51
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Bigler ED. Structural neuroimaging in sport-related concussion. Int J Psychophysiol 2018; 132:105-123. [DOI: 10.1016/j.ijpsycho.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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Tremblay S, Pascual-Leone A, Théoret H. A review of the effects of physical activity and sports concussion on brain function and anatomy. Int J Psychophysiol 2018; 132:167-175. [PMID: 28893565 DOI: 10.1016/j.ijpsycho.2017.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 01/13/2023]
Abstract
Physical activity has been associated with widespread anatomical and functional brain changes that occur following acute exercise or, in the case of athletes, throughout life. High levels of physical activity through the practice of sports also lead to better general health and increased cognitive function. Athletes are at risk, however, of suffering a concussion, the effects of which have been extensively described for brain function and anatomy. The level to which these effects are modulated by increased levels of fitness is not known. Here, we review literature describing the effects of physical activity and sports concussions on white matter, grey matter, neurochemistry and cortical excitability. We suggest that the effects of sports concussion can be coufounded by the effects of exercise. Indeed, available data show that the brain of athletes is different from that of healthy individuals with a non-active lifestyle. As a result, sports concussions take place in a context where structural/functional plasticity has occurred prior to the concussive event. The sports concussion literature does not permit, at present, to separate the effects of intense and repeated physical activity, and the abrupt removal from such activities, from those of concussion on brain structure and function.
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Affiliation(s)
- Sara Tremblay
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Hugo Théoret
- Département de psychologie, Université de Montréal, Montréal, Canada.
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Conley AC, Cooper PS, Karayanidis F, Gardner AJ, Levi CR, Stanwell P, Gaetz MB, Iverson GL. Resting State Electroencephalography and Sports-Related Concussion: A Systematic Review. J Neurotrauma 2018; 36:1-13. [PMID: 30014761 DOI: 10.1089/neu.2018.5761] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Sports-related concussion is associated with a range of short-term functional deficits that are commonly thought to recover within a two-week post-injury period for most, but certainly not all, persons. Resting state electroencephalography (rs-EEG) may prove to be an affordable, accessible, and sensitive method of assessing severity of brain injury and rate of recovery after a concussion. This article presents a systematic review of rs-EEG in sports-related concussion. A systematic review of articles published in the English language, up to June 2017, was retrieved via PsychINFO, Medline, Medline In Process, Embase, SportDiscus, CINAHL, and Cochrane Library, Reviews, and Trials. The following key words were used for database searches: electroencephalography, quantitative electroencephalography, qEEG, cranio-cerebral trauma, mild traumatic brain injury, mTBI, traumatic brain injury, brain concussion, concussion, brain damage, sport, athletic, and athlete. Observational, cohort, correlational, cross-sectional, and longitudinal studies were all included in the current review. Sixteen articles met inclusion criteria, which included data on 504 athletes and 367 controls. All 16 articles reported some abnormality in rs-EEG activity after a concussion; however, the cortical rhythms that were affected varied. Despite substantial methodological and analytical differences across the 16 studies, the current review suggests that rs-EEG may provide a reliable technique to identify persistent functional changes in athletes after a concussion. Because of the varied approaches, however, considerable work is needed to establish a systematic methodology to assess its efficacy as a marker of return-to-play.
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Affiliation(s)
- Alexander C Conley
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
- 4 Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Patrick S Cooper
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
| | - Frini Karayanidis
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
| | - Andrew J Gardner
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 5 School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
- 6 Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital , New Lambton Heights, New South Wales, Australia
| | - Chris R Levi
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
- 5 School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
- 6 Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital , New Lambton Heights, New South Wales, Australia
| | - Peter Stanwell
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 7 School of Health Sciences, University of Newcastle , Callaghan, New South Wales, Australia
| | - Michael B Gaetz
- 8 Faculty of Health Sciences, University of the Fraser Valley , Chilliwack, British Columbia, Canada
| | - Grant L Iverson
- 9 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
- 10 Spaulding Rehabilitation Hospital , Boston, Massachusetts
- 11 MassGeneral Hospital for Children™ Sport Concussion Program , Boston, Massachusetts
- 12 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
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54
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Longitudinal Changes in Resting State Connectivity and White Matter Integrity in Adolescents With Sports-Related Concussion. J Int Neuropsychol Soc 2018; 24:781-792. [PMID: 30139405 DOI: 10.1017/s1355617718000413] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to investigate alterations in functional connectivity, white matter integrity, and cognitive abilities due to sports-related concussion (SRC) in adolescents using a prospective longitudinal design. METHODS We assessed male high school football players (ages 14-18) with (n=16) and without (n=12) SRC using complementary resting state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) along with cognitive performance using the Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT). We assessed both changes at the acute phase (<7 days post-SRC) and at 21 days later, as well as, differences between athletes with SRC and age- and team-matched control athletes. RESULTS The results revealed rs-fMRI hyperconnectivity within posterior brain regions (e.g., precuneus and cerebellum), and hypoconnectivity in more anterior areas (e.g., inferior and middle frontal gyri) when comparing SRC group to control group acutely. Performance on the ImPACT (visual/verbal memory composites) was correlated with resting state network connectivity at both time points. DTI results revealed altered diffusion in the SRC group along a segment of the corticospinal tract and the superior longitudinal fasciculus in the acute phase of SRC. No differences between the SRC group and control group were seen at follow-up imaging. CONCLUSIONS Acute effects of SRC are associated with both hyperconnectivity and hypoconnectivity, with disruption of white matter integrity. In addition, acute memory performance was most sensitive to these changes. After 21 days, adolescents with SRC returned to baseline performance, although chronic hyperconnectivity of these regions could place these adolescents at greater risk for secondary neuropathological changes, necessitating future follow-up. (JINS, 2018, 24, 781-792).
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55
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Mustafi SM, Harezlak J, Koch KM, Nencka AS, Meier TB, West JD, Giza CC, DiFiori JP, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McCrea M, McAllister TW, Wu YC. Acute White-Matter Abnormalities in Sports-Related Concussion: A Diffusion Tensor Imaging Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2018; 35:2653-2664. [PMID: 29065805 DOI: 10.1089/neu.2017.5158] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sports-related concussion (SRC) is an important public health issue. Although standardized assessment tools are useful in the clinical management of acute concussion, the underlying pathophysiology of SRC and the time course of physiological recovery after injury remain unclear. In this study, we used diffusion tensor imaging (DTI) to detect white matter alterations in football players within 48 h after SRC. As part of the NCAA-DoD CARE Consortium study of SRC, 30 American football players diagnosed with acute concussion and 28 matched controls received clinical assessments and underwent advanced magnetic resonance imaging scans. To avoid selection bias and partial volume effects, whole-brain skeletonized white matter was examined by tract-based spatial statistics to investigate between-group differences in DTI metrics and their associations with clinical outcome measures. Mean diffusivity was significantly higher in brain white matter of concussed athletes, particularly in frontal and subfrontal long white matter tracts. In the concussed group, axial diffusivity was significantly correlated with the Brief Symptom Inventory and there was a similar trend with the symptom severity score of the Sport Concussion Assessment Tool. In addition, concussed athletes with higher fractional anisotropy performed better on the cognitive component of the Standardized Assessment of Concussion. Overall, the results of this study are consistent with the hypothesis that SRC is associated with changes in white matter tracts shortly after injury, and these differences are correlated clinically with acute symptoms and functional impairments.
