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Leunissen I, Coxon JP, Caeyenberghs K, Michiels K, Sunaert S, Swinnen SP. Subcortical volume analysis in traumatic brain injury: The importance of the fronto-striato-thalamic circuit in task switching. Cortex 2014; 51:67-81. [DOI: 10.1016/j.cortex.2013.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/07/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
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Tartaglia MC, Hazrati LN, Davis KD, Green REA, Wennberg R, Mikulis D, Ezerins LJ, Keightley M, Tator C. Chronic traumatic encephalopathy and other neurodegenerative proteinopathies. Front Hum Neurosci 2014; 8:30. [PMID: 24550810 PMCID: PMC3907709 DOI: 10.3389/fnhum.2014.00030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 01/14/2014] [Indexed: 12/14/2022] Open
Abstract
"Chronic traumatic encephalopathy" (CTE) is described as a slowly progressive neurodegenerative disease believed to result from multiple concussions. Traditionally, concussions were considered benign events and although most people recover fully, about 10% develop a post-concussive syndrome with persisting neurological, cognitive and neuropsychiatric symptoms. CTE was once thought to be unique to boxers, but it has now been observed in many different athletes having suffered multiple concussions as well as in military personal after repeated blast injuries. Much remains unknown about the development of CTE but its pathological substrate is usually tau, similar to that seen in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). The aim of this "perspective" is to compare and contrast clinical and pathological CTE with the other neurodegenerative proteinopathies and highlight that there is an urgent need for understanding the relationship between concussion and the development of CTE as it may provide a window into the development of a proteinopathy and thus new avenues for treatment.
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Affiliation(s)
- Maria Carmela Tartaglia
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - Lili-Naz Hazrati
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada ; Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, ON, Canada
| | - Karen D Davis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, University Health Network, University of Toronto Toronto, ON, Canada ; Division of Brain, Imaging and Behaviour - Systems Neuroscience, Toronto Western Research Institute, University Health Network Toronto, ON, Canada ; Department of Surgery, University of Toronto Toronto, ON, Canada ; Institute of Medical Science, University of Toronto Toronto, ON, Canada
| | - Robin E A Green
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurology, Krembil Neuroscience Centre, University Health Network, University of Toronto Toronto, ON, Canada ; Canadian Sports Concussion Project Toronto, ON, Canada
| | - David Mikulis
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, The University of Toronto Toronto, ON, Canada
| | - Leo J Ezerins
- Canadian Sports Concussion Project Toronto, ON, Canada ; Executive Director, Canadian Football League Alumni Association Toronto, ON, Canada
| | - Michelle Keightley
- Canadian Sports Concussion Project Toronto, ON, Canada ; Toronto Rehabilitation Institute Toronto, ON, Canada ; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, ON, Canada ; Department of Occupational Science and Occupational Therapy, University of Toronto Toronto, ON, Canada ; Graduate Department of Rehabilitation Science, University of Toronto Toronto, ON, Canada ; Department of Psychology, University of Toronto Toronto, ON, Canada
| | - Charles Tator
- Canadian Sports Concussion Project Toronto, ON, Canada ; Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto Toronto, ON, Canada
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Adnan A, Crawley A, Mikulis D, Moscovitch M, Colella B, Green R. Moderate-severe traumatic brain injury causes delayed loss of white matter integrity: evidence of fornix deterioration in the chronic stage of injury. Brain Inj 2013; 27:1415-22. [PMID: 24102365 DOI: 10.3109/02699052.2013.823659] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine structural integrity loss in the fornix from 5-30 months after moderate and severe traumatic brain injury (TBI) using diffusion tensor imaging. METHODS MRIs were prospectively undertaken in 29 adults with moderate and severe TBI at two time points. Fractional anisotropy (FA) was calculated for the fornix (column/body, right crux and left crux) at 5 and 30 months post-injury. RESULTS Paired t-tests revealed significant FA reductions with large effect sizes across time in the column/body, p < 0.001, right crux, p < 0.001 and left crux, p < 0.001. CONCLUSIONS These data contribute to the growing body of evidence that loss of white matter continues in moderate and severe TBI even after the acute neurological effects of TBI have resolved. As the fornix plays a critical role in memory, this may be a contributing factor to the poor clinical outcomes observed in these patients.
