The Cerebellum

Spinocerebellar ataxia type 7 (SCA7) is a rare neurodegenerative disorder characterized by progressive cerebellar ataxia and visual impairment. We investigated longitudinal changes in resting-state functional connectivity and their clinical associations. Resting-state functional MRI was acquired from 16 individuals with SCA7 and 16 age- and sex-matched healthy controls across three visits over 24 months. Network-to-network functional connectivity was quantified, and machine-learning models were trained using functional connectivity features. SCA7 showed lower MoCA (p = 0.045) and MMSE (p = 0.025) scores and progressive worsening of ataxia (SARA, p < 0.001). Significant Group x Visit interactions were observed for Visual-Default Mode (p = 0.012) and Somatomotor-Cerebellar Dorsal Attention connectivity (p = 0.038). Functional connectivity abnormalities involved cortical, cortico-cerebellar, and cerebellar networks that became more widespread at the final follow-up assessment, with the visual network emerging as the most consistently affected system across analyses. Functional connectivity abnormalities were associated with cognitive performance (MMSE: r = -0.62, p = 0.01) and disease severity (SARA: r = 0.589, p = 0.016). Functional connectivity features accurately classified SCA7 and healthy controls (accuracy = 96.4%, F1 = 0.969). These findings support resting-state functional connectivity as a candidate biomarker warranting further validation in larger, independent cohorts.

Background: Transcranial direct current stimulation (tDCS) is increasingly used as an adjunct to rehabilitation for young people with cerebral palsy (CP), yet considerable variability exists in clinical response. Individualised electric field modelling provides an opportunity to estimate the distribution of electrical fields generated by the stimulation delivered to the brain and explore potential relationships with functional outcomes. Methods: Structural MRI scans from nineteen participants (10-16 years) from a previously published randomised controlled trial (ISRCTN74235136) investigating the effects of tDCS combined with motor training, underwent participant-specific finite element modelling using SimNIBS. Electric field strength was quantified within anatomically defined motor regions of interest, including the primary motor cortex (M1), dorsal premotor cortex (PMd), supplementary motor area (SMA), and a combined motor network. Global grey matter electric field metrics and stimulation focality were also extracted. Results: Estimated electric field strength differed significantly across motor regions (p<0.001), with PMd receiving significantly greater stimulation than both M1 and SMA. Electric field strength within a control region (primary visual cortex) was significantly lower than within M1 (p<0.001). Despite inter-individual variability in regional and global electric field metrics, no significant associations were observed between estimated electric field strength or focality and changes in function following intervention. Conclusion: Individualised electric field modelling demonstrated that an M1-targeted tDCS montage preferentially stimulated PMd rather than M1 in young people with CP. These findings highlight the importance of subject-specific modelling when characterising current distribution and suggest that variability in electric field strength alone does not explain variability in behavioural response.

Abstract Background: Transcranial direct current stimulation (tDCS) paired with behavioral language therapy can improve naming in persons with aphasia (PWA), yet naming errors persist. Little is known about how naming error patterns change after non-invasive brain stimulation is combined with language treatment. Aims: To examine whether right cerebellar tDCS plus computerized aphasia therapy changes the types of naming errors in people with chronic aphasia across timepoints, and to determine whether effects differ by cerebellar tDCS polarity (anode vs. cathode). Methods and Procedures: In a randomized, double-blind, sham-controlled, within-subject crossover study, we retrospectively analyzed behavioral data from 24 individuals with post-stroke aphasia. Each participant completed two 15-session intervention periods (3-5 sessions/week) with active cerebellar tDCS + computerized aphasia therapy and sham + computerized aphasia therapy, separated by a two-month washout. General linear models (GLMs) assessed longitudinal changes in six error types (semantic, phonological real word, phonological nonword, no response, mixed, unrelated) on an untrained picture naming task (Philadelphia Naming Test; PNT) and a trained task (Naming 80; N80). Additional GLMs evaluated polarity effects with 2 (Group: anode vs. cathode) x 2 (Treatment) interactions, and treatment-order effects with 2 (Group: tDCS-first vs. sham-first) x 2 (Treatment) interactions. Outcomes and Results: Active cerebellar tDCS did not significantly change error types for trained items (N80). For untrained items (PNT), active tDCS reduced several error types relative to sham, with the clearest and most durable reduction in phonological nonword errors; more moderate reductions occurred for phonological real word and unrelated errors. Mixed errors showed a marginally opposite pattern, tending to increase after tDCS and decrease after sham. Polarity analyses indicated broadly similar effects across anodal and cathodal stimulation overall, but only the anode group showed a reliable treatment effect for phonological nonword errors on the PNT. Treatment-order analyses revealed no significant order effects. Conclusions: Our results indicate a shift in naming error types, particularly after tDCS treatment for the untrained naming task (PNT). These findings may help guide the course of treatment approaches of those with aphasia and what error naming pattern types may show changes post stroke when combining non-invasive brain stimulation and computerized aphasia therapy. Clinical Trial Registration: Cerebellar Transcranial Direct Current Stimulation and Aphasia Treatment [NCT02901574] Keywords: aphasia, naming errors, non-invasive brain stimulation, cerebellar tDCS, computerized aphasia treatment

