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Lima Santos JP, Jia-Richards M, Kontos AP, Collins MW, Versace A. Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6274. [PMID: 37444121 PMCID: PMC10341732 DOI: 10.3390/ijerph20136274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Meilin Jia-Richards
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
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Kumar H, Green R, Cornfeld DM, Condron P, Emsden T, Elsayed A, Zhao D, Gilbert K, Nash MP, Clark AR, Tawhai MH, Burrowes K, Murphy R, Tayebi M, McGeown J, Kwon E, Shim V, Wang A, Choisne J, Carman L, Besier T, Handsfield G, Babarenda Gamage TP, Shen J, Maso Talou G, Safaei S, Maller JJ, Taylor D, Potter L, Holdsworth SJ, Wilson GA. Roadmap for an imaging and modelling paediatric study in rural NZ. Front Physiol 2023; 14:1104838. [PMID: 36969588 PMCID: PMC10036853 DOI: 10.3389/fphys.2023.1104838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
Our study methodology is motivated from three disparate needs: one, imaging studies have existed in silo and study organs but not across organ systems; two, there are gaps in our understanding of paediatric structure and function; three, lack of representative data in New Zealand. Our research aims to address these issues in part, through the combination of magnetic resonance imaging, advanced image processing algorithms and computational modelling. Our study demonstrated the need to take an organ-system approach and scan multiple organs on the same child. We have pilot tested an imaging protocol to be minimally disruptive to the children and demonstrated state-of-the-art image processing and personalized computational models using the imaging data. Our imaging protocol spans brain, lungs, heart, muscle, bones, abdominal and vascular systems. Our initial set of results demonstrated child-specific measurements on one dataset. This work is novel and interesting as we have run multiple computational physiology workflows to generate personalized computational models. Our proposed work is the first step towards achieving the integration of imaging and modelling improving our understanding of the human body in paediatric health and disease.
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Affiliation(s)
- Haribalan Kumar
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- GE Healthcare (Australia & New Zealand), Auckland, New Zealand
| | - Robby Green
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Daniel M. Cornfeld
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Paul Condron
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Taylor Emsden
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Ayah Elsayed
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Debbie Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kat Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Martyn P. Nash
- Mātai Medical Research Institute, Gisborne, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Alys R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn H. Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kelly Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Maryam Tayebi
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Josh McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Eryn Kwon
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Alan Wang
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Laura Carman
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Thor Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Geoffrey Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Jiantao Shen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Gonzalo Maso Talou
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Soroush Safaei
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jerome J. Maller
- GE Healthcare (Australia & New Zealand), Auckland, New Zealand
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | | | - Leigh Potter
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Samantha J. Holdsworth
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
- *Correspondence: Samantha J. Holdsworth,
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Medeiros GC, Twose C, Weller A, Dougherty JW, Goes FS, Sair HI, Smith GS, Roy D. Neuroimaging correlates of depression after traumatic brain injury: A systematic review. J Neurotrauma 2022; 39:755-772. [PMID: 35229629 DOI: 10.1089/neu.2021.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Depression is the most frequent neuropsychiatric complication after traumatic brain injury (TBI) and is associated with poorer outcomes. Neuroimaging has the potential to improve our understanding of the neural correlates of depression after TBI and may improve our capacity to accurately predict and effectively treat this condition. We conducted a systematic review of structural and functional neuroimaging studies that examined the association between depression after TBI, and neuroimaging measures. Electronic searches were conducted in four databases and were complemented by manual searches. In total, 2,035 citations were identified and, ultimately, 38 articles were included totaling 1,793 individuals (median [25%-75%] sample size of 38.5 (21.8-54.3) individuals). The most frequently used modality was structural magnetic resonance imaging (MRI) (n=17, 45%), followed by diffusion tensor imaging (n=11, 29%), resting-state functional MRI (n=10, 26%), task-based functional MRI (n=4, 8%), and positron emission tomography (n=2, 4%). Most studies (n=27, 71%) were cross-sectional. Overall, depression after TBI was associated with lower grey matter measures (volume, thickness, and/or density) and greater white matter damage. However, identification of specific brain areas was somewhat inconsistent. Findings that were replicated in more than one study included reduced grey matter in the rostral anterior cingulate cortex, prefrontal cortex and hippocampus, and damage in five white matter tracts (cingulum, internal capsule, superior longitudinal fasciculi, anterior, and posterior corona radiata). This systematic review found that the available data did not converge on a clear neuroimaging biomarker for depression after TBI. However, there are promising targets that warrant further study.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Weller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gumus M, Mack ML, Green R, Khodadadi M, Wennberg R, Crawley A, Colella B, Tarazi A, Mikulis DJ, Tator CH, Tartaglia MC. Brain Connectivity Changes in Post-Concussion Syndrome as the Neural Substrate of a Heterogeneous Syndrome. Brain Connect 2022; 12:711-724. [PMID: 35018791 DOI: 10.1089/brain.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Post-concussion syndrome (PCS) or persistent symptoms of concussion refers to a constellation of symptoms that persist for weeks and months after a concussion. To better capture the heterogeneity of the symptoms of patients with post-concussion syndrome, we aimed to separate patients into clinical subtypes based on brain connectivity changes. METHODS Subject-specific structural and functional connectomes were created based on Diffusion Weighted and Resting State Functional Magnetic Resonance Imaging, respectively. Following an informed dimensionality reduction, a gaussian mixture model was used on patient specific structural and functional connectivity matrices to find potential patient clusters. For validation, the resulting patient subtypes were compared in terms of cognitive, neuropsychiatric, and post-concussive symptom differences. RESULTS Multimodal analyses of brain connectivity were predictive of behavioural outcomes. Our modelling revealed 2 patient subtypes; mild and severe. The severe group showed significantly higher levels of depression, anxiety, aggression, and a greater number of symptoms than the mild patient subgroup. CONCLUSION This study suggests that structural and functional connectivity changes together can help us better understand the symptom severity and neuropsychiatric profiles of patients with post-concussion syndrome. This work allows us to move towards precision medicine in concussions and provides a novel machine learning approach that can be applicable to other heterogeneous conditions.