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Affiliation(s)
- Areeba Adnan
- Toronto Rehabilitation Institute , Toronto, ON , Canada
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Spitz G, Bigler ED, Abildskov T, Maller JJ, O’Sullivan R, Ponsford JL. Regional cortical volume and cognitive functioning following traumatic brain injury. Brain Cogn 2013; 83:34-44. [DOI: 10.1016/j.bandc.2013.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/15/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
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Miller LS, Colella B, Mikulis D, Maller J, Green REA. Environmental enrichment may protect against hippocampal atrophy in the chronic stages of traumatic brain injury. Front Hum Neurosci 2013; 7:506. [PMID: 24093011 PMCID: PMC3782701 DOI: 10.3389/fnhum.2013.00506] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/07/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the relationship between environmental enrichment (EE) and hippocampal atrophy in the chronic stages of moderate to severe traumatic brain injury (TBI). DESIGN Retrospective analysis of prospectively collected data; observational, within-subjects. PARTICIPANTS Patients (N = 25) with moderate to severe TBI. MEASURES Primary predictors: (1) An aggregate of self-report rating of EE (comprising hours of cognitive, physical, and social activities) at 5 months post-injury; (2) pre-injury years of education as a proxy for pre-morbid EE (or cognitive reserve). PRIMARY OUTCOME bilateral hippocampal volume change from 5 to 28 months post-injury. RESULTS As predicted, self-reported EE was significantly negatively correlated with bilateral hippocampal atrophy (p < 0.05), with greater EE associated with less atrophy from 5 to 28 months. Contrary to prediction, years of education (a proxy for cognitive reserve) was not significantly associated with atrophy. CONCLUSION Post-injury EE may serve as a buffer against hippocampal atrophy in the chronic stages of moderate-severe TBI. Clinical application of EE should be considered for optimal maintenance of neurological functioning in the chronic stages of moderate-severe TBI.
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Affiliation(s)
- Lesley S Miller
- Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto Toronto, ON, Canada
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Bigler ED. Traumatic brain injury, neuroimaging, and neurodegeneration. Front Hum Neurosci 2013; 7:395. [PMID: 23964217 PMCID: PMC3734373 DOI: 10.3389/fnhum.2013.00395] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 07/05/2013] [Indexed: 12/14/2022] Open
Abstract
Depending on severity, traumatic brain injury (TBI) induces immediate neuropathological effects that in the mildest form may be transient but as severity increases results in neural damage and degeneration. The first phase of neural degeneration is explainable by the primary acute and secondary neuropathological effects initiated by the injury; however, neuroimaging studies demonstrate a prolonged period of pathological changes that progressively occur even during the chronic phase. This review examines how neuroimaging may be used in TBI to understand (1) the dynamic changes that occur in brain development relevant to understanding the effects of TBI and how these relate to developmental stage when the brain is injured, (2) how TBI interferes with age-typical brain development and the effects of aging thereafter, and (3) how TBI results in greater frontotemporolimbic damage, results in cerebral atrophy, and is more disruptive to white matter neural connectivity. Neuroimaging quantification in TBI demonstrates degenerative effects from brain injury over time. An adverse synergistic influence of TBI with aging may predispose the brain injured individual for the development of neuropsychiatric and neurodegenerative disorders long after surviving the brain injury.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University Provo, UT, USA ; Neuroscience Center, Brigham Young University Provo, UT, USA ; Department of Psychiatry, University of Utah Salt Lake City, UT, USA ; The Brain Institute of Utah, University of Utah Salt Lake City, UT, USA
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Bigler ED. Neuroinflammation and the dynamic lesion in traumatic brain injury. ACTA ACUST UNITED AC 2013; 136:9-11. [PMID: 23365089 DOI: 10.1093/brain/aws342] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erin D Bigler
- Department of Psychology and Neuroscience Centre, 1001 SWKT, Brigham Young University, Provo, UT 84602, USA.
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Frasca D, Tomaszczyk J, McFadyen BJ, Green RE. Traumatic brain injury and post-acute decline: what role does environmental enrichment play? A scoping review. Front Hum Neurosci 2013; 7:31. [PMID: 23616755 PMCID: PMC3628363 DOI: 10.3389/fnhum.2013.00031] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 01/25/2013] [Indexed: 12/26/2022] Open
Abstract
Objectives: While a growing number of studies provide evidence of neural and cognitive decline in traumatic brain injury (TBI) survivors during the post-acute stages of injury, there is limited research as of yet on environmental factors that may influence this decline. The purposes of this paper, therefore, are to (1) examine evidence that environmental enrichment (EE) can influence long-term outcome following TBI, and (2) examine the nature of post-acute environments, whether they vary in degree of EE, and what impact these variations have on outcomes. Methods: We conducted a scoping review to identify studies on EE in animals and humans, and post-discharge experiences that relate to barriers to recovery. Results: One hundred and twenty-three articles that met inclusion criteria demonstrated the benefits of EE on brain and behavior in healthy and brain-injured animals and humans. Nineteen papers on post-discharge experiences revealed that variables such as insurance coverage, financial, and social support, home therapy, and transition from hospital to home, can have an impact on clinical outcomes. Conclusion: There is evidence to suggest that lack of EE, whether from lack of resources or limited ability to engage in such environments, may play a role in post-acute cognitive and neural decline. Maximizing EE in the post-acute stages of TBI may improve long-term outcomes for the individual, their family and society.
