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Mayer AR, Dodd AB, Robertson-Benta CR, Zotev V, Ryman SG, Meier TB, Campbell RA, Phillips JP, van der Horn HJ, Hogeveen J, Tarawneh R, Sapien RE. Multifaceted neural and vascular pathologies after pediatric mild traumatic brain injury. J Cereb Blood Flow Metab 2024; 44:118-130. [PMID: 37724718 PMCID: PMC10905640 DOI: 10.1177/0271678x231197188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/01/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2023]
Abstract
Dynamic changes in neurodevelopment and cognitive functioning occur during adolescence, including a switch from reactive to more proactive forms of cognitive control, including response inhibition. Pediatric mild traumatic brain injury (pmTBI) affects these cognitions immediately post-injury, but the role of vascular versus neural injury in cognitive dysfunction remains debated. This study consecutively recruited 214 sub-acute pmTBI (8-18 years) and age/sex-matched healthy controls (HC; N = 186), with high retention rates (>80%) at four months post-injury. Multimodal imaging (functional MRI during response inhibition, cerebral blood flow and cerebrovascular reactivity) assessed for pathologies within the neurovascular unit. Patients exhibited increased errors of commission and hypoactivation of motor circuitry during processing of probes. Evidence of increased/delayed cerebrovascular reactivity within motor circuitry during hypercapnia was present along with normal perfusion. Neither age-at-injury nor post-concussive symptom load were strongly associated with imaging abnormalities. Collectively, mild cognitive impairments and clinical symptoms may continue up to four months post-injury. Prolonged dysfunction within the neurovascular unit was observed during proactive response inhibition, with preliminary evidence that neural and pure vascular trauma are statistically independent. These findings suggest pmTBI is characterized by multifaceted pathologies during the sub-acute injury stage that persist several months post-injury.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | | | - Vadim Zotev
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard A Campbell
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/LBERI, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | | | - Jeremy Hogeveen
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Rawan Tarawneh
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
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2
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van der Horn HJ, Dodd AB, Wick TV, Robertson‐Benta CR, McQuaid JR, Hittson AK, Ling JM, Zotev V, Ryman SG, Erhardt EB, Phillips JP, Campbell RA, Sapien RE, Mayer AR. Neural correlates of cognitive control deficits in pediatric mild traumatic brain injury. Hum Brain Mapp 2023; 44:6173-6184. [PMID: 37800467 PMCID: PMC10619369 DOI: 10.1002/hbm.26504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
There is a growing body of research showing that cerebral pathophysiological processes triggered by pediatric mild traumatic brain injury (pmTBI) may extend beyond the usual clinical recovery timeline. It is paramount to further unravel these processes, because the possible long-term cognitive effects resulting from ongoing secondary injury in the developing brain are not known. In the current fMRI study, neural processes related to cognitive control were studied in 181 patients with pmTBI at sub-acute (SA; ~1 week) and early chronic (EC; ~4 months) stages post-injury. Additionally, a group of 162 age- and sex-matched healthy controls (HC) were recruited at equivalent time points. Proactive (post-cue) and reactive (post-probe) cognitive control were examined using a multimodal attention fMRI paradigm for either congruent or incongruent stimuli. To study brain network function, the triple-network model was used, consisting of the executive and salience networks (collectively known as the cognitive control network), and the default mode network. Additionally, whole-brain voxel-wise analyses were performed. Decreased deactivation was found within the default mode network at the EC stage following pmTBI during both proactive and reactive control. Voxel-wise analyses revealed sub-acute hypoactivation of a frontal area of the cognitive control network (left pre-supplementary motor area) during proactive control, with a reversed effect at the EC stage after pmTBI. Similar effects were observed in areas outside of the triple-network during reactive control. Group differences in activation during proactive control were limited to the visual domain, whereas for reactive control findings were more pronounced during the attendance of auditory stimuli. No significant correlations were present between task-related activations and (persistent) post-concussive symptoms. In aggregate, current results show alterations in neural functioning during cognitive control in pmTBI up to 4 months post-injury, regardless of clinical recovery. We propose that subacute decreases in activity reflect a general state of hypo-excitability due to the injury, while early chronic hyperactivation represents a compensatory mechanism to prevent default mode interference and to retain cognitive control.