The cerebellar nuclei (CN) has demonstrated its influence on cognitive behavior via the cerebello-cortico circuit, yet the role of CN critical period mechanisms and how they may influence cognitive behavior, such as parvalbumin (PV) expressing interneurons enwrapped by perineuronal nets (PNNs), is still unclear. Therefore, we investigated the role of the lateral CN (LCN) PV cell calcium activity while animals performed a visual discrimination touchscreen cognitive task. All animals received the PV cell calcium indicator GCaMP6f at postnatal day 21 (P21). We targeted the LCN critical period by manipulating neural activity in male mice using the inhibitory Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) from postnatal day 21 to 35 or by injecting an Hapln1-AAV vector to selectively target LCN PNN development. After animals completed the visual discrimination task, cerebellar tissue was collected for viral recovery and antibody staining for PNN components, Hapln1 and aggrecan. Results revealed DREADD animals showed improved reversal learning, an increase in calcium response to learning-related activity and altered PNN expression (Hapln1 and aggrecan). Hapln1 treated animals displayed a decrease in final day acquisition performance, lower reversal performance compared to DREADD groups, a decrease in reversal calcium learning-related activity, and an increase in PNN expression (Hapln1). Together, these data provide further evidence of LCN mechanisms associated with learning as well as the importance of understanding region-specific critical periods of plasticity.

Background: The hydrodynamic model of hydrocephalus proposes that ventriculomegaly is driven by exaggerated intraventricular pulsations rather than impaired CSF circulation alone. Under this model, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) treats hydrocephalus by creating a pulsation absorber and by reducing a primary source of intraventricular pulsation. However, direct intraoperative human evidence supporting this two-step mechanism is lacking. This study aimed to test the hypothesis that ETV followed by CPC would produce measurable, stepwise decreases in mean intraventricular pressure (ICP) and pulsation amplitude in infants with hydrocephalus. Methods: This single-institution proof-of-concept study included infants with symptomatic hydrocephalus undergoing ETV/CPC as the first definitive treatment. A fiber-optic ICP sensor was attached to the operative ventriculoscope and passively recorded mean and pulsatile ICP (pulsation amplitude) throughout the procedure. Longitudinal brain parenchymal volume (BPV) and cerebrospinal fluid volume (CSFV) were obtained through segmentation of clinically acquired T2-weighted MRI and converted to age- and sex-matched z-scores. All patients were followed for a minimum of 6 months postoperatively. Results: Five infants (median corrected age at ETV/CPC 8 months) were included. No surgical complications occurred, and no ETV/CPC failures were observed during follow-up. Overall, mean ICP decreased by 56-97% after the combined procedure in four patients. In three patients (Patients 1, 3, and 5), both mean ICP and pulsation amplitude decreased stepwise following ETV and then CPC, consistent with the hypothesized therapeutic mechanism. Patient 4 demonstrated a large reduction in mean ICP after ETV with minimal additional effect from CPC and no significant change in pulsation amplitude. Patient 2 demonstrated neither a reduction in mean ICP nor a meaningful change in pulsation amplitude after either procedure; this patient also had a delayed and atypical clinical response. Intracranial segmentation demonstrated BPV z-score stabilization within normal range and CSFV plateau in all patients after surgery. Conclusions: This proof-of-concept study provides the first direct intraoperative human evidence supporting the hydrodynamic mechanism of ETV/CPC in a subset of infant with hydrocephalus. Our findings suggest that determination of intraoperative ICP parameters is feasible, safe and might ultimately prove helpful in improving patient selection for ETV/CPC, warranting further investigation in larger cohorts.