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Affiliation(s)
- Melisa Gumus
- University of Toronto, 7938, 60 Leonard Avenue, Krembil Discovery Tower, Toronto, Toronto, Ontario, Canada, M5S 1A1;
| | | | - Robin Green
- University of Toronto, 7938, Toronto, Ontario, Canada;
| | | | | | | | - Brenda Colella
- University Health Network, 7989, Toronto, Ontario, Canada;
| | - Apameh Tarazi
- University Health Network, 7989, Toronto, Ontario, Canada;
| | - David J Mikulis
- Toronto Western Hospital, 26625, Joint Department of Medical Imaging, 399 Bathurst St., Toronto, Ontario, Canada, m5t2s8;
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Gumus M, Santos A, Tartaglia MC. Diffusion and functional MRI findings and their relationship to behaviour in postconcussion syndrome: a scoping review. J Neurol Neurosurg Psychiatry 2021; 92:1259-1270. [PMID: 34635568 DOI: 10.1136/jnnp-2021-326604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/22/2021] [Indexed: 11/04/2022]
Abstract
Postconcussion syndrome (PCS) is a term attributed to the constellation of symptoms that fail to recover after a concussion. PCS is associated with a variety of symptoms such as headaches, concentration deficits, fatigue, depression and anxiety that have an enormous impact on patients' lives. There is currently no diagnostic biomarker for PCS. There have been attempts at identifying structural and functional brain changes in patients with PCS, using diffusion tensor imaging (DTI) and functional MRI (fMRI), respectively, and relate them to specific PCS symptoms. In this scoping review, we appraised, synthesised and summarised all empirical studies that (1) investigated structural or functional brain changes in PCS using DTI or fMRI, respectively, and (2) assessed behavioural alterations in patients with PCS. We performed a literature search in MEDLINE (Ovid), Embase (Ovid) and PsycINFO (Ovid) for primary research articles published up to February 2020. We identified 8306 articles and included 45 articles that investigated the relationship between DTI and fMRI parameters and behavioural changes in patients with PCS: 20 diffusion, 20 fMRI studies and 5 papers with both modalities. Most frequently studied structures were the corpus callosum, superior longitudinal fasciculus in diffusion and the dorsolateral prefrontal cortex and default mode network in the fMRI literature. Although some white matter and fMRI changes were correlated with cognitive or neuropsychiatric symptoms, there were no consistent, converging findings on the relationship between neuroimaging abnormalities and behavioural changes which could be largely due to the complex and heterogeneous presentation of PCS. Furthermore, the heterogeneity of symptoms in PCS may preclude discovery of one biomarker for all patients. Further research should take advantage of multimodal neuroimaging to better understand the brain-behaviour relationship, with a focus on individual differences rather than on group comparisons.
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Affiliation(s)
- Melisa Gumus
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Santos
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.,Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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6
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Thapaliya K, Marshall-Gradisnik S, Staines D, Barnden L. Diffusion tensor imaging reveals neuronal microstructural changes in myalgic encephalomyelitis/chronic fatigue syndrome. Eur J Neurosci 2021; 54:6214-6228. [PMID: 34355438 PMCID: PMC9291819 DOI: 10.1111/ejn.15413] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients suffer from a variety of physical and neurological complaints indicating the central nervous system plays a role in ME/CFS pathophysiology. Diffusion tensor imaging (DTI) has been used to study microstructural changes in neurodegenerative diseases. In this study, we evaluated DTI parameters to investigate microstructural abnormalities in ME/CFS patients. We estimated DTI parameters in 25 ME/CFS patients who met Fukuda criteria (ME/CFSFukuda ), 18 ME/CFS patients who met International Consensus Criteria (ICC) (ME/CFSICC ) only and 26 healthy control (HC) subjects. In addition to voxel-based DTI-parameter group comparisons, we performed voxel-based DTI-parameter interaction-with-group regressions with clinical and autonomic measures to test for abnormal regressions. Group comparisons between ME/CFSICC and HC detected significant clusters (a) with decreased axial diffusivity (p = .001) and mean diffusivity (p = .01) in the descending cortico-cerebellar tract in the midbrain and pons and (b) with increased transverse diffusivity in the medulla. The mode of anisotropy was significantly decreased (p = .001) in a cluster in the superior longitudinal fasciculus region. Voxel-based group comparisons between ME/CFSFukuda and HC did not detect significant clusters. For ME/CFSICC and HC, DTI parameter interaction-with-group regressions were abnormal for the clinical measures of information processing score, SF36 physical, sleep disturbance score and respiration rate in both grey and white matter regions. Our study demonstrated that DTI parameters are sensitive to microstructural changes in ME/CFSICC and could potentially act as an imaging biomarker of abnormal pathophysiology in ME/CFS. The study also shows that strict case definitions are essential in investigation of the pathophysiology of ME/CFS.