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Affiliation(s)
- Diana Frasca
- Graduate Department of Rehabilitation Science, University of Toronto Toronto, ON, Canada ; Cognitive Neurorehabilitation Sciences Laboratory, Toronto Rehabilitation Institute Toronto, ON, Canada
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Kim J, Avants B, Whyte J, Gee JC. Methodological considerations in longitudinal morphometry of traumatic brain injury. Front Hum Neurosci 2013; 7:52. [PMID: 23549059 PMCID: PMC3581852 DOI: 10.3389/fnhum.2013.00052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 02/07/2013] [Indexed: 11/17/2022] Open
Abstract
Traumatic brain injury (TBI) has recently been reconceptualized as a chronic, evolving disease process. This new view necessitates quantitative assessment of post-injury changes in brain structure that may allow more accurate monitoring and prediction of recovery. In particular, TBI is known to trigger neurodegenerative processes and therefore quantifying progression of diffuse atrophy over time is currently of utmost interest. However, there are various methodological issues inherent to longitudinal morphometry in TBI. In this paper, we first overview several of these methodological challenges: lesion evolution, neurosurgical procedures, power, bias, and non-linearity. We then introduce a sensitive, reliable, and unbiased longitudinal multivariate analysis protocol that combines dimensionality reduction and region of interest approaches. This analysis pipeline is demonstrated using a small dataset consisting of four chronic TBI survivors.
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Affiliation(s)
- Junghoon Kim
- Moss Rehabilitation Research Institute Elkins Park, PA, USA
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) is a leading cause of death and long-term cognitive and behavioral dysfunction in children and young adults, yet effective treatments are lacking, in part because critical aspects of TBI neurobiology and natural history are not understood. We review recent advances in neuroimaging and discuss how they are helping to address these fundamental gaps. RECENT FINDINGS Novel imaging methods provide detailed information on how TBI affects anatomical integrity (diffusion tensor imaging; voxel-based morphometry; susceptibility-weighted imaging, magnetization transfer imaging), metabolic activity (magnetic resonance spectroscopy), perfusion (positron emission tomography, perfusion computed tomography, perfusion magnetic resonance), and patterns of functional activation (functional magnetic resonance imaging). Individually and collectively, these methods can significantly enhance TBI diagnosis and outcome prediction. SUMMARY Refinements in neuroimaging offer a window into the complex neuroanatomical and neurophysiological disturbances induced by TBI. Research is needed to understand how these alterations evolve with time and in response to therapeutic interventions.
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Masel BE, Bell RS, Brossart S, Grill RJ, Hayes RL, Levin HS, Rasband MN, Ritzel DV, Wade CE, DeWitt DS. Galveston Brain Injury Conference 2010: Clinical and Experimental Aspects of Blast Injury. J Neurotrauma 2012; 29:2143-71. [DOI: 10.1089/neu.2011.2258] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brent E. Masel
- Transitional Learning Center, Galveston, Texas; Department of Neurology, The University of Texas Medical Branch, Galveston, Texas
| | - Randy S. Bell
- Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland
| | - Shawn Brossart
- Project Victory, The Transitional Learning Center, Galveston, Texas
| | - Raymond J. Grill
- Department of Integrative Biology and Pharmacology, The University of Texas Medical School at Houston, Houston, Texas
| | - Ronald L. Hayes
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Charles E. Wade
- Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas
| | - Douglas S. DeWitt
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas
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Jiang Q, Thiffault C, Kramer BC, Ding GL, Zhang L, Nejad-Davarani SP, Li L, Arbab AS, Lu M, Navia B, Victor SJ, Hong K, Li QJ, Wang SY, Li Y, Chopp M. MRI detects brain reorganization after human umbilical tissue-derived cells (hUTC) treatment of stroke in rat. PLoS One 2012; 7:e42845. [PMID: 22900057 PMCID: PMC3416784 DOI: 10.1371/journal.pone.0042845] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/12/2012] [Indexed: 11/24/2022] Open
Abstract
Human umbilical tissue-derived cells (hUTC) represent an attractive cell source and a potential technology for neurorestoration and improvement of functional outcomes following stroke. Male Wistar rats were subjected to a transient middle cerebral artery occlusion (tMCAo) and were intravenously administered hUTC (N = 11) or vehicle (N = 10) 48 hrs after stroke. White matter and vascular reorganization was monitored over a 12-week period using MRI and histopathology. MRI results were correlated with neurological functional and histology outcomes to demonstrate that MRI can be a useful tool to measure structural recovery after stroke. MRI revealed a significant reduction in the ventricular volume expansion and improvement in cerebral blood flow (CBF) in the hUTC treated group compared to vehicle treated group. Treatment with hUTC resulted in histological and functional improvements as evidenced by enhanced expression of vWF and