1
|
Spielman LA, Maruta J, Ghajar J. Dual statistical models link baseline visual attention measure to risk for significant symptomatic concussion in sports. Concussion 2023; 8:CNC112. [PMID: 38855758 PMCID: PMC10945612 DOI: 10.2217/cnc-2023-0002] [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] [Received: 02/23/2023] [Accepted: 12/01/2023] [Indexed: 06/11/2024] Open
Abstract
Aim Athletic pre-season testing can establish functional baseline for comparison following concussion. Whether impacts of future concussions may be foretold by such testing is little known. Materials & methods Two sets of models for a significant burden of concussion were generated: a traditional approach using a series of logistic regressions, and a penalized regression approach using elastic net. Results 3091 youth and adult athletes were baseline-assessed. 90 subsequently experienced concussion and 35 were still experiencing a significant burden of concussion when tested within two weeks. Both models associated prior history of head injury and visual attention-related metrics with a significant burden of concussion. Conclusion Pre-season testing of visual attention may identify athletes who are at risk for significant sports-related concussion.
Collapse
Affiliation(s)
- Lisa A Spielman
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jun Maruta
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | |
Collapse
|
2
|
Bai L, Yin B, Lei S, Li T, Wang S, Pan Y, Gan S, Jia X, Li X, Xiong F, Yan Z, Bai G. Reorganized Hubs of Brain Functional Networks after Acute Mild Traumatic Brain Injury. J Neurotrauma 2023; 40:63-73. [PMID: 35747994 DOI: 10.1089/neu.2021.0450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI)-associated damage to hub regions can lead to disrupted modular structures of functional brain networks and may result in widespread cognitive and behavioral deficits. The spatial layout of brain connections and modules is essential for understanding the reorganization of brain networks to trauma. We investigated the roles of hubs in inter-subnetwork information coordination and integration using participation coefficients (PCs) in 74 patients with acute mTBI and 51 matched healthy controls. In some brain networks, such as default mode network (DMN) and frontoparietal network (FPN), mild TBI patients had decreased PC levels, while this measure was saliently increased in patients in other networks, such as the visual network. The hub disruption index was defined as the gradient of a straight line fitted to scatterplots of individual mTBI in participation coefficient versus mean participation coefficient of healthy groups. There was a trend of radical reorganization of some efficient "hub" nodes in patients (κ = -0.15), compared with controls (κ close to 0). The PC of brain hubs can also differentiate mTBI patients from controls with an 88% accuracy, and decreased PC levels in FPN can predict patient' s worse cognitive information processing speed (r = 0.36, p < 0.002) and working memory performance (r = 0.35, p < 0.002). Reduced PC within the DMN was associated with patients' complaints of post-concussion symptoms (r = -0.35, p < 0.002). This evidence suggests a trend of spatial transition of hub profiles in acute mTBI, and graph metrics of PC measures can be used as potential diagnostic biomarkers.
Collapse
Affiliation(s)
- Lijun Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuoyan Lei
- School of Electronic Information and Artificial Intelligence, Shaanxi University of Science and Technology, Xi'an, China
| | - Tianhui Li
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yizhen Pan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Li
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Feng Xiong
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Zhihan Yan
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
3
|
D3 Receptors and PET Imaging. Curr Top Behav Neurosci 2022; 60:251-275. [PMID: 35711027 DOI: 10.1007/7854_2022_374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This chapter encapsulates a short introduction to positron emission tomography (PET) imaging and the information gained by using this technology to detect changes of the dopamine 3 receptor (D3R) at the molecular level in vivo. We will discuss available D3R radiotracers, emphasizing [11C]PHNO. The focus, however, will be on PET findings in conditions including substance abuse, obesity, traumatic brain injury, schizophrenia, Parkinson's disease, and aging. Finally, there is a discussion about progress in producing next-generation selective D3R radiotracers.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Mousavinejad M, Mozafari J, Ilkhchi RB, Hanafi MG, Ebrahimi P. Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial. Rev Recent Clin Trials 2021; 15:70-75. [PMID: 31744452 DOI: 10.2174/1574887114666191118111826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. METHODS This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). RESULTS 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). CONCLUSION Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.
