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Morris AR, Gudenschwager Basso EK, Gutierrez-Monreal MA, Arja RD, Kobeissy FH, Janus CG, Wang KK, Zhu J, Liu AC. Lifelong Chronic Sleep Disruption in a Mouse Model of Traumatic Brain Injury. Neurotrauma Rep 2024; 5:61-73. [PMID: 38288298 PMCID: PMC10823169 DOI: 10.1089/neur.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Chronic sleep/wake disturbances (SWDs) are strongly associated with traumatic brain injury (TBI) in patients and are being increasingly recognized. However, the underlying mechanisms are largely understudied and there is an urgent need for animal models of lifelong SWDs. The objective of this study was to develop a chronic TBI rodent model and investigate the lifelong chronic effect of TBI on sleep/wake behavior. We performed repetitive midline fluid percussion injury (rmFPI) in 4-month-old mice and monitored their sleep/wake behavior using the non-invasive PiezoSleep system. Sleep/wake states were recorded before injury (baseline) and then monthly thereafter. We found that TBI mice displayed a significant decrease in sleep duration in both the light and dark phases, beginning at 3 months post-TBI and continuing throughout the study. Consistent with the sleep phenotype, these TBI mice showed circadian locomotor activity phenotypes and exhibited reduced anxiety-like behavior. TBI mice also gained less weight, and had less lean mass and total body water content, compared to sham controls. Further, TBI mice showed extensive brain tissue loss and increased glial fibrillary acidic protein and ionized calcium-binding adaptor molecule 1 levels in the hypothalamus and vicinity of the injury, indicative of chronic neuropathology. In summary, our study identified a critical time window of TBI pathology and associated circadian and sleep/wake phenotypes. Future studies should leverage this mouse model to investigate the molecular mechanisms underlying the chronic sleep/wake phenotypes post-TBI early in life.
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Affiliation(s)
- Andrew R. Morris
- Department of Physiology and Aging, Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Erwin K. Gudenschwager Basso
- Department of Physiology and Aging, Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Miguel A. Gutierrez-Monreal
- Department of Physiology and Aging, Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rawad Daniel Arja
- Center for Neurotrauma, Multiomics & Biomarkers, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Firas H. Kobeissy
- Center for Neurotrauma, Multiomics & Biomarkers, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Christopher G. Janus
- Center for Translational Research in Neurodegenerative Disease (CTRND), Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kevin K.W. Wang
- Center for Neurotrauma, Multiomics & Biomarkers, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jiepei Zhu
- Center for Neurotrauma, Multiomics & Biomarkers, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Andrew C. Liu
- Department of Physiology and Aging, Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida, USA
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Morris AR, Gudenschwager Basso EK, Gutierrez-Monreal MA, Arja RD, Kobeissy FH, Janus CG, Wang KKW, Zhu J, Liu AC. Sleep Disruption in a Mouse Model of Chronic Traumatic Brain Injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.10.566553. [PMID: 38014315 PMCID: PMC10680804 DOI: 10.1101/2023.11.10.566553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Chronic sleep/wake disturbances are strongly associated with traumatic brain injury (TBI) in patients and are being increasingly recognized. However, the underlying mechanisms are largely understudied and there is an urgent need for animal models of lifelong sleep/wake disturbances. The objective of this study was to develop a chronic TBI rodent model and investigate the lifelong chronic effect of TBI on sleep/wake behavior. We performed repetitive midline fluid percussion injury (rmFPI) in four months old mice and monitored their sleep/wake behavior using the non-invasive PiezoSleep system. The sleep/wake states were recorded before injury (baseline) and then monthly thereafter. We found that TBI mice displayed a significant decrease in sleep duration in both the light and dark phases, beginning at three months post-TBI and continuing throughout the study. Consistent with the sleep phenotype, these TBI mice showed circadian locomotor activity phenotypes and exhibited reduced anxiety-like behavior. TBI mice also gained less weight, and had less lean mass and total body water content, compared to sham controls. Furthermore, TBI mice showed extensive brain tissue loss and increased GFAP and IBA1 levels in the hypothalamus and the vicinity of the injury, indicative of chronic neuropathology. In summary, our study identified a critical time window of TBI pathology and associated circadian and sleep/wake phenotypes. Future studies should leverage this mouse model to investigate the molecular mechanisms underlying the chronic sleep/wake phenotypes following TBI early in life.
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Duhart JM, Inami S, Koh K. Many faces of sleep regulation: beyond the time of day and prior wake time. FEBS J 2023; 290:931-950. [PMID: 34908236 PMCID: PMC9198110 DOI: 10.1111/febs.16320] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 12/19/2022]
Abstract
The two-process model of sleep regulation posits two main processes regulating sleep: the circadian process controlled by the circadian clock and the homeostatic process that depends on the history of sleep and wakefulness. The model has provided a dominant conceptual framework for sleep research since its publication ~ 40 years ago. The time of day and prior wake time are the primary factors affecting the circadian and homeostatic processes, respectively. However, it is critical to consider other factors influencing sleep. Since sleep is incompatible with other behaviors, it is affected by the need for essential behaviors such as eating, foraging, mating, caring for offspring, and avoiding predators. Sleep is also affected by sensory inputs, sickness, increased need for memory consolidation after learning, and other factors. Here, we review multiple factors influencing sleep and discuss recent insights into the mechanisms balancing competing needs.
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Affiliation(s)
- José Manuel Duhart
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
- These authors contributed equally
- Present address: Fundación Instituto Leloir, Instituto de Investigaciones Bioquímicas de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Sho Inami
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
- These authors contributed equally
| | - Kyunghee Koh
- Department of Neuroscience, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia PA
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Padmakumar S, Kulkarni P, Ferris CF, Bleier BS, Amiji MM. Traumatic brain injury and the development of parkinsonism: Understanding pathophysiology, animal models, and therapeutic targets. Biomed Pharmacother 2022; 149:112812. [PMID: 35290887 PMCID: PMC9050934 DOI: 10.1016/j.biopha.2022.112812] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
The clinical translation of therapeutic approaches to combat debilitating neurodegenerative conditions, such as Parkinson's disease (PD), remains as an urgent unmet challenge. The strong molecular association between the pathogenesis of traumatic brain injury (TBI) and the development of parkinsonism in humans has been well established. Therefore, a lot of ongoing research aims to investigate this pathology overlap in-depth, to exploit the common targets of TBI and PD for development of more effective and long-term treatment strategies. This review article intends to provide a detailed background on TBI pathophysiology and its established overlap with PD with an additional emphasis on the recent findings about their effect on perivascular clearance. Although, the traditional animal models of TBI and PD are still being considered, there is a huge focus on the development of combinatory hybrid animal models coupling concussion with the pre-established PD models for a better recapitulation of the human context of PD pathogenesis. Lastly, the therapeutic targets for TBI and PD, and the contemporary research involving exosomes, DNA vaccines, miRNA, gene therapy and gene editing for the development of potential candidates are discussed, along with the recent development of lesser invasive and promising central nervous system (CNS) drug delivery strategies.
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Affiliation(s)
- Smrithi Padmakumar
- Department of Pharmaceutical Sciences, School of Pharmacy and Department of Chemical Engineering, College of Engineering, Northeastern University, Boston, MA, United States of America
| | - Praveen Kulkarni
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States of America
| | - Craig F Ferris
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States of America
| | - Benjamin S Bleier
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Mansoor M Amiji
- Department of Pharmaceutical Sciences, School of Pharmacy and Department of Chemical Engineering, College of Engineering, Northeastern University, Boston, MA, United States of America.