synaptophysin, and improved outcomes on behavioral tests. Significant correlations were detected between MRI ventricular volumes and histological lesion volume as well as number of apoptotic cells. A positive correlation was also observed between MRI CBF or cerebral blood volume (CBV) and histological synaptic density. Neurological functional tests were also significantly correlated with MRI ventricular volume and CBV. Our data demonstrated that MRI measurements can detect the effect of hUTC therapy on the brain reorganization and exhibited positive correlation with histological measurements of brain structural changes and functional behavioral tests after stroke. MRI ventricular volumes provided the most sensitive index in monitoring brain remodeling and treatment effects and highly correlated with histological and functional measurements.
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Affiliation(s)
- Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, Michigan, United States of America.
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Hånell A, Hedin J, Clausen F, Marklund N. Facilitated assessment of tissue loss following traumatic brain injury. Front Neurol 2012; 3:29. [PMID: 22435063 PMCID: PMC3303156 DOI: 10.3389/fneur.2012.00029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/16/2012] [Indexed: 11/17/2022] Open
Abstract
All experimental models of traumatic brain injury (TBI) result in a progressive loss of brain tissue. The extent of tissue loss reflects the injury severity and can be measured to evaluate the potential neuroprotective effect of experimental treatments. Quantitation of tissue volumes is commonly performed using evenly spaced brain sections stained using routine histochemical methods and digitally captured. The brain tissue areas are then measured and the corresponding volumes are calculated using the distance between the sections. Measurements of areas are usually performed using a general purpose image analysis software and the results are then transferred to another program for volume calculations. To facilitate the measurement of brain tissue loss we developed novel algorithms which automatically separate the areas of brain tissue from the surrounding image background and identify the ventricles. We implemented these new algorithms by creating a new computer program (SectionToVolume) which also has functions for image organization, image adjustments and volume calculations. We analyzed brain sections from mice subjected to severe focal TBI using both SectionToVolume and ImageJ, a commonly used image analysis program. The volume measurements made by the two programs were highly correlated and analysis using SectionToVolume required considerably less time. The inter-rater reliability was high. Given the extensive use of brain tissue loss measurements in TBI research, SectionToVolume will likely be a useful tool for TBI research. We therefore provide both the source code and the program as attachments to this article.
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Affiliation(s)
- Anders Hånell
- Neurosurgery, Department of Neuroscience, Uppsala University Uppsala, Sweden
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64
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Ross DE. Review of longitudinal studies of MRI brain volumetry in patients with traumatic brain injury. Brain Inj 2011; 25:1271-8. [DOI: 10.3109/02699052.2011.624568] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marklund N, Hillered L. Animal modelling of traumatic brain injury in preclinical drug development: where do we go from here? Br J Pharmacol 2011; 164:1207-29. [PMID: 21175576 PMCID: PMC3229758 DOI: 10.1111/j.1476-5381.2010.01163.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 12/02/2010] [Accepted: 12/06/2010] [Indexed: 11/26/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Survivors of TBI frequently suffer from long-term personality changes and deficits in cognitive and motor performance, urgently calling for novel pharmacological treatment options. To date, all clinical trials evaluating neuroprotective compounds have failed in demonstrating clinical efficacy in cohorts of severely injured TBI patients. The purpose of the present review is to describe the utility of animal models of TBI for preclinical evaluation of pharmacological compounds. No single animal model can adequately mimic all aspects of human TBI owing to the heterogeneity of clinical TBI. To successfully develop compounds for clinical TBI, a thorough evaluation in several TBI models and injury severities is crucial. Additionally, brain pharmacokinetics and the time window must be carefully evaluated. Although the search for a single-compound, 'silver bullet' therapy is ongoing, a combination of drugs targeting various aspects of neuroprotection, neuroinflammation and regeneration may be needed. In summary, finding drugs and prove clinical efficacy in TBI is a major challenge ahead for the research community and the drug industry. For a successful translation of basic science knowledge to the clinic to occur we believe that a further refinement of animal models and functional outcome methods is important. In the clinical setting, improved patient classification, more homogenous patient cohorts in clinical trials, standardized treatment strategies, improved central nervous system drug delivery systems and monitoring of target drug levels and drug effects is warranted.