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Affiliation(s)
- Sourajit Mitra Mustafi
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jaroslaw Harezlak
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University , Bloomington, Indiana
| | - Kevin M Koch
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Timothy B Meier
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - John D West
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Christopher C Giza
- 5 Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Division of Pediatric Neurology, Mattel Children's Hospital-UCLA Los Angeles , California
| | - John P DiFiori
- 6 Division of Sports Medicine, Departments of Family Medicine and Orthopedics, University of California Los Angeles , Los Angeles, California
| | - Kevin M Guskiewicz
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jason P Mihalik
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Stephen M LaConte
- 8 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Virginia Tech Carilion Research Institute, Roanoke, Virginia
| | - Stefan M Duma
- 9 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Blacksburg, Virginia
| | - Steven P Broglio
- 10 NeuroTrauma Research Laboratory, School of Kinesiology, University of Michigan , Ann Arbor, Michigan
| | - Andrew J Saykin
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael McCrea
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Thomas W McAllister
- 11 Department of Psychology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yu-Chien Wu
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
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56
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Lancaster MA, Meier TB, Olson DV, McCrea MA, Nelson LD, Muftuler LT. Chronic differences in white matter integrity following sport-related concussion as measured by diffusion MRI: 6-Month follow-up. Hum Brain Mapp 2018; 39:4276-4289. [PMID: 29964356 DOI: 10.1002/hbm.24245] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/19/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022] Open
Abstract
Recent studies demonstrated evidence of physiological changes in the brain following sport-related concussion (SRC) that persisted beyond the point at which athletes achieved full symptom recovery. Diffusion MRI techniques have been used to study brain white matter (WM) changes following SRC; however, longitudinal studies that follow injured athletes from the acute to chronic stages of injury are sparse. The current study explores potential persisting effects of the injury, which serves as a follow-up to our previous work that reported WM changes in the acute and subacute phase of SRC recovery. Concussed high school and collegiate football players (n = 17) and well-matched teammate controls (n = 20) were followed up at 6 months postinjury with diffusion tensor (DTI) and diffusion kurtosis imaging (DKI) as well as measures of self-reported symptoms, cognitive functioning, and balance. Results of tract-based spatial statistics (TBSS) analyses revealed continued widespread decreased mean and axial diffusivity compared to control subjects in 6-month follow-up scans. On the other hand, kurtosis metrics, which were significantly higher in concussed athletes in the acute phase, had normalized. WM tract regions-of-interest (ROIs) were created from significant clusters in the TBSS analysis, and linear mixed effects (LME) analyses were used to look at longitudinal changes in these ROIs over time. LME analyses revealed few time × group interactions indicating findings were relatively stable over time. In addition, acute concussion symptoms predicted diffusivity measures at 6 months postinjury. Findings indicate that DTI and DKI may be useful tools in assessing concussion severity, recovery, and possible long-term effects of concussion.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Center for Imaging Research Medical College of Wisconsin, Milwaukee, Wisconsin
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57
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Coyle HL, Ponsford J, Hoy KE. Understanding individual variability in symptoms and recovery following mTBI: A role for TMS-EEG? Neurosci Biobehav Rev 2018; 92:140-149. [PMID: 29885426 DOI: 10.1016/j.neubiorev.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
The pathophysiology associated with mild traumatic brain injury (mTBI) includes neurometabolic and cytoskeletal changes that have been shown to impair structural and functional connectivity. Evidence that persistent neuropsychological impairments post injury are linked to structural and functional connectivity changes is increasing. However, to date the relationship between connectivity changes, heterogeneity of persistent symptoms and recovery post mTBI has been poorly characterised. Recent innovations in neuroimaging provide new ways of exploring connectivity changes post mTBI. Namely, combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) offers several advantages over traditional approaches for studying connectivity changes post TBI. Its ability to perturb neural function in a controlled manner allows for measurement of causal interactions or effective connectivity between brain regions. We review the current literature assessing structural and functional connectivity following mTBI and outline the rationale for the use of TMS-EEG as an ideal tool for investigating the neural substrates of connectivity dysfunction and reorganisation post mTBI. The diagnostic, prognostic and potential therapeutic implications will also be explored.
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Affiliation(s)
- Hannah L Coyle
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, Australia.
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, Australia
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58
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Wilkerson GB, Grooms DR, Acocello SN. Neuromechanical Considerations for Postconcussion Musculoskeletal Injury Risk Management. Curr Sports Med Rep 2018; 16:419-427. [PMID: 29135640 DOI: 10.1249/jsr.0000000000000430] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent epidemiological studies have documented increased susceptibility to musculoskeletal injury after sport-related concussion, which raises questions about the adequacy of current clinical practices to ensure safe return to sport. A growing body of evidence derived from advanced neuroimaging and neurological assessment methods strongly suggests that mild traumatic brain injury has long-lasting adverse effects that persist beyond resolution of clinical symptoms. Plausible interrelationships among postconcussion changes in brain structure and function support the rationale for specific methods of clinical assessment and training to target the interaction of cognitive and motor function for reduction of musculoskeletal injury risk after concussion. The findings of preliminary clinical studies are presented to support suggested strategies for reduction of postconcussion musculoskeletal injury risk, and to identify novel approaches that we consider worthy areas for further research.
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Affiliation(s)
- Gary B Wilkerson
- 1Division of Athletic Training, School of Applied Health Sciences and Wellness, and Ohio Musculoskeletal and Neurological Institute, University of Tennessee at Chattanooga, Chattanooga, TN; and 2Graduate Athletic Training Program, Department of Health and Human Performance, Ohio University, Athens, OH
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59
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Clough M, Mutimer S, Wright DK, Tsang A, Costello DM, Gardner AJ, Stanwell P, Mychasiuk R, Sun M, Brady RD, McDonald SJ, Webster KM, Johnstone MR, Semple BD, Agoston DV, White OB, Frayne R, Fielding J, O'Brien TJ, Shultz SR. Oculomotor Cognitive Control Abnormalities in Australian Rules Football Players with a History of Concussion. J Neurotrauma 2018; 35:730-738. [DOI: 10.1089/neu.2017.5204] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Meaghan Clough
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Steven Mutimer
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - David K. Wright
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Adrian Tsang
- The Department of Radiology, The University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Center, Foothills Medical Center, Calgary, Alberta, Canada
| | - Daniel M. Costello
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J. Gardner
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Richelle Mychasiuk
- The Department of Psychology, The University of Calgary, Calgary, Alberta, Canada
| | - Mujun Sun
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Rhys D. Brady
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Stuart J. McDonald
- Physiology, Anatomy & Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Kyria M. Webster
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Maddison R. Johnstone
- Physiology, Anatomy & Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Bridgette D. Semple
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Denes V. Agoston
- Anatomy, Physiology & Genetics, Uniformed Services University, Bethesda, Maryland
| | - Owen B. White
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Frayne
- The Department of Radiology, The University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Center, Foothills Medical Center, Calgary, Alberta, Canada
| | - Joanne Fielding
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Terence J. O'Brien
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R. Shultz
- The Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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60
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Taghdiri F, Chung J, Irwin S, Multani N, Tarazi A, Ebraheem A, Khodadadi M, Goswami R, Wennberg R, Mikulis D, Green R, Davis K, Tator C, Eizenman M, Tartaglia MC. Decreased Number of Self-Paced Saccades in Post-Concussion Syndrome Associated with Higher Symptom Burden and Reduced White Matter Integrity. J Neurotrauma 2018; 35:719-729. [DOI: 10.1089/neu.2017.5274] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Chung
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Irwin
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Apameh Tarazi
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Ebraheem
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Mozghan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Ruma Goswami
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - David Mikulis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Robin Green
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Karen Davis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles Tator
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Moshe Eizenman
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Higger M, Shenton M, Bouix S. Pairwise, Ordinal Outlier Detection of Traumatic Brain Injuries. BRAINLESION : GLIOMA, MULTIPLE SCLEROSIS, STROKE AND TRAUMATIC BRAIN INJURIES. BRAINLES (WORKSHOP) 2018; 10670:100-110. [PMID: 29932171 PMCID: PMC6004828 DOI: 10.1007/978-3-319-75238-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Because mild Traumatic Brain Injuries (mTBI) are heterogeneous, classification methods perform outlier detection from a model of healthy tissue. Such a model is challenging to construct. Instead, we utilize region-specific pairwise (person-to-person) comparisons. Each person-region is characterized by a distribution of Fractional Anisotropy and comparisons are made via Median, Mean, Bhattacharya and Kullback-Liebler distances. Additionally, we examine an ordinal decision rule which compares a subject's nth most atypical region to a healthy control's. Ordinal comparison is motivated by mTBI's heterogeneity; each mTBI has some set of damaged tissue which is not necessarily spatially consistent. These improvements correctly distinguish Persistent Post-Concussive Symptoms in a small dataset but achieve only a .74 AUC in identifying mTBI subjects with milder symptoms. Finally, we perform subject-specific simulations which characterize which injuries are detected and which are missed.
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Affiliation(s)
- Matt Higger
- Psychiatry Neuroimaging Laboratory 1249 Boylston St. Boston, MA 02215
| | - Martha Shenton
- Psychiatry Neuroimaging Laboratory 1249 Boylston St. Boston, MA 02215
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory 1249 Boylston St. Boston, MA 02215
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63
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Lancaster MA, Olson DV, McCrea MA, Nelson LD, LaRoche AA, Muftuler LT. Acute white matter changes following sport-related concussion: A serial diffusion tensor and diffusion kurtosis tensor imaging study. Hum Brain Mapp 2018; 37:3821-3834. [PMID: 27237455 DOI: 10.1002/hbm.23278] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
Recent neuroimaging studies have suggested that following sport-related concussion (SRC) physiological brain alterations may persist after an athlete has shown full symptom recovery. Diffusion MRI is a versatile technique to study white matter injury following SRC, yet serial follow-up studies in the very acute stages following SRC utilizing a comprehensive set of diffusion metrics are lacking. The aim of the current study was to characterize white matter changes within 24 hours of concussion in a group of high school and collegiate athletes, using Diffusion Tensor and Diffusion Kurtosis Tensor metrics. Participants were reassessed a week later. At 24 hours post-injury, the concussed group reported significantly more concussion symptoms than a well-matched control group and demonstrated poorer performance on a cognitive screening measure, yet these differences were nonsignificant at the 8-day follow-up. Similarly, within 24-hours after injury, the concussed group exhibited a widespread decrease in mean diffusivity, increased axial kurtosis and, to a lesser extent, decreased axial and radial diffusivities compared with control subjects. At 8 days post injury, the differences in these diffusion metrics were even more widespread in the injured athletes, despite improvement of symptoms and cognitive performance. These MRI findings suggest that the athletes might not have reached full physiological recovery a week after the injury. These findings have significant implications for the management of SRC because allowing an athlete to return to play before the brain has fully recovered from injury may have negative consequences. Hum Brain Mapp 37:3821-3834, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Ashley A LaRoche
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.