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Babu Henry Samuel I, Breneman CB, Chun T, Hamedi A, Murphy R, Barrett JP. Compounding Effects of Traumatic Brain Injury, Military Status, and Other Factors on Pittsburgh Sleep Quality Index: A Meta-analysis. Mil Med 2021; 187:e589-e597. [PMID: 34557901 DOI: 10.1093/milmed/usab377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) or concussion is a known risk factor for multiple adverse health outcomes, including disturbed sleep. Although prior studies show adverse effects of TBI on sleep quality, its compounding effect with other factors on sleep is unknown. This meta-analysis aimed to quantify the effects of TBI on subjective sleep quality in the context of military status and other demographic factors. MATERIALS AND METHODS A programmatic search of PubMed database from inception to June 2020 was conducted to identify studies that compared subjective sleep quality measured using Pittsburgh Sleep Quality Index (PSQI) in individuals with TBI relative to a control group. The meta-analysis included group-wise standard mean difference (SMD) and 95% CI. Pooled means and SDs were obtained for TBI and non-TBI groups with and without military service, and meta-regression was conducted to test for group effects. Exploratory analysis was performed to test for the effect of TBI, non-head injury, military status, sex, and age on sleep quality across studies. RESULTS Twenty-six articles were included, resulting in a combined total of 5,366 individuals (2,387 TBI and 2,979 controls). Overall, individuals with TBI self-reported poorer sleep quality compared to controls (SMD = 0.63, 95% CI: 0.45 to 0.80). Subgroup analysis revealed differences in the overall effect of TBI on PSQI, with a large effect observed in the civilian subgroup (SMD: 0.80, 95% CI: 0.57 to 1.03) and a medium effect in the civilian subgroup with orthopedic injuries (SMD: 0.40, 95% CI: 0.13 to 0.65) and military/veteran subgroup (SMD: 0.43, 95% CI: 0.14 to 0.71). Exploratory analysis revealed that age and history of military service significantly impacted global PSQI scores. CONCLUSIONS Poor sleep quality in TBI cohorts may be due to the influence of multiple factors. Military/veteran samples had poorer sleep quality compared to civilians even in the absence of TBI, possibly reflecting unique stressors associated with prior military experiences and the sequelae of these stressors or other physical and/or psychological traumas that combine to heightened vulnerability. These findings suggest that military service members and veterans with TBI are particularly at a higher risk of poor sleep and its associated adverse health outcomes. Additional research is needed to identify potential exposures that may further heighten vulnerability toward poorer sleep quality in those with TBI across both civilian and military/veteran populations.
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Affiliation(s)
- Immanuel Babu Henry Samuel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, DC 20422, USA
| | - Charity B Breneman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, DC 20422, USA
| | - Timothy Chun
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, DC 20422, USA
| | - Arghavan Hamedi
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, DC 20422, USA
| | - Rayelynn Murphy
- Cardiometabolic Health Unit, Washington DC VA Medical Center, Washington, DC 20422, USA
| | - John P Barrett
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, DC 20422, USA.,Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
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Schmid W, Fan Y, Chi T, Golanov E, Regnier-Golanov AS, Austerman RJ, Podell K, Cherukuri P, Bentley T, Steele CT, Schodrof S, Aazhang B, Britz GW. Review of wearable technologies and machine learning methodologies for systematic detection of mild traumatic brain injuries. J Neural Eng 2021; 18. [PMID: 34330120 DOI: 10.1088/1741-2552/ac1982] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
Mild traumatic brain injuries (mTBIs) are the most common type of brain injury. Timely diagnosis of mTBI is crucial in making 'go/no-go' decision in order to prevent repeated injury, avoid strenuous activities which may prolong recovery, and assure capabilities of high-level performance of the subject. If undiagnosed, mTBI may lead to various short- and long-term abnormalities, which include, but are not limited to impaired cognitive function, fatigue, depression, irritability, and headaches. Existing screening and diagnostic tools to detect acute andearly-stagemTBIs have insufficient sensitivity and specificity. This results in uncertainty in clinical decision-making regarding diagnosis and returning to activity or requiring further medical treatment. Therefore, it is important to identify relevant physiological biomarkers that can be integrated into a mutually complementary set and provide a combination of data modalities for improved on-site diagnostic sensitivity of mTBI. In recent years, the processing power, signal fidelity, and the number of recording channels and modalities of wearable healthcare devices have improved tremendously and generated an enormous amount of data. During the same period, there have been incredible advances in machine learning tools and data processing methodologies. These achievements are enabling clinicians and engineers to develop and implement multiparametric high-precision diagnostic tools for mTBI. In this review, we first assess clinical challenges in the diagnosis of acute mTBI, and then consider recording modalities and hardware implementation of various sensing technologies used to assess physiological biomarkers that may be related to mTBI. Finally, we discuss the state of the art in machine learning-based detection of mTBI and consider how a more diverse list of quantitative physiological biomarker features may improve current data-driven approaches in providing mTBI patients timely diagnosis and treatment.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Yingying Fan
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Taiyun Chi
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Eugene Golanov
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | | | - Ryan J Austerman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | - Kenneth Podell
- Department of Neurology, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | - Paul Cherukuri
- Institute of Biosciences and Bioengineering (IBB), Rice University, Houston, TX 77005, United States of America
| | - Timothy Bentley
- Office of Naval Research, Arlington, VA 22203, United States of America
| | - Christopher T Steele
- Military Operational Medicine Research Program, US Army Medical Research and Development Command, Fort Detrick, MD 21702, United States of America
| | - Sarah Schodrof
- Department of Athletics-Sports Medicine, Rice University, Houston, TX 77005, United States of America
| | - Behnaam Aazhang
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
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Saber M, Murphy SM, Cho Y, Lifshitz J, Rowe RK. Experimental diffuse brain injury and a model of Alzheimer's disease exhibit disease-specific changes in sleep and incongruous peripheral inflammation. J Neurosci Res 2021; 99:1136-1160. [PMID: 33319441 PMCID: PMC7897258 DOI: 10.1002/jnr.24771] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 01/09/2023]
Abstract
Elderly populations (≥65 years old) have the highest risk of developing Alzheimer's disease (AD) and/or obtaining a traumatic brain injury (TBI). Using translational mouse models, we investigated sleep disturbances and inflammation associated with normal aging, TBI and aging, and AD. We hypothesized that aging results in marked changes in sleep compared with adult mice, and that TBI and aging would result in sleep and inflammation levels similar to AD mice. We used female 16-month-old wild-type (WT Aged) and 3xTg-AD mice, as well as a 2-month-old reference group (WT Adult), to evaluate sleep changes. WT Aged mice received diffuse TBI by midline fluid percussion, and blood was collected from both WT Aged (pre- and post-TBI) and 3xTg-AD mice to evaluate inflammation. Cognitive behavior was tested, and tissue was collected for histology. Bayesian generalized additive and mixed-effects models were used for analyses. Both normal aging and AD led to increases in sleep compared with adult mice. WT Aged mice with TBI slept substantially more, with fragmented shorter bouts, than they did pre-TBI and compared with AD mice. However, differences between WT Aged and 3xTg-AD mice in immune cell populations and plasma cytokine levels were incongruous, cognitive deficits were similar, and cumulative sleep was not predictive of inflammation or behavior for either group. Our results suggest that in similarly aged individuals, TBI immediately induces more profound sleep alterations than in AD, although both diseases likely include cognitive impairments. Unique pathological sleep pathways may exist in elderly individuals who incur TBI compared with similarly aged individuals who have AD, which may warrant disease-specific treatments in clinical settings.
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Affiliation(s)
- Maha Saber
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Yerin Cho
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
| | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ
| | - Rachel K. Rowe
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ
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Lugo GJ, Beletanga M, Goldstein L, Rana M, Jonas R, Torres AR. Assessment and Treatment of Concussion in the Pediatric Population. Semin Neurol 2021; 41:132-146. [PMID: 33657625 DOI: 10.1055/s-0041-1725135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non-sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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Affiliation(s)
- Giancarlo J Lugo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Maria Beletanga
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Laura Goldstein
- Division of Child Psychiatry, Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Mandeep Rana
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Pediatric Brain Injury Program, Boston University School of Medicine, Boston, Massachusetts
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Overeem S, van Litsenburg RRL, Reading PJ. Sleep disorders and the hypothalamus. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:369-385. [PMID: 34266606 DOI: 10.1016/b978-0-12-819973-2.00025-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As early as the 1920s, pathological studies of encephalitis lethargica allowed Von Economo to correctly identify hypothalamic damage as crucial for the profound associated sleep-related symptoms that helped define the condition. Only over the last 3 decades, however, has the key role of the hypothalamus in sleep-wake regulation become increasingly recognized. As a consequence, a close relation between abnormal sleep symptomatology and hypothalamic pathology is now widely accepted for a variety of medical disorders. Narcolepsy is discussed in some detail as the cardinal primary sleep disorder that is caused directly and specifically by hypothalamic pathology, most notably destruction of hypocretin (orexin)-containing neurons. Thereafter, various conditions are described that most likely result from hypothalamic damage, in part at least, producing a clinical picture resembling (symptomatic) narcolepsy. Kleine-Levin syndrome is a rare primary sleep disorder with intermittent symptoms, highly suggestive of hypothalamic involvement but probably reflecting a wider pathophysiology. ROHHAD (rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation) and Prader-Willi syndrome are also covered as hypothalamic syndromes with prominent sleep-related symptoms. Finally, sleep issues in several endocrine disorders are briefly discussed.