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Affiliation(s)
- Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
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Li L, Jiang Q, Qu CS, Ding GL, Li QJ, Wang SY, Lee JH, Lu M, Mahmood A, Chopp M. Transplantation of marrow stromal cells restores cerebral blood flow and reduces cerebral atrophy in rats with traumatic brain injury: in vivo MRI study. J Neurotrauma 2011; 28:535-45. [PMID: 21275806 DOI: 10.1089/neu.2010.1619] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cell therapy promotes brain remodeling and improves functional recovery after various central nervous system disorders, including traumatic brain injury (TBI). We tested the hypothesis that treatment of TBI with intravenous administration of human marrow stromal cells (hMSCs) provides therapeutic benefit in modifying hemodynamic and structural abnormalities, which are detectable by in vivo MRI. hMSCs were labeled with superparamagnetic iron oxide (SPIO) nanoparticles. Male Wistar rats (300-350 g, n=18) subjected to controlled cortical impact TBI were intravenously injected with 1 mL of saline (n=9) or hMSCs in suspension (n=9, approximately 3 × 10(6) SPIO-labeled hMSCs) 5 days post-TBI. In vivo MRI measurements consisting of cerebral blood flow (CBF), T2-weighted imaging, and 3D gradient echo imaging were performed for all animals 2 days post-TBI and weekly for 6 weeks. Functional outcome was evaluated with modified neurological severity score and Morris water maze test. Cell engraftment was detected in vivo by 3D MRI and confirmed by double staining. Ventricle and lesion volumetric alterations were measured using T2 maps, and hemodynamic abnormality was tracked by MRI CBF measurements. Our data demonstrate that treatment with hMSCs following TBI diminishes hemodynamic abnormalities by early restoration and preservation of CBF in the brain regions adjacent to and remote from the impact site, and reduces generalized cerebral atrophy, all of which may contribute to the observed improvement of functional outcome.
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Affiliation(s)
- Lian Li
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Cerebral volume loss, cognitive deficit, and neuropsychological performance: comparative measures of brain atrophy: II. Traumatic brain injury. J Int Neuropsychol Soc 2011; 17:308-16. [PMID: 21352625 DOI: 10.1017/s1355617710001670] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Traumatic brain injury (TBI) results in a variable degree of cerebral atrophy that is not always related to cognitive measures across studies. However, the use of different methods for examining atrophy may be a reason why differences exist. The purpose of this manuscript was to examine the predictive utility of seven magnetic resonance imaging (MRI)-derived brain volume or indices of atrophy for a large cohort of TBI patients (n = 65). The seven quantitative MRI (qMRI) measures included uncorrected whole brain volume, brain volume corrected by total intracranial volume, brain volume corrected by the ratio of the individual TICV by group TICV, a ventricle to brain ratio, total ventricular volume, ventricular volume corrected by TICV, and a direct measure of parenchymal volume loss. Results demonstrated that the various qMRI measures were highly interrelated and that corrected measures proved to be the most robust measures related to neuropsychological performance. Similar to an earlier study that examined cerebral atrophy in aging and dementia, these results suggest that a single corrected brain volume measure is all that is necessary in studies examining global MRI indicators of cerebral atrophy in relationship to cognitive function making additional measures of global atrophy redundant and unnecessary.
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Abstract
Traumatic brain injury (TBI) is seen by the insurance industry and many health care providers as an "event." Once treated and provided with a brief period of rehabilitation, the perception exists that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems. In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care. TBI increases long-term mortality and reduces life expectancy. It is associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist for months to years post-injury. The purpose of this article is to encourage the classification of TBI as the beginning of an ongoing, perhaps lifelong process, that impacts multiple organ systems and may be disease causative and accelerative. Our intent is not to discourage patients with TBI or their families and caregivers, but rather to emphasize that TBI should be managed as a chronic disease and defined as such by health care and insurance providers. Furthermore, if the chronic nature of TBI is recognized by government and private funding agencies, research can be directed at discovering therapies that may interrupt the disease processes months or even years after the initiating event.