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Affiliation(s)
| | | | | | | | | | | | - Josef M. Ling
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
| | - Vadim Zotev
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
| | | | - Erik B. Erhardt
- Department of Mathematics and StatisticsUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | | | - Richard A. Campbell
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Robert E. Sapien
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Andrew R. Mayer
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
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3
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Brown JC, Goldszer IM, Brooks MC, Milano NJ. An Evaluation of the Emerging Techniques in Sports-Related Concussion. J Clin Neurophysiol 2023; 40:384-390. [PMID: 36930205 PMCID: PMC10329722 DOI: 10.1097/wnp.0000000000000879] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sports-related concussion is now in public awareness more than ever before. Investigations into underlying pathophysiology and methods of assessment have correspondingly increased at an exponential rate. In this review, we aim to highlight some of the evidence supporting emerging techniques in the fields of neurophysiology, neuroimaging, vestibular, oculomotor, autonomics, head sensor, and accelerometer technology in the setting of the current standard: clinical diagnosis and management. In summary, the evidence we reviewed suggests that (1) head impact sensors and accelerometers may detect possible concussions that would not otherwise receive evaluation; (2) clinical diagnosis may be aided by sideline vestibular, oculomotor, and portable EEG techniques; (3) clinical decisions on return-to-play eligibility are currently not sensitive at capturing the neurometabolic, cerebrovascular, neurophysiologic, and microstructural changes that biomarkers have consistently detected days and weeks after clinical clearance. Such biomarkers include heart rate variability, quantitative electroencephalography, as well as functional, metabolic, and microstructural neuroimaging. The current challenge is overcoming the lack of consistency and replicability of any one particular technique to reach consensus.
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Affiliation(s)
- Joshua C. Brown
- Dept. of Neurology, Medical University of South Carolina
- Dept. of Psychiatry and Behavioral Sciences, Medical University of South Carolina
- Department of Psychiatry and Human Behavior, Department of Neurology, Alpert Medical School of Brown University
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4
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Podolak OE, Arbogast KB, Master CL, Sleet D, Grady MF. Pediatric Sports-Related Concussion: An Approach to Care. Am J Lifestyle Med 2022; 16:469-484. [PMID: 35860366 PMCID: PMC9290185 DOI: 10.1177/1559827620984995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 08/14/2023] Open
Abstract
Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the vast amount of youth sports participation, an increase in awareness of concussion and evidence that the injury can lead to consequences for school, sports and overall quality of life, it has become increasingly important to properly diagnose and manage concussion. SRC in the student athlete is a unique and complex injury, and it is important to highlight the differences in the management of child and adolescent concussion compared with adults. This review focuses on the importance of developing a multimodal systematic approach to diagnosing and managing pediatric sports-related concussion, from the sidelines through recovery.
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Affiliation(s)
- Olivia E. Podolak
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David Sleet
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew F. Grady
- Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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5
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Schmidt J, Brown KE, Feldman SJ, Babul S, Zwicker JG, Boyd LA. Evidence of altered interhemispheric communication after pediatric concussion. Brain Inj 2021; 35:1143-1161. [PMID: 34384288 DOI: 10.1080/02699052.2021.1929485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES: To investigate neurophysiological alterations within the typical symptomatic period after concussion (1-month) and throughout recovery (6-months) in adolescents; and (2) to examine relationships between neurophysiological and upper limb kinematic outcomes.METHODS: 18 adolescents with concussion were compared to 17 healthy controls. Transcranial magnetic stimulation (TMS) was used to assess neurophysiological differences between groups including: short- and long-interval intracortical inhibition, intracortical facilitation, short- and long-latency afferent inhibition, afferent facilitation, and transcallosal inhibition (TCI). Behavioral measures of upper limb kinematics were assessed with a robotic device.RESULTS: Mixed model analysis of neurophysiological data identified two key findings. First, participants with concussion demonstrated delayed onset of interhemispheric inhibition, as indexed by TCI, compared to healthy controls. Second, our exploratory analysis indicated that the magnitude of TCI onset delay in adolescents with concussion was related to upper limb kinematics.CONCLUSIONS: Our findings indicate that concussion in adolescence alters interhemispheric communication. We note relationships between neurophysiological and kinematic data, suggesting an affinity for individuals with less concussion-related physiological change to improve their motor behavior over time. These data serve as an important step in future development of assessments (neurobiological and clinical) and interventions for concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katlyn E Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK.,Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha J Feldman
