of piano training or to a control group. Selective attention was evaluated approximately seven weeks apart (pre-/post-music training or control intervention), examining longitudinal effects using the Attention Networks Test (ANT), a well-established paradigm designed to evaluate attention and inhibitory control, while recording EEG. There was a significant group by pre-/post-intervention interaction for the P250 ms peak of the even...
ABSTRACT. Objective: The aim of the study was to determine the prevalence and characteristics of ... more ABSTRACT. Objective: The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a sec-ond primary school cohort in a community in South Africa. Method: Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psy-chological characteristics of the children and measures of maternal al-cohol use and smoking were analyzed. Results: The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000).
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Galle Medical Journal, 2020
Introduction: Loss of memory is the hallmark of dementia. In Sri Lanka, validated tests are not a... more Introduction: Loss of memory is the hallmark of dementia. In Sri Lanka, validated tests are not available for assessment of memory. The objective of the project was to study performance of Sri Lankan older adults on three memory tests: Lankan Verbal Learning Test (LVLT), Benton Visual Retention Test (BVRT) and Modified Enhanced Cued Recall Test (MECRT). Methods: Participants were 241 healthy individuals aged between 50 to 80 years. They were individually administered the tests by a research assistant. The LVLT is a verbal list learning task. The BVRT contains geometric figures that are presented in the recognition memory format. The MECRT assesses the memory for pictures aided with semantic cues. Means of test scores were calculated and compared for gender, age and levels of education. Multiple linear regression models were used. Results: The mean age was 63 (SD=7.7) years. Gender effect was prominent on verbal memory scores. The test scores were influenced by gender and education l...
AJNR. American journal of neuroradiology, 1999
Patients with mild traumatic brain injury (TBI) often show significant neuropsychological dysfunc... more Patients with mild traumatic brain injury (TBI) often show significant neuropsychological dysfunction despite the absence of abnormalities on traditional neuroradiologic examinations or EEG. Our objective was to determine if magnetic source imaging (MSI), using a combination of MR imaging and magnetoencephalography (MEG), is more sensitive than EEG and MR imaging in providing objective evidence of minor brain injury. Four subject groups were evaluated with MR, MSI, and EEG. Group A consisted of 20 neurologically normal control subjects without histories of head trauma. Group B consisted of 10 subjects with histories of mild head trauma but complete recovery. Group C consisted of 20 subjects with histories of mild head injury and persistent postconcussive symptoms. The 15 subjects included in group D underwent repeat examinations at an interval of 2 to 4 months. No MR abnormalities were seen in the normal control group or the asymptomatic group, but five (20%) of the patients with pe...
Current Developmental Disorders Reports, 2014
The term "fetal alcohol spectrum disorders" (FASD) denotes the broad spectrum of morphological ch... more The term "fetal alcohol spectrum disorders" (FASD) denotes the broad spectrum of morphological changes and functional deficits seen in children exposed to alcohol prenatally. While some children on the spectrum show the characteristic pattern of malformations called "fetal alcohol syndrome" (FAS), a significant proportion of alcohol-exposed children do not evidence clinically identifiable morphological alterations. The term "alcohol-related neurodevelopmental disorder" (ARND) is used to label the latter group. The identification of children with ARND has proven to be challenging because of the lack of clinically discernable physical signs. Therefore, some investigators have used the strategy of assessing maternal drinking during pregnancy and then tracking developmental outcomes in offspring longitudinally. Other methods that investigators have utilized to identify children with prenatal alcohol exposure in population-based studies include multi-source surveillance and active case ascertainment. In the current review, we discuss the merits and demerits of these methodologies and then present novel methods of identifying prenatal alcohol exposure (e.g., biomarkers) and subtle effects of morphological alterations and neural effects (e.g., neuroimaging).
Human Brain Mapping, 2012
Relapse presents a significant problem for patients recovering from stimulant dependence. Here we... more Relapse presents a significant problem for patients recovering from stimulant dependence. Here we examined the hypothesis that patterns of brain function obtained at an early stage of abstinence differentiates patients who later relapse versus those who remain abstinent. Forty-five recently abstinent stimulant-dependent patients were tested using a randomized event-related functional MRI (ER-fMRI) design that was developed in order to replicate a previous ERP study of relapse using a selective attention task, and were then monitored until 6 months of verified abstinence or stimulant use occurred. SPM revealed smaller absolute blood oxygen level-dependent (BOLD) response amplitude in bilateral ventral posterior cingulate and right insular cortex in 23 patients positive for relapse to stimulant use compared with 22 who remained abstinent. ER-fMRI, psychiatric, neuropsychological, demographic, personal and family history of drug use were compared in order to form predictive models. ER-fMRI was found to predict abstinence with higher accuracy than any other single measure obtained in this study. Logistic regression using fMRI amplitude in right posterior cingulate and insular cortex predicted abstinence with 77.8% accuracy, which increased to 89.9% accuracy when history of mania was included. Using 10-fold cross-validation, Bayesian logistic regression and multilayer perceptron algorithms provided the highest accuracy of 84.4%. These results, combined with previous This manuscript is dedicated to Dr. Robert E. Anderson, who played an essential part in acquiring the data described here, and who passed away during the preparation of this article.