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64
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The Use of an Electrophysiological Brain Function Index in the Evaluation of Concussed Athletes. J Head Trauma Rehabil 2018; 33:1-6. [DOI: 10.1097/htr.0000000000000328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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65
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España LY, Lee RM, Ling JM, Jeromin A, Mayer AR, Meier TB. Serial Assessment of Gray Matter Abnormalities after Sport-Related Concussion. J Neurotrauma 2017; 34:3143-3152. [DOI: 10.1089/neu.2017.5002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Lezlie Y. España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ryan M. Lee
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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66
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Zhao W, Cai Y, Li Z, Ji S. Injury prediction and vulnerability assessment using strain and susceptibility measures of the deep white matter. Biomech Model Mechanobiol 2017; 16:1709-1727. [PMID: 28500358 PMCID: PMC5682246 DOI: 10.1007/s10237-017-0915-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022]
Abstract
Reliable prediction and diagnosis of concussion is important for its effective clinical management. Previous model-based studies largely employ peak responses from a single element in a pre-selected anatomical region of interest (ROI) and utilize a single training dataset for injury prediction. A more systematic and rigorous approach is necessary to scrutinize the entire white matter (WM) ROIs as well as ROI-constrained neural tracts. To this end, we evaluated injury prediction performances of the 50 deep WM regions using predictor variables based on strains obtained from simulating the 58 reconstructed American National Football League head impacts. To objectively evaluate performance, repeated random subsampling was employed to split the impacts into independent training and testing datasets (39 and 19 cases, respectively, with 100 trials). Univariate logistic regressions were conducted based on training datasets to compute the area under the receiver operating characteristic curve (AUC), while accuracy, sensitivity, and specificity were reported based on testing datasets. Two tract-wise injury susceptibilities were identified as the best overall via pair-wise permutation test. They had comparable AUC, accuracy, and sensitivity, with the highest values occurring in superior longitudinal fasciculus (SLF; 0.867-0.879, 84.4-85.2, and 84.1-84.6%, respectively). Using metrics based on WM fiber strain, the most vulnerable ROIs included genu of corpus callosum, cerebral peduncle, and uncinate fasciculus, while genu and main body of corpus callosum, and SLF were among the most vulnerable tracts. Even for one un-concussed athlete, injury susceptibility of the cingulum (hippocampus) right was elevated. These findings highlight the unique injury discriminatory potentials of computational models and may provide important insight into how best to incorporate WM structural anisotropy for investigation of brain injury.
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Affiliation(s)
- Wei Zhao
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
| | - Yunliang Cai
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
| | - Zhigang Li
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03766, USA
| | - Songbai Ji
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA.
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA.
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
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67
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Hanley D, Prichep LS, Badjatia N, Bazarian J, Chiacchierini R, Curley KC, Garrett J, Jones E, Naunheim R, O'Neil B, O'Neill J, Wright DW, Huff JS. A Brain Electrical Activity Electroencephalographic-Based Biomarker of Functional Impairment in Traumatic Brain Injury: A Multi-Site Validation Trial. J Neurotrauma 2017; 35:41-47. [PMID: 28599608 DOI: 10.1089/neu.2017.5004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The potential clinical utility of a novel quantitative electroencephalographic (EEG)-based Brain Function Index (BFI) as a measure of the presence and severity of functional brain injury was studied as part of an independent prospective validation trial. The BFI was derived using quantitative EEG (QEEG) features associated with functional brain impairment reflecting current consensus on the physiology of concussive injury. Seven hundred and twenty adult patients (18-85 years of age) evaluated within 72 h of sustaining a closed head injury were enrolled at 11 U.S. emergency departments (EDs). Glasgow Coma Scale (GCS) score was 15 in 97%. Standard clinical evaluations were conducted and 5 to 10 min of EEG acquired from frontal locations. Clinical utility of the BFI was assessed for raw scores and percentile values. A multinomial logistic regression analysis demonstrated that the odds ratios (computed against controls) of the mild and moderate functionally impaired groups were significantly different from the odds ratio of the computed tomography (CT) postive (CT+, structural injury visible on CT) group (p = 0.0009 and p = 0.0026, respectively). However, no significant differences were observed between the odds ratios of the mild and moderately functionally impaired groups. Analysis of variance (ANOVA) demonstrated significant differences in BFI among normal (16.8%), mild TBI (mTBI)/concussed with mild or moderate functional impairment, (61.3%), and CT+ (21.9%) patients (p < 0.0001). Regression slopes of the odds ratios for likelihood of group membership suggest a relationship between the BFI and severity of impairment. Findings support the BFI as a quantitative marker of brain function impairment, which scaled with severity of functional impairment in mTBI patients. When integrated into the clinical assessment, the BFI has the potential to aid in early diagnosis and thereby potential to impact the sequelae of TBI by providing an objective marker that is available at the point of care, hand-held, non-invasive, and rapid to obtain.
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Affiliation(s)
- Daniel Hanley
- 1 Brain Injury Outcomes-The Johns Hopkins Medical Institutions , Baltimore, Maryland
| | - Leslie S Prichep
- 2 Department of Psychiatry, New York University School of Medicine , New York, New York.,3 BrainScope Co., Inc. , Bethesda, Maryland
| | | | | | | | - Kenneth C Curley
- 7 Iatrikos Research and Development Strategies, LLC , Tampa, Florida.,8 Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - John Garrett
- 9 Baylor University Medical Center , Dallas, Texas
| | - Elizabeth Jones
- 10 University of Texas Memorial Hermann Hospital , Houston, Texas
| | - Rosanne Naunheim
- 11 Washington University Barnes Jewish Medical Center , St. Louis, Missouri
| | - Brian O'Neil
- 12 Detroit Receiving Hospital , Detroit, Michigan
| | - John O'Neill
- 13 Allegheny General Hospital , Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - David W Wright
- 14 Emory University School of Medicine & Grady Memorial Hospital , Atlanta, Geogia
| | - J Stephen Huff
- 15 University of Virginia Health System , Charlottesville, Virginia
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68
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Panenka WJ, Gardner AJ, Dretsch MN, Crynen GC, Crawford FC, Iverson GL. Systematic Review of Genetic Risk Factors for Sustaining a Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:2093-2099. [PMID: 28100103 DOI: 10.1089/neu.2016.4833] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This systematic review examined the association between genetics and risk for sustaining a traumatic brain injury. We retrieved articles published in English from 1980 to July 2016 obtained from the online databases PubMed, PsycINFO®, MEDLINE®, Embase, and Web of Science. In total 5903 articles were identified, 77 underwent full-text screening, and 6 were included in this review. Five studies examined the risk of concussion associated with apolipoprotein E alleles (APOE-ɛ2, ɛ3,ɛ4), and polymorphisms of the APOE promoter (rs405509), brain derived neurotrophic factor (BDNF, rs6265), and dopamine receptor D2 (DRD2, rs1800497) were each considered in two studies. Microtubule associated protein tau (TAU exon 6 polymorphisms His47Tyr [rs2258689] and Ser53Pro [rs10445337]), and neurofilament heavy (NEHF, rs165602) genotypic variants, were the focus of single studies. No study showed an increased risk associated solely with the presence of the APOE-ɛ4 allele, nor were there any significant findings for the NEFH, TAU, or DRD2 genotypic variants. Two studies examined the APOE promoter -219G/T polymorphism in athletes, and both found an association with concussion. Both BDNF studies also found a significant association with concussion incidence; United States soldiers with the Met/Met genotype were more likely to report a history of concussion prior to deployment and to sustain a concussion during deployment. We conclude that the APOE promoter -219G/T polymorphism and the BDNF Met/Met genotype might confer risk for sustaining a TBI. Based on research to date, the APOE-ɛ4 allele does not appear to influence risk. More research is needed to determine if these findings replicate.
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Affiliation(s)
- William J Panenka
- 1 British Columbia Neuropsychiatry Program and Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrew J Gardner
- 2 Hunter New England Local Health District Sports Concussion Program; & Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
| | - Michael N Dretsch
- 3 Human Dimension Division (HDD), Headquarters Army Training and Doctrine Command (HQ TRADOC) , Fort Eustis, Virginia
| | | | | | - Grant L Iverson
- 5 Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
- 6 Defense and Veterans Brain Injury Center , Bethesda, Maryland
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69
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Broglio SP, McCrea M, McAllister T, Harezlak J, Katz B, Hack D, Hainline B. A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sports Med 2017; 47:1437-1451. [PMID: 28281095 PMCID: PMC5488134 DOI: 10.1007/s40279-017-0707-1] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The natural history of mild traumatic brain injury (TBI) or concussion remains poorly defined and no objective biomarker of physiological recovery exists for clinical use. The National Collegiate Athletic Association (NCAA) and the US Department of Defense (DoD) established the Concussion Assessment, Research and Education (CARE) Consortium to study the natural history of clinical and neurobiological recovery after concussion in the service of improved injury prevention, safety and medical care for student-athletes and military personnel. OBJECTIVES The objectives of this paper were to (i) describe the background and driving rationale for the CARE Consortium; (ii) outline the infrastructure of the Consortium policies, procedures, and governance; (iii) describe the longitudinal 6-month clinical and neurobiological study methodology; and (iv) characterize special considerations in the design and implementation of a multicenter trial. METHODS Beginning Fall 2014, CARE Consortium institutions have recruited and enrolled 23,533 student-athletes and military service academy students (approximately 90% of eligible student-athletes and cadets; 64.6% male, 35.4% female). A total of 1174 concussions have been diagnosed in participating subjects, with both concussion and baseline cases deposited in the Federal Interagency Traumatic Brain Injury Research (FITBIR) database. CONCLUSIONS Challenges have included coordinating regulatory issues across civilian and military institutions, operationalizing study procedures, neuroimaging protocol harmonization across sites and platforms, construction and maintenance of a relational database, and data quality and integrity monitoring. The NCAA-DoD CARE Consortium represents a comprehensive investigation of concussion in student-athletes and military service academy students. The richly characterized study sample and multidimensional approach provide an opportunity to advance the field of concussion science, not only among student athletes but in all populations at risk for mild TBI.