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Affiliation(s)
- Brent E Masel
- Department of Neurology, Transitional Learning Center at Galveston, The Moody Center for Traumatic Brain & Spinal Cord Injury Research/Mission Connect, The University of Texas Medical Branch, Galveston, Texas 77550, USA.
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Strangman GE, O'Neil-Pirozzi TM, Supelana C, Goldstein R, Katz DI, Glenn MB. Regional brain morphometry predicts memory rehabilitation outcome after traumatic brain injury. Front Hum Neurosci 2010; 4:182. [PMID: 21048895 PMCID: PMC2967347 DOI: 10.3389/fnhum.2010.00182] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 09/07/2010] [Indexed: 01/28/2023] Open
Abstract
Cognitive deficits following traumatic brain injury (TBI) commonly include difficulties with memory, attention, and executive dysfunction. These deficits are amenable to cognitive rehabilitation, but optimally selecting rehabilitation programs for individual patients remains a challenge. Recent methods for quantifying regional brain morphometry allow for automated quantification of tissue volumes in numerous distinct brain structures. We hypothesized that such quantitative structural information could help identify individuals more or less likely to benefit from memory rehabilitation. Fifty individuals with TBI of all severities who reported having memory difficulties first underwent structural MRI scanning. They then participated in a 12 session memory rehabilitation program emphasizing internal memory strategies (I-MEMS). Primary outcome measures (HVLT, RBMT) were collected at the time of the MRI scan, immediately following therapy, and again at 1-month post-therapy. Regional brain volumes were used to predict outcome, adjusting for standard predictors (e.g., injury severity, age, education, pretest scores). We identified several brain regions that provided significant predictions of rehabilitation outcome, including the volume of the hippocampus, the lateral prefrontal cortex, the thalamus, and several subregions of the cingulate cortex. The prediction range of regional brain volumes were in some cases nearly equal in magnitude to prediction ranges provided by pretest scores on the outcome variable. We conclude that specific cerebral networks including these regions may contribute to learning during I-MEMS rehabilitation, and suggest that morphometric measures may provide substantial predictive value for rehabilitation outcome in other cognitive interventions as well.
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Affiliation(s)
- Gary E Strangman
- Department of Psychiatry, Harvard Medical School Boston, MA, USA
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Kharatishvili I, Pitkänen A. Association of the severity of cortical damage with the occurrence of spontaneous seizures and hyperexcitability in an animal model of posttraumatic epilepsy. Epilepsy Res 2010; 90:47-59. [PMID: 20435440 DOI: 10.1016/j.eplepsyres.2010.03.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/07/2010] [Accepted: 03/12/2010] [Indexed: 11/29/2022]
Abstract
Posttraumatic epilepsy is a common consequence of traumatic brain injury in humans. Major predictors for the development of posttraumatic epilepsy include the severity of injury and occurrence of cortical contusions. The effect of the size or location of the cortical lesion on the risk of epileptogenesis, however, is poorly understood. Here, we investigated the extent and location of cortical damage and its association with a lowered seizure threshold and the occurrence of spontaneous seizures in rats (n=77) that had experienced moderate or severe lateral fluid-percussion brain injury (FPBI) 12 months earlier. Spontaneous seizures were detected with video-electroencephalography monitoring and a lowered seizure threshold was determined based on a pentylenetetrazol (PTZ) test. Cortical atrophy was evaluated from thionin-stained sections using the Cavalieri estimation in four different experiments in which rats developed either spontaneous recurrent seizures (i.e., epilepsy) or a lowered seizure threshold. Our data show that damage to the cortex ipsilateral to the injury was more severe and extended more caudally in epileptic animals than in those without epilepsy (p<0.05 and p<0.001 for 2 independent experiments). Further, the extent of the cortical damage correlated positively with chronically increased hyperexcitability (number of spikes in PTZ test) in animals with traumatic brain injury (r=-0.54, p<0.05; r=-0.72, p<0.01 for 2 independent experiments). Specifically, cortical lesions located at the level of the perirhinal, entorhinal, and postrhinal cortices were associated with a lowered seizure threshold and seizures. The severity of the cortical injury did not correlate with the severity of hippocampal damage. These findings indicate that, like in humans, the severity of cortical injury correlates with epileptogenesis and epilepsy in an experimental model of posttraumatic epilepsy.