Collapse
Affiliation(s)
- Maryam Mousavinejad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mozafari
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Bahrami Ilkhchi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pouya Ebrahimi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
6
|
Camarano JG, Ratliff HT, Korst GS, Hrushka JM, Jupiter DC. Predicting in-hospital mortality after traumatic brain injury: External validation of CRASH-basic and IMPACT-core in the national trauma data bank. Injury 2021; 52:147-153. [PMID: 33070947 DOI: 10.1016/j.injury.2020.10.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) prognostic prediction models offer value to individualized treatment planning, systematic outcome assessments and clinical research design but require continuous external validation to ensure generalizability to different settings. The Corticosteroid Randomization After Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis on Clinical Trials in TBI (IMPACT) models are widely available but lack robust assessments of performance in a current national sample of patients. The purpose of this study is to assess the performance of the CRASH-Basic and IMPACT-Core models in predicting in-hospital mortality using a nationwide retrospective cohort from the National Trauma Data Bank (NTDB). METHODS The 2016 NTDB was used to analyze an adult cohort with moderate-severe TBI (Glasgow Coma Scale [GCS] ≤ 12, head Abbreviated Injury Scale of 2-6). Observed in-hospital mortality or discharge to hospice was compared to the CRASH-Basic and IMPACT-Core models' predicted probability of 14-day or 6-month mortality, respectively. Performance measures included discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plots and Brier scores). Further sensitivity analysis included patients with GCS ≤ 14 and considered patients discharged to hospice to be alive at 14-days. RESULTS A total of 26,228 patients were included in this study. Both models demonstrated good ability in differentiating between patients who died and those who survived, with IMPACT demonstrating a marginally greater AUC (0.863; 95% CI: 0.858 - 0.867) than CRASH (0.858; 0.854 - 0.863); p < 0.001. On calibration, IMPACT overpredicted at lower scores and underpredicted at higher scores but had good calibration-in-the-large (indicating no systemic over/underprediction), while CRASH consistently underpredicted mortality. Brier scores were similar (0.152 for IMPACT, 0.162 for CRASH; p < 0.001). Both models showed slight improvement in performance when including patients with GCS ≤ 14. CONCLUSION Both CRASH-Basic and IMPACT-Core accurately predict in-hospital mortality following moderate-severe TBI, and IMPACT-Core performs well beyond its original GCS cut-off of 12, indicating potential utility for mild TBI (GCS 13-15). By demonstrating validity in the NTDB, these models appear generalizable to new data and offer value to current practice in diverse settings as well as to large-scale research design.
Collapse
Affiliation(s)
- Joseph G Camarano
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Hunter T Ratliff
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Genevieve S Korst
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Jaron M Hrushka
- School of Medicine, University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas 77555, USA; Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas, 77555 USA.
| |
Collapse
|
7
|
Ondek K, Pevzner A, Tercovich K, Schedlbauer AM, Izadi A, Ekstrom AD, Cowen SL, Shahlaie K, Gurkoff GG. Recovery of Theta Frequency Oscillations in Rats Following Lateral Fluid Percussion Corresponds With a Mild Cognitive Phenotype. Front Neurol 2020; 11:600171. [PMID: 33343499 PMCID: PMC7746872 DOI: 10.3389/fneur.2020.600171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 01/31/2023] Open
Abstract
Whether from a fall, sports concussion, or even combat injury, there is a critical need to identify when an individual is able to return to play or work following traumatic brain injury (TBI). Electroencephalogram (EEG) and local field potentials (LFP) represent potential tools to monitor circuit-level abnormalities related to learning and memory: specifically, theta oscillations can be readily observed and play a critical role in cognition. Following moderate traumatic brain injury in the rat, lasting changes in theta oscillations coincide with deficits in spatial learning. We hypothesized, therefore, that theta oscillations can be used as an objective biomarker of recovery, with a return of oscillatory activity corresponding with improved spatial learning. In the current study, LFP were recorded from dorsal hippocampus and anterior cingulate in awake, behaving adult Sprague Dawley rats in both a novel environment on post-injury days 3 and 7, and Barnes maze spatial navigation on post-injury days 8–11. Theta oscillations, as measured by power, theta-delta ratio, peak theta frequency, and phase coherence, were significantly altered on day 3, but had largely recovered by day 7 post-injury. Injured rats had a mild behavioral phenotype and were not different from shams on the Barnes maze, as measured by escape latency. Injured rats did use suboptimal search strategies. Combined with our previous findings that demonstrated a correlation between persistent alterations in theta oscillations and spatial learning deficits, these new data suggest that neural oscillations, and particularly theta oscillations, have potential as a biomarker to monitor recovery of brain function following TBI. Specifically, we now demonstrate that oscillations are depressed following injury, but as oscillations recover, so does behavior.