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Affiliation(s)
- Sebastiaan Overeem
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands; Biomedical Diagnostics Laboratory, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Raphaële R L van Litsenburg
- Psychooncology Group, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pedicatric Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul J Reading
- Department of Neurology, James Cook University Hospital, Middlesbrough, United Kingdom
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Green TRF, Ortiz JB, Wonnacott S, Williams RJ, Rowe RK. The Bidirectional Relationship Between Sleep and Inflammation Links Traumatic Brain Injury and Alzheimer's Disease. Front Neurosci 2020; 14:894. [PMID: 32982677 PMCID: PMC7479838 DOI: 10.3389/fnins.2020.00894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) are diseases during which the fine-tuned autoregulation of the brain is lost. Despite the stark contrast in their causal mechanisms, both TBI and AD are conditions which elicit a neuroinflammatory response that is coupled with physical, cognitive, and affective symptoms. One commonly reported symptom in both TBI and AD patients is disturbed sleep. Sleep is regulated by circadian and homeostatic processes such that pathological inflammation may disrupt the chemical signaling required to maintain a healthy sleep profile. In this way, immune system activation can influence sleep physiology. Conversely, sleep disturbances can exacerbate symptoms or increase the risk of inflammatory/neurodegenerative diseases. Both TBI and AD are worsened by a chronic pro-inflammatory microenvironment which exacerbates symptoms and worsens clinical outcome. Herein, a positive feedback loop of chronic inflammation and sleep disturbances is initiated. In this review, the bidirectional relationship between sleep disturbances and inflammation is discussed, where chronic inflammation associated with TBI and AD can lead to sleep disturbances and exacerbated neuropathology. The role of microglia and cytokines in sleep disturbances associated with these diseases is highlighted. The proposed sleep and inflammation-mediated link between TBI and AD presents an opportunity for a multifaceted approach to clinical intervention.
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Affiliation(s)
- Tabitha R. F. Green
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - J. Bryce Ortiz
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
| | - Sue Wonnacott
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Robert J. Williams
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Rachel K. Rowe
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, United States
- Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, United States
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ, United States
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11
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Crichton T, Singh R, Abosi-Appeadu K, Dennis G. Excessive daytime sleepiness after traumatic brain injury. Brain Inj 2020; 34:1525-1531. [DOI: 10.1080/02699052.2020.1810316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thomas Crichton
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Rajiv Singh
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Gary Dennis
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Department of Neurology, Sheffield Teaching Hospitals, Sheffield, UK
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12
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Assessment and Treatment of Sleep in Mild Traumatic Brain Injury. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Bhattrai A, Irimia A, Van Horn JD. Neuroimaging of traumatic brain injury in military personnel: An overview. J Clin Neurosci 2019; 70:1-10. [PMID: 31331746 PMCID: PMC6861663 DOI: 10.1016/j.jocn.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of blunt-force traumatic brain injury (TBI) is especially prevalent in the military, where the emergency care admission rate has been reported to be 24.6-41.8 per 10,000 soldier-years. Given substantial advancements in modern neuroimaging techniques over the past decade in terms of structural, functional, and connectomic approaches, this mode of exploration can be viewed as best suited for understanding the underlying pathology and for providing proper intervention at effective time-points. APPROACH Here we survey neuroimaging studies of mild-to-severe TBI in military veterans with the intent to aid the field in the creation of a roadmap for clinicians and researchers whose aim is to understand TBI progression. DISCUSSION Recent advancements on the quantification of neurocognitive dysfunction, cellular dysfunction, intracranial pressure, cerebral blood flow, inflammation, post-traumatic neuropathophysiology, on blood serum biomarkers and on their correlation to neuroimaging findings are reviewed to hypothesize how they can be used in conjunction with one another. This may allow clinicians and scientists to comprehensively study TBI in military service members, leading to new treatment strategies for both currently-serving as well as veteran personnel, and to improve the study of TBI more broadly.
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Affiliation(s)
- Avnish Bhattrai
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, 2025 Zonal Avenue, SHN, Los Angeles, CA 90033, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Room 228C, Los Angeles, CA 90089-0191, USA.
| | - John Darrell Van Horn
- USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, 2025 Zonal Avenue, SHN, Los Angeles, CA 90033, USA.
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14
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Fedele B, Williams G, McKenzie D, Sutherland E, Olver J. Subacute sleep disturbance in moderate to severe traumatic brain injury: a systematic review. Brain Inj 2019; 34:316-327. [PMID: 31774695 DOI: 10.1080/02699052.2019.1695288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This systematic review evaluated subacute sleep disturbance following moderate to severe traumatic brain injury (TBI) and the impact of secondary factors such as mood or pain.Methods: A comprehensive search strategy was applied to nine databases. Inclusion criteria included: adults ≥18 years, moderate and severe TBI and within 3 months of injury. Eligible studies were critically appraised using the McMaster Quantitative Critical Review Form. Study characteristics, outcomes, and methodological quality were synthesized. This systematic review was registered with PROSPERO (Registration number: CRD42018087799).Results: Ten studies were included. Research identified early-onset sleep disturbances; characterized as fragmented sleep periods and difficulty initiating sleep. Alterations to sleep architecture (e.g. rapid eye movement sleep) were reported. Sleep disturbance appears to associate with alterations of consciousness. Sleep disturbance tended to be particularly increased during the phase of post-traumatic amnesia (PTA) (78.7%).Conclusions: There is a limited amount of research available, which has inherent measurement and sample size limitations. The gold standard for measuring sleep (polysomnography) was rarely utilized, which may affect the detection of sleep disturbance and sleep architecture. Secondary factors potentially influencing sleep were generally not reported. Further evaluation on associations between sleep and PTA is needed.
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Affiliation(s)
- Bianca Fedele
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Dean McKenzie
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Research Development and Governance Unit, Epworth HealthCare, Melbourne, Australia
| | - Edwina Sutherland
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation, Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
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15
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Wang YS, Hsieh W, Chung JR, Lan TH, Wang Y. Repetitive mild traumatic brain injury alters diurnal locomotor activity and response to the light change in mice. Sci Rep 2019; 9:14067. [PMID: 31575951 PMCID: PMC6773703 DOI: 10.1038/s41598-019-50513-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common cause of brain damage with a high incidence of multiple mTBIs found among athletes and soldiers. The purpose of this study is to examine the diurnal behavioral changes after multiple mTBIs. Adult mice were anesthetized; mTBI was conducted by dropping a 30-g weight to the right temporal skull once (mTBI1) or three times (mTBI3) over 3-week. Open-field motor behavior was recorded for 3 days after the last mTBI. In the first 4-hour exploratory phase, mTBI1 or mTBI3 equally reduced locomotor activity. A significant reduction of locomotor activity was found in the dark cycle between 4–72 hour in mTBI1 or mTBI3 mice; higher motor activity was seen after mTBI3 compared to mTBI1. In the light cycle, mTBI3 mice demonstrated an earlier immobilization followed by hyperactivity. The response to light change significantly correlated with the number of impacts. The IBA1 and BAX protein levels were equally increased in the lesioned cortex after mTBI1 and mTBI3. mTBI3 selectively upregulated the expression of circadian clock gene Per1 in hypothalamus and hippocampus as well as iNOS expression in the lesioned side cortex. Our data suggest multiple mTBIs alter diurnal locomotor activity and response to the change of light, which may involve Per1 expression in the lesioned brain.
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Affiliation(s)
- Yu-Syuan Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wei Hsieh
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Jia-Ru Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Tsuo-Hung Lan
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.,Department of Psychiatry, Taichung Veteran General Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun Wang
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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16
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Iaccarino MA, Zafonte RD, Roy ED, Wojtowicz M. Case 27-2019: A 16-Year-Old Girl with Head Trauma during a Sailboat Race. N Engl J Med 2019; 381:863-871. [PMID: 31461598 DOI: 10.1056/nejmcpc1900590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mary A Iaccarino
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Ross D Zafonte
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Emily D Roy
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Magdalena Wojtowicz
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
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17
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Shah EJ, Gurdziel K, Ruden DM. Mammalian Models of Traumatic Brain Injury and a Place for Drosophila in TBI Research. Front Neurosci 2019; 13:409. [PMID: 31105519 PMCID: PMC6499071 DOI: 10.3389/fnins.2019.00409] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023] Open
Abstract
Traumatic brain injury (TBI), caused by a sudden blow or jolt to the brain that disrupts normal function, is an emerging health epidemic with ∼2.5 million cases occurring annually in the United States that are severe enough to cause hospitalization or death. Most common causes of TBI include contact sports, vehicle crashes and domestic violence or war injuries. Injury to the central nervous system is one of the most consistent candidates for initiating the molecular and cellular cascades that result in Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Not every TBI event is alike with effects varying from person to person. The majority of people recover from mild TBI within a short period of time, but repeated incidents can have deleterious long-lasting effects which depend on factors such as the number of TBIs sustained, time till medical attention, age, gender and genetics of the individual. Despite extensive research, many questions still remain regarding diagnosis, treatment, and prevention of long-term effects from TBI as well as recovery of brain function. In this review, we present an overview of TBI pathology, discuss mammalian models for TBI and focus on current methods using Drosophila melanogaster as a model for TBI study. The relatively small brain size (∼100,000 neurons and glia), conserved neurotransmitter signaling mechanisms and sophisticated genetics of Drosophila allows for cell biological, molecular and genetic analyses that are impractical in mammalian models of TBI.