Background: Infant muscle tone reflects early central nervous system integrity and has been associated with later motor and cognitive development, including autism traits. The cerebellum regulates both motor control and higher-order socio-cognitive functions and has been repeatedly implicated in autism, but its role in linking infant muscle tone to adolescent autistic traits has not previously been studied in a large, prospective population cohort. Methods: We used data from the prospective Generation R Study. Infant muscle tone (hypotonia and hypertonia) was assessed via Prechtl examination, and third-trimester fetal transcerebellar diameter was measured using ultrasound n=6,842). Cerebellar morphology at ages 6, 10, and 14 years (n=4,861) was measured using structural MRI. Linear mixed-effects models tested associations between infant muscle tone and 35 anatomical and 10 functional cerebellar regions. Causal mediation models tested whether cerebellar volume mediated associations between infant muscle tone and adolescent autistic traits at age 14 (Social Responsiveness Scale). Results: Hypotonia predicted larger vermis IX volumes across childhood (beta=0.037, pFDR =0.043). Hypertonia showed an age-dependent association with left lateral lobule IX (beta=-0.0027, pFDR =0.041), with differences diminishing with age. Third-trimester transcerebellar diameter did not predict postnatal muscle tone. Given its significant main effect, vermis IX volume was tested as a mediator, but did not mediate the pathway to adolescent autistic traits. However, infant hypotonia showed a small direct association with elevated autistic traits at age 14, specific to girls (beta=0.0255, p=0.020). Conclusions: Infant muscle tone is associated with localized differences in cerebellar volumes. These associations are specific to vermal and left hemispheric lobule IX, a region commonly implicated in spinocerebellar postural control, axial stability, and higher-order sensorimotor integration. Furthermore, infant muscle tone was not predicted by prenatal cerebellar diameter, and cerebellar volumes did not mediate the association between infant hypotonia and adolescent autistic traits in our study. Future research should further investigate these findings in clinical populations, integrating longitudinal whole-brain, multi-modal imaging to clarify the association between infant muscle tone, the cerebellar functioning, and autistic traits.

A central challenge in systems neuroscience is understanding how computational mechanisms--including those implemented within a single brain region--interact to produce behavior. For example, prior work in the literature attributes many computational functions to the cerebellum, but these functions have been tested in isolation and it remains unclear how they jointly contribute to motor control. Here, we test several established hypotheses of cerebellar function: internal modeling, timing of movement dynamics, sensory-error processing, delay processing, and multimodal integration. We first formalize these functions as mechanistic parameters within a computational model of speech motor control. We then use this formalism to investigate the relative contribution of each function to the abnormal speech corrective response seen in adults with cerebellar degeneration during perturbed auditory feedback. We find the following functions explain most of the behavioral differences: internal modeling, timing of movement dynamics, and multimodal integration. We also show that the key mechanisms have a trade-off relationship, and that cerebellar degeneration modulates those trade-off strengths and boundaries. These results both elaborate the mechanistic function of the cerebellum in speech feedback control and, more broadly, demonstrate the promise of using this paradigm to simultaneously test competing theories of neural function underlying behavior.

The Visual Word Form Area (VWFA), located in ventral occipitotemporal cortex, plays a critical role in skilled reading. Researchers have theorized that the VWFA develops in its specific anatomical location due to the convergence of major white matter tracts and proximity to functionally similar regions. This suggests that precise anatomical positioning may be crucial for optimal VWFA function. Previous research has identified several functional differences in this region between typical and struggling readers (i.e. dyslexia): struggling readers show weaker text-selective responses and often exhibit a smaller or even absent VWFA. However, it remains unexplored whether the precise anatomical location of this region also differs between typical and struggling readers. We tested whether VWFA anatomy differs between children with and without dyslexia (N=87). Participants completed a functional localizer, which we used to manually define the VWFA in each individuals native anatomy. We examined whether: (1) VWFA anatomical location relates to reading ability, (2) children with dyslexia show greater variability in VWFA location compared to typical readers, and (3) VWFA location with respect to white matter tracts relates to reading ability. Results reveal that, despite being smaller in children with dyslexia, there is no relationship between VWFA location and reading ability. Specifically, individual VWFA location relative to anatomy, relative to others VWFAs, and relative to white matter tracts, is not related to reading ability. These findings suggest that while the VWFAs general anatomy may be facilitated by development, its precise location remains stable and unrelated to reading proficiency.