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelina Babul
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill G Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre at BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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6
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McGeown JP, Hume PA, Kara S, King D, Theadom A. Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI. SPORTS MEDICINE - OPEN 2021; 7:56. [PMID: 34370132 PMCID: PMC8353035 DOI: 10.1186/s40798-021-00340-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the clinical utility of tactile somatosensory assessments to assist clinicians in diagnosing sport-related mild traumatic brain injury (SR-mTBI), classifying recovery trajectory based on performance at initial clinical assessment, and determining if neurophysiological recovery coincided with clinical recovery. RESEARCH DESIGN Prospective cohort study with normative controls. METHODS At admission (n = 79) and discharge (n = 45/79), SR-mTBI patients completed the SCAT-5 symptom scale, along with the following three components from the Cortical Metrics Brain Gauge somatosensory assessment (BG-SA): temporal order judgement (TOJ), TOJ with confounding condition (TOJc), and duration discrimination (DUR). To assist SR-mTBI diagnosis on admission, BG-SA performance was used in logistic regression to discriminate cases belonging to the SR-mTBI sample or a healthy reference sample (pooled BG-SA data for healthy participants in previous studies). Decision trees evaluated how accurately BG-SA performance classified SR-mTBI recovery trajectories. RESULTS BG-SA TOJ, TOJc, and DUR poorly discriminated between cases belonging to the SR-mTBI sample or a healthy reference sample (0.54-0.70 AUC, 47.46-64.71 PPV, 48.48-61.11 NPV). The BG-SA evaluated did not accurately classify SR-mTBI recovery trajectories (> 14-day resolution 48%, ≤14-day resolution 54%, lost to referral/follow-up 45%). Mann-Whitney U tests revealed differences in BG-SA TOJc performance between SR-mTBI participants and the healthy reference sample at initial clinical assessment and at clinical recovery (p < 0.05). CONCLUSIONS BG-SA TOJ, TOJc, and DUR appear to have limited clinical utility to assist clinicians with diagnosing SR-mTBI or predicting recovery trajectories under ecologically valid conditions. Neurophysiological abnormalities persisted beyond clinical recovery given abnormal BG-SA TOJc performance observed when SR-mTBI patients achieved clinical recovery.
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Affiliation(s)
- Joshua P McGeown
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand
| | - Stephen Kara
- Axis Sports Medicine Clinic, Auckland, New Zealand
| | - Doug King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Alice Theadom
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand
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7
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Traumatic brain injury biomarkers in pediatric patients: a systematic review. Neurosurg Rev 2021; 45:167-197. [PMID: 34170424 DOI: 10.1007/s10143-021-01588-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Traumatic brain injury (TBI) is the main cause of pediatric trauma death and disability worldwide. Recent studies have sought to identify biomarkers of TBI for the purpose of assessing functional outcomes. The aim of this systematic review was to evaluate the utility of TBI biomarkers in the pediatric population by summarizing recent findings in the medical literature. A total of 303 articles were retrieved from our search. An initial screening to remove duplicate studies yielded 162 articles. After excluding all articles that did not meet the inclusion criteria, 56 studies were gathered. Among the 56 studies, 36 analyzed serum biomarkers; 11, neuroimaging biomarkers; and 9, cerebrospinal fluid (CSF) biomarkers. Most studies assessed biomarkers in the serum, reflecting the feasibility of obtaining blood samples compared to obtaining CSF or performing neuroimaging. S100B was the most studied serum biomarker in TBI, followed by SNE and UCH-L1, whereas in CSF analysis, there was no unanimity. Among the different neuroimaging techniques employed, diffusion tensor imaging (DTI) was the most common, seemingly holding diagnostic power in the pediatric TBI clinical setting. The number of cross-sectional studies was similar to the number of longitudinal studies. Our data suggest that S100B measurement has high sensitivity and great promise in diagnosing pediatric TBI, ideally when associated with head CT examination and clinical decision protocols. Further large-scale longitudinal studies addressing TBI biomarkers in children are required to establish more accurate diagnostic protocols and prognostic tools.