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Affiliation(s)
- Ekta J. Shah
- Department of Pharmacology, Wayne State University, Detroit, MI, United States
| | - Katherine Gurdziel
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Douglas M. Ruden
- Department of Pharmacology, Wayne State University, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, United States
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18
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Merritt BP, Kretzmer T, McKenzie-Hartman TL, Gootam P. Neurobehavioral Management of the Polytrauma Veteran. Phys Med Rehabil Clin N Am 2018; 30:133-154. [PMID: 30470418 DOI: 10.1016/j.pmr.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Since the inception of the Afghanistan and Iraq wars, an increasing number of veterans have sought treatment from the Department of Veterans Affairs for combat-related injuries. Many veterans experience postconcussive symptoms, traumatic stress, chronic pain, sensory deficits, and/or headaches. The goal of this article was to highlight some of the challenges treatment providers may face, while providing rehabilitation specialists with important evaluation and treatment considerations in working with this population to maximize outcomes for these veterans.
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Affiliation(s)
- Bryan P Merritt
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Neurology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA.
| | - Tracy Kretzmer
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Tamara L McKenzie-Hartman
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, USA
| | - Praveen Gootam
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
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19
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Transient disruption of mouse home cage activities and assessment of orexin immunoreactivity following concussive- or blast-induced brain injury. Brain Res 2018; 1700:138-151. [DOI: 10.1016/j.brainres.2018.08.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/21/2022]
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20
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Liu S, Huang Y, Tai H, Zhang K, Wang Z, Shen D, Fu H, Su N, Shi J, Ding Q, Liu M, Guan Y, Gao J, Cui L. Excessive daytime sleepiness in Chinese patients with sporadic amyotrophic lateral sclerosis and its association with cognitive and behavioural impairments. J Neurol Neurosurg Psychiatry 2018; 89:1038-1043. [PMID: 30045943 DOI: 10.1136/jnnp-2018-318810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the frequency and clinical features of excessive daytime sleepiness (EDS) and its association with cognitive and behavioural impairments in patients with amyotrophic lateral sclerosis (ALS). METHODS We conducted a cross-sectional investigation to explore the frequency and clinical features of EDS in a group of 121 Chinese patients with ALS compared with 121 age-matched and sex-matched healthy subjects. EDS was diagnosed using the Epworth Sleepiness Scale (ESS). Other characteristics of patients with ALS including sleep quality, REM sleep behaviour disorder (RBD), restless legs syndrome (RLS), cognition, behaviour, depression and anxiety were also evaluated. RESULTS EDS was significantly more frequent in patients with ALS than in controls (26.4% vs 8.3%; p<0.05). Patients with ALS with EDS scored lower scores on the revised ALS Functional Rating Scale (ALSFRS-R), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and MMSE and MoCA delayed memory subitems and higher on the Frontal Behavioural Inventory (FBI) than patients with ALS without EDS. ESS scores correlated with global ALSFRS-R, FBI, MMSE and MoCA scores and MMSE and MoCA delayed memory scores. RLS and global ALSFRS-R scores were independently associated with EDS in patients with ALS. CONCLUSIONS We identified a high frequency of EDS symptoms in Chinese patients with ALS, and these patients might have more serious physical, cognitive and frontal behaviour impairment. Patients with ALS might improve quality of life from the timely recognition and optimised management of EDS symptoms. Our results further suggest that ALS is a heterogeneous disease that might exhibit abnormal sleep-wake patterns.
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Affiliation(s)
- Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hanhui Fu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jiayu Shi
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China .,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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21
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Liu S, Shen D, Tai H, Su N, Ding Q, Fu H, Zhang K, Wang Z, Liu M, Huang Y, Cui L. Restless Legs Syndrome in Chinese Patients With Sporadic Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:735. [PMID: 30214425 PMCID: PMC6125374 DOI: 10.3389/fneur.2018.00735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: To evaluate the frequency and clinical features of restless legs syndrome (RLS) in a group of Chinese patients with amyotrophic lateral sclerosis (ALS). Methods: 109 Patients included in this study fulfilled the revised El Escorial diagnostic criteria for clinically definite, probable and lab-supported probable ALS, and a group of 109 control subjects was matched for age and sex to the ALS group. Disease severity was assessed by the revised ALS functional rating scale (ALSFRS-R). The diagnosis of RLS was made according to the criteria of the International RLS Study Group. Other characteristics including sleep quality, excessive daytime sleepiness (EDS), REM sleep behavior disorder (RBD), depression and anxiety were also evaluated in ALS patients. Results: RLS was significantly more frequent in ALS patients than in control subjects (14.6 vs. 0.9%; P < 0.05). Compared to those without RLS, ALS patients with RLS reported a higher frequency of anxiety and EDS. ALS patients with RLS showed more severe legs dysfunction. EDS and legs function scores of the ALSFRS-R were independent factors significantly associated with RLS in ALS patients. Conclusions: Our findings suggest that Chinese ALS patients exhibit a high frequency of RLS symptoms and that these patients may benefit from recognition of the condition and optimized management of its symptoms. Moreover, ALS patients might cause circadian rhythms disturbance and our study further supports that ALS is a heterogeneous disorder involving multiple systems; further studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hanhui Fu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China.,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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22
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Wickwire EM, Schnyer DM, Germain A, Williams SG, Lettieri CJ, McKeon AB, Scharf SM, Stocker R, Albrecht J, Badjatia N, Markowitz AJ, Manley GT. Sleep, Sleep Disorders, and Circadian Health following Mild Traumatic Brain Injury in Adults: Review and Research Agenda. J Neurotrauma 2018; 35:2615-2631. [PMID: 29877132 DOI: 10.1089/neu.2017.5243] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). Although many questions remain unanswered, the preponderance of evidence suggests that sleep and circadian disorders can result from mTBI. Among those with mTBI, sleep disturbances and clinical sleep and circadian disorders contribute to the morbidity and long-term sequelae across domains of functional outcomes and quality of life. Specifically, along with deterioration of neurocognitive performance, insufficient and disturbed sleep can precede, exacerbate, or perpetuate many of the other common sequelae of mTBI, including depression, post-traumatic stress disorder, and chronic pain. Further, sleep and mTBI share neurophysiologic and neuroanatomic mechanisms that likely bear directly on success of rehabilitation following mTBI. For these reasons, focus on disturbed sleep as a modifiable treatment target has high likelihood of improving outcomes in mTBI. Here, we review relevant literature and present a research agenda to 1) advance understanding of the reciprocal relationships between sleep and circadian factors and mTBI sequelae and 2) advance rapidly the development of sleep-related treatments in this population.