Research suggests that motor difficulties in Developmental Coordination Disorder (DCD) are related to altered motor sequence planning, but it is unclear which mechanisms are affected, particularly in adults. This study addresses that gap by examining how the order of upcoming movements during the planning of skilled typing sequences affects motor production in adults with DCD. Previous monkey neurophysiology and behavioural findings in humans have shown that elements of a sequence are pre-ordered prior to execution, known as competitive queuing (CQ). CQ quality is predictive of subsequent performance, with skilled performers, those with fewer errors, having a larger position-dependent difference. DCD (N=28) and control participants (N=54) performed two 4-element finger sequences from memory in a delayed sequence production task over 3 sessions. Probe trials, which involved participants performing a single press after the Go Cue, assessed motor planning at each sequence position by measuring reaction time (RT) and error rate. We found that adults with DCD had a higher error rate and were slower to initiate and perform correct sequences. In terms of planning, the DCD group showed reduced preordering of sequence elements. Whilst the DCD group had a higher error rate on a working memory task, this was not correlated with the degree of pre-ordering of presses of the upcoming sequence. These findings suggest that disrupted motor sequence planning in DCD is characterised specifically by a failure to pre-order movements during the retrieval of sequences from memory. Additionally, motor sequence pre-ordering deficits in DCD are independent of general working memory impairments. These results extend prior evidence from motor imagery paradigms, demonstrating that internal modelling deficits are evident during the execution of motor plans. HighlightsO_LIAdults with DCD show diminished pre-ordering of sequential movements during planning. C_LIO_LIThe DCD group were slower to initiate and perform correct sequences from memory. C_LIO_LIMotor sequence planning is distinct from working memory performance. C_LIO_LIThis provides evidence for the IMD hypothesis in a skilled sequential task. C_LI

Objective: Working memory (WM) deficits are a co-occurring feature to numerous neuropsychiatric disorders, particularly attention-deficit/hyperactivity disorder (ADHD), and there remain no treatments that directly target WM. The coupling between the phase of theta band activity and amplitude of gamma band activity (i.e., TGC) is an established neural correlate of WM. However, no studies have examined WM-related TGC in ADHD or whether neuromodulation can modulate these oscillatory dynamics in youth. This set of studies examined the effects of intermittent theta burst stimulation (iTBS) to the left dorsolateral prefrontal cortex (DLPFC) and left posterior parietal cortex (PPC) on TGC in youth with ADHD. Methods: In two randomized, double-blind, sham-controlled crossover trials, adolescents with ADHD and clinically significant parent-reported WM symptoms first completed a single-session study comparing DLPFC versus PPC iTBS targeting (n = 47) and then a multi-session clinical trial comparing 10 sessions of active versus sham left DLPFC iTBS (n = 29). Participants completed a computerized visuospatial Sternberg WM task with concurrent electroencephalography (EEG) before and after the single sessions, as well as at baseline, midway through treatment, and approximately 24 hours after the final session within the multi-session trial. Phase-amplitude coupling between theta phase and gamma amplitude was quantified using the Kullback Leibler modulation index at frontoparietal electrodes. Linear mixed-effects models examined treatment effects and associations between change in TGC and WM status (including accuracy, reaction time, and clinical symptoms). Results: Across participants, lower TGC was associated with lower symptoms and better WM performance, including higher accuracy, faster and more consistent RT. Active iTBS increased frontoparietal TGC relative to sham stimulation, with effects observed both acutely after a single session and ~24 hours after multiple sessions. DLPFC-targeted iTBS increased TGC, whereas PPC-iTBS had no measurable effect. Change in TGC was associated with change in WM, such that a decrease in TGC was associated with faster RT and decreased RT variability. Higher baseline TGC was associated with greater improvement in WM. Active iTBS decoupled the TGC-WM association observed during sham iTBS, and greater electric field intensity of iTBS was associated with greater improvement in WM accuracy and greater decrease in TGC. Conclusions: Active iTBS to the left DLPFC modulated WM-related TGC in youth with ADHD. These findings provide preliminary evidence that neuromodulation may improve WW by modifying oscillatory dynamics within frontoparietal networks. Larger clinical trials with higher stimulation doses are needed to determine whether targeting oscillatory coupling represents a potential therapeutic strategy for WM deficits.