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Affiliation(s)
- Kiran Thapaliya
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Donald Staines
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Leighton Barnden
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Kreitzer N, Ancona R, McCullumsmith C, Kurowski BG, Foreman B, Ngwenya LB, Adeoye O. The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis. J Head Trauma Rehabil 2020; 34:E47-E54. [PMID: 30169440 PMCID: PMC8730802 DOI: 10.1097/htr.0000000000000439] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. We performed a meta-analysis to estimate the benefit of antidepressants following TBI and compare the estimated effects between antidepressants and placebo. PARTICIPANTS Multiple databases were searched to find prospective pharmacological treatment studies of major depressive disorder (MDD) in adults following TBI. MAIN MEASURES Effect sizes for antidepressant medications in patients with TBI were calculated for within-subjects designs that examined change from baseline after receiving medical treatment and treatment/placebo designs that examined the differences between the antidepressants and placebo groups. DESIGN A random-effects model was used for both analyses. RESULTS Of 1028 titles screened, 11 were included. Pooled estimates showed nonsignificant difference in reduction of depression scores between medications and placebo (standardized mean difference of 5 trials = -0.3; 95% CI, -0.6 to 0.0; I = 17%), and a significant reduction in depression scores for individuals after pharmacotherapy (mean change = -11.2; 95% CI, -14.7 to -7.6 on the Hamilton Depression Scale; I = 87%). CONCLUSIONS This meta-analysis found no significant benefit of antidepressant over placebo in the treatment of MDD following TBI. Pooled estimates showed a high degree of bias and heterogeneity. Prospective studies on the impact of antidepressants in well-defined cohorts of TBI patients are warranted.
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Affiliation(s)
- Natalie Kreitzer
- Division of Neurocritical Care (Drs Kreitzer, Foreman, and Adeoye), Department of Emergency Medicine (Drs Kreitzer and Adeoye and Ms Ancona), Department of Psychiatry (Dr McCullumsmith), Department of Pediatrics (Dr Kurowski), Department of Physical Medicine and Rehabilitation (Dr Kurowski), Department of Neurology and Rehabilitation Medicine (Drs Foreman and Ngwenya), and Department of Neurosurgery (Dr Ngwenya), University of Cincinnati, Cincinnati, Ohio
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8
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Liu Q, Li R, Qu W, Li B, Yang W, Cui R. Pharmacological and non-pharmacological interventions of depression after traumatic brain injury: A systematic review. Eur J Pharmacol 2019; 865:172775. [DOI: 10.1016/j.ejphar.2019.172775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
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Jiang M, Wen Z, Long L, Wong CW, Ye N, Zee C, Chen BT. Assessing Cerebral White Matter Microstructure in Children With Congenital Sensorineural Hearing Loss: A Tract-Based Spatial Statistics Study. Front Neurosci 2019; 13:597. [PMID: 31293368 PMCID: PMC6598398 DOI: 10.3389/fnins.2019.00597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/27/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the microstructural properties of cerebral white matter in children with congenital sensorineural hearing loss (CSNHL). Methods Children (>4 years of age) with profound CSNHL and healthy controls with normal hearing (the control group) were enrolled and underwent brain magnetic resonance imaging (MRI) scans with diffusion tensor imaging (DTI). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were obtained from a whole-brain tract-based spatial statistics analysis and were compared between the two groups. In addition, a region of interest (ROI) approach focusing on auditory cortex, i.e., Heschl’s gyrus, using visual cortex, i.e., forceps major as an internal control, was performed. Correlations between mean DTI values and age were obtained with the ROI method. Results The study cohort consisted of 23 children with CSHNL (11 boys and 12 girls; mean age ± SD: 7.21 ± 2.67 years; range: 4.1–13.5 years) and 18 children in the control group (11 boys and 7 girls; mean age ± SD: 10.86 ± 3.56 years; range: 4.5–15.3 years). We found the axial diffusivity values being significantly greater in the left anterior thalamic radiation, right corticospinal tract, and corpus callosum in the CSHNL group than in the control group (p < 0.05). Significantly higher radial diffusivity values in the white matter tracts were noted in the CSHNL group as compared to the control group (p < 0.05). The fractional anisotropy values in the Heschl’s gyrus in the CSNHL group were lower compared to the control group (p = 0.0015). There was significant negative correlation between the mean fractional anisotropy values in Heschl’s gyrus and age in the CSNHL group < 7 years of age (r = −0.59, p = 0.004). Conclusion Our study showed higher axial and radial diffusivities in the children affected by CNHNL as compared to the hearing children. We also found lower fractional anisotropy values in the Heschl’s gyrus in the CSNHL group. Furthermore, we identified negative correlation between the fractional anisotropy values and age up to 7 years in the children born deaf. Our study findings suggest that myelination and axonal structure may be affected due to acoustic deprivation. This information may help to monitor hearing rehabilitation in the deaf children.