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Affiliation(s)
- Emerson M Wickwire
- 1 Department of Psychiatry, University of Maryland School of Medicine , Baltimore, Maryland.,2 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland
| | - David M Schnyer
- 3 Department of Psychology, University of Texas , Austin, Texas
| | - Anne Germain
- 4 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Scott G Williams
- 5 Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland.,6 Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Christopher J Lettieri
- 5 Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland.,6 Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Ashlee B McKeon
- 4 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Steven M Scharf
- 2 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland
| | - Ryan Stocker
- 7 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Jennifer Albrecht
- 8 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | - Neeraj Badjatia
- 9 Department of Neurology, University of Maryland School of Medicine , Baltimore, Maryland
| | - Amy J Markowitz
- 10 UCSF Brain and Spinal Injury Center , San Francisco, California
| | - Geoffrey T Manley
- 11 Department of Neurosurgery, University of California , San Francisco, California
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23
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Boone DR, Leek JM, Falduto MT, Torres KEO, Sell SL, Parsley MA, Cowart JC, Uchida T, Micci MA, DeWitt DS, Prough DS, Hellmich HL. Effects of AAV-mediated knockdown of nNOS and GPx-1 gene expression in rat hippocampus after traumatic brain injury. PLoS One 2017; 12:e0185943. [PMID: 29016640 PMCID: PMC5634593 DOI: 10.1371/journal.pone.0185943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023] Open
Abstract
Virally mediated RNA interference (RNAi) to knock down injury-induced genes could improve functional outcome after traumatic brain injury (TBI); however, little is known about the consequences of gene knockdown on downstream cell signaling pathways and how RNAi influences neurodegeneration and behavior. Here, we assessed the effects of adeno-associated virus (AAV) siRNA vectors that target two genes with opposing roles in TBI pathogenesis: the allegedly detrimental neuronal nitric oxide synthase (nNOS) and the potentially protective glutathione peroxidase 1 (GPx-1). In rat hippocampal progenitor cells, three siRNAs that target different regions of each gene (nNOS, GPx-1) effectively knocked down gene expression. However, in vivo, in our rat model of fluid percussion brain injury, the consequences of AAV-siRNA were variable. One nNOS siRNA vector significantly reduced the number of degenerating hippocampal neurons and showed a tendency to improve working memory. GPx-1 siRNA treatment did not alter TBI-induced neurodegeneration or working memory deficits. Nevertheless, microarray analysis of laser captured, virus-infected neurons showed that knockdown of nNOS or GPx-1 was specific and had broad effects on downstream genes. Since nNOS knockdown only modestly ameliorated TBI-induced working memory deficits, despite widespread genomic changes, manipulating expression levels of single genes may not be sufficient to alter functional outcome after TBI.
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Affiliation(s)
- Deborah R. Boone
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jeanna M. Leek
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | | | | | - Stacy L. Sell
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Margaret A. Parsley
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jeremy C. Cowart
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Tatsuo Uchida
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Maria-Adelaide Micci
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Douglas S. DeWitt
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald S. Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Helen L. Hellmich
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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24
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Suzuki Y, Khoury S, El-Khatib H, Chauny JM, Paquet J, Giguère JF, Denis R, Gosselin N, Lavigne GJ, Arbour C. Individuals with pain need more sleep in the early stage of mild traumatic brain injury. Sleep Med 2017; 33:36-42. [DOI: 10.1016/j.sleep.2016.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 10/20/2022]
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25
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Mollayeva T, Colantonio A, Cassidy JD, Vernich L, Moineddin R, Shapiro CM. Sleep stage distribution in persons with mild traumatic brain injury: a polysomnographic study according to American Academy of Sleep Medicine standards. Sleep Med 2017; 34:179-192. [PMID: 28522089 DOI: 10.1016/j.sleep.2017.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE AND BACKGROUND Sleep stage disruption in persons with mild traumatic brain injury (mTBI) has received little research attention. We examined deviations in sleep stage distribution in persons with mTBI relative to population age- and sex-specific normative data and the relationships between such deviations and brain injury-related, medical/psychiatric, and extrinsic factors. PATIENTS AND METHODS We conducted a cross-sectional polysomnographic investigation in 40 participants diagnosed with mTBI (mean age 47.54 ± 11.30 years; 56% males). MEASUREMENTS At the time of investigation, participants underwent comprehensive clinical and neuroimaging examinations and one full-night polysomnographic study. We used the 2012 American Academy of Sleep Medicine recommendations for recording, scoring, and summarizing sleep stages. We compared participants' sleep stage data with normative data stratified by age and sex to yield z-scores for deviations from available population norms and then employed stepwise multiple regression analyses to determine the factors associated with the identified significant deviations. RESULTS In patients with mTBI, the mean duration of nocturnal wakefulness was higher and consolidated sleep stage N2 and REM were lower than normal (p < 0.0001, p = 0.018, and p = 0.010, respectively). In multivariate regression analysis, several covariates accounted for the variance in the relative changes in sleep stage duration. No sex differences were observed in the mean proportion of non-REM or REM sleep. CONCLUSIONS We observed longer relative nocturnal wakefulness and shorter relative N2 and REM sleep in patients with mTBI, and these outcomes were associated with potentially modifiable variables. Addressing disruptions in sleep architecture in patients with mTBI could improve their health status.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada; Collaborative Program in Neuroscience, University of Toronto, Canada; Toronto Rehab-University Health Network, Ontario, Canada.
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada; Acquired Brain Injury Research Lab, University of Toronto, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada
| | - J David Cassidy
- Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Canada; Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Lee Vernich
- Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Rahim Moineddin
- Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Colin M Shapiro
- Faculty of Arts and Science, University of Toronto, Canada; Toronto Western Hospital, University Health Network, Ontario, Canada; Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada
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Stocker RPJ, Paul BTE, Mammen O, Khan H, Cieply MA, Germain A. Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD. J Clin Sleep Med 2017; 12:49-56. [PMID: 26414975 DOI: 10.5664/jcsm.5392] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). METHODS Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters. RESULTS There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation. CONCLUSIONS The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults.
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Affiliation(s)
- Ryan P J Stocker
- University of Pittsburgh Medical Center, Pittsburgh, PA.,University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | | | - Oommen Mammen
- University of Pittsburgh Medical Center, Pittsburgh, PA.,University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Hassen Khan
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Anne Germain
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
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Khoury S, Segal J, Parisien M, Noreau A, Dion P, Benavides R, Giguère JF, Denis R, Belfer I, Diatchenko L, Rouleau GA, Lavigne GJ. Post-concussion symptoms and chronic pain after mild traumatic brain injury are modulated by multiple locus effect in the BDNF gene through the expression of antisense: A pilot prospective control study. Can J Pain 2017; 1:112-126. [PMID: 35005347 PMCID: PMC8730664 DOI: 10.1080/24740527.2017.1362942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) often results in post-concussion symptoms, chronic pain, and sleepiness. Genetic factors are thought to play an important role in poor prognosis. Aims: The aims of this study are to (1) document the prevalence of pain and post-concussion symptoms in mTBI patients in acute and chronic phases (2) determine whether candidate genes predispose to post-concussive symptoms and pain. Methods: Posttraumatic symptoms, evaluated using the Rivermead Post-Concussion Symptoms Questionnaire, and pain were assessed in 94 mTBI patients in the acute phase as well as in 22 healthy controls. Assessment was repeated in 36 patients after one year who agreed to participate in the follow-up visit. Gene polymorphisms and expression were assessed in mTBI patients and healthy controls. Results: In the acute phase, mTBI patients with pain (69%) presented more psychological symptoms and sleepiness and were less able to return to work than those without pain. At one year, 19% of mTBI patients had persistent pain and psychological distress. Two haplotypes (H2 and H3) in the brain-derived neurotrophic factor (BDNF) gene were shown to be respectively deleterious and protective against post-concussion symptoms and pain in both acute and chronic phases. Protective haplotype H3 was associated with a decreased expression of the anti-sense of BDNF (BDNF-AS). Deleterious haplotype H2 predicted the development of chronic pain at one year, whereas H3 was protective. Conclusions: This pilot study suggests a protective mechanism of a multilocus effect in BDNF, through BDNF-AS, against post-concussion symptoms and pain in the acute phase and possibly chronic pain at one year post-mTBI. The role of antisense RNA should be validated in larger cohorts.
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Affiliation(s)
- Samar Khoury
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Julia Segal
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Marc Parisien
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Anne Noreau
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Patrick Dion
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Rodrigo Benavides
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Jean-François Giguère
- Department of Surgery, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
| | - Ronald Denis
- Department of Surgery, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
| | - Inna Belfer
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Luda Diatchenko
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Guy A. Rouleau
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Gilles J. Lavigne
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Cœur and Université de Montréal, Montréal, QC, Canada
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Qu W, Liu NK, Xie XMS, Li R, Xu XM. Automated monitoring of early neurobehavioral changes in mice following traumatic brain injury. Neural Regen Res 2016; 11:248-56. [PMID: 27073377 PMCID: PMC4810988 DOI: 10.4103/1673-5374.177732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury often causes a variety of behavioral and emotional impairments that can develop into chronic disorders. Therefore, there is a need to shift towards identifying early symptoms that can aid in the prediction of traumatic brain injury outcomes and behavioral endpoints in patients with traumatic brain injury after early interventions. In this study, we used the SmartCage system, an automated quantitative approach to assess behavior alterations in mice during an early phase of traumatic brain injury in their home cages. Female C57BL/6 adult mice were subjected to moderate controlled cortical impact (CCI) injury. The mice then received a battery of behavioral assessments including neurological score, locomotor activity, sleep/wake states, and anxiety-like behaviors on days 1, 2, and 7 after CCI. Histological analysis was performed on day 7 after the last assessment. Spontaneous activities on days 1 and 2 after injury were significantly decreased in the CCI group. The average percentage of sleep time spent in both dark and light cycles were significantly higher in the CCI group than in the sham group. For anxiety-like behaviors, the time spent in a light compartment and the number of transitions between the dark/light compartments were all significantly reduced in the CCI group than in the sham group. In addition, the mice suffering from CCI exhibited a preference of staying in the dark compartment of a dark/light cage. The CCI mice showed reduced neurological score and histological abnormalities, which are well correlated to the automated behavioral assessments. Our findings demonstrate that the automated SmartCage system provides sensitive and objective measures for early behavior changes in mice following traumatic brain injury.