Objective: Pediatric epilepsy patients undergoing stereo-electroencephalography (sEEG) for ictal onset evaluation provide a rare window to study the developing brain. While methodological frameworks for task-based sEEG research are well-established in adults, pediatric-specific guidance remains underdeveloped. Furthermore, many pediatric epilepsy patients have comorbidities that might typically exclude them from participating in research. We examine factors that influence research participation and discuss considerations for conducting sEEG research in children. Methods: Here, we present a retrospective analysis of task-based research participation patterns from an NIH-funded study of speech and language representations (1R01DC018579) in 66 patients (ages 4-24) undergoing sEEG monitoring at Texas Children's Hospital to determine whether specific comorbidities influenced research participation. Results: Eighty-nine percent (n=66) of patients approached for consent agreed to participate in the study. Despite high rates of comorbidities including neurocognitive disorder (66.67%), language delay (31.75%), global developmental delay (23.81%), mood disorders (33.33%), ADHD (46.03%), autism spectrum disorder (14.29%) or other cognitive/intellectual disabilities (36.51%), all participants engaged in at least one task. While the majority of these diagnoses did not appear to influence subject participation, global developmental delay was associated with a significant reduction in time spent on active tasks. Discussion: Despite high prevalence of neuropsychological comorbidities among participants, our evidence suggests that these participants contribute meaningfully to studies investigating important developmental questions. We suggest strategies for tailoring task-based research to accommodate the unique needs of individuals in this population. Such practices are important for ensuring that research studies reflect the true diversity of the population.

Preterm birth is associated with increased risk for communication difficulties, yet early neural markers of later outcomes remain poorly understood. This study examined associations between structural and functional brain connectivity in infancy and communication skills at 24to 30 months in children born very preterm ([&le;]32 weeks gestation). Participants (n = 180) MRI at term-equivalent age during natural sleep. Resting-state functional and diffusion data were used to derive structural and functional connectivity across regions implicated in communication. At follow-up, communication outcomes were assessed using Communication and Symbolic Behavior Scales (CSBS), which captures verbal, gestural, social-affective, and symbolic communication skills. We analyzed 22x22 functional and structural connectomes among selected ROIs, using a LASSO regression approach to identify connectivity associated with CSBS scores adjusting for demographic and medical covariates. Significant relationships were observed between both functional and structural connectivity and communication skills, differing by domain. Functional connectivity between left and right temporal regions was positively associated with overall communication scores, whereas several structural connections involving cortical, cerebellar, and subcortical regions showed negative associations. Distinct connectivity patterns were also associated with gestural, verbal, social-affective, and symbolic communication skills. These findings demonstrate that variability in early brain connectivity is associated with later communication outcomes in children born very preterm. We found both significant positive and negative associations after adjusting for relevant covariates; these patterns potentially reflect compensatory or atypical network organization. These results highlight the value of multimodal neuroimaging in identifying early neural correlates of communication in this high-risk population.

Objectives: Transcranial magnetic stimulation (TMS) is widely used to probe corticospinal excitability by eliciting motor evoked potential (MEP)s in targeted muscles, with MEP characteristics such as magnitude and latency reflecting the physiological state of the pathways being stimulated. Although numerous studies have examined MEP reliability in upper extremity muscles, less is known about the reliability of this measurement across the lower extremity. We hypothesized that inter-session, test-retest reliability of MEPs recorded simultaneously from multiple lower-limb muscles, from a single TMS location, would differ by muscle, stimulation intensity, and quantification method. Materials and Methods: Ten healthy participants (5 males, 5 females) completed three TMS sessions separated by atleast one week. At each session, the stimulation hotspot was identified using a five-location virtual grid anchored at the vertex, with electromyography (EMG) recorded from all eight muscles of interest at each grid location; the grid location producing the largest and most consistent MEPs in the tibialis anterior (TA), the primary target muscle, was selected as the stimulation site and held constant across all three sessions. MEPs were then recorded bilaterally from the TA, soleus, rectus femoris, and biceps femoris muscles at two stimulation intensities (110% and 120% resting motor threshold (RMT)). MEP size was quantified using mean rectified magnitude and peak-to-peak amplitude, and inter-session reliability was assessed using intraclass correlation coefficients (ICC). Bland-Altman analysis was used to characterize the range of measurement variability across all eight muscles. Results: MEP size differed across sessions, and reliability varied by muscle, intensity, and quantification method. The highest reliability was observed in the right TA, the muscle used to establish the stimulation hotspot, using mean rectified magnitude at 120% RMT. Reliability was comparatively lower in the seven non-target muscles recorded from the same fixed stimulation site, indicating that MEP consistency was not uniform across the lower-limb musculature. Conclusions: MEP reliability in the lower extremity depends heavily on the muscle, stimulation intensity, and quantification method used, and is highest in the muscle for which the stimulation site was optimized. These findings support the interpretation that coil positioning targeted to a specific muscle yields more consistent responses in that muscle than in others recorded from the same fixed site, and underscore the importance of careful muscle selection and hotspot optimization when designing TMS protocols for longitudinal or clinical lower-limb research.