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Affiliation(s)
- Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, 401 Washtenaw Ave, Ann Arbor, MI, 48109, USA.
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA
| | - Barry Katz
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Dallas Hack
- National Collegiate Athletic Association, Indianapolis, IN, USA
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN, USA
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70
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Main KL, Soman S, Pestilli F, Furst A, Noda A, Hernandez B, Kong J, Cheng J, Fairchild JK, Taylor J, Yesavage J, Wesson Ashford J, Kraemer H, Adamson MM. DTI measures identify mild and moderate TBI cases among patients with complex health problems: A receiver operating characteristic analysis of U.S. veterans. Neuroimage Clin 2017; 16:1-16. [PMID: 28725550 PMCID: PMC5503837 DOI: 10.1016/j.nicl.2017.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 06/10/2017] [Accepted: 06/23/2017] [Indexed: 01/10/2023]
Abstract
Standard MRI methods are often inadequate for identifying mild traumatic brain injury (TBI). Advances in diffusion tensor imaging now provide potential biomarkers of TBI among white matter fascicles (tracts). However, it is still unclear which tracts are most pertinent to TBI diagnosis. This study ranked fiber tracts on their ability to discriminate patients with and without TBI. We acquired diffusion tensor imaging data from military veterans admitted to a polytrauma clinic (Overall n = 109; Age: M = 47.2, SD = 11.3; Male: 88%; TBI: 67%). TBI diagnosis was based on self-report and neurological examination. Fiber tractography analysis produced 20 fiber tracts per patient. Each tract yielded four clinically relevant measures (fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity). We applied receiver operating characteristic (ROC) analyses to identify the most diagnostic tract for each measure. The analyses produced an optimal cutpoint for each tract. We then used kappa coefficients to rate the agreement of each cutpoint with the neurologist's diagnosis. The tract with the highest kappa was most diagnostic. As a check on the ROC results, we performed a stepwise logistic regression on each measure using all 20 tracts as predictors. We also bootstrapped the ROC analyses to compute the 95% confidence intervals for sensitivity, specificity, and the highest kappa coefficients. The ROC analyses identified two fiber tracts as most diagnostic of TBI: the left cingulum (LCG) and the left inferior fronto-occipital fasciculus (LIF). Like ROC, logistic regression identified LCG as most predictive for the FA measure but identified the right anterior thalamic tract (RAT) for the MD, RD, and AD measures. These findings are potentially relevant to the development of TBI biomarkers. Our methods also demonstrate how ROC analysis may be used to identify clinically relevant variables in the TBI population.
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Key Words
- AD, axial diffusivity
- Axon degeneration
- CC, corpus callosum
- Concussion
- DAI, diffuse axonal injury
- DTI, diffusion tensor imaging
- FA, fractional anisotropy
- GN, genu
- Imaging
- LAT, left anterior thalamic tract
- LCG, left cingulum
- LCH, left cingulum – hippocampus
- LCS, left cortico-spinal tract
- LIF, left inferior fronto-occipital fasciculus
- LIL, left inferior longitudinal fasciculus
- LSL, left superior longitudinal fasciculus
- LST, left superior longitudinal fasciculus – temporal
- LUN, left uncinate
- MD, mean diffusivity
- Neurodegeneration
- PTSD, post-traumatic stress disorder
- RAT, right anterior thalamic tract
- RCG, right cingulum
- RCH, right cingulum – Hippocampus
- RCS, right cortico-spinal tract
- RD, radial diffusivity
- RIF, right inferior fronto-occipital fasciculus
- RIL, right inferior longitudinal fasciculus
- ROC, receiver operating characteristic
- RSL, right superior longitudinal fasciculus
- RST, right superior longitudinal fasciculus – temporal
- RUN, right uncinate
- SP, splenium
- TBI, traumatic brain injury
- Traumatic brain injury
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Affiliation(s)
- Keith L. Main
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, United States
- General Dynamics Health Solutions (GDHS), Fairfax, VA, United States
| | - Salil Soman
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Ansgar Furst
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Art Noda
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Kong
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jauhtai Cheng
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
| | - Jennifer K. Fairchild
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Joy Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jerome Yesavage
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Maheen M. Adamson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, United States
- Defense and Veterans Brain Injury Center (DVBIC), Veterans Affairs, Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, United States
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71
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Thomas AW, Watts R, Filippi CG, Nickerson JP, Andrews T, Lieberman G, Naylor MR, Eppstein MJ, Freeman K. Dynamic changes in diffusion measures improve sensitivity in identifying patients with mild traumatic brain injury. PLoS One 2017; 12:e0178360. [PMID: 28604837 PMCID: PMC5467843 DOI: 10.1371/journal.pone.0178360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/11/2017] [Indexed: 12/03/2022] Open
Abstract
The goal of this study was to investigate patterns of axonal injury in the first week after mild traumatic brain injury (mTBI). We performed a prospective cohort study of 20 patients presenting to the emergency department with mTBI, using 3.0T diffusion tensor MRI immediately after injury and again at 1 week post-injury. Corresponding data were acquired from 16 controls over a similar time interval. Fractional anisotropy (FA) and other diffusion measures were calculated from 11 a priori selected axon tracts at each time-point, and the change across time in each region was quantified for each subject. Clinical outcomes were determined by standardized neurocognitive assessment. We found that mTBI subjects were significantly more likely to have changes in FA in those 11 regions of interest across the one week time period, compared to control subjects whose FA measurements were stable across time. Longitudinal imaging was more sensitive to these subtle changes in white matter integrity than cross-sectional assessments at either of two time points, alone. Analyzing the sources of variance in our control population, we show that this increased sensitivity is likely due to the smaller within-subject variability obtained by longitudinal analysis with each subject as their own control. This is in contrast to the larger between-subject variability obtained by cross-sectional analysis of each individual subject to normalized data from a control group. We also demonstrated that inclusion of all a priori ROIs in an analytic model as opposed to measuring individual ROIs improves detection of white matter changes by overcoming issues of injury heterogeneity. Finally, we employed genetic programming (a bio-inspired computational method for model estimation) to demonstrate that longitudinal changes in FA have utility in predicting the symptomatology of patients with mTBI. We conclude concussive brain injury caused acute, measurable changes in the FA of white matter tracts consistent with evolving axonal injury and/or edema, which may contribute to post-concussive symptoms.
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Affiliation(s)
- Alexander W. Thomas
- Department of Surgery, University of Vermont, Burlington, Vermont, United States of America
| | - Richard Watts
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
| | - Christopher G. Filippi
- Department of Neurology, University of Vermont, Burlington, Vermont, United States of America
- Hofstra North Shore LIJ School of Medicine; Hempstead, New York, United States of America
| | - Joshua P. Nickerson
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
| | - Trevor Andrews
- Department of Radiology, University of Vermont, Burlington, Vermont, United States of America
- Philips HealthTech, Cleveland, Ohio, United States of America
| | - Gregory Lieberman
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- U.S. Army Research Laboratory, Human Research and Engineering Directorate, Aberdeen Proving Ground, Aberdeen, Maryland, United States of America
| | - Magdalena R. Naylor
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Margaret J. Eppstein
- Department of Computer Science, University of Vermont, Burlington, Vermont, United States of America
| | - Kalev Freeman
- Department of Surgery, University of Vermont, Burlington, Vermont, United States of America
- * E-mail:
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Coughlin JM, Wang Y, Minn I, Bienko N, Ambinder EB, Xu X, Peters ME, Dougherty JW, Vranesic M, Koo SM, Ahn HH, Lee M, Cottrell C, Sair HI, Sawa A, Munro CA, Nowinski CJ, Dannals RF, Lyketsos CG, Kassiou M, Smith G, Caffo B, Mori S, Guilarte TR, Pomper MG. Imaging of Glial Cell Activation and White Matter Integrity in Brains of Active and Recently Retired National Football League Players. JAMA Neurol 2017; 74:67-74. [PMID: 27893897 DOI: 10.1001/jamaneurol.2016.3764] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Microglia, the resident immune cells of the central nervous system, play an important role in the brain's response to injury and neurodegenerative processes. It has been proposed that prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury. Objective To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity. Design, Setting, and Participants This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level-, and body mass index-matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016. Main Outcomes and Measures Positron emission tomography-based regional measures of TSPO using [11C]DPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance. Results The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using [11C]DPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004). We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance. Conclusions and Relevance The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.