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Affiliation(s)
- Wenrui Qu
- Hand & Foot Surgery and Reparative & Reconstructive Surgery Center, Orthopaedic Hospital of the Second Hospital of Jilin University, Changchun, Jilin Province, China; Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Nai-Kui Liu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | | | - Rui Li
- Hand & Foot Surgery and Reparative & Reconstructive Surgery Center, Orthopaedic Hospital of the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
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Schönberger M, Reutens D, Beare R, O'Sullivan R, Rajaratnam SMW, Ponsford J. Brain lesion correlates of fatigue in individuals with traumatic brain injury. Neuropsychol Rehabil 2016; 27:1056-1070. [PMID: 26957190 DOI: 10.1080/09602011.2016.1154875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the neurological correlates of both subjective fatigue as well as objective fatigability in individuals with traumatic brain injury (TBI). The study has a cross-sectional design. Participants (N = 53) with TBI (77% male, mean age at injury 38 years, mean time since injury 1.8 years) underwent a structural magnetic resonance imaging (MRI) scan and completed the Fatigue Severity Scale (FSS), while a subsample (N = 36) was also tested with a vigilance task. While subjective fatigue (FSS) was not related to measures of brain lesions, multilevel analyses showed that a change in the participants' decision time was significantly predicted by grey matter (GM) lesions in the right frontal lobe. The time-dependent development of the participants' error rate was predicted by total brain white matter (WM) lesion volumes, as well as right temporal GM and WM lesion volumes. These findings could be explained by decreased functional connectivity of attentional networks, which results in accelerated exhaustion during cognitive task performance. The disparate nature of objectively measurable fatigability on the one hand and the subjective experience of fatigue on the other needs further investigation.
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Affiliation(s)
- Michael Schönberger
- a Department of Rehabilitation Psychology , Institute of Psychology, University of Freiburg , Freiburg , Germany.,b School of Psychological Sciences , Monash University Melbourne , Melbourne , Australia.,c Monash-Epworth Rehabilitation Research Centre , Epworth Hospital , Melbourne , Australia
| | - David Reutens
- d Department of Medicine, Monash Medical Centre , Monash University Melbourne , Melbourne , Australia.,e Centre for Advanced Imaging , The University of Queensland , St Lucia , Australia
| | - Richard Beare
- d Department of Medicine, Monash Medical Centre , Monash University Melbourne , Melbourne , Australia.,f Murdoch Childrens Research Institute, Royal Children's Hospital , Melbourne , Australia
| | | | - Shantha M W Rajaratnam
- b School of Psychological Sciences , Monash University Melbourne , Melbourne , Australia
| | - Jennie Ponsford
- b School of Psychological Sciences , Monash University Melbourne , Melbourne , Australia.,c Monash-Epworth Rehabilitation Research Centre , Epworth Hospital , Melbourne , Australia.,h National Trauma Research Institute , Melbourne , Australia
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Abstract
Sleep and energy balance are essential for health. The two processes act in concert to regulate central and peripheral homeostasis. During sleep, energy is conserved due to suspended activity, movement, and sensory responses, and is redirected to restore and replenish proteins and their assemblies into cellular structures. During wakefulness, various energy-demanding activities lead to hunger. Thus, hunger promotes arousal, and subsequent feeding, followed by satiety that promotes sleep via changes in neuroendocrine or neuropeptide signals. These signals overlap with circuits of sleep-wakefulness, feeding, and energy expenditure. Here, we will briefly review the literature that describes the interplay between the circadian system, sleep-wake, and feeding-fasting cycles that are needed to maintain energy balance and a healthy metabolic profile. In doing so, we describe the neuroendocrine, hormonal/peptide signals that integrate sleep and feeding behavior with energy metabolism.
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Affiliation(s)
- Charu Shukla
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
| | - Radhika Basheer
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
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Greater neurobehavioral deficits occur in adult mice after repeated, as compared to single, mild traumatic brain injury (mTBI). Behav Brain Res 2015; 298:111-24. [PMID: 26542813 DOI: 10.1016/j.bbr.2015.10.052] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/07/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023]
Abstract
Mild traumatic brain injury (mTBI) accounts for the majority of all brain injuries and affected individuals typically experience some extent of cognitive and/or neuropsychiatric deficits. Given that repeated mTBIs often result in worsened prognosis, the cumulative effect of repeated mTBIs is an area of clinical concern and on-going pre-clinical research. Animal models are critical in elucidating the underlying mechanisms of single and repeated mTBI-associated deficits, but the neurobehavioral sequelae produced by these models have not been well characterized. Thus, we sought to evaluate the behavioral changes incurred after single and repeated mTBIs in mice utilizing a modified impact-acceleration model. Mice in the mTBI group received 1 impact while the repeated mTBI group received 3 impacts with an inter-injury interval of 24h. Classic behavior evaluations included the Morris water maze (MWM) to assess learning and memory, elevated plus maze (EPM) for anxiety, and forced swim test (FST) for depression/helplessness. Additionally, species-typical behaviors were evaluated with the marble-burying and nestlet shredding tests to determine motivation and apathy. Non-invasive vibration platforms were used to examine sleep patterns post-mTBI. We found that the repeated mTBI mice demonstrated deficits in MWM testing and poorer performance on species-typical behaviors. While neither single nor repeated mTBI affected behavior in the EPM or FST, sleep disturbances were observed after both single and repeated mTBI. Here, we conclude that behavioral alterations shown after repeated mTBI resemble several of the deficits or disturbances reported by patients, thus demonstrating the relevance of this murine model to study repeated mTBIs.
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Harrison JL, Rowe RK, Ellis TW, Yee NS, O’Hara BF, Adelson PD, Lifshitz J. Resolvins AT-D1 and E1 differentially impact functional outcome, post-traumatic sleep, and microglial activation following diffuse brain injury in the mouse. Brain Behav Immun 2015; 47:131-40. [PMID: 25585137 PMCID: PMC4468045 DOI: 10.1016/j.bbi.2015.01.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/22/2014] [Accepted: 01/01/2015] [Indexed: 02/09/2023] Open
Abstract
Traumatic brain injury (TBI) is induced by mechanical forces which initiate a cascade of secondary injury processes, including inflammation. Therapies which resolve the inflammatory response may promote neural repair without exacerbating the primary injury. Specific derivatives of omega-3 fatty acids loosely grouped as specialized pro-resolving lipid mediators (SPMs) and termed resolvins promote the active resolution of inflammation. In the current study, we investigate the effect of two resolvin molecules, RvE1 and AT-RvD1, on post-traumatic sleep and functional outcome following diffuse TBI through modulation of the inflammatory response. Adult, male C57BL/6 mice were injured using a midline fluid percussion injury (mFPI) model (6-10min righting reflex time for brain-injured mice). Experimental groups included mFPI administered RvE1 (100ng daily), AT-RvD1 (100ng daily), or vehicle (sterile saline) and counterbalanced with uninjured sham mice. Resolvins or saline were administered daily for seven consecutive days beginning 3days prior to TBI to evaluate proof-of-principle to improve outcome. Immediately following diffuse TBI, post-traumatic sleep was recorded for 24h post-injury. For days 1-7 post-injury, motor outcome was assessed by rotarod. Cognitive function was measured at 6days post-injury using novel object recognition (NOR). At 7days post-injury, microglial activation was quantified using immunohistochemistry for Iba-1. In the diffuse brain-injured mouse, AT-RvD1 treatment, but not RvE1, mitigated motor and cognitive deficits. RvE1 treatment significantly increased post-traumatic sleep in brain-injured mice compared to all other groups. RvE1 treated mice displayed a higher proportion of ramified microglia and lower proportion of activated rod microglia in the cortex compared to saline or AT-RvD1 treated brain-injured mice. Thus, RvE1 treatment modulated post-traumatic sleep and the inflammatory response to TBI, albeit independently of improvement in motor and cognitive outcome as seen in AT-RvD1-treated mice. This suggests AT-RvD1 may impart functional benefit through mechanisms other than resolution of inflammation alone.