Spinal muscular atrophy (SMA) is caused by a deficiency in the survival motor neuron (SMN) protein, resulting in degeneration of spinal motor neurons (MNs). However, persistent neurological deficits despite postnatal SMN-restoring therapies suggest that recovery of sensorimotor and supraspinal circuits may be incomplete. The cerebellum has recently emerged as a supraspinal contributor to motor deficits in the severe SMN{Delta}7 mouse model, yet it remains unclear whether cerebellar pathology is a conserved and therapeutically reversible feature across severe SMA mouse models and clinical subtypes. Here, we identify cerebellar pathology in Taiwanese SMA mice, characterized by hypoplasia, disrupted organization and loss of Purkinje cells (PCs), altered synaptic circuitry, and impaired cerebellar cortical output. Unlike the previously described p53-dependent PC degeneration in SMN{Delta}7 mice, cerebellar pathology in Taiwanese SMA mice was associated with developmental disorganization and external granule layer (EGL)-restricted p53 activation. Human cerebellar tissue mirrored this distinction, with p53 activation found in PCs from SMA Type I and in the EGL from SMA Type 0 individuals, indicating that cerebellar pathology arises through distinct mechanisms across severe forms of SMA. Importantly, two SMN-restoring strategies produced divergent therapeutic outcomes. In SMN{Delta}7 mice, AAV9-SMN prevented PC degeneration yet incompletely restored cerebellar circuitry. AAV9-SMN-treated Taiwanese mice developed severe ataxia-like deficits, retained profound cerebellar pathology, and survived to approximately one month of age. In contrast, systemic risdiplam rescued cerebellar pathology, motor behavior, and survival in both models. Together, these findings identify cerebellar pathology as a conserved yet distinct feature across severe forms of SMA and reveal cell type-specific tropism as a critical determinant of therapeutic outcome. More broadly, these findings suggest that successful recovery requires restoration of distributed supraspinal circuit integrity in addition to rescue of spinal motor pathways.

Background: Spinocerebellar ataxia type 3 (SCA3) presents with significant clinical heterogeneity. Traditional case-control neuroimaging, based on group means, obscures inter-individual anatomical variability, hindering the identification of stratification biomarkers for interventions like Transcranial Magnetic Stimulation (TMS). Methods: To quantify individual neuroanatomical deviations, we constructed a cerebellar normative model using a multi-center dataset of 2,071 healthy controls with 2,549 MRI scans. Gray matter volume deviations (Z-scores) were mapped across 27 cerebellar lobules in 114 genetically confirmed SCA3 patients, and unsupervised clustering was applied to identify neuroanatomical biotypes. Clinical relevance was assessed by associating biotypes with ataxia severity and deep TMS (dTMS) outcomes in a longitudinal subset . Results: We identified two distinct biotypes: Biotype 1 exhibited relative structural preservation (positive deviations) predominantly in the posterior cerebellum (lobules VIIB, VIIIA), whereas Biotype 2 was characterized by extensive atrophy (negative deviations) centered on the anterior motor cerebellum (lobules I-VI). Clinically, Biotype 2 patients presented with significantly more severe baseline ataxia. However, regarding treatment response, an inverse relationship was observed: Biotype 2 patients demonstrated significantly greater symptomatic improvement following dTMS compared to Biotype 1. To further identify the optimal neuromodulatory strategy for each biotype, we compared the therapeutic efficacy of repetitive TMS (rTMS) and dTMS. While both biotypes showed clinical improvement following rTMS, Biotype 1 exhibited a superior therapeutic response to rTMS relative to dTMS. Furthermore, feature weight analysis identified atrophy of the right lobule VIIB as a critical predictor of clinical severity in Biotype 2. Conclusion: This study demonstrates that normative modeling can decode SCA3 heterogeneity. The identification of these biotypes reveals a dissociation between baseline structural integrity and neuromodulatory responsiveness, suggesting that patients with severe anterior cerebellar atrophy may, counterintuitively, derive greater therapeutic benefit from dTMS. Furthermore, by comparing the therapeutic efficacy of rTMS and dTMS, we further clarified biotype-specific treatment responses. These findings support the use of individualized neuroanatomical mapping for patient stratification in precision medicine.