Alcoholism: Clinical & Experimental Research, 2004
Alcoholism: Clinical and Experimental Research, 1995
The present study utilizes a conceptual framework derived from theories of cognition to explain t... more The present study utilizes a conceptual framework derived from theories of cognition to explain the pattern of behavioral and learning problems observed in subjects with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Based on a modern interpretation of Luria's theory of self‐regulation, this study used a neuropsychological test battery to compare 10 subjects (mean age = 13 years) having FAS/FAE with 10 control subjects (mean age = 12 years and 9 months). Subjects with FAS/FAE were relatively high functioning and did not significantly differ from controls with respect to receptive vocabulary. However, those with FAS/FAE exhibited greater difficulty than controls on tasks that involved the manipulation of information and goal management in working memory (e.g., Planning, Controlled Oral Word Association, etc). Both groups performed equally well on some tasks that demanded rule learning (Delayed Response) and response inhibition (Go‐No‐Go). The above impairments were...
Developmental Cognitive Neuroscience
Fetal alcohol spectrum disorder (FASD) is characterized by a broad range of behavioral and cognit... more Fetal alcohol spectrum disorder (FASD) is characterized by a broad range of behavioral and cognitive deficits that impact the long-term quality of life for affected individuals. However, the underlying changes in brain structure and function associated with these cognitive impairments are not well-understood. Previous studies identified deficits in behavioral performance of prosaccade tasks in children with FASD. In this study, we investigated group differences in gamma oscillations during performance of a prosaccade task. We collected magnetoencephalography (MEG) data from 15 adolescents with FASD and 20 age-matched healthy controls (HC) with amean age of 15.9 ± 0.4 years during performance of a prosaccade task. Eye movement was recorded and synchronized to the MEG data using an MEG compatible eye-tracker. The MEG data were analyzed relative to the onset of the visual saccade. Time-frequency analysis was performed using Fieldtrip with a focus on group differences in gamma-band osci...
Pediatric neurology, 2021
BACKGROUND Prior work suggests that event-related potential (ERP) studies in infancy may help pre... more BACKGROUND Prior work suggests that event-related potential (ERP) studies in infancy may help predict developmental outcome. METHODS As part of a longitudinal study of early child development, we used the auditory oddball stimulus paradigm with a portable electroencephalography system to obtain ERP data from two-month-old infants (32 term, six preterm) in Sri Lanka. The mismatch negativity was calculated between 200 and 350 milliseconds after stimulus presentation. RESULTS We found a significant correlation between birth weight and mismatch negativity (P = 0.046), and our time-frequency analysis indicated power differences between standard and oddball tones at approximately 5 and 18 Hz. There was no significant difference between mismatch negativity in children undergoing ERP studies in a hospital setting (30) versus in the child's home (eight). CONCLUSIONS Although our modest sample size precludes drawing definitive conclusions, these preliminary results show that it is possibl...
OBJECTIVE Factors associated with alcohol consumption during pregnancy and with fetal alcohol syn... more OBJECTIVE Factors associated with alcohol consumption during pregnancy and with fetal alcohol syndrome (FAS) births were examined as part of a larger epidemiologic study of FAS in a community in the Western Cape Province of South Africa. METHOD Using retrospective case-control methodology, 31 mothers who had given birth to FAS children 6 to 9 years previously were compared with 31 matched controls on a variety of demographic, socioeconomic, drinking, family and maternity variables. Descriptive analyses were utilized to determine major differential characteristics between the two groups. RESULTS In this community with a very high rate of FAS and rather uniform low socioeconomic status, the two groups were found to be comparable with respect to age, annual income, ethnic background, age of initiation of regular drinking, age at birth of the index child, gravidity and parity. However, mothers of FAS children reported initiating drinking at an earlier age, as well as reporting higher ra...
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Papers by Piyadasa Kodituwakku