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Affiliation(s)
- Muliang Jiang
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Zuguang Wen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liling Long
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chi Wah Wong
- Center for Informatics, City of Hope National Medical Center, Duarte, CA, United States
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Chishing Zee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
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10
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Sarica A, Curcio M, Rapisarda L, Cerasa A, Quattrone A, Bono F. Periventricular white matter changes in idiopathic intracranial hypertension. Ann Clin Transl Neurol 2019; 6:233-242. [PMID: 30847356 PMCID: PMC6389746 DOI: 10.1002/acn3.685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate whether increased cerebrospinal fluid (CSF) pressure causes alteration of periventricular white matter (WM) microstructure in patients with idiopathic intracranial hypertension (IIH). Methods In a prospective study, patients with refractory chronic headache with and without IIH performed a neuroimaging study including 3T MRI, 3D Phase Contrast MR venography, and diffusion tensor imaging (DTI) of the brain. Whole‐brain voxel‐wise comparisons of DTI abnormalities of WM were performed using tract‐based spatial statistics. A correlation analysis between DTI indices and CSF opening pressure, highest peak, and mean pressure was also performed in patients with IIH. Results We enrolled 62 consecutive patients with refractory chronic headaches. Thirty‐five patients with IIH, and 27 patients without increased intracranial pressure. DTI analysis revealed no fractional anisotropy changes, but decreased mean, axial, and radial diffusivity in body (IIHMD = 0.80 ± 0.04, non‐IIHMD = 0.84 ± 0.4, IIHAD = 1.67 ± 0.07, non‐IIHAD = 1.74 ± 0.05, IIHRD = 0.38 ± 0.04, non‐IIHRD = 0.42 ± 0.05 [mm2/sec × 10−3]) of corpus callosum, and in right superior corona radiata (IIHMD = 0.75 ± 0.04, non‐IIHMD = 0.79 ± 0.05, IIHAD = 1.19 ± 0.07, non‐IIHAD = 1.28 ± 0.09, IIHRD = 0.59 ± 0.03, non‐IIHRD = 0.53 ± 0.03 [mm2/sec × 10−3]) of 35 patients with IIH compared with 27 patients without increased intracranial pressure. DTI indices were negatively correlated with high CSF pressures (P < 0.05). After medical treatment, eight patients showed incremented MD in anterior corona radiata left and right and superior corona radiata right. Conclusions There is significant DTI alteration in periventricular WM microstructure of patients with IIH suggesting tissue compaction correlated with high CSF pressure. This periventricular WM change may be partially reversible after medical treatment.
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Affiliation(s)
- Alessia Sarica
- Department of Medical and Surgical Sciences Neuroscience Centre Magna Græcia University of Catanzaro Catanzaro Italy
| | - Maria Curcio
- Department of Medical and Surgical Sciences Center for Headache and Intracranial Pressure Disorders Institute of Neurology Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Rapisarda
- Department of Medical and Surgical Sciences Center for Headache and Intracranial Pressure Disorders Institute of Neurology Magna Græcia University of Catanzaro Catanzaro Italy
| | - Antonio Cerasa
- Neuroimaging Research Unit Institute of Bioimaging and Molecular Physiology National Research Council Catanzaro Italy.,S. Anna Institute and Research in Advanced Neurorehabilitation Crotone Italy
| | - Aldo Quattrone
- Department of Medical and Surgical Sciences Neuroscience Centre Magna Græcia University of Catanzaro Catanzaro Italy.,Neuroimaging Research Unit Institute of Bioimaging and Molecular Physiology National Research Council Catanzaro Italy
| | - Francesco Bono
- Department of Medical and Surgical Sciences Center for Headache and Intracranial Pressure Disorders Institute of Neurology Magna Græcia University of Catanzaro Catanzaro Italy
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11
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Jones M, Acion L, Jorge RE. What are the complications and emerging strategies for preventing depression following traumatic brain injury? Expert Rev Neurother 2017; 17:631-640. [PMID: 28343407 DOI: 10.1080/14737175.2017.1311788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Depression is a common and disabling complication of traumatic brain injury (TBI). The high rates of post-TBI depression (PTBID) make this condition an important candidate for selective preventive interventions. Areas covered: The authors recently reported on the efficacy of sertraline, a selective serotonin reuptake inhibitor (SSRI), for the prevention of new cases of depression in the first six months after TBI. The authors review this and other studies on preventive strategies in PTBID as ascertained from a PubMed and citation search. The potential complications and barriers to the implementation of pharmacological prevention in patients with TBI are also discussed. Expert commentary: The prevention of depression in patients with TBI has received little attention relative to other medical conditions. Future studies are needed to confirm the benefit of SSRIs and investigate other pharmacological and non-pharmacological interventions, including in special groups of patients at greater risk of developing PTBID.
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Affiliation(s)
- Melissa Jones
- a VA South Central Mental Illness Research , Education and Clinical Center , Houston , TX , USA.,b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Laura Acion
- c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,e Iowa Consortium for Substance Abuse Research and Evaluation , University of Iowa , Iowa , IA , USA
| | - Ricardo E Jorge
- b Mental Health Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA.,d Beth K. and Stuart C. Yudofsky Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
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12
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Merkel SF, Cannella LA, Razmpour R, Lutton E, Raghupathi R, Rawls SM, Ramirez SH. Factors affecting increased risk for substance use disorders following traumatic brain injury: What we can learn from animal models. Neurosci Biobehav Rev 2017; 77:209-218. [PMID: 28359860 DOI: 10.1016/j.neubiorev.2017.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/06/2017] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
Recent studies have helped identify multiple factors affecting increased risk for substance use disorders (SUDs) following traumatic brain injury (TBI). These factors include age at the time of injury, repetitive injury and TBI severity, neurocircuits, neurotransmitter systems, neuroinflammation, and sex differences. This review will address each of these factors by discussing 1) the clinical and preclinical data identifying patient populations at greatest risk for SUDs post-TBI, 2) TBI-related neuropathology in discrete brain regions heavily implicated in SUDs, and 3) the effects of TBI on molecular mechanisms that may drive substance abuse behavior, like dopaminergic and glutamatergic transmission or neuroimmune signaling in mesolimbic regions of the brain. Although these studies have laid the groundwork for identifying factors that affect risk of SUDs post-TBI, additional studies are required. Notably, preclinical models have been shown to recapitulate many of the behavioral, cellular, and neurochemical features of SUDs and TBI. Therefore, these models are well suited for answering important questions that remain in future investigations.