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Affiliation(s)
- Jennifer M Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland2Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Yuchuan Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Il Minn
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Nicholas Bienko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Emily B Ambinder
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Xin Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - John W Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Melin Vranesic
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Soo Min Koo
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hye-Hyun Ahn
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Merton Lee
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Chris Cottrell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland3Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher J Nowinski
- Concussion Legacy Foundation, Waltham, Massachusetts5Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
| | - Robert F Dannals
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Kassiou
- School of Chemistry, University of Sydney, New South Wales, Australia7Discipline of Medical Radiation Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Gwenn Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susumu Mori
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Tomas R Guilarte
- Department of Environmental and Occupational Health, Florida International University, Miami10Program in Cognitive Neuroscience and Imaging, Florida International University, Miami
| | - Martin G Pomper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland2Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Abstract
Concussion is a significant issue in medicine and the media today. With growing interest on the long-term effects of sports participation, it is important to understand what occurs in the brain after an impact of any degree. While some of the basic pathophysiology has been elucidated, much is still unknown about what happens in the brain after traumatic brain injury, particularly with milder injuries where no damage can be seen at the structural level on standard neuroimaging. Understanding the chain of events from a cellular level using studies investigating more severe injuries can help to drive research efforts in understanding the symptomatology that is seen in the acute phase after concussion, as well as point to mechanisms that may underlie persistent post-concussive symptoms. This review discusses the basic neuropathology that occurs after traumatic brain injury at the cellular level. We also present the pathology of chronic traumatic encephalopathy and its similarities to other neurodegenerative diseases. We conclude with recent imaging and biomarker findings looking at changes that may occur after repeated subconcussive blows, which may help to guide efforts in understanding if cumulative subconcussive mechanical forces upon the brain are detrimental in the long term or if concussive symptoms mark the threshold for brain injury.
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Affiliation(s)
- Meeryo C Choe
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine, 22-474 MDCC, 10833 LeConte Avenue, Los Angeles, CA, 90095-1752, USA.
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74
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Gardner AJ, Shih SL, Adamov EV, Zafonte RD. Research Frontiers in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2017; 28:413-431. [DOI: 10.1016/j.pmr.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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75
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McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, Manley G, Menon D, Chen JK, Wall R, Schneider KJ, McAllister T. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51:919-929. [DOI: 10.1136/bjsports-2016-097447] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 01/17/2023]
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76
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Ganpule S, Daphalapurkar NP, Ramesh KT, Knutsen AK, Pham DL, Bayly PV, Prince JL. A Three-Dimensional Computational Human Head Model That Captures Live Human Brain Dynamics. J Neurotrauma 2017; 34:2154-2166. [PMID: 28394205 DOI: 10.1089/neu.2016.4744] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Diffuse axonal injury (DAI) is a debilitating consequence of traumatic brain injury (TBI) attributed to abnormal stretching of axons caused by blunt head trauma or acceleration of the head. We developed an anatomically accurate, subject-specific, three-dimensional (3D) computational model of the human brain, and used it to study the dynamic deformations in the substructures of the brain when the head is subjected to rotational accelerations. The computational head models use anatomy and morphology of the white matter fibers obtained using MRI. Subject-specific full-field shearing motions in live human brains obtained through a recently developed tagged MRI imaging technique are then used to validate the models by comparing the measured and predicted heterogeneous dynamic mechanical response of the brain. These results are used to elucidate the dynamics of local shearing deformations in the brain substructures caused by rotational acceleration of the head. Our work demonstrates that the rotational dynamics of the brain has a timescale of ∼100 ms as determined by the shearing wave speeds, and thus the injuries associated with rotational accelerations likely occur over these time scales. After subject-specific validation using the live human subject data, a representative subject-specific head model is used to simulate a real life scenario that resulted in a concussive injury. Results suggest that regions of the brain, in the form of a toroid, encompassing the white matter, the cortical gray matter, and outer parts of the limbic system have a higher susceptibility to injury under axial rotations of the head.
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Affiliation(s)
- Shailesh Ganpule
- 1 Hopkins Extreme Materials Institute, Johns Hopkins University , Baltimore, Maryland
| | - Nitin P Daphalapurkar
- 1 Hopkins Extreme Materials Institute, Johns Hopkins University , Baltimore, Maryland
| | - Kaliat T Ramesh
- 1 Hopkins Extreme Materials Institute, Johns Hopkins University , Baltimore, Maryland
| | - Andrew K Knutsen
- 2 Center for Neuroscience and Regenerative Medicine , The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Dzung L Pham
- 2 Center for Neuroscience and Regenerative Medicine , The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Philip V Bayly
- 3 Department of Mechanical Engineering, Washington University in St. Louis , St. Louis, Missouri
| | - Jerry L Prince
- 4 Department of Electrical and Computer Engineering, Johns Hopkins University , Baltimore, Maryland
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77
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Shinoda J, Asano Y. Disorder of Executive Function of the Brain after Head Injury and Mild Traumatic Brain Injury - Neuroimaging and Diagnostic Criteria for Implementation of Administrative Support in Japan. Neurol Med Chir (Tokyo) 2017; 57:199-209. [PMID: 28381654 PMCID: PMC5447811 DOI: 10.2176/nmc.ra.2016-0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The diagnotic criteria for disorder of the executive function of the brain (DEFB) as a syndrome of sequela were administratively established (ad-DEFB) in Japan in 2006 to support disabled patients whose impairment, limited to cognition (memory, attention, execution, and behavior), emerges after organic brain injuries regardless of physical deficits. However, some patients suffering from traumatic brain injury (TBI) have been excluded from receiving medico-social services. In particular, this tendency is more prominent in patients with mild TBI because no lesions are apparent on conventional computed tomography (CT) or magnetic resonance imaging (MRI) in the chronic phase. Recent development of new MRI neuroimaging modalities and positron emission tomography (PET) imaging makes it possible to detect regions of minute organic lesions and metabolic dysfunction in the brain where organic lesions may be absent or cannot be detected on conventional CT or MRI. In this review, we discuss diagnostic criteria for mild TBI and ad-DEFB, the relationship between the two disorders, characteristic neuroimaging [(MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)] of diffuse brain injury including cerebral concussion, which is the principal cause of mild TBI, and suggested pathological mechanisms of ad-DEFB in DBI.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
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78
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Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
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Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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79
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Urban KJ, Riggs L, Wells GD, Keightley M, Chen JK, Ptito A, Fait P, Taha T, Sinopoli KJ. Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth. J Neurotrauma 2016; 34:816-823. [PMID: 27629883 DOI: 10.1089/neu.2016.4502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.
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Affiliation(s)
- Karolina J Urban
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Lily Riggs
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Greg D Wells
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada .,4 Department of Physiology and Experimental Medicine, the Hospital for Sick Children , Toronto, Ontario, Canada
| | - Michelle Keightley
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Jen-Kai Chen
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Alain Ptito
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Philippe Fait
- 6 Department of Human Kinetic, University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada .,7 Research Group on Neuromusculoskeletal Dysfunctions (GRAN), University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada
| | - Tim Taha
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada
| | - Katia J Sinopoli
- 8 Department of Psychology, Division of Neurology, the Hospital for Sick Children , Toronto, Ontario, Canada
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80
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Genc S, Anderson V, Ryan NP, Malpas CB, Catroppa C, Beauchamp MH, Silk TJ. Recovery of White Matter following Pediatric Traumatic Brain Injury Depends on Injury Severity. J Neurotrauma 2016; 34:798-806. [PMID: 27468807 DOI: 10.1089/neu.2016.4584] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Previous studies in pediatric traumatic brain injury (TBI) have been variable in describing the effects of injury severity on white-matter development. The present study used diffusion tensor imaging to investigate prospective sub-acute and longitudinal relationships between early clinical indicators of injury severity, diffusion metrics, and neuropsychological outcomes. Pediatric patients with TBI underwent magnetic resonance imaging (MRI) (n = 78, mean [M] = 10.56, standard deviation [SD] = 2.21 years) at the sub-acute stage after injury (M = 5.55, SD = 3.05 weeks), and typically developing children were also included and imaged (n = 30, M = 10.60, SD = 2.88 years). A sub-set of the patients with TBI (n = 15) was followed up with MRI 2 years post-injury. Diffusion MRI images were acquired at sub-acute and 2-year follow-up time points and analyzed using Tract-Based Spatial Statistics. At the sub-acute stage, mean diffusivity and axial diffusivity were significantly higher in the TBI group compared with matched controls (p < 0.05). TBI severity significantly predicted diffusion profiles at the sub-acute and 2-year post-injury MRI. Patients with more severe TBI also exhibited poorer information processing speed at 6-months post-injury, which in turn correlated with their diffusion metrics. These findings highlight that the severity of the injury not only has an impact on white-matter microstructure, it also impacts its recovery over time. Moreover, findings suggest that sub-acute microstructural changes may represent a useful prognostic marker to identify children at elevated risk for longer term deficits.