Collapse
Affiliation(s)
- Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Aleksandr Pevzner
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Kayleen Tercovich
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Amber M Schedlbauer
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Ali Izadi
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Arne D Ekstrom
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Stephen L Cowen
- Department of Psychology, The University of Arizona, Tucson, AZ, United States.,McKnight Brain Institute, The University of Arizona, Tucson, AZ, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States.,Center for Neuroscience, University of California, Davis, Davis, CA, United States
| |
Collapse
|
8
|
Panayiotou A, Crowe S, Jackson M. An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2010.00018.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Simon Crowe
- School of Psychological Science, La Trobe University
| | | |
Collapse
|
9
|
K. SP, Reddy RP, Mathulla AR, Rajeswaran J, Shukla DP. Traumatic Brain Injury: Effect of Litigation Status on Executive Functioning—A Pilot Study. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1717214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTraumatic brain injury (TBI) is associated with a wide range of physiological, behavioral, emotional, and cognitive sequelae. Litigation status is one of the many factors that has an impact on recovery. The aim of this study was to compare executive functions, postconcussion, and depressive symptoms in TBI patients with and without litigation. A sample of 30 patients with TBI, 15 patients with litigation (medicolegal case [MLC]), and 15 without litigation (non-MLC) was assessed. The tools used were sociodemographic and clinical proforma, executive function tests, Rivermead Post-Concussion Symptom Questionnaire, and Beck Depression Inventory. Assessment revealed that more than 50% of patients showed deficits in category fluency, set shifting, and concept formation. The MLC group showed significant impairment on verbal working memory in comparison to the non-MLC group. The performance of both groups was comparable on tests of semantic fluency, visuospatial working memory, concept formation, set shifting, planning, and response inhibition. The MLC group showed more verbal working memory deficits in the absence of significant postconcussion and depressive symptoms on self-report measures.
Collapse
Affiliation(s)
- Simi Prakash K.
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Anna R. Mathulla
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dhaval P. Shukla
- Neurosurgery, National Institute of Mental Health & Neurosciences, Karnataka, India
| |
Collapse
|
10
|
Sekely A, Dhillon S, Zakzanis KK. The effect of diagnostic terminology on cognitive, emotional, and post-concussive sequelae following mild brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:499-508. [PMID: 32546013 DOI: 10.1080/23279095.2020.1775599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We sought to determine whether the diagnostic terms 'mild traumatic brain injury (mTBI)' and 'concussion' result in differences in perceived cognitive, emotional, and post-concussive sequelae.Method: A total of 81 healthy university students (79% female; 69% of Asian descent) were randomly assigned to one of two conditions: mTBI (n = 41), or concussion (n = 40), and were instructed to simulate on a battery of cognitive (Neuropsychological Assessment Battery - Screening Module), emotional (Beck Anxiety Inventory, Beck Depression Inventory-II), and post-concussive (Rivermead Postconcussive Symptoms Questionnaire) measures.Results: There were no significant group differences between expected cognitive, emotional, or post-concussive consequences. However, both groups received poorer scores than the normative data.Conclusions: These results suggest that diagnostic terminology does not appear to influence anticipated recovery following mild brain injury. However, the presentation of information about the injury itself may impact recovery outcomes. This study provides preliminary support for the potential negative effects that may arise as a result of providing participants with non-evidence based information about mild brain injuries.