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Affiliation(s)
- Steven F Merkel
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Lee Anne Cannella
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Roshanak Razmpour
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Evan Lutton
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Scott M Rawls
- Department of Pharmacology, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Servio H Ramirez
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Shriners Hospitals Pediatric Research Center, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
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13
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Bailey NW, Rogasch NC, Hoy KE, Maller JJ, Segrave RA, Sullivan CM, Fitzgerald PB. Increased gamma connectivity during working memory retention following traumatic brain injury. Brain Inj 2017; 31:379-389. [PMID: 28095052 DOI: 10.1080/02699052.2016.1239273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE Alterations to functional connectivity following a traumatic brain injury (TBI) may lead to impaired cognitive performance and major depressive disorder (MDD). In particular, functional gamma band connectivity is thought to reflect information binding important for working memory. The objective of this study was to determine whether altered functional gamma connectivity may be a factor in MDD following TBI (TBI-MDD). RESEARCH DESIGN This study assessed individuals with TBI-MDD, as well as individuals with TBI alone and MDD alone using electroencephalographic recordings while participants performed a working memory task to assess differences in functional connectivity between these groups. METHODS AND PROCEDURES Functional connectivity was compared using the debiased weighted phase lag index (wPLI). wPLI was measured from a group of healthy controls (n = 31), participants with MDD (n = 17), participants with TBI (n = 20) and participants with TBI-MDD (n = 15). MAIN OUTCOMES AND RESULTS Contrary to the predictions, this study found both the groups with TBI and TBI-MDD showed higher gamma connectivity from posterior regions during WM retention. CONCLUSIONS This may reflect dysfunctional functional connectivity in these groups, as a result of maladaptive neuroplastic reorganization.
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Affiliation(s)
- Neil W Bailey
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
| | - Nigel C Rogasch
- b Monash Clinical and Imaging Neuroscience, School of Psychological Science and Monash Biomedical Imaging , Monash University , Melbourne , Australia
| | - Kate E Hoy
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
| | - Jerome J Maller
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
| | - Rebecca A Segrave
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
| | - Caley M Sullivan
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
| | - Paul B Fitzgerald
- a Monash Alfred Psychiatry Research Centre , Alfred Hospital and Central Clinical School, Monash University , Melbourne , VIC , Australia
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Spitz G, Alway Y, Gould KR, Ponsford JL. Disrupted White Matter Microstructure and Mood Disorders after Traumatic Brain Injury. J Neurotrauma 2016; 34:807-815. [PMID: 27550509 DOI: 10.1089/neu.2016.4527] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with an elevated frequency of mood disorders that may, in part, be explained by changes in white-matter microstructure. This study is the first to examine the relationship between mood disorders and white-matter pathology in a sample of patients with mild to severe TBI using a standardized psychiatric interview. This study reports on a sub-sample of 29 individuals recruited from a large prospective study that examined the evolution of psychiatric disorders following complicated, mild to severe TBI. Individuals with TBI were also compared with 23 healthy control participants. Individuals were invited to complete the Structured Clinical Interview for DSM-IV Disorders (SCID) to diagnose psychiatric disorders. Participants who developed a mood disorder within the first 3 years were categorized into a TBI-Mood group. Diffusion tensor tractography assessed white matter microstructure using atlas-based tract-averaged and along-tract approaches. Fractional anisotropy (FA) was used as the measure of white-matter microstructure. TBI participants with and without a mood disorder did not differ in regard to injury severity and other background factors. Nevertheless, TBI participants diagnosed with a mood disorder displayed significantly lower tract-averaged FA values for the right arcuate fasciculus (p = 0.011), right inferior longitudinal fasciculus (p = 0.009), and anterior segments I (p = 0.0004) and II (p = 0.007) of the corpus callosum, as well as the left (p = 0.014) and right (p = 0.015) fronto-occipital longitudinal fasciculi. The pattern of white matter disruption identified in the current study provides further support for a neurobiological basis of post-TBI mood disorders. Greater understanding of individuals' underlying neuropathology may enable better characterization and prediction of mood disorders. Integration of neuropathology may also inform the potential efficacy of pharmacological and psychological interventions.
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Affiliation(s)
- Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Yvette Alway
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Kate Rachel Gould
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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Ozolins B, Aimers N, Parrington L, Pearce AJ. Movement disorders and motor impairments following repeated head trauma: A systematic review of the literature 1990-2015. Brain Inj 2016; 30:937-47. [PMID: 27120772 DOI: 10.3109/02699052.2016.1147080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing attention on the long-term sequelae following multiple concussions and traumatic brain injury (TBI) in later life. The majority of the research has focused on long-term cognitive impairments and behavioural changes. Despite being researched and reported, long-term motor dysfunction and movement disorders as a consequence of concussions and TBI have not received due consideration. REVIEW This study used a systematic review and qualitative analysis that focused on two key areas: (1) identified movement disorders in individuals with a reported history of repeated concussions or repeated mild-to-moderate TBIs; and (2) identified motor impairments in individuals with a history of repeated concussions or repeated mild-to-moderate TBIs. Fourteen studies investigating long-term movement disorders or motor impairments as a result of repeated concussions or TBI met the selection criteria. Study ratings were moderate-to-high; therefore, evidence was strong enough to conclude that repeated concussions or repeated mild/moderate TBIs did affect the motor system. CONCLUSION The evidence in this systematic review highlights the need for future studies to include motor outcomes along with cognitive and behavioural outcomes when assessing the long-term effects of repeated concussions or repeated mild/moderate TBIs.