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Affiliation(s)
- Irina Kharatishvili
- Epilepsy Research Laboratory, Department of Neurobiology, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, and Department of Neurology, Kuopio University Hospital, FIN-70211 Kuopio, Finland
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Xu Y, McArthur DL, Alger JR, Etchepare M, Hovda DA, Glenn TC, Huang S, Dinov I, Vespa PM. Early nonischemic oxidative metabolic dysfunction leads to chronic brain atrophy in traumatic brain injury. J Cereb Blood Flow Metab 2010; 30:883-94. [PMID: 20029449 PMCID: PMC2949156 DOI: 10.1038/jcbfm.2009.263] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic brain atrophy after traumatic brain injury (TBI) is a well-known phenomenon, the causes of which are unknown. Early nonischemic reduction in oxidative metabolism is regionally associated with chronic brain atrophy after TBI. A total of 32 patients with moderate-to-severe TBI prospectively underwent positron emission tomography (PET) and volumetric magnetic resonance imaging (MRI) within the first week and at 6 months after injury. Regional lobar assessments comprised oxidative metabolism and glucose metabolism. Acute MRI showed a preponderance of hemorrhagic lesions with few irreversible ischemic lesions. Global and regional chronic brain atrophy occurred in all patients by 6 months, with the temporal and frontal lobes exhibiting the most atrophy compared with the occipital lobe. Global and regional reduction in cerebral metabolic rate of oxygen (CMRO(2)), cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of glucose were observed. The extent of metabolic dysfunction was correlated with the total hemorrhage burden on initial MRI (r=0.62, P=0.01). The extent of regional brain atrophy correlated best with CMRO(2) and CBF. Lobar values of OEF were not in the ischemic range and did not correlate with chronic brain atrophy. Chronic brain atrophy is regionally specific and associated with regional reductions in oxidative brain metabolism in the absence of irreversible ischemia.
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Affiliation(s)
- Yueqiao Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Bigler ED, Abildskov TJ, Wilde EA, McCauley SR, Li X, Merkley TL, Fearing MA, Newsome MR, Scheibel RS, Hunter JV, Chu Z, Levin HS. Diffuse damage in pediatric traumatic brain injury: A comparison of automated versus operator-controlled quantification methods. Neuroimage 2010; 50:1017-26. [DOI: 10.1016/j.neuroimage.2010.01.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/05/2009] [Accepted: 01/01/2010] [Indexed: 11/17/2022] Open
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Bouilleret V, Cardamone L, Liu YR, Fang K, Myers DE, O'Brien TJ. Progressive brain changes on serial manganese-enhanced MRI following traumatic brain injury in the rat. J Neurotrauma 2010; 26:1999-2013. [PMID: 19604101 DOI: 10.1089/neu.2009.0943] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) has a high incidence of long-term morbidity. Manganese-enhanced MRI (MEMRI) provides high contrast structural and functional detail of the brain in-vivo. The study utilized serial MEMRI scanning in the fluid percussion injury (FPI) rat's model to assess long-term changes in the brain following TBI. Rats underwent a left-sided craniotomy and a 3.5 atmosphere FPI pulse (n = 23) or sham procedure (n = 22). MEMRI acquisition was performed at baseline, 1 day, 1 month, and 6 months after FPI. Volume changes and MnCl(2) enhancement were measured blindly using region-of-interest analysis and the results analyzed with repeated measures MANOVA. Compared to the shams, FPI animals showed a progressive decrease in brain volume from 1 (right, p = 0.02; left, p = 0.008) to 6 months (right, p = 0.04; left, p = 0.006), with progression over time (F = 7.16, p = 0.00018). Similar changes were found in the cortex and the hippocampus. Conversely, the ventricular volume was increased at 1 (p = 0.02) and 6 months (p = 0.003), with progression over time (F = 7.27, p = 0.0001). There were no differences in thalamic or amygdalae volumes. The severity of the early neuromotor deficits and the T2 signal intensity of the subacute focal lesion were highly predictive of the severity of the long-term hippocampal decrease, and the former was also associated with the degree of neuronal sprouting. Differential MnCl(2) enhancement occurred only in the dentate gyrus at 1 month on the side of trauma (p = 0.04). Progressive functional and structural changes occur in specific brain regions post-FPI. The severity of the neuromotor deficit and focal signal changes on MRI subacutely post-injury are predictive of severity of these long-term neurodegenerative changes.