Collapse
Affiliation(s)
- Angela Sekely
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Sonya Dhillon
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Ebrahimi P, Mozafari J, Ilkhchi RB, Hanafi MG, Mousavinejad M. Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial. Rev Recent Clin Trials 2020; 14:286-291. [PMID: 31218964 DOI: 10.2174/1574887114666190620112829] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/25/2019] [Accepted: 06/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recovery of patients with traumatic brain injury largely depends on the reduction in secondary brain damage. The present study aims at investigating the effect of Tranexamic Acid (TXA) administration within the first hours of brain trauma in the emergency department (ED). METHODS This randomized, double-blind, placebo-controlled clinical trial was carried out in patients with subdural and epidural hemorrhage. Patients with any type of bleeding were assigned into two groups of TXA and 0.9% normal saline as placebo. The rate of intracranial hemorrhage after surgery was assessed by CT-scan and amount of hemoglobin (Hb) was measured immediately before surgery and after 6 hours of surgery. RESULTS A total of 80 participants were randomly assigned into four groups of 20 people. There was a significant difference in the mean of intraoperative bleeding during surgery in patients receiving TXA and placebo in both SDH (Subdural hematoma) and EDH (Epidural Hemorrhage) groups (P= 0.012). The Hb drop amount had no significant difference with placebo (P< 0.0001). No complications were observed in any of the intervention and control groups during the study as well. CONCLUSION The use of TXA may reduce bleeding, however, based on the results of this study, such effect was not statistically significant in controlling the epidural and subdural hemorrhage, but clinical trials with a higher sample size are suggested for further investigation in this regard.
Collapse
Affiliation(s)
- Pouya Ebrahimi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mozafari
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Bahrami Ilkhchi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Maryam Mousavinejad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
12
|
Huang M, Lewine JD, Lee RR. Magnetoencephalography for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. Neuroimaging Clin N Am 2020; 30:175-192. [DOI: 10.1016/j.nic.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
13
|
Row J, Chan L, Damiano D, Shenouda C, Collins J, Zampieri C. Balance Assessment in Traumatic Brain Injury: A Comparison of the Sensory Organization and Limits of Stability Tests. J Neurotrauma 2019; 36:2435-2442. [PMID: 30909842 PMCID: PMC6661911 DOI: 10.1089/neu.2018.5755] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Balance problems are common after a traumatic brain injury (TBI). Symptoms of dizziness, unsteadiness, or imbalance have been most frequently attributed to sensory organization problems involving the use of visual, proprioceptive, and/or vestibular information for postural control. These problems can be assessed with the Sensory Organization Test (SOT). However, as head trauma can affect any brain region, areas responsible for voluntary control of movements involved in dynamic balance tasks, such as the motor cortex and its projections, could also be compromised, which would likely affect one's limits of stability. The Limits of Stability (LOS) balance test has received little attention in TBI. In the present study, we compared the prevalence of SOT versus LOS abnormalities in a cohort of 48 patients, the majority classified as having mild or moderate chronic TBI. Compared with a normative database provided by the balance testing manufacturer, a larger portion of our cohort presented abnormalities in the LOS test. Dizziness Handicap Inventory (DHI) results indicated mild disability, with the five activities most frequently endorsed as problematic being: looking up, performing quick head movements, performing ambitious such as sports or dancing activities, feeling frustrated, and performing strenuous house/yard work. Although regression analysis revealed that both tests significantly predicted subjective scores on the DHI, more LOS than SOT testing variables were important predictors of DHI results indicating disability. These results suggest that the LOS test is an informative tool that should be included in any objective balance evaluations that screen TBI patients with balance complaints.