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8
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Safar K, Zhang J, Emami Z, Gharehgazlou A, Ibrahim G, Dunkley BT. Mild traumatic brain injury is associated with dysregulated neural network functioning in children and adolescents. Brain Commun 2021; 3:fcab044. [PMID: 34095832 PMCID: PMC8176148 DOI: 10.1093/braincomms/fcab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Mild traumatic brain injury is highly prevalent in paediatric populations, and can result in chronic physical, cognitive and emotional impairment, known as persistent post-concussive symptoms. Magnetoencephalography has been used to investigate neurophysiological dysregulation in mild traumatic brain injury in adults; however, whether neural dysrhythmia persists in chronic mild traumatic brain injury in children and adolescents is largely unknown. We predicted that children and adolescents would show similar dysfunction as adults, including pathological slow-wave oscillations and maladaptive, frequency-specific, alterations to neural connectivity. Using magnetoencephalography, we investigated regional oscillatory power and distributed brain-wide networks in a cross-sectional sample of children and adolescents in the chronic stages of mild traumatic brain injury. Additionally, we used a machine learning pipeline to identify the most relevant magnetoencephalography features for classifying mild traumatic brain injury and to test the relative classification performance of regional power versus functional coupling. Results revealed that the majority of participants with chronic mild traumatic brain injury reported persistent post-concussive symptoms. For neurophysiological imaging, we found increased regional power in the delta band in chronic mild traumatic brain injury, predominantly in bilateral occipital cortices and in the right inferior temporal gyrus. Those with chronic mild traumatic brain injury also showed dysregulated neuronal coupling, including decreased connectivity in the delta range, as well as hyper-connectivity in the theta, low gamma and high gamma bands, primarily involving frontal, temporal and occipital brain areas. Furthermore, our multivariate classification approach combined with functional connectivity data outperformed regional power in terms of between-group classification accuracy. For the first time, we establish that local and large-scale neural activity are altered in youth in the chronic phase of mild traumatic brain injury, with the majority presenting persistent post-concussive symptoms, and that dysregulated interregional neural communication is a reliable marker of lingering paediatric ‘mild’ traumatic brain injury.
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Affiliation(s)
- Kristina Safar
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Jing Zhang
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Zahra Emami
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Avideh Gharehgazlou
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - George Ibrahim
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9 Canada
| | - Benjamin T Dunkley
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada M5T 1W7
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9
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Fatih P, Kucuker MU, Vande Voort JL, Doruk Camsari D, Farzan F, Croarkin PE. A Systematic Review of Long-Interval Intracortical Inhibition as a Biomarker in Neuropsychiatric Disorders. Front Psychiatry 2021; 12:678088. [PMID: 34149483 PMCID: PMC8206493 DOI: 10.3389/fpsyt.2021.678088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022] Open
Abstract
Long-interval intracortical inhibition (LICI) is a paired-pulse transcranial magnetic stimulation (TMS) paradigm mediated in part by gamma-aminobutyric acid receptor B (GABAB) inhibition. Prior work has examined LICI as a putative biomarker in an array of neuropsychiatric disorders. This review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sought to examine existing literature focused on LICI as a biomarker in neuropsychiatric disorders. There were 113 articles that met the inclusion criteria. Existing literature suggests that LICI may have utility as a biomarker of GABAB functioning but more research with increased methodologic rigor is needed. The extant LICI literature has heterogenous methodology and inconsistencies in findings. Existing findings to date are also non-specific to disease. Future research should carefully consider existing methodological weaknesses and implement high-quality test-retest reliability studies.
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Affiliation(s)
- Parmis Fatih
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - M Utku Kucuker
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L Vande Voort
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Deniz Doruk Camsari
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, BC, Canada
| | - Paul E Croarkin
- Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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10
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Altered motor system function in post-concussion syndrome as assessed via transcranial magnetic stimulation. Clin Neurophysiol Pract 2020; 5:157-164. [PMID: 32939420 PMCID: PMC7479250 DOI: 10.1016/j.cnp.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022] Open
Abstract
Study examining corticospinal and cortical activity in post-concussion. Reduction in GABAB-mediated inhibition observed. These changes were associated with depression-related symptoms.
Objective It is unclear why specific individuals incur chronic symptoms following a concussion. This exploratory research aims to identify and characterize any neurophysiological differences that may exist in motor cortex function in post-concussion syndrome (PCS). Methods Fifteen adults with PCS and 13 healthy, non-injured adults were tested. All participants completed symptom questionnaires, and transcranial magnetic stimulation (TMS) was used to measure intracortical and transcallosal excitability and inhibition in the dominant motor cortex. Results Cortical silent period (p = 0.02, g = 0.96) and ipsilateral silent period (p = 0.04, g = 0.78) were shorter in the PCS group compared to the control group which may reflect reduced GABA-mediated inhibition in PCS. Furthermore, increased corticomotor excitability was observed in the left hemisphere but not the right hemisphere. Conclusions These data suggest that persistent neurophysiological differences are present in those with PCS. The exact contributing factors to such changes remain to be investigated by future studies. Significance This study provides novel evidence of lasting neurophysiological changes in PCS.