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Affiliation(s)
- Jordan L. Harrison
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ
,Interdisciplinary Graduate Program in Neuroscience, Arizona State University, Tempe, AZ
| | - Rachel K. Rowe
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ
,Phoenix Veteran Affairs Healthcare System, Phoenix, AZ
| | - Timothy W. Ellis
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ
,College of Osteopathic Medicine, Midwestern University, Glendale, AZ
| | - Nicole S. Yee
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ
| | - Bruce F. O’Hara
- Department of Biology, University of Kentucky College of Arts and Sciences, Lexington, KY
,Spinal Cord and Brain Injury Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - P. David Adelson
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ
,Interdisciplinary Graduate Program in Neuroscience, Arizona State University, Tempe, AZ
| | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Interdisciplinary Graduate Program in Neuroscience, Arizona State University, Tempe, AZ, USA; Phoenix Veteran Affairs Healthcare System, Phoenix, AZ, USA.
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Kawada T. Daytime total sleep time relates to the association between acute traumatic brain injury and cognitive function recovery: Comment on Chiu et al. (2014). Int J Nurs Stud 2015; 52:1653-4. [PMID: 26113200 DOI: 10.1016/j.ijnurstu.2015.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Japan.
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Tholfsen LK, Larsen JP, Schulz J, Tysnes OB, Gjerstad MD. Development of excessive daytime sleepiness in early Parkinson disease. Neurology 2015; 85:162-8. [PMID: 26085603 DOI: 10.1212/wnl.0000000000001737] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/18/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the frequency, development, and risk factors of excessive daytime sleepiness (EDS) in a cohort of originally drug-naive patients with incident Parkinson disease (PD) during the first 5 years after diagnosis. METHODS One hundred fifty-three drug-naive patients with early PD derived from a population-based incident cohort and 169 control participants were assessed for EDS and reevaluated after 1, 3, and 5 years on medication. EDS was diagnosed according to the Epworth Sleepiness Scale. Cutoff score above 10 was applied. Generalized estimating equation models for correlated data were used to examine associated and risk factors for EDS. RESULTS Patients reported EDS more often than control participants at the time of diagnosis and during follow-up. The frequency of EDS in PD increased from 11.8% at baseline to 23.4% after 5 years. Associated factors were male sex, the use of dopamine agonists, and higher Montgomery-Åsberg Depression Rating Scale and Unified Parkinson's Disease Rating Scale-activities of daily living scores. Main risk factor for developing EDS was an increased Epworth Sleepiness Scale score at baseline. CONCLUSION EDS is more frequent in PD even before treatment initiation compared with control participants and increases in occurrence with disease progression. The main risk factor for developing EDS with time is an early predisposition for sleepiness. In addition, the use of dopamine agonists was associated with the development of EDS. These findings necessitate caution in patients with PD and early increased sleep propensity and when using dopamine agonists.
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Affiliation(s)
- Lena K Tholfsen
- From The Norwegian Centre for Movement Disorders (L.K.T., J.P.L., J.S., M.D.G.), Stavanger; Department of Neurology (L.K.T., M.D.G.), Stavanger University Hospital; and Department of Neurology (O-B.T.), Haukeland University Hospital, Bergen, Norway
| | - Jan P Larsen
- From The Norwegian Centre for Movement Disorders (L.K.T., J.P.L., J.S., M.D.G.), Stavanger; Department of Neurology (L.K.T., M.D.G.), Stavanger University Hospital; and Department of Neurology (O-B.T.), Haukeland University Hospital, Bergen, Norway
| | - Jörn Schulz
- From The Norwegian Centre for Movement Disorders (L.K.T., J.P.L., J.S., M.D.G.), Stavanger; Department of Neurology (L.K.T., M.D.G.), Stavanger University Hospital; and Department of Neurology (O-B.T.), Haukeland University Hospital, Bergen, Norway
| | - Ole-Bjorn Tysnes
- From The Norwegian Centre for Movement Disorders (L.K.T., J.P.L., J.S., M.D.G.), Stavanger; Department of Neurology (L.K.T., M.D.G.), Stavanger University Hospital; and Department of Neurology (O-B.T.), Haukeland University Hospital, Bergen, Norway
| | - Michaela D Gjerstad
- From The Norwegian Centre for Movement Disorders (L.K.T., J.P.L., J.S., M.D.G.), Stavanger; Department of Neurology (L.K.T., M.D.G.), Stavanger University Hospital; and Department of Neurology (O-B.T.), Haukeland University Hospital, Bergen, Norway.
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Gilbert KS, Kark SM, Gehrman P, Bogdanova Y. Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clin Psychol Rev 2015; 40:195-212. [PMID: 26164549 DOI: 10.1016/j.cpr.2015.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 04/27/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.
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Affiliation(s)
- Karina Stavitsky Gilbert
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Sarah M Kark
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Yelena Bogdanova
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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Nixon JP, Mavanji V, Butterick TA, Billington CJ, Kotz CM, Teske JA. Sleep disorders, obesity, and aging: the role of orexin. Ageing Res Rev 2015; 20:63-73. [PMID: 25462194 DOI: 10.1016/j.arr.2014.11.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/19/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
The hypothalamic neuropeptides orexin A and B (hypocretin 1 and 2) are important homeostatic mediators of central control of energy metabolism and maintenance of sleep/wake states. Dysregulation or loss of orexin signaling has been linked to narcolepsy, obesity, and age-related disorders. In this review, we present an overview of our current understanding of orexin function, focusing on sleep disorders, energy balance, and aging, in both rodents and humans. We first discuss animal models used in studies of obesity and sleep, including loss of function using transgenic or viral-mediated approaches, gain of function models using exogenous delivery of orexin receptor agonist, and naturally-occurring models in which orexin responsiveness varies by individual. We next explore rodent models of orexin in aging, presenting evidence that orexin loss contributes to age-related changes in sleep and energy balance. In the next section, we focus on clinical importance of orexin in human obesity, sleep, and aging. We include discussion of orexin loss in narcolepsy and potential importance of orexin in insomnia, correlations between animal and human studies of age-related decline, and evidence for orexin involvement in age-related changes in cognitive performance. Finally, we present a summary of recent studies of orexin in neurodegenerative disease. We conclude that orexin acts as an integrative homeostatic signal influencing numerous brain regions, and that this pivotal role results in potential dysregulation of multiple physiological processes when orexin signaling is disrupted or lost.
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39
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A systematic review of fatigue in patients with traumatic brain injury: The course, predictors and consequences. Neurosci Biobehav Rev 2014; 47:684-716. [DOI: 10.1016/j.neubiorev.2014.10.024] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/18/2014] [Accepted: 10/28/2014] [Indexed: 11/22/2022]
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40
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Stocker RPJ, Cieply MA, Paul B, Khan H, Henry L, Kontos AP, Germain A. Combat-related blast exposure and traumatic brain injury influence brain glucose metabolism during REM sleep in military veterans. Neuroimage 2014; 99:207-14. [PMID: 24893322 PMCID: PMC4112017 DOI: 10.1016/j.neuroimage.2014.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/30/2014] [Accepted: 05/24/2014] [Indexed: 12/01/2022] Open
Abstract
Traumatic brain injury (TBI), a signature wound of Operations Enduring and Iraqi Freedom, can result from blunt head trauma or exposure to a blast/explosion. While TBI affects sleep, the neurobiological underpinnings between TBI and sleep are largely unknown. To examine the neurobiological underpinnings of this relationship in military veterans, [(18)F]-fluorodeoxyglucose positron emission tomography (FDG PET) was used to compare mTBI-related changes in relative cerebral metabolic rate of glucose (rCMRglc) during wakefulness, Rapid Eye Movement (REM) sleep, and non-REM (NREM) sleep, after adjusting for the effects of posttraumatic stress (PTS). Fourteen veterans with a history of blast exposure and/or mTBI (B/mTBI) (age 27.5±3.9) and eleven veterans with no history (No B/mTBI) (age 28.1±4.3) completed FDG PET studies during wakefulness, REM sleep, and NREM sleep. Whole-brain analyses were conducted using Statistical Parametric Mapping (SPM8). Between group comparisons revealed that B/mTBI was associated with significantly lower rCMRglc during wakefulness and REM sleep in the amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, uncus, culmen, visual association cortices, and midline medial frontal cortices. These results suggest that alterations in neurobiological networks during wakefulness and REM sleep subsequent to B/mTBI exposure may contribute to chronic sleep disturbances and differ in individuals with acute symptoms.