Generalization is a key cognitive process that allows humans to flexibly apply prior knowledge to guide new behaviors. Difficulties with generalization and flexibility are observed across neurodevelopmental disorders, especially autism, limiting adaptive function and quality of life. Cognitive-behavioral treatment benefits some but not all autistic individuals. As treatment requires application of learned skills to everyday life, variability in generalization ability may limit intervention success in autism. While cognitive substrates of learning and generalization are well established, their potential for explaining clinical outcomes is not known. Here, we combined a category learning task with computational modelling to distinguish two learning strategies underlying generalization -- prototype abstraction vs. exemplar memorization -- and tested whether individual differences in these learning strategies predicted real-world intervention outcomes in autistic youth. Fifty-four participants completed the category learning task at two pre-intervention timepoints, and then completed Unstuck and On Target:14-22 intervention targeting flexible problem solving, goal setting, and planning. We found that participants who consistently relied on prototype abstraction (N=26) were subsequently more likely to benefit from the intervention, showing improvement in parent- and self-reported flexibility. These findings identify prototype abstraction as a clinically relevant cognitive capacity that may help explain individual differences in intervention response and support the tailoring of interventions. More broadly, they demonstrate the value of linking basic cognitive mechanisms to clinical outcomes and may inform strategies to enhance the effectiveness of cognitive-behavioral interventions for youth with developmental disabilities.

AIM: To evaluate whether selective motor control quantified from spontaneous infant movement recordings provides diagnostic and prognostic information for cerebral palsy (CP) beyond established movement-based assessments. METHOD: This multicenter diagnostic and prognostic accuracy study included 302 infants (151 with CP) with spontaneous movement recordings obtained between 10 and 20 weeks corrected age from cohorts in Australia and the United States. All eligible infants with CP were included, and a comparison sample without CP was randomly selected. Recordings were scored using the Baby Observational Selective Control Appraisal (BabyOSCAR), Motor Optimality Score Revised (MOS-R), and General Movements Assessment (GMA). Outcomes at 2 years or older included CP diagnosis, Gross Motor Function Classification System (GMFCS) level, and motor distribution. RESULTS: BabyOSCAR discriminated CP diagnosis (area under the curve [AUC] 0.98), including children later classified in GMFCS level I. Among infants with CP, BabyOSCAR discriminated GMFCS levels I - II from III - V (AUC 0.89). BabyOSCAR absolute asymmetry also discriminated unilateral CP from all other infants (AUC 0.90). Diagnostic discrimination was also observed for MOS-R (AUC 0.94) and GMA (AUC 0.86). INTERPRETATION: Quantifying selective motor control from brief infant movement recordings may provide complementary early information about CP diagnosis, functional level, and motor distribution.

Optimising the currently heterogenous efficacy of transcranial direct current stimulation (tDCS) interventions for motor learning requires identifying stimulation parameters facilitating performance while accounting for age-related differences in baseline performance and mechanisms underlying neuroplasticity. We systematically explored anodal tDCS intensity effects on implicit motor sequence learning (IMSL) in young and older adults. The study utilised a randomised, double-blind, counterbalanced crossover design. Ninety-six healthy participants (48 young adults, 48 older adults) completed a serial reaction time task (SRTT) with online sham or anodal tDCS over M1 at intensities of 1, 2, and 3 mA. The next day, memory consolidation was assessed in a recall test. Both age groups demonstrated IMSL and consolidation across conditions. While 1 mA tDCS improved IMSL in young adults by reducing reaction times, higher intensities had no significant benefit compared to sham. In older adults, anodal tDCS did not affect general task performance compared to sham, but 1mA tDCS acutely impaired selective sequence learning. The results demonstrate age-dependent and non-linear dose-dependent effects of anodal tDCS on IMSL. This underscores the necessity for age-adapted protocols for experimental and clinical tDCS applications. Future research should explore neurophysiological reasons for reduced tDCS efficacy in older adults found in the present study.