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11
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Stokes W, Runnalls K, Choynowki J, St Pierre M, Anaya M, Statton MA, Celnik PA, Cantarero G. Altered corticomotor latencies but normal motor neuroplasticity in concussed athletes. J Neurophysiol 2020; 123:1600-1605. [PMID: 32073936 DOI: 10.1152/jn.00774.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Persistent cognitive, affective, and motor symptoms have been associated with sports-related concussions including several neurophysiological changes in the primary motor cortex. In particular, previous research has provided some evidence of altered latencies of the corticomotor pathway and altered motor neuroplasticity. However, to date, no studies have assessed these neurophysiological metrics in a common group of athletes across different phases of injury and recovery. In this study corticomotor latencies and neuroplasticity were assessed in collegiate athletes with or without a history of prior concussion across two different phases of injury: either in an acute state of concussion (within 2 wk of injury) or in a chronic state of concussion (more than 1 yr after injury). Corticomotor latencies were determined by measuring the motor evoked potential (MEP) onset time, and motor neuroplasticity was assessed by measuring MEP amplitudes following application of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1). We found that concussed athletes had slower corticomotor latencies than nonconcussed athletes, and corticomotor latency was also positively correlated with the number of prior concussions. In contrast, there was no evidence of altered motor neuroplasticity in athletes regardless of concussion history. These findings suggest concussions may lead to permanent changes in the corticospinal tract that are exacerbated by repeated injury.NEW & NOTEWORTHY We are the first to assess corticomotor latencies and motor neuroplasticity in a common group of collegiate athletes across different phases of injury and recovery. We found that the number of concussions an individual sustains negatively impacts corticomotor latencies with a higher number of prior concussions correlating positively with longer latencies. Our findings indicate that concussions may lead to permanent changes in the corticospinal tract that are exacerbated by repeated injury.
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Affiliation(s)
| | | | - Jake Choynowki
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Maria St Pierre
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Manuel Anaya
- Johns Hopkins Medical Institute, Baltimore, Maryland
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12
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Mayer AR, Stephenson DD, Wertz CJ, Dodd AB, Shaff NA, Ling JM, Park G, Oglesbee SJ, Wasserott BC, Meier TB, Witkiewitz K, Campbell RA, Yeo RA, Phillips JP, Quinn DK, Pottenger A. Proactive inhibition deficits with normal perfusion after pediatric mild traumatic brain injury. Hum Brain Mapp 2019; 40:5370-5381. [PMID: 31456319 PMCID: PMC6864901 DOI: 10.1002/hbm.24778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022] Open
Abstract
Although much attention has been generated in popular media regarding the deleterious effects of pediatric mild traumatic brain injury (pmTBI), a paucity of empirical evidence exists regarding the natural course of biological recovery. Fifty pmTBI patients (12-18 years old) were consecutively recruited from Emergency Departments and seen approximately 1 week and 4 months post-injury in this prospective cohort study. Data from 53 sex- and age-matched healthy controls (HC) were also collected. Functional magnetic resonance imaging was obtained during proactive response inhibition and at rest, in conjunction with independent measures of resting cerebral blood flow. High temporal resolution imaging enabled separate modeling of neural responses for preparation and execution of proactive response inhibition. A priori predictions of failed inhibitory responses (i.e., hyperactivation) were observed in motor circuitry (pmTBI>HC) and sensory areas sub-acutely and at 4 months post-injury. Paradoxically, pmTBI demonstrated hypoactivation (HC>pmTBI) during target processing, along with decreased activation within prefrontal cognitive control areas. Functional connectivity within motor circuitry at rest suggested that deficits were limited to engagement during the inhibitory task, whereas normal resting cerebral perfusion ruled out deficits in basal perfusion. In conclusion, current results suggest blood oxygen-level dependent deficits during inhibitory control may exceed commonly held beliefs about physiological recovery following pmTBI, potentially lasting up to 4 months post-injury.