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Affiliation(s)
- Bede Ozolins
- a Faculty of Health , Deakin University , Melbourne , Australia
| | - Nicole Aimers
- b Centre for Design Innovation (CDI) , Swinburne University of Technology , Melbourne , Australia
| | - Lucy Parrington
- c Department of Biomedical and Health Sciences , Swinburne University of Technology , Melbourne , Australia
| | - Alan J Pearce
- b Centre for Design Innovation (CDI) , Swinburne University of Technology , Melbourne , Australia.,d Melbourne School of Health Sciences , The University of Melbourne , Australia
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16
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van der Horn HJ, Liemburg EJ, Aleman A, Spikman JM, van der Naalt J. Brain Networks Subserving Emotion Regulation and Adaptation after Mild Traumatic Brain Injury. J Neurotrauma 2016; 33:1-9. [DOI: 10.1089/neu.2015.3905] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Harm J. van der Horn
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith J. Liemburg
- BCN NeuroImaging Center of the Department of Neuroscience, University of Groningen, Groningen, The Netherlands
| | - André Aleman
- BCN NeuroImaging Center of the Department of Neuroscience, University of Groningen, Groningen, The Netherlands
| | - Jacoba M. Spikman
- Department of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Han K, Chapman SB, Krawczyk DC. Altered Amygdala Connectivity in Individuals with Chronic Traumatic Brain Injury and Comorbid Depressive Symptoms. Front Neurol 2015; 6:231. [PMID: 26581959 PMCID: PMC4631949 DOI: 10.3389/fneur.2015.00231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/19/2015] [Indexed: 01/04/2023] Open
Abstract
Depression is one of the most common psychiatric conditions in individuals with chronic traumatic brain injury (TBI). Though depression has detrimental effects in TBI and network dysfunction is a "hallmark" of TBI and depression, there have not been any prior investigations of connectivity-based neuroimaging biomarkers for comorbid depression in TBI. We utilized resting-state functional magnetic resonance imaging to identify altered amygdala connectivity in individuals with chronic TBI (8 years post-injury on average) exhibiting comorbid depressive symptoms (N = 31), relative to chronic TBI individuals having minimal depressive symptoms (N = 23). Connectivity analysis of these participant sub-groups revealed that the TBI-plus-depressive symptoms group showed relative increases in amygdala connectivity primarily in the regions that are part of the salience, somatomotor, dorsal attention, and visual networks (p voxel < 0.01, p cluster < 0.025). Relative increases in amygdala connectivity in the TBI-plus-depressive symptoms group were also observed within areas of the limbic-cortical mood-regulating circuit (the left dorsomedial and right dorsolateral prefrontal cortices and thalamus) and the brainstem. Further analysis revealed that spatially dissociable patterns of correlation between amygdala connectivity and symptom severity according to subtypes (Cognitive and Affective) of depressive symptoms (p voxel < 0.01, p cluster < 0.025). Taken together, these results suggest that amygdala connectivity may be a potentially effective neuroimaging biomarker for comorbid depressive symptoms in chronic TBI.
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Affiliation(s)
- Kihwan Han
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA
| | - Sandra B Chapman
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA
| | - Daniel C Krawczyk
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA ; Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, TX , USA
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18
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Alhilali LM, Delic JA, Gumus S, Fakhran S. Evaluation of White Matter Injury Patterns Underlying Neuropsychiatric Symptoms after Mild Traumatic Brain Injury. Radiology 2015; 277:793-800. [PMID: 26079380 DOI: 10.1148/radiol.2015142974] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine if a central axonal injury underlies neuropsychiatric symptoms after mild traumatic brain injury (mTBI) by using tract-based spatial statistics analysis of diffusion-tensor images. MATERIALS AND METHODS The institutional review board approved this study, with waiver of informed consent. Diffusion-tensor imaging and serial neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Testing evaluation were performed in 45 patients with mTBI (38 with irritability, 32 with depression, and 18 with anxiety). Control subjects consisted of 29 patients with mTBI without neuropsychiatric symptoms. Fractional anisotropy and diffusivity maps were analyzed by using tract-based spatial statistics with a multivariate general linear model. Diffusion-tensor imaging findings were correlated with symptom severity, neurocognitive test scores, and time to recovery with the Pearson correlation coefficient. RESULTS Compared with control subjects, patients with mTBI and depression had decreased fractional anisotropy in the superior longitudinal fasciculus (P = .006), white matter around the nucleus accumbens (P = .03), and anterior limb of the internal capsule (P = .02). Patients with anxiety had diminished fractional anisotropy in the vermis (P = .04). No regions of significantly decreased fractional anisotropy were seen in patients with irritability relative to control subjects. Injury in the region of the nucleus accumbens inversely correlated with recovery time in patients with depression (r = -0.480, P = .005). CONCLUSION Unique white matter injury patterns were seen for two major posttraumatic neuropsychiatric symptoms. Injury to the cerebellar vermis in patients with mTBI and anxiety may indicate underlying dysfunction in primitive fear conditioning circuits in the cerebellum. Involvement of the nucleus accumbens in depression after mTBI may suggest an underlying dysfunctional reward circuit that affects the prognosis in these patients.