Collapse
Affiliation(s)
- Jessica Row
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Diane Damiano
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Christian Shenouda
- Division of Neurological and Physical Medicine Devices, Food and Drug Administration, Silver Spring, Maryland
| | - John Collins
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
- Department of Rehabilitation Science, College of Health and Human Services, Fairfax, Virginia
| | - Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| |
Collapse
|
14
|
Vander Werff KR, Rieger B. Auditory and Cognitive Behavioral Performance Deficits and Symptom Reporting in Postconcussion Syndrome Following Mild Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2501-2518. [PMID: 31260387 PMCID: PMC6808357 DOI: 10.1044/2019_jslhr-h-18-0281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 05/07/2023]
Abstract
Purpose This study examined auditory deficits and symptom reporting in individuals with long-term postconcussion symptoms following a single mild traumatic brain injury (mTBI) compared to age- and gender-matched controls without a history of mTBI. Method Case history interviews, symptom questionnaires, and a battery of central auditory and neuropsychological tests were administered to 2 groups. The mTBI group was a civilian population recruited from a local concussion management program who were seeking rehabilitation for postconcussion-related problems in a postacute period between 3 and 18 months following injury. Symptom validity testing was included to assess the rate of possible insufficient test effort and its influence on scores for all outcome measures. Analyses of group differences in test scores were performed both with and without the participants who showed insufficient test effort. Rates of symptom reporting, correlations among symptoms and behavioral test outcomes, and the relationships between auditory and cognitive test performance were analyzed. Results The mTBI group reported a high rate of auditory symptoms and general postconcussion symptoms. Performance on neuropsychological tests of cognitive function showed some differences in raw scores between groups, but when effort was considered, there were no significant differences in the rate of abnormal performance between groups. In contrast, there were significant differences in both raw scores and the rate of abnormal performance between groups for some auditory tests when only considering participants with sufficient effort. Auditory symptoms were strongly correlated with other general postconcussion symptoms. Conclusions Significant auditory symptoms and evidence of long-term central auditory dysfunction were found in a subset of individuals who had chronic postconcussion symptoms after a single mTBI unrelated to blast trauma. The rate of abnormal performance on auditory behavioral tests exceeded the rate of abnormal performance on tests of cognitive function. Supplemental Material https://doi.org/10.23641/asha.8329955.
Collapse
Affiliation(s)
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY
| |
Collapse
|
15
|
Kaufman NK, Bush SS, Aguilar MR. What Attorneys and Factfinders Need to Know About Mild Traumatic Brain Injuries. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09355-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Moussavi Z, Suleiman A, Rutherford G, Ranjbar Pouya O, Dastgheib Z, Zhang W, Salter J, Wang X, Mansouri B, Lithgow B. A Pilot Randomised Double-Blind Study of the Tolerability and efficacy of repetitive Transcranial Magnetic Stimulation on Persistent Post-Concussion Syndrome. Sci Rep 2019; 9:5498. [PMID: 30940870 PMCID: PMC6445141 DOI: 10.1038/s41598-019-41923-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
This study investigates the effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on persistent post-concussion syndrome (PCS). The study design was a randomized (coin toss), placebo controlled, and double-blind study. Thirty-seven participants with PCS were assessed for eligibility; 22 were randomised and 18 completed the study requirements. Half the participants with PCS were given an Active rTMS intervention and the other half given Sham rTMS over 3 weeks. Follow ups were at the end of treatment and at 30 and 60 days. The primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire (RPQ3 & RPQ13). The results indicate participants with more recent injuries (<12 month), who received Active rTMS, showed significant improvements compared to those of: 1) the same subgroup who received Sham, and 2) those with a longer duration of injury (>14 months) who received Active rTMS. This improvement predominantly manifested in RPQ13 in the follow up periods 1 and 2 months after the intervention (RPQ13 change (mean ± SD): at 1 month, Active = −21.8 ± 6.6, Sham = −2.2 ± 9.8; at 2 months, Active = −21.2 ± 5.3, Sham = −5.4 ± 13.7). No improvement was found in the subgroup with longer duration injuries. The results support rTMS as a tolerable and potentially effective treatment option for individuals with a recent (<1 year) concussion.