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Affiliation(s)
- Viviane Bouilleret
- Department of Medicine (RMH), University of Melbourne, Victoria, Australia
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Robertson IH. Traumatic brain injury: recovery, prediction, and the clinician. Arch Phys Med Rehabil 2009; 89:S1-2. [PMID: 19081436 DOI: 10.1016/j.apmr.2008.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
Traumatic Brain Injury produces long term disabling effects in a young population of normal life expectancy, yet very little is known about its medium to long-term outcome with the underlying pathologies often invisible to standard brain imaging methods. This collection of papers offers a major advance in defining the course of recovery following TBI, and demonstrating the utility of new brain imaging techniques such as diffusion-tensor imaging to predict outcome and detect hitherto concealed pathologies. These pathologies partly explain the profound behavioral deficits that have been widely demonstrated in TBI but often disputed in courts and elsewhere because of the lack of correlates in underlying brain structure. This edition also offers the first clear evidence of progressive postinsult long-term brain atrophy in some cases of TBI, as well as highlighting important neuropsychological and behavioral predictive variables for recovery, and including the possibility of effective behavioral treatments to mitigate some of these profoundly disabling deficits. This collection of papers is outstanding in a number of ways - in giving the clinician a sense of what can be said to the worried family and what cannot, and in offering researchers important insights from imaging and neuropsychology into the possible mechanisms for the postacute recovery process. But they are important in a third, even more important way - in yielding some real pointers as to how the course of recovery may be influenced.
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Affiliation(s)
- Ian H Robertson
- Institute of Neuroscience, Trinity College, Dublin, Ireland.
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Ruttan L, Martin K, Liu A, Colella B, Green RE. Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury. Arch Phys Med Rehabil 2009; 89:S69-76. [PMID: 19081444 DOI: 10.1016/j.apmr.2008.07.007] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/22/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine long-term outcome of moderate to severe traumatic brain injury (TBI) on timed and untimed cognitive tests using meta-analysis. DESIGN Meta-analysis examining outcome at 2 epochs, 6 to 18 months postinjury (epoch 1) and 4.5 to 11 years postinjury (epoch 2). SETTING Data source was published articles (1966-2007) identified through electronic and manual search. PARTICIPANTS A total of 1380 subjects with moderate to severe TBI participated in the 16 studies meeting inclusion criteria. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Timed and untimed neuropsychologic tests with quantitative results (means, SDs, t, and df tests) from studies containing a healthy comparison group and a mean time since injury falling within 1 of the 2 epochs. RESULTS Patient versus control weighted effect sizes were medium to large at epoch 1 for both untimed tasks (r=-.46; confidence interval [CI], -.32 to -.65) and timed tasks (r=-.46; CI, -.35 to -.59). At epoch 2, effect sizes were slightly smaller for untimed tasks (r=-.38; CI, -.25 to -.60) and timed tasks (r=-.40; CI, -.32 to -.62). CONCLUSIONS Patients showed robust, persisting impairments on both timed and untimed tests at recovery plateau (ie, 6-18mo postinjury) and many years later. These findings converge with previous studies, though using an alternative approach that obviates some of the methodologic problems of longitudinal studies, such as selective attrition.
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Affiliation(s)
- Lesley Ruttan
- Toronto Rehabilitation Institute, Toronto, ON, Canada.
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Greenberg G, Mikulis DJ, Ng K, DeSouza D, Green RE. Use of diffusion tensor imaging to examine subacute white matter injury progression in moderate to severe traumatic brain injury. Arch Phys Med Rehabil 2009; 89:S45-50. [PMID: 19081441 DOI: 10.1016/j.apmr.2008.08.211] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/22/2008] [Accepted: 08/25/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate subacute progression of white matter (WM) injury (4.5mo-2.5y postinjury) in patients with traumatic brain injury using diffusion-tensor imaging. DESIGN Prospective, repeated-measures, within-subjects design. SETTING Inpatient neurorehabilitation program and teaching hospital MRI department. PARTICIPANTS Brain-injured adults (N=13) with a mean Glasgow Coma Scale score of 7.67+/-4.16. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fractional anisotropy (FA) values were measured at 4.5 and 29 months postinjury in right and left frontal and temporal deep WM tracts and the anterior and posterior corpus callosum. RESULTS FA significantly decreased in frontal and temporal tracts: right frontal (.38+/-.06 to .30+/-.06; P<.005), left frontal (.37+/-.06 to .32+/-.06; P<.05), right temporal (.28+/-.05 to .22+/-.018; P<.005), and left temporal (.28+/-.05 to .24+/-.02; P<.05). No significant changes were in the corpus callosum. CONCLUSIONS Preliminary results demonstrate progression of WM damage as evidenced by interval changes in diffusion anisotropy. Future research should examine the relationship between decreased FA and long-term clinical outcome.
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Affiliation(s)
- Gahl Greenberg
- Department of Medical Imaging, Division of Neuroradiology, University Health Network, Toronto, ON, Canada
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