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Affiliation(s)
- Lea M Alhilali
- From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213
| | - Joseph A Delic
- From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213
| | - Serter Gumus
- From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213
| | - Saeed Fakhran
- From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213
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Wintermark M, Coombs L, Druzgal TJ, Field AS, Filippi CG, Hicks R, Horton R, Lui YW, Law M, Mukherjee P, Norbash A, Riedy G, Sanelli PC, Stone JR, Sze G, Tilkin M, Whitlow CT, Wilde EA, York G, Provenzale JM. Traumatic brain injury imaging research roadmap. AJNR Am J Neuroradiol 2015; 36:E12-23. [PMID: 25655872 DOI: 10.3174/ajnr.a4254] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The past decade has seen impressive advances in the types of neuroimaging information that can be acquired in patients with traumatic brain injury. However, despite this increase in information, understanding of the contribution of this information to prognostic accuracy and treatment pathways for patients is limited. Available techniques often allow us to infer the presence of microscopic changes indicative of alterations in physiology and function in brain tissue. However, because histologic confirmation is typically lacking, conclusions reached by using these techniques remain solely inferential in almost all cases. Hence, a need exists for validation of these techniques by using data from large population samples that are obtained in a uniform manner, analyzed according to well-accepted procedures, and correlated with closely monitored clinical outcomes. At present, many of these approaches remain confined to population-based research rather than diagnosis at an individual level, particularly with regard to traumatic brain injury that is mild or moderate in degree. A need and a priority exist for patient-centered tools that will allow advanced neuroimaging tools to be brought into clinical settings. One barrier to developing these tools is a lack of an age-, sex-, and comorbidities-stratified, sequence-specific, reference imaging data base that could provide a clear understanding of normal variations across populations. Such a data base would provide researchers and clinicians with the information necessary to develop computational tools for the patient-based interpretation of advanced neuroimaging studies in the clinical setting. The recent "Joint ASNR-ACR HII-ASFNR TBI Workshop: Bringing Advanced Neuroimaging for Traumatic Brain Injury into the Clinic" on May 23, 2014, in Montreal, Quebec, Canada, brought together neuroradiologists, neurologists, psychiatrists, neuropsychologists, neuroimaging scientists, members of the National Institute of Neurologic Disorders and Stroke, industry representatives, and other traumatic brain injury stakeholders to attempt to reach consensus on issues related to and develop consensus recommendations in terms of creating both a well-characterized normative data base of comprehensive imaging and ancillary data to serve as a reference for tools that will allow interpretation of advanced neuroimaging tests at an individual level of a patient with traumatic brain injury. The workshop involved discussions concerning the following: 1) designation of the policies and infrastructure needed for a normative data base, 2) principles for characterizing normal control subjects, and 3) standardizing research neuroimaging protocols for traumatic brain injury. The present article summarizes these recommendations and examines practical steps to achieve them.
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Affiliation(s)
- M Wintermark
- From the Neuroradiology Division (M.W.), Department of Radiology, Stanford University, Stanford, California
| | - L Coombs
- American College of Radiology (L.C., M.T., R. Horton), Reston, Virginia
| | | | - A S Field
- Neuroradiology Section (A.S.F.), Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - C G Filippi
- Department of Radiology (C.G.F.), Columbia University, New York, New York Department of Radiology (C.G.F., P.C.S.), North Shore-Long Island Jewish Health System, Manhasset, New York
| | - R Hicks
- One Mind (R. Hicks), Seattle, Washington
| | - R Horton
- American College of Radiology (L.C., M.T., R. Horton), Reston, Virginia
| | - Y W Lui
- Neuroradiology Division (Y.W.L.), Department of Radiology, NYU School of Medicine, New York, New York
| | - M Law
- Neuroradiology Section (M.L.), Department of Radiology, University of Southern California, Los Angeles, California
| | - P Mukherjee
- Neuroradiology Section (P.M.), Department of Radiology, University of California, San Francisco, San Francisco, California
| | - A Norbash
- Department of Radiology (A.N.), Boston University School of Medicine, Boston, Massachusetts
| | - G Riedy
- National Intrepid Center of Excellence (G.R.), Washington, DC
| | - P C Sanelli
- Department of Radiology (C.G.F., P.C.S.), North Shore-Long Island Jewish Health System, Manhasset, New York
| | - J R Stone
- Departments of Radiology (T.J.D., J.R.S.) Medical Imaging and Neurological Surgery (J.R.S.), University of Virginia, Charlottesville, Virginia
| | - G Sze
- Neuroradiology Section (G.S.), Department of Radiology, Yale University, New Haven, Connecticut
| | - M Tilkin
- American College of Radiology (L.C., M.T., R. Horton), Reston, Virginia
| | - C T Whitlow
- Department of Radiology-Neuroradiology and Translational Science Institute (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - E A Wilde
- Departments of Physical Medicine and Rehabilitation, Neurology, and Radiology (E.A.W.), Baylor College of Medicine, Houston, Texas
| | - G York
- San Antonio Military Medical Center (G.Y.), San Antonio, Texas
| | - J M Provenzale
- Department of Radiology (J.M.P.), Duke University Medical Center, Durham, North Carolina
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20
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Volumetrics relate to the development of depression after traumatic brain injury. Behav Brain Res 2014; 271:147-53. [DOI: 10.1016/j.bbr.2014.05.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/24/2014] [Accepted: 05/22/2014] [Indexed: 01/16/2023]