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Affiliation(s)
- Ryan P J Stocker
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Counseling Psychology, Chatham University, Pittsburgh, PA, USA
| | | | - Benjamin Paul
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hassen Khan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Luke Henry
- Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | | | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Sleep and wake disturbances following traumatic brain injury. ACTA ACUST UNITED AC 2014; 62:252-61. [DOI: 10.1016/j.patbio.2014.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/13/2014] [Indexed: 01/16/2023]
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Rowe RK, Harrison JL, O'Hara BF, Lifshitz J. Diffuse brain injury does not affect chronic sleep patterns in the mouse. Brain Inj 2014; 28:504-10. [PMID: 24702469 DOI: 10.3109/02699052.2014.888768] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To test if the current model of diffuse brain injury produces chronic sleep disturbances similar to those reported by TBI patients. METHODS AND PROCEDURES Adult male C57BL/6 mice were subjected to moderate midline fluid percussion injury (n = 7; 1.4 atm; 6-10 minutes righting reflex time) or sham injury (n = 5). Sleep-wake activity was measured post-injury using a non-invasive, piezoelectric cage system. Chronic sleep patterns were analysed weekly for increases or decreases in percentage sleep (hypersomnia or insomnia) and changes in bout length (fragmentation). MAIN OUTCOMES AND RESULTS During the first week after diffuse TBI, brain-injured mice exhibited increased mean percentage sleep and mean bout length compared to sham-injured mice. Further analysis indicated the increase in mean percentage sleep occurred during the dark cycle. Injury-induced changes in sleep, however, did not extend beyond the first week post-injury and were not present in weeks 2-5 post-injury. CONCLUSIONS Previously, it has been shown that the midline fluid percussion model used in this study immediately increased post-traumatic sleep. The current study extended the timeline of investigation to show that sleep disturbances extended into the first week post-injury, but did not develop into chronic sleep disturbances. However, the clinical prevalence of TBI-related sleep-wake disturbances warrants further experimental investigation.
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Affiliation(s)
- Rachel K Rowe
- BARROW Neurological Institute at Phoenix Children's Hospital , Phoenix, AZ , USA
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Rowe RK, Striz M, Bachstetter AD, Van Eldik LJ, Donohue KD, O'Hara BF, Lifshitz J. Diffuse brain injury induces acute post-traumatic sleep. PLoS One 2014; 9:e82507. [PMID: 24416145 PMCID: PMC3885381 DOI: 10.1371/journal.pone.0082507] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Clinical observations report excessive sleepiness immediately following traumatic brain injury (TBI); however, there is a lack of experimental evidence to support or refute the benefit of sleep following a brain injury. The aim of this study is to investigate acute post-traumatic sleep. METHODS Sham, mild or moderate diffuse TBI was induced by midline fluid percussion injury (mFPI) in male C57BL/6J mice at 9:00 or 21:00 to evaluate injury-induced sleep behavior at sleep and wake onset, respectively. Sleep profiles were measured post-injury using a non-invasive, piezoelectric cage system. In separate cohorts of mice, inflammatory cytokines in the neocortex were quantified by immunoassay, and microglial activation was visualized by immunohistochemistry. RESULTS Immediately after diffuse TBI, quantitative measures of sleep were characterized by a significant increase in sleep (>50%) for the first 6 hours post-injury, resulting from increases in sleep bout length, compared to sham. Acute post-traumatic sleep increased significantly independent of injury severity and time of injury (9:00 vs 21:00). The pro-inflammatory cytokine IL-1β increased in brain-injured mice compared to sham over the first 9 hours post-injury. Iba-1 positive microglia were evident in brain-injured cortex at 6 hours post-injury. CONCLUSION Post-traumatic sleep occurs for up to 6 hours after diffuse brain injury in the mouse regardless of injury severity or time of day. The temporal profile of secondary injury cascades may be driving the significant increase in post-traumatic sleep and contribute to the natural course of recovery through cellular repair.
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Affiliation(s)
- Rachel K. Rowe
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, United States of America
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States of America
- Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Martin Striz
- Department of Biology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, United States of America
| | - Adam D. Bachstetter
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Linda J. Van Eldik
- Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Kevin D. Donohue
- Department of Electrical and Computer Engineering, College of Engineering, University of Kentucky, Lexington, Kentucky, United States of America
| | - Bruce F. O'Hara
- Department of Biology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, United States of America
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, United States of America
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States of America
- Phoenix Veteran Affairs Healthcare System, Phoenix, Arizona, United States of America
- Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Physical Medicine & Rehabilitation, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
- * E-mail:
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Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, Colantonio A. Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain Inj 2013; 27:1364-76. [PMID: 24070180 PMCID: PMC3809926 DOI: 10.3109/02699052.2013.823663] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/28/2013] [Accepted: 07/07/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To longitudinally examine objective and self-reported outcomes for recovery of cognition, communication, mood and participation in adults with traumatic brain injury (TBI) and co-morbid post-traumatic sleep/wake disorders. DESIGN Prospective, longitudinal, single blind outcome study. SETTING Community-based. PARTICIPANTS Ten adults with moderate-severe TBI and two adults with mild TBI and persistent symptoms aged 18-58 years. Six males and six females, who were 1-22 years post-injury and presented with self-reported sleep/wake disturbances with onset post-injury. INTERVENTIONS Individualized treatments for sleep/wake disorders that included sleep hygiene recommendations, pharmacological interventions and/or treatments for sleep apnea with follow-up. MAIN OUTCOME MEASURES Insomnia Severity Index, Beck Depression and Anxiety Inventories, Latrobe Communication Questionnaire, Speed and Capacity of Language Processing, Test of Everyday Attention, Repeatable Battery for the Assessment of Neuropsychological Status, Daily Cognitive-Communication and Sleep Profile. RESULTS Group analysis revealed positive trends in change for each measure and across sub-tests of all measures. Statistically significant changes were noted in insomnia severity, p = 0.0003; depression severity, p = 0.03; language, p = 0.01; speed of language processing, p = 0.007. CONCLUSIONS These results add to a small but growing body of evidence that sleep/wake disorders associated with TBI exacerbate trauma-related cognitive, communication and mood impairments. Treatment for sleep/wake disorders may optimize recovery and outcomes.
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Affiliation(s)
- Catherine Wiseman-Hakes
- Department of Rehabilitation Science, University of TorontoToronto, ONCanada
- Toronto Rehabilitation InstituteToronto, ONCanada
| | - Brian Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of TorontoToronto, ONCanada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| | - Elizabeth Rochon
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Speech Language Pathology, University of TorontoToronto, ONCanada
| | - Nora Cullen
- Toronto Rehabilitation InstituteToronto, ONCanada
- West Park Health Care CentreToronto, ONCanada
| | | | - Angela Colantonio
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Occupational Therapy and Occupational Science, University of TorontoToronto, ONCanada
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Traumatic brain injury-induced dysregulation of the circadian clock. PLoS One 2012; 7:e46204. [PMID: 23056261 PMCID: PMC3463592 DOI: 10.1371/journal.pone.0046204] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/28/2012] [Indexed: 01/08/2023] Open
Abstract
Circadian rhythm disturbances are frequently reported in patients recovering from traumatic brain injury (TBI). Since circadian clock output is mediated by some of the same molecular signaling cascades that regulate memory formation (cAMP/MAPK/CREB), cognitive problems reported by TBI survivors may be related to injury-induced dysregulation of the circadian clock. In laboratory animals, aberrant circadian rhythms in the hippocampus have been linked to cognitive and memory dysfunction. Here, we addressed the hypothesis that circadian rhythm disruption after TBI is mediated by changes in expression of clock genes in the suprachiasmatic nuclei (SCN) and hippocampus. After fluid-percussion TBI or sham surgery, male Sprague-Dawley rats were euthanized at 4 h intervals, over a 48 h period for tissue collection. Expression of circadian clock genes was measured using quantitative real-time PCR in the SCN and hippocampus obtained by laser capture and manual microdissection respectively. Immunofluorescence and Western blot analysis were used to correlate TBI-induced changes in circadian gene expression with changes in protein expression. In separate groups of rats, locomotor activity was monitored for 48 h. TBI altered circadian gene expression patterns in both the SCN and the hippocampus. Dysregulated expression of key circadian clock genes, such as Bmal1 and Cry1, was detected, suggesting perturbation of transcriptional-translational feedback loops that are central to circadian timing. In fact, disruption of circadian locomotor activity rhythms in injured animals occurred concurrently. These results provide an explanation for how TBI causes disruption of circadian rhythms as well as a rationale for the consideration of drugs with chronobiotic properties as part of a treatment strategy for TBI.
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