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/LBERIAlbuquerqueNew Mexico
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew Mexico
- Department of NeurologyUniversity of New MexicoAlbuquerqueNew Mexico
- Department of PsychiatryUniversity of New MexicoAlbuquerqueNew Mexico
| | | | | | | | | | - Josef M. Ling
- The Mind Research Network/LBERIAlbuquerqueNew Mexico
| | - Grace Park
- Emergency MedicineUniversity of New MexicoAlbuquerqueNew Mexico
| | | | | | - Timothy B. Meier
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsin
- Department of Cell BiologyNeurobiology and Anatomy, Medical College of WisconsinMilwaukeeWisconsin
| | - Katie Witkiewitz
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew Mexico
| | | | - Ronald A. Yeo
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew Mexico
| | - John P. Phillips
- The Mind Research Network/LBERIAlbuquerqueNew Mexico
- Department of NeurologyUniversity of New MexicoAlbuquerqueNew Mexico
| | - Davin K. Quinn
- Department of PsychiatryUniversity of New MexicoAlbuquerqueNew Mexico
| | - Amy Pottenger
- Emergency MedicineUniversity of New MexicoAlbuquerqueNew Mexico
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13
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Franz CK, Joshi D, Daley EL, Grant RA, Dalamagkas K, Leung A, Finan JD, Kiskinis E. Impact of traumatic brain injury on amyotrophic lateral sclerosis: from bedside to bench. J Neurophysiol 2019; 122:1174-1185. [PMID: 31116639 DOI: 10.1152/jn.00572.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the loss of upper and lower motor neurons, which manifests clinically as progressive weakness. Although several epidemiological studies have found an association between traumatic brain injury (TBI) and ALS, there is not a consensus on whether TBI is an ALS risk factor. It may be that it can cause ALS in a subset of susceptible patients, based on a history of repetitive mild TBI and genetic predisposition. This cannot be determined based on clinical observational studies alone. Better preclinical models are necessary to evaluate the effects of TBI on ALS onset and progression. To date, only a small number of preclinical studies have been performed, mainly in the superoxide dismutase 1 transgenic rodents, which, taken together, have mixed results and notable methodological limitations. The more recent incorporation of additional animal models such as Drosophila flies, as well as patient-induced pluripotent stem cell-derived neurons, should facilitate a better understanding of a potential functional interaction between TBI and ALS.
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Affiliation(s)
- Colin K Franz
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Divya Joshi
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Elizabeth L Daley
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rogan A Grant
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kyriakos Dalamagkas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, TIRR Memorial Hermann, Houston, Texas
| | - Audrey Leung
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John D Finan
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Evangelos Kiskinis
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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King R, Kirton A, Zewdie E, Seeger TA, Ciechanski P, Barlow KM. Longitudinal Assessment of Cortical Excitability in Children and Adolescents With Mild Traumatic Brain Injury and Persistent Post-concussive Symptoms. Front Neurol 2019; 10:451. [PMID: 31156530 PMCID: PMC6533942 DOI: 10.3389/fneur.2019.00451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/12/2019] [Indexed: 01/18/2023] Open
Abstract
Introduction: Symptoms following a mild traumatic brain injury (mTBI) usually resolve quickly but may persist past 3 months in up to 15% of children. Mechanisms of mTBI recovery are poorly understood, but may involve alterations in cortical neurophysiology. Transcranial Magnetic Stimulation (TMS) can non-invasively investigate such mechanisms, but the time course of neurophysiological changes in mTBI are unknown. Objective/Hypothesis: To determine the relationship between persistent post-concussive symptoms (PPCS) and altered motor cortex neurophysiology over time. Methods: This was a prospective, longitudinal, controlled cohort study comparing children (8-18 years) with mTBI (symptomatic vs. asymptomatic) groups to controls. Cortical excitability was measured using TMS paradigms at 1 and 2 months post injury. The primary outcome was the cortical silent period (cSP). Secondary outcomes included short interval intracortical inhibition (SICI) and facilitation (SICF), and long-interval cortical inhibition (LICI). Generalized linear mixed model analyses were used to evaluate the effect of group and time on neurophysiological parameters. Results: One hundred seven participants (median age 15.1, 57% female) including 78 (73%) with symptomatic PPCS and 29 with asymptomatic mTBI, were compared to 26 controls. Cortical inhibition (cSP and SICI) was reduced in the symptomatic group compared to asymptomatic group and tended to increase over time. Measures of cortical facilitation (SICF and ICF) were increased in the asymptomatic group and decreased over time. TMS was well tolerated with no serious adverse events. Conclusions: TMS-assessed cortical excitability is altered in children following mild TBI and is dependent on recovery trajectory. Our findings support delayed return to contact sports in children even where clinical symptoms have resolved.