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Affiliation(s)
- Sila Genc
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia
| | - Vicki Anderson
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Nicholas P Ryan
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Charles B Malpas
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia
| | - Cathy Catroppa
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Miriam H Beauchamp
- 3 Department of Psychology, The University of Montreal , Montreal, Quebec, Canada .,4 Ste-Justine Hospital Research Center , Montreal, Quebec, Canada
| | - Timothy J Silk
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,5 Department of Paediatrics, University of Melbourne , The Royal Children's Hospital, Melbourne, Australia
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81
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Shultz SR, McDonald SJ, Vonder Haar C, Meconi A, Vink R, van Donkelaar P, Taneja C, Iverson GL, Christie BR. The potential for animal models to provide insight into mild traumatic brain injury: Translational challenges and strategies. Neurosci Biobehav Rev 2016; 76:396-414. [PMID: 27659125 DOI: 10.1016/j.neubiorev.2016.09.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 09/07/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
Mild traumatic brain injury (mTBI) is a common health problem. There is tremendous variability and heterogeneity in human mTBI, including mechanisms of injury, biomechanical forces, injury severity, spatial and temporal pathophysiology, genetic factors, pre-injury vulnerability and resilience factors, and clinical outcomes. Animal models greatly reduce this variability and heterogeneity, and provide a means to study mTBI in a rigorous, controlled, and efficient manner. Rodent models, in particular, are time- and cost-efficient, and they allow researchers to measure morphological, cellular, molecular, and behavioral variables in a single study. However, inter-species differences in anatomy, morphology, metabolism, neurobiology, and lifespan create translational challenges. Although the term "mild" TBI is used often in the pre-clinical literature, clearly defined criteria for mild, moderate, and severe TBI in animal models have not been agreed upon. In this review, we introduce current issues facing the mTBI field, summarize the available research methodologies and previous studies in mTBI animal models, and discuss how a translational research approach may be useful in advancing our understanding and management of mTBI.
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Affiliation(s)
- Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
| | - Stuart J McDonald
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC, Australia
| | - Cole Vonder Haar
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Alicia Meconi
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
| | - Robert Vink
- Division of Health Sciences, The University of South Australia, Adelaide, SA, Australia
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Chand Taneja
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, and MassGeneral Hospital for Children™ Sports Concussion Program, Boston, MA, USA
| | - Brian R Christie
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
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82
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Davenport EM, Urban JE, Mokhtari F, Lowther EL, Van Horn JD, Vaughan CG, Gioia GA, Whitlow CT, Stitzel JD, Maldjian JA. Subconcussive impacts and imaging findings over a season of contact sports. ACTA ACUST UNITED AC 2016; 1:CNC19. [PMID: 30202561 PMCID: PMC6093756 DOI: 10.2217/cnc-2016-0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/28/2016] [Indexed: 12/26/2022]
Abstract
The effect of repeated subconcussive head impacts in youth and high school sports on the developing brain is poorly understood. Emerging neuroimaging data correlated with biomechanical exposure metrics are beginning to demonstrate relationships across a variety of modalities. The long-term consequences of these changes are unknown. A review of the currently available literature on the effect of subconcussive head impacts on youth and high school-age male football players provides compelling evidence for more focused studies of these effects in these vulnerable populations. Concussions are known to cause clinical symptoms, which are especially concerning for youth and high school athletes. However, the effects of repeated head impacts that do not cause a diagnosed concussion, known as subconcussive head impacts, are currently unknown. Recent research has identified similar changes in the brain following repeated nonconcussive impacts to the head, once thought to be caused only by the occurrence of concussion with the presence of clinical symptoms. Similarly, many reports suggest that a higher exposure to head impacts is associated with a greater amount of structural and/or functional changes in the brain. Given the similar effects on the brain, with or without symptoms, more work is needed to determine the long-term effects of subconcussive head impacts on individual athletes, particularly in the youth and high school age population.
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Affiliation(s)
- Elizabeth M Davenport
- Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jillian E Urban
- Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA
| | - Fatemeh Mokhtari
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA
| | - Ervin L Lowther
- Department of Radiology-Neuroradiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Department of Radiology-Neuroradiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA
| | - John D Van Horn
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA.,USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Christopher G Vaughan
- Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, MD 20850, USA.,Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, MD 20850, USA
| | - Gerard A Gioia
- Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, MD 20850, USA.,Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, MD 20850, USA
| | - Christopher T Whitlow
- Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA
| | - Joel D Stitzel
- Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA.,Virginia Tech - Wake Forest School of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC 27157-1088, USA
| | - Joseph A Maldjian
- Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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83
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Finkel AG, Yerry JA, Klaric JS, Ivins BJ, Scher A, Choi YS. Headache in military service members with a history of mild traumatic brain injury: A cohort study of diagnosis and classification. Cephalalgia 2016; 37:548-559. [DOI: 10.1177/0333102416651285] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Headaches after concussion are highly prevalent, relatively persistent and are being treated like primary headaches, especially migraine. Methods We studied all new patients seen between August 2008 and December 2009 assessed by a civilian headache specialist at the TBI Center at Womack Army Medical Center, Fort Bragg, NC. We report sample demographics, injuries and headache characteristics, including time from injury to headache onset, detailed descriptions and International Classification of Headache Disorders second edition primary headache diagnosis type. Results A total of 95 soldiers reported 166 headaches. The most common injury cited was a blast (53.7%). Most subjects (76.8%) recalled the onset of any headache within 7 days of injury. The most commonly diagnosed headache was a continuous type with migraine features ( n = 31 (18.7%)), followed by chronic migraine (type 1.5.1, n = 14 (8.4%)), migraine with aura (type 1.2.1, n = 10 (6.0%)), hemicrania continua (type 4.7, n = 12 (7.2%)), chronic cluster (type 3.1.2, n = 6 (3.6%)) and headaches not otherwise classifiable (type 14.1, n = 5 (3.0%)) also present. The most clinically important was a continuous headache with migraine features. Conclusion We present a series of patients seen in a military treatment facility for headache diagnosis after concussion in whom we found migraine, as well as uncommon primary headache types, at frequencies that were much higher than expected.
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Affiliation(s)
- Alan G Finkel
- Womack Army Medical Center (WAMC), Fort Bragg, NC, USA
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Carolina Headache Institute, Chapel Hill, NC, USA
| | | | - John S Klaric
- Womack Army Medical Center (WAMC), Fort Bragg, NC, USA
| | - Brian J Ivins
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Ann Scher
- Uniformed Services University, Bethesda, MD, USA
| | - Young S Choi
- Womack Army Medical Center (WAMC), Fort Bragg, NC, USA
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84
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Henry LC, Tremblay S, De Beaumont L. Long-Term Effects of Sports Concussions: Bridging the Neurocognitive Repercussions of the Injury with the Newest Neuroimaging Data. Neuroscientist 2016; 23:567-578. [PMID: 27188455 DOI: 10.1177/1073858416651034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Little is known of the long-term effects of sports-related concussion. Within the scientific literature, conclusions vary substantially where some work suggests there are no long-term consequences at all and other studies show rampant neurodegeneration thought to be caused by sometimes even a single concussive blow to the head. There is growing evidence that supports multiple long-term outcomes, showing both subclinical and clinically relevant changes in the brains of athletes, young and old alike. This article reviews the pathohistology of cerebral concussions and examines the extant literature with a focus on electrophysiological and neuroimaging findings. Neurobehavioral and neurocognitive changes are also reviewed, particularly as they are related to chronic traumatic encephalopathy. Lacunae within the literature are explored, and future research directions are proposed.
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Affiliation(s)
- Luke C Henry
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sebastien Tremblay
- 2 Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- 3 Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,4 Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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85
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Fink AZ, Mogil LB, Lipton ML. Advanced neuroimaging in the clinic: critical appraisal of the evidence base. Br J Radiol 2016; 89:20150753. [PMID: 27074623 DOI: 10.1259/bjr.20150753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The shortage of high-quality systematic reviews in the field of radiology limits evidence-based integration of imaging methods into clinical practice and may perpetuate misconceptions regarding the efficacy and appropriateness of imaging techniques for specific applications. Diffusion tensor imaging for patients with mild traumatic brain injury (DTI-mTBI) and dynamic susceptibility contrast MRI for patients with glioma (DSC-glioma) are applications of quantitative neuroimaging, which similarly detect manifestations of disease where conventional neuroimaging techniques cannot. We performed a critical appraisal of reviews, based on the current evidence-based medicine methodology, addressing the ability of DTI-mTBI and DSC-glioma to (a) detect brain abnormalities and/or (b) predict clinical outcomes. 23 reviews of DTI-mTBI and 26 reviews of DSC-glioma met criteria for inclusion. All reviews addressed detection of brain abnormalities, whereas 12 DTI-mTBI reviews and 22 DSC-glioma reviews addressed prediction of a clinical outcome. All reviews were assessed using a critical appraisal worksheet consisting of 19 yes/no questions. Reviews were graded according to the total number of positive responses and the 2011 Oxford Centre for evidence-based medicine levels of evidence criteria. Reviews addressing DTI-mTBI detection had moderate quality, while those addressing DSC-glioma were of low quality. Reviews addressing prediction of outcomes for both applications were of low quality. Five DTI-mTBI reviews, but only one review of DSC-glioma met criteria for classification as a meta-analysis/systematic/quantitative review.
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Affiliation(s)
- Adam Z Fink
- 1 The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa B Mogil
- 1 The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA.,2 SUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Michael L Lipton
- 1 The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA.,3 Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.,4 The Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.,5 Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.,6 Departments of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
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86
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Roberts RM, Mathias JL, Rose SE. Relationship Between Diffusion Tensor Imaging (DTI) Findings and Cognition Following Pediatric TBI: A Meta-Analytic Review. Dev Neuropsychol 2016; 41:176-200. [PMID: 27232263 PMCID: PMC4960507 DOI: 10.1080/87565641.2016.1186167] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study meta-analyzed research examining relationships between diffusion tensor imaging and cognition following pediatric traumatic brain injury (TBI). Data from 14 studies that correlated fractional anisotropy (FA) or apparent diffusion coefficient/mean diffusivity with cognition were analyzed. Short-term (<4 weeks post-TBI) findings were inconsistent, but, in the medium to long term, FA values for numerous large white matter tracts and the whole brain were related to cognition. However, the analyses were limited by the diversity of brain regions and cognitive outcomes that have been examined; all in relatively small samples. Moreover, additional data are needed to investigate the impact of age and injury severity on these findings.