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Romero K, Black SE, Feinstein A. Differences in cerebral perfusion deficits in mild traumatic brain injury and depression using single-photon emission computed tomography. Front Neurol 2014; 5:158. [PMID: 25191305 PMCID: PMC4138441 DOI: 10.3389/fneur.2014.00158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/05/2014] [Indexed: 12/04/2022] Open
Abstract
Background: Numerous studies have shown decreased perfusion in the prefrontal cortex following mild traumatic brain injury (mTBI). However, similar hypoperfusion can also be observed in depression. Given the high prevalence of depressive symptoms following mTBI, it is unclear to what extent depression influences hypoperfusion in TBI. Methods: Mild TBI patients without depressive symptoms (mTBI-noD, n = 39), TBI patients with depressive symptoms (mTBI-D, n = 13), and 15 patients with major depressive disorder (MDD), but no TBI were given 99m T-ECD single-photon emission computed tomography (SPECT) scans within 2 weeks of injury. All subjects completed tests of information processing speed, complex attention, and executive functioning, and a self-report questionnaire measuring symptoms of psychological distress. Between-group comparisons of quantified SPECT perfusion were undertaken using univariate and multivariate (partial least squares) analyses. Results: mTBI-D and mTBI-noD groups did not differ in terms of cerebral perfusion. However, patients with MDD showed hypoperfusion compared to both TBI groups in several frontal (orbitofrontal, middle frontal, and superior frontal cortex), superior temporal, and posterior cingulate regions. The mTBI-D group showed poorer performance on a measure of complex attention and working memory compared to both the mTBI-noD and MDD groups. Conclusion: These results suggest that depressive symptoms do not affect SPECT perfusion in the sub-acute phase following a mild TBI. Conversely, MDD is associated with hypoperfusion primarily in frontal regions.
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Affiliation(s)
- Kristoffer Romero
- Department of Psychiatry, Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | - Sandra E Black
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre , Toronto, ON , Canada ; L. C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre , Toronto, ON , Canada
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Wang X, Wei XE, Li MH, Li WB, Zhou YJ, Zhang B, Li YH. Microbleeds on susceptibility-weighted MRI in depressive and non-depressive patients after mild traumatic brain injury. Neurol Sci 2014; 35:1533-9. [PMID: 24740482 DOI: 10.1007/s10072-014-1788-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to explore the relationship between abnormality on susceptibility-weighted imaging (SWI) and newly-developed depression after mild traumatic brain injury. The study registered 200 patients with closed TBI and normal finding at CT and conventional MRI. All patients underwent MRI including conventional MR sequences and SWI. The number and volume of microbleed lesions were semi-automatically outlined and manually counted. All patients were followed up with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV) within 1 year after TBI. The difference in microbleed lesions on SWI was compared between the depressive and non-depressive groups. The depressive group had a higher rate of abnormality on SWI than did the non-depressive group (p < 0.001). Among patients that had exhibited microbleed lesions, the number and volume of lesions were greater in the depressive group than the non-depressive group (both p < 0.001). These differences in numbers and volume of lesions were found only at the frontal, parietal and temporal lobes (all p < 0.001). Among patients that had exhibited microbleed lesions, the number and volume of lesions in other areas were not significantly different between the depressive and non-depressive groups (all p > 0.05). In conclusion, SWI was useful to identify the microbleed lesions after mild TBI. The distribution range and location of microbleed lesions were correlated with depression after TBI.
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Affiliation(s)
- Xuan Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China
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24
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Kushner DS, Johnson-Greene D. Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury. ACTA ACUST UNITED AC 2014; 51:1057-68. [DOI: 10.1682/jrrd.2014.01.0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/06/2014] [Indexed: 11/05/2022]
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Neuroprotective effects of geranylgeranylacetone in experimental traumatic brain injury. J Cereb Blood Flow Metab 2013; 33:1897-908. [PMID: 23942364 PMCID: PMC3851897 DOI: 10.1038/jcbfm.2013.144] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/11/2022]
Abstract
Geranylgeranylacetone (GGA) is an inducer of heat-shock protein 70 (HSP70) that has been used clinically for many years as an antiulcer treatment. It is centrally active after oral administration and is neuroprotective in experimental brain ischemia/stroke models. We examined the effects of single oral GGA before treatment (800 mg/kg, 48 hours before trauma) or after treatment (800 mg/kg, 3 hours after trauma) on long-term functional recovery and histologic outcomes after moderate-level controlled cortical impact, an experimental traumatic brain injury (TBI) model in mice. The GGA pretreatment increased the number of HSP70(+) cells and attenuated posttraumatic α-fodrin cleavage, a marker of apoptotic cell death. It also improved sensorimotor performance on a beam walk task; enhanced recovery of cognitive/affective function in the Morris water maze, novel object recognition, and tail-suspension tests; and improved outcomes using a composite neuroscore. Furthermore, GGA pretreatment reduced the lesion size and neuronal loss in the hippocampus, cortex, and thalamus, and decreased microglial activation in the cortex when compared with vehicle-treated TBI controls. Notably, GGA was also effective in a posttreatment paradigm, showing significant improvements in sensorimotor function, and reducing cortical neuronal loss. Given these neuroprotective actions and considering its longstanding clinical use, GGA should be considered for the clinical treatment of TBI.
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