Pathogenic variants in MAPK8IP3 (JIP3) cause Neurodevelopmental Disorder with or without variable Brain Abnormalities (NEDBA), characterized by cognitive impairment, global developmental delay, motor dysfunction, abnormal muscle tone, behavioral dysregulation including autism and attention deficit hyperactivity disorder (ADHD), seizures, and structural brain abnormalities. While more than 30 largely de novo MAPK8IP3 variants have been reported, the functional impact of variants across JIP3 protein structural domains is poorly defined. To address this knowledge gap, we compare clinical features of individuals with a truncating (p.E27X) or one of two missense (p.R578C and p.R1146C) variants from distinct JIP3 functional protein domains to corresponding knock-in mouse models. Our findings showed that all individuals, regardless of variant type, exhibited delays in language and gross motor function, but individual variants were associated with distinct motor, cognitive, and psychiatric symptoms. Corresponding homozygous p.E27X and p.R1147C variant mice resulted in embryonic lethality, consistent with essential roles for JIP3 in early neurodevelopment. Behavioral characterization of viable heterozygous mice revealed variant-specific locomotor, motor coordination, and hindlimb clasping defects that closely recapitulate clinical observations. Heterozygous p.R579C mice exhibited reduced locomotion, impaired motor performance, and hypertonia-like clasping, mirroring human motor deficits. In contrast, p.R1147C mice displayed hyperactivity, hindlimb clasping, and decreased brain weight, paralleling human clinical features. Together, our findings demonstrate that while distinct MAPK8IP3 variants lead to some shared phenotypes, they are also associated with distinct phenotypes that could reveal domain-specific aspects of JIP3 function. This work establishes the first domain-resolved in vivo rodent models of NEDBA and provides a validated translational platform for mechanistic investigation and preclinical therapeutic testing.

Introduction: Autism spectrum disorder, or autism, is a common neurodevelopmental condition characterized by socio-communicative problems together with restrictive and repetitive behaviors. Typically, the latter is manifested as deficits in behavioral flexibility, i.e. changing routine behaviors to adapt to environmental changes. Despite noticeable difficulties with flexible behavior in autism, there is to date not adequate knowledge about the intricacies of such challenges and neurobiological processes that may subserve them. This study aims to investigate both cognitive and motor flexibility in autistic compared with neurotypical adults using a novel combination of detailed methods for brain imaging and behavioral investigations in relation to probabilistic reversal learning (PRL) paradigms. In addition, the experiences of autistic adults on flexible behavior in education and everyday activities will be explored. Methods and analysis: Differences in cognitive flexibility between autistic (n[&ge;]20) and neurotypical (n[&ge;]20) adults (18-35 years) will be investigated in terms of brain activations, measured by functional magnetic resonance imaging (fMRI), during two-choice PRL performance (cognitive task). In addition, group differences in microcirculation as measured by arterial spin labelling (ASL) will be evaluated. Group differences in motor flexibility will be investigated as expressed in movement planning and execution (spatio-temporal parameters), measured by a robotic manipulandum platform (KinArm End-Point Robot), during two-choice PRL performance (motor task). Semi-structured interviews will be conducted individually with autistic participants (n=15). Questions concern own experiences of cognitive and motor behavior, and strategies used to support flexibility in these behaviors. Data from this qualitative approach will be analyzed by thematic analysis. Ethics and dissemination: Ethical approval has been obtained from the Swedish Ethical Review Authority (ref:2025-07939-01) and the study will be conducted in accordance with the Declaration of Helsinki, the European Union General Data Protection Regulation (GDPR) and national guidelines for the storing of personal data. The different investigations included are well-established, non-invasive and safe. Study outcomes will be published in peer-reviewed international scientific journals (open access), presented at national and international conferences, and to any interested audience/stakeholders.