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Affiliation(s)
| | - Jane L. Mathias
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Stephen E. Rose
- CSIRO Health & Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women’s Hospital, Herston, Australia
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87
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Wright AD, Jarrett M, Vavasour I, Shahinfard E, Kolind S, van Donkelaar P, Taunton J, Li D, Rauscher A. Myelin Water Fraction Is Transiently Reduced after a Single Mild Traumatic Brain Injury--A Prospective Cohort Study in Collegiate Hockey Players. PLoS One 2016; 11:e0150215. [PMID: 26913900 PMCID: PMC4767387 DOI: 10.1371/journal.pone.0150215] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/10/2016] [Indexed: 12/12/2022] Open
Abstract
Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite ‘compromised white matter integrity’ often being described as a consequence of mTBI. In this preliminary cohort study, myelin water imaging was used to prospectively evaluate changes in myelin water fraction, derived from the T2 decay signal, in two varsity hockey teams (45 players) over one season of athletic competition. 11 players sustained a concussion during competition, and were scanned at 72 hours, 2 weeks, and 2 months post-injury. Results demonstrated a reduction in myelin water fraction at 2 weeks post-injury in several brain areas relative to preseason scans, including the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule. Myelin water fraction recovered to pre-season values by 2 months post-injury. These results may indicate transient myelin disruption following a single mTBI, with subsequent remyelination of affected neurons. Myelin disruption was not apparent in the athletes who did not experience a concussion, despite exposure to repetitive subconcussive trauma over a season of collegiate hockey. These findings may help to explain many of the metabolic and neurological deficits observed clinically following mTBI.
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Affiliation(s)
- Alexander D. Wright
- MD/PhD Program, University of British Columbia, Vancouver, Canada
- Southern Medical Program, University of British Columbia Okanagan, Kelowna, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Jarrett
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Irene Vavasour
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Elham Shahinfard
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Shannon Kolind
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Jack Taunton
- Faculty of Medicine, Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| | - David Li
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada
- * E-mail:
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88
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Abstract
Traumatic brain injury survivors often experience cognitive deficits and neuropsychiatric symptoms. However, the neurobiological mechanisms underlying specific impairments are not fully understood. Advances in neuroimaging techniques (such as diffusion tensor imaging and functional MRI) have given us new insights on structural and functional connectivity patterns of the human brain in both health and disease. The connectome derived from connectivity maps reflects the entire constellation of distributed brain networks. Using these powerful neuroimaging approaches, changes at the microstructural level can be detected through regional and global properties of neuronal networks. Here we will review recent developments in the study of brain network abnormalities in traumatic brain injury, mainly focusing on structural and functional connectivity. Some connectomic studies have provided interesting insights into the neurological dysfunction that occurs following traumatic brain injury. These techniques could eventually be helpful in developing imaging biomarkers of cognitive and neurobehavioral sequelae, as well as predicting outcome and prognosis.
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Affiliation(s)
- Hui Xiao
- Center of Medical Imaging, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian Province, China; Department of Medical Imaging, Dongfang Hospital, Xiamen University, Fuzhou, Fujian Province, China
| | - Yang Yang
- Department of Emergency, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian Province, China
| | - Ji-Hui Xi
- Department of Medical Imaging, Dongfang Hospital, Xiamen University, Fuzhou, Fujian Province, China
| | - Zi-Qian Chen
- Center of Medical Imaging, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian Province, China
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89
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Czerniak SM, Sikoglu EM, Liso Navarro AA, McCafferty J, Eisenstock J, Stevenson JH, King JA, Moore CM. A resting state functional magnetic resonance imaging study of concussion in collegiate athletes. Brain Imaging Behav 2016; 9:323-32. [PMID: 25112544 DOI: 10.1007/s11682-014-9312-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.
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Affiliation(s)
- Suzanne M Czerniak
- Department of Psychiatry, Center for Comparative NeuroImaging, University of Massachusetts Medical School, 303 Belmont Street, Worcester, MA, 01604, USA,
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90
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Abstract
OBJECTIVES Recent advances in neuroimaging methodologies sensitive to axonal injury have made it possible to assess in vivo the extent of traumatic brain injury (TBI) -related disruption in neural structures and their connections. The objective of this paper is to review studies examining connectivity in TBI with an emphasis on structural and functional MRI methods that have proven to be valuable in uncovering neural abnormalities associated with this condition. METHODS We review studies that have examined white matter integrity in TBI of varying etiology and levels of severity, and consider how findings at different times post-injury may inform underlying mechanisms of post-injury progression and recovery. Moreover, in light of recent advances in neuroimaging methods to study the functional connectivity among brain regions that form integrated networks, we review TBI studies that use resting-state functional connectivity MRI methodology to examine neural networks disrupted by putative axonal injury. RESULTS The findings suggest that TBI is associated with altered structural and functional connectivity, characterized by decreased integrity of white matter pathways and imbalance and inefficiency of functional networks. These structural and functional alterations are often associated with neurocognitive dysfunction and poor functional outcomes. CONCLUSIONS TBI has a negative impact on distributed brain networks that lead to behavioral disturbance.
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91
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Shen Q, Watts LT, Li W, Duong TQ. Magnetic Resonance Imaging in Experimental Traumatic Brain Injury. Methods Mol Biol 2016; 1462:645-58. [PMID: 27604743 DOI: 10.1007/978-1-4939-3816-2_35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in the USA. Common causes of TBI include falls, violence, injuries from wars, and vehicular and sporting accidents. The initial direct mechanical damage in TBI is followed by progressive secondary injuries such as brain swelling, perturbed cerebral blood flow (CBF), abnormal cerebrovascular reactivity (CR), metabolic dysfunction, blood-brain-barrier disruption, inflammation, oxidative stress, and excitotoxicity, among others. Magnetic resonance imaging (MRI) offers the means to noninvasively probe many of these secondary injuries. MRI has been used to image anatomical, physiological, and functional changes associated with TBI in a longitudinal manner. This chapter describes controlled cortical impact (CCI) TBI surgical procedures, a few common MRI protocols used in TBI imaging, and, finally, image analysis pertaining to experimental TBI imaging in rats.
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Affiliation(s)
- Qiang Shen
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX, 78229, USA. .,Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA. .,Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA.
| | - Lora Tally Watts
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX, 78229, USA.,Departments of Cellular and Structure Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Wei Li
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX, 78229, USA.,Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Timothy Q Duong
- Research Imaging Institute, University of Texas Health Science Center, 8403 Floyd Curl Dr, San Antonio, TX, 78229, USA. .,Department of Ophthalmology, University of Texas Health Science Center, San Antonio, TX, USA. .,Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA. .,Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX, USA.
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92
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Abstract
Weight drop models in rodents have been used for several decades to advance our understanding of the pathophysiology of traumatic brain injury. Weight drop models have been used to replicate focal cerebral contusion as well as diffuse brain injury characterized by axonal damage. More recently, closed head injury models with free head rotation have been developed to model sports concussions, which feature functional disturbances in the absence of overt brain damage assessed by conventional imaging techniques. Here, we describe the history of development of closed head injury models in the first part of the chapter. In the second part, we describe the development of our own weight drop closed head injury model that features impact plus rapid downward head rotation, no structural brain injury, and long-term cognitive deficits in the case of multiple injuries. This rodent model was developed to reproduce key aspects of sports concussion so that a mechanistic understanding of how long-term cognitive deficits might develop will eventually follow. Such knowledge is hoped to impact athletes and war fighters and others who suffer concussive head injuries by leading to targeted therapies aimed at preventing cognitive and other neurological sequelae in these high-risk groups.
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Affiliation(s)
- Brian T Kalish
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Michael J Whalen
- Department of Pediatric Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pediatric Critical Care Medicine, Massachusetts General Hospital, East Building 149, 13th Street, Charlestown, MA, 02129, USA.
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93
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Meier TB, Bergamino M, Bellgowan PSF, Teague TK, Ling JM, Jeromin A, Mayer AR. Longitudinal assessment of white matter abnormalities following sports-related concussion. Hum Brain Mapp 2015; 37:833-45. [PMID: 26663463 DOI: 10.1002/hbm.23072] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/23/2015] [Indexed: 01/08/2023] Open
Abstract
There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Patrick S F Bellgowan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, North Bethesda, Maryland
| | - T K Teague
- Departments of Surgery and Psychiatry, University of Oklahoma College of Medicine, Tulsa, Oklahoma.,Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma.,Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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94
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Meier TB, Bellgowan PSF, Bergamino M, Ling JM, Mayer AR. Thinner Cortex in Collegiate Football Players With, but not Without, a Self-Reported History of Concussion. J Neurotrauma 2015; 33:330-8. [PMID: 26061068 DOI: 10.1089/neu.2015.3919] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Emerging evidence suggests that a history of sports-related concussions can lead to long-term neuroanatomical changes. The extent to which similar changes are present in young athletes is undetermined at this time. Here, we tested the hypothesis that collegiate football athletes with (n = 25) and without (n = 24) a self-reported history of concussion would have cortical thickness differences and altered white matter integrity relative to healthy controls (n = 27) in fronto-temporal regions that appear particularly susceptible to traumatic brain injury. Freesurfer software was used to estimate cortical thickness, fractional anisotropy was calculated in a priori white matter tracts, and behavior was assessed using a concussion behavioral battery. Groups did not differ in self-reported symptoms (p > 0.10) or cognitive performance (p > 0.10). Healthy controls reported significantly higher happiness levels than both football groups (all p < 0.01). Contrary to our hypothesis, no differences in fractional anisotropy were observed between our groups (p > 0.10). However, football athletes with a history of concussion had significantly thinner cortex in the left anterior cingulate cortex, orbital frontal cortex, and medial superior frontal cortex relative to healthy controls (p = 0.02, d = -0.69). Further, football athletes with a history of concussion had significantly thinner cortex in the right central sulcus and precentral gyrus relative to football athletes without a history of concussion (p = 0.03, d = -0.71). No differences were observed between football athletes without a history of concussion and healthy controls. These results suggest that previous concussions, but not necessarily football exposure, may be associated with cortical thickness differences in collegiate football athletes.