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Affiliation(s)
- Regan King
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
- Departments of Pediatrics, Clinical Neurosciences and Community Health Sciences, Calgary, AB, Canada
| | - Ephrem Zewdie
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Trevor A Seeger
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Patrick Ciechanski
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Karen M Barlow
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
- Departments of Pediatrics, Clinical Neurosciences and Community Health Sciences, Calgary, AB, Canada
- Department of Pediatrics, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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King R, Grohs MN, Kirton A, Lebel C, Esser MJ, Barlow KM. Microstructural neuroimaging of white matter tracts in persistent post-concussion syndrome: A prospective controlled cohort study. Neuroimage Clin 2019; 23:101842. [PMID: 31108457 PMCID: PMC6526293 DOI: 10.1016/j.nicl.2019.101842] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/08/2019] [Accepted: 04/27/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Children with mild traumatic brain injury (mTBI) typically recover quickly, however approximately 15% experience persistent post-concussive symptoms (PPCS) past 3 months. The microstructural pathology associated with underlying persistent symptoms is poorly understood but is suggested to involve axonal injury to white matter tracts. Diffusion tensor imaging (DTI) can be used to visualize and characterize damage to white matter microstructure of the brain. OBJECTIVE We aimed to investigate white matter microstructure in children with persistent concussive symptoms as compared to typically developing controls, alongside evaluating differences in white matter changes over time and how this relates to symptom recovery. METHODS The current study is a prospective, longitudinal, controlled cohort study of children with mTBI. 104 children aged 8 to 18 years with a mTBI (72 symptomatic; 32 asymptomatic) were recruited from the Alberta Children's Hospital and compared to 20 healthy controls. Microstructural evidence of white matter injury was evaluated using DTI one month post injury and repeated 4 to 6 weeks later. Primary outcomes included fractional anisotropy and mean diffusivity of the corticospinal tracts, uncinate fasciculi, and motor fibers of the corpus callosum. Post-concussive symptoms were also measured using the Post-Concussion Symptom Inventory (PCSI) taken at both time points. RESULTS Fractional anisotropy of the left uncinate fasciculi was lower in symptomatic children compared to controls (F(2,119) = 3.582, p = 0.031). No other significant differences were observed. CONCLUSIONS Our findings provide evidence of microstructural injury following mTBI in children with ongoing post-concussive symptoms one month post injury. The changes were persistent 4-6 weeks later. Further longitudinal studies of white matter microstructure in PPCS will be helpful to clarify whether these white matter alterations resolve over time.
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Affiliation(s)
- Regan King
- Hotchkiss Brain Institute, Canada; Alberta Children's Hospital Research Institute, Canada; Department of Clinical Neurosciences, Canada
| | - Melody N Grohs
- Alberta Children's Hospital Research Institute, Canada; Department of Clinical Neurosciences, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, Canada; Alberta Children's Hospital Research Institute, Canada; Department of Clinical Neurosciences, Canada; Department of Pediatrics, Canada; Cummings School of Medicine, University of Calgary, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, Canada; Department of Clinical Neurosciences, Canada; Department of Pediatrics, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, Canada; Department of Pediatrics, Canada; Cummings School of Medicine, University of Calgary, Canada
| | - Karen M Barlow
- Hotchkiss Brain Institute, Canada; Alberta Children's Hospital Research Institute, Canada; Department of Clinical Neurosciences, Canada; Department of Pediatrics, Canada; Cummings School of Medicine, University of Calgary, Canada.
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16
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Papathanasiou ES, Cronin T, Seemungal B, Sandhu J. Electrophysiological testing in concussion: A guide to clinical applications. JOURNAL OF CONCUSSION 2018. [DOI: 10.1177/2059700218812634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The diagnosis of mild traumatic brain injury in concussion is difficult since it is often unwitnessed, the patient’s recall is unreliable and initial clinical examination is often unrevealing, correlating poorly with the extent of brain injury. At present, there are no objective biomarkers of mild traumatic brain injury in concussion. Thus, a sensitive gold standard test is required to enable the effective and safe triage of patients who present to the acute services. As well as triage, objective monitoring of patients’ recovery over time and separate from clinical features that patients may develop following the injury (e.g. depression and migraine) is also needed. In contrast to neuroimaging, which is widely used to investigate traumatic brain injury patients, electrophysiology is readily available, is cheap and there are internationally recognized standardised methodologies. Herein, we review the existing literature on electrophysiological testing in concussion and mild traumatic brain injury; specifically, electroencephalogram, polysomnography, brainstem auditory evoked potentials, electro- and videonystagmography, vestibular evoked myogenic potentials, visually evoked potentials, somatosensory evoked potentials and transcranial magnetic stimulation.