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Affiliation(s)
- Timothy B Meier
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,2 Laureate Institute for Brain Research , Tulsa, Oklahoma
| | - Patrick S F Bellgowan
- 3 National Institute of Neurological Disorders and Stroke, National Institute of Health , North Bethesda, Maryland
| | | | - Josef M Ling
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
| | - Andrew R Mayer
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico .,4 Neurology Department, University of New Mexico School of Medicine , Albuquerque, New Mexico .,5 Department of Psychology, University of New Mexico , Albuquerque, New Mexico
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95
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Isokuortti H, Iverson GL, Kataja A, Brander A, Öhman J, Luoto TM. Who Gets Head Trauma or Recruited in Mild Traumatic Brain Injury Research? J Neurotrauma 2015; 33:232-41. [PMID: 26054639 DOI: 10.1089/neu.2015.3888] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a public health problem. Outcome from mTBI is heterogeneous in part due to pre-injury individual differences that typically are not well described or understood. Pre-injury health characteristics of all consecutive patients (n=3023) who underwent head computed tomography due to acute head trauma in the emergency department of Tampere University Hospital, Finland, between August 2010 and July 2012 were examined. Patients were screened to obtain a sample of working age adults with no pre-injury medical or mental health problems who had sustained a "pure" mTBI. Of all patients screened, 1990 (65.8%) fulfilled the mTBI criteria, 257 (8.5%) had a more severe TBI, and 776 (25.7%) had a head trauma without obvious signs of brain injury. Injury-related data and participant-related data (e.g., age, sex, diagnosed diseases, and medications) were collected from hospital records. The most common pre-injury diseases were circulatory (39.4%-43.2%), neurological (23.7%-25.2%), and psychiatric (25.8%-27.5%) disorders. Alcohol abuse was present in 18.4%-26.8%. The most common medications were for cardiovascular (33.1%-36.6%), central nervous system (21.4%-30.8%), and blood clotting and anemia indications (21.5%-22.6%). Of the screened patients, only 2.5% met all the enrollment criteria. Age, neurological conditions, and psychiatric problems were the most common reasons for exclusion. Most of the patients sustaining an mTBI have some pre-injury diseases or conditions that could affect clinical outcome. By excluding patients with pre-existing conditions, the patients with known risk factors for poor outcome remain poorly studied.
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Affiliation(s)
| | - Grant L Iverson
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program; Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts
| | - Anneli Kataja
- 3 Department of Radiology, Tampere University Hospital , Tampere, Finland
| | - Antti Brander
- 3 Department of Radiology, Tampere University Hospital , Tampere, Finland
| | - Juha Öhman
- 4 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Teemu M Luoto
- 5 Department of Neurosurgery, Tampere University Hospital , Tampere, Finland
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96
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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97
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Panenka WJ, Lange RT, Bouix S, Shewchuk JR, Heran MKS, Brubacher JR, Eckbo R, Shenton ME, Iverson GL. Neuropsychological outcome and diffusion tensor imaging in complicated versus uncomplicated mild traumatic brain injury. PLoS One 2015; 10:e0122746. [PMID: 25915776 PMCID: PMC4411162 DOI: 10.1371/journal.pone.0122746] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022] Open
Abstract
This study examined whether intracranial neuroimaging abnormalities in those with mild traumatic brain injury (MTBI) (i.e., “complicated” MTBIs) are associated with worse subacute outcomes as measured by cognitive testing, symptom ratings, and/or diffusion tensor imaging (DTI). We hypothesized that (i) as a group, participants with complicated MTBIs would report greater symptoms and have worse neurocognitive outcomes than those with uncomplicated MTBI, and (ii) as a group, participants with complicated MTBIs would show more Diffusion Tensor Imaging (DTI) abnormalities. Participants were 62 adults with MTBIs (31 complicated and 31 uncomplicated) who completed neurocognitive testing, symptom ratings, and DTI on a 3T MRI scanner approximately 6-8 weeks post injury. There were no statistically significant differences between groups on symptom ratings or on a broad range of neuropsychological tests. When comparing the groups using tract-based spatial statistics for DTI, no significant difference was found for axial diffusivity or mean diffusivity. However, several brain regions demonstrated increased radial diffusivity (purported to measure myelin integrity), and decreased fractional anisotropy in the complicated group compared with the uncomplicated group. Finally, when we extended the DTI analysis, using a multivariate atlas based approach, to 32 orthopedic trauma controls (TC), the findings did not reveal significantly more areas of abnormal DTI signal in the complicated vs. uncomplicated groups, although both MTBI groups had a greater number of areas with increased radial diffusivity compared with the trauma controls. This study illustrates that macrostructural neuroimaging changes following MTBI are associated with measurable changes in DTI signal. Of note, however, the division of MTBI into complicated and uncomplicated subtypes did not predict worse clinical outcome at 6-8 weeks post injury.
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Affiliation(s)
- William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Rael T. Lange
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason R. Shewchuk
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Manraj K. S. Heran
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Jeffrey R. Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ryan Eckbo
- Psychiatry Neuroimaging Laboratory, Brigham Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Brigham Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- VA Boston Healthcare System, Brockton, Massachusetts, United States of America
| | - Grant L. Iverson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, United States of America
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98
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Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
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99
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Wäljas M, Iverson GL, Lange RT, Hakulinen U, Dastidar P, Huhtala H, Liimatainen S, Hartikainen K, Öhman J. A prospective biopsychosocial study of the persistent post-concussion symptoms following mild traumatic brain injury. J Neurotrauma 2015; 32:534-47. [PMID: 25363626 DOI: 10.1089/neu.2014.3339] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined multiple biopsychosocial factors relating to post-concussion symptom (PCS) reporting in patients with mild traumatic brain injuries (mTBI), including structural (computed tomography and magnetic resonance imaging [MRI]) and microstructural neuroimaging (diffusion tensor imaging [DTI]). Patients with mTBIs completed several questionnaires and cognitive testing at approximately one month (n=126) and one year (n=103) post-injury. At approximately three weeks post-injury, DTI was undertaken using a Siemens 3T scanner in a subgroup (n=71). Measures of fractional anisotropy were calculated for 16 regions of interest (ROIs) and measures of apparent diffusion coefficient were calculated for 10 ROIs. Patients were compared with healthy control subjects. Using International Classification of Diseases, Tenth Revision (ICD-10) PCS criteria and mild or greater symptom reporting, 59% of the mTBI sample met criteria at one month and 38% met criteria at one year. However, 31% of the healthy control sample also met criteria for the syndrome-illustrating a high false-positive rate. Significant predictors of ICD-10 PCS at one month were pre-injury mental health problems and the presence of extra-cranial bodily injuries. Being symptomatic at one month was a significant predictor of being symptomatic at one year, and depression was significantly related to PCS at both one month and one year. Intracranial abnormalities visible on MRI were present in 12.1% of this sample, and multifocal areas of unusual white matter as measured by DTI were present in 50.7% (compared with 12.4% of controls). Structural MRI abnormalities and microstructural white matter findings were not significantly associated with greater post-concussion symptom reporting. The personal experience and reporting of post-concussion symptoms is likely individualized, representing the cumulative effect of multiple variables, such as genetics, mental health history, current life stress, medical problems, chronic pain, depression, personality factors, and other psychosocial and environmental factors. The extent to which damage to the structure of the brain contributes to the persistence of post-concussion symptoms remains unclear.
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Affiliation(s)
- Minna Wäljas
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
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100
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Roberts RM, Mathias JL, Rose SE. Diffusion Tensor Imaging (DTI) findings following pediatric non-penetrating TBI: a meta-analysis. Dev Neuropsychol 2015; 39:600-37. [PMID: 25470224 PMCID: PMC4270261 DOI: 10.1080/87565641.2014.973958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study meta-analyzed research examining Diffusion Tensor Imaging following pediatric non-penetrating traumatic brain injury to identify the location and extent of white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data from 20 studies were analyzed. FA increased and ADC decreased in most white matter tracts in the short-term (moderate-to-large effects), and FA decreased and ADC increased in the medium- to long-term (moderate-to-very-large effects). Whole brain (short-term), cerebellum and corpus callosum (medium- to long-term) FA values have diagnostic potential, but the impact of age/developmental stage and injury severity on FA/ADC, and the predictive value, is unclear.
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Affiliation(s)
- R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
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