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Affiliation(s)
- Eleftherios S Papathanasiou
- Clinical Neurophysiology Laboratory, Clinic B, The Cyprus Institute of Neurology & Genetics, Nicosia, Cyprus
| | - Thomas Cronin
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Barry Seemungal
- Division of Brain Sciences, St Mary’s and Charing Cross Hospitals, Imperial College London, London, UK
| | - Jaswinder Sandhu
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
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17
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Mayer AR, Kaushal M, Dodd AB, Hanlon FM, Shaff NA, Mannix R, Master CL, Leddy JJ, Stephenson D, Wertz CJ, Suelzer EM, Arbogast KB, Meier TB. Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils. Neurosci Biobehav Rev 2018; 94:149-165. [PMID: 30098989 DOI: 10.1016/j.neubiorev.2018.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, 02115, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States; Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, 14214, United States
| | - David Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Elizabeth M Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
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18
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Shin SS, Krishnan V, Stokes W, Robertson C, Celnik P, Chen Y, Song X, Lu H, Liu P, Pelled G. Transcranial magnetic stimulation and environmental enrichment enhances cortical excitability and functional outcomes after traumatic brain injury. Brain Stimul 2018; 11:1306-1313. [PMID: 30082198 DOI: 10.1016/j.brs.2018.07.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapeutic strategies for traumatic brain injury (TBI) in the last three decades have failed to show significant benefit in large scale studies. Given the multitude of pathological mechanisms involved in TBI, strategies focusing on multimodality regimen have gained interest as promising future interventions. HYPOTHESIS We hypothesized that combining noninvasive transcranial magnetic stimulation (TMS) with rehabilitative training in an environmental enrichment (EE) can facilitate post-TBI recovery in rats via cortical excitability and reorganization. METHODS We subjected rats to controlled cortical impact, and then assigned them to one of four groups: 1. No treatments (TBI), 2. EE after injury (TBI + EE), 3. TMS for one week (TBI + TMS), and 4. TMS for one week combined with EE (TBI + TMS/EE). For TMS, a 10 Hz repetitive TMS protocol was used. RESULTS At 7 days, TBI + TMS and TBI + TMS/EE groups had significantly increased primary somatosensory cortex local field potential (LFP) compared to TBI and TBI + EE groups (P < 0.05). Also, TBI + TMS/EE group had significantly improved performance on beam walk test compared to TBI group (P < 0.005). At 6 weeks, there was significantly higher response in TBI + TMS/EE group compared to TBI + TMS for somatosensory cortex LFP (P < 0.05), bicep motor evoked potentials (MEP) (P < 0.05), challenge ladder test performance (P < 0.01), and fMRI responses to tactile forepaw stimulation. CONCLUSIONS We demonstrate here for the first time the mechanism by which combined therapy using TMS and EE after TBI leads to functional improvement, possibly via cortical excitability and reorganization.
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Affiliation(s)
- Samuel S Shin
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijai Krishnan
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA; The Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - William Stokes
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney Robertson
- Department of Anesthesiology/Critical Care Medicine and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo Celnik
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yanrong Chen
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaolei Song
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Galit Pelled
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA; The Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Radiology, Michigan State University, East Lansing, MI, USA.
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The Role of Physical Activity in Recovery From Concussion in Youth: A Neuroscience Perspective. J Neurol Phys Ther 2018; 42:155-162. [PMID: 29864097 DOI: 10.1097/npt.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Concussion is a major public health concern and one of the least understood neurological injuries. Children and youth are disproportionally affected by concussion, and once injured, take longer to recover. Current guidelines recommend a period of physical and cognitive rest with a gradual progressive return to activity. Although there is limited high-quality evidence (eg, randomized controlled trials) on the benefit of physical activity and exercise after concussion, most studies report a positive impact of exercise in facilitating recovery after concussion. In this article we characterize the complex and dynamic changes in the brain following concussion by reviewing recent results from neuroimaging studies and to inform physical activity participation guidelines for the management of a younger population (eg, 14-25 years of age) after concussion. SUMMARY OF KEY POINTS Novel imaging methods and tools are providing a picture of the changes in the structure and function of the brain following concussion. These emerging results will, in the future, assist in creating objective, evidence-based pathways for clinical decision-making. Until such time, physical therapists should be aware that current neuroimaging evidence supports participation in physical activity after an initial and brief period of rest, and consider how best to incorporate exercise into rehabilitation to enhance recovery following concussion. RECOMMENDATIONS FOR CLINICAL PRACTICE It is important that physical therapists understand the neurobiological impact of concussion injury and recovery, and be informed of the scientific rationale for the recommendations and guidelines for engagement in physical activity.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A205).
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Development of corticospinal motor excitability and cortical silent period from mid-childhood to adulthood – a navigated TMS study. Neurophysiol Clin 2018; 48:65-75. [DOI: 10.1016/j.neucli.2017.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023] Open
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