Collapse
Affiliation(s)
- Zahra Moussavi
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada. .,Riverview Health Centre, Winnipeg, Canada.
| | | | - Grant Rutherford
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | | | - Zeinab Dastgheib
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | - Weijia Zhang
- Statistics Department, University of Manitoba, Winnipeg, Canada
| | | | - Xikui Wang
- Statistics Department, University of Manitoba, Winnipeg, Canada
| | - Behzad Mansouri
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada.,Neurology Department, University of Manitoba, Winnipeg, Canada
| | - Brian Lithgow
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada.,Riverview Health Centre, Winnipeg, Canada.,Monash Alfred Psychiatry Research Center, Melbourne, Australia
| |
Collapse
|
17
|
Hanks RA, Rapport LJ, Seagly K, Millis SR, Scott C, Pearson C. Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of Symptoms. J Neurotrauma 2019; 36:554-558. [DOI: 10.1089/neu.2018.5873] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robin A. Hanks
- Departments of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan
- Department of Psychology,Wayne State University College of Liberal Arts and Sciences, Detroit, Michigan
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Lisa J. Rapport
- Department of Psychology,Wayne State University College of Liberal Arts and Sciences, Detroit, Michigan
| | - Katharine Seagly
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Scott R. Millis
- Departments of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
18
|
Chen G, Zhao X, Yu G, Jian H, Li Y, Xu G. Otolith dysfunction in recurrent benign paroxysmal positional vertigo after mild traumatic brain injury. Acta Otolaryngol 2019; 139:18-21. [PMID: 30714506 DOI: 10.1080/00016489.2018.1562214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The pathogenesis of recurrence of traumatic benign paroxysmal positional vertigo (BPPV) is poorly understood by far. OBJECTIVES To evaluate the value of secondary otolith dysfunction using vestibular evoked myogenic potential (VEMP) test in the pathogenesis of recurrence of BPPV after mild traumatic brain injury (mTBI). MATERIAL AND METHODS We reviewed 42 patients with BPPV after mTBI. According to recurrence, patients were divided into two groups. Both cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests were performed on all of them. RESULTS We detected abnormal cVEMP responses in four (26.7%) patients in the recurrent BPPV group after mTBI and five (18.5%) patients in the non-recurrent BPPV group after mTBI, and there was no significant difference between both groups. We detected abnormal oVMEP responses in nine (60.0%) patients in the recurrent BPPV group after mTBI and six (22.2%) patients in the non-recurrent BPPV group after mTBI, and there was a significant difference between both groups. CONCLUSIONS AND SIGNIFICANCE Our study shows that oVEMP abnormalities in recurrent BPPV group after mTBI are significantly higher than those in non-recurrent BPPV group after mTBI. Therefore, we can conclude that secondary utricular dysfunction may be a potential pathogenesis of recurrence of traumatic BPPV.
Collapse
Affiliation(s)
- Gang Chen
- Department of Otolaryngology – Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xuening Zhao
- Department of Otolaryngology – Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Gang Yu
- Department of Otolaryngology – Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Huirong Jian
- Department of Otolaryngology – Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yun Li
- Department of Otolaryngology – Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guangming Xu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| |
Collapse
|
19
|
Predictive Validity of the Neuropsychological Assessment Battery-Screening Module for Assessing Real-World Disability in Patients with Mild Traumatic Brain Injury. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9329-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Oldenburg C, Lundin A, Edman G, Deboussard CN, Bartfai A. Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study. BMJ Open 2018; 8:e020884. [PMID: 29982209 PMCID: PMC6042551 DOI: 10.1136/bmjopen-2017-020884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Prolonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective. DESIGN Prospective cohort study. SETTING Patients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals. PARTICIPANTS 122 patients with a history of blunt head trauma (aged 15-65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14-15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including previous significant head injury. PROCEDURE Recruitment in three emergency departments. Initial assessments were made within 1 week after the injury. Patients were mailed the follow-up questionnaires 1 year postinjury. OUTCOME MEASURES A psychiatric assessment was performed at 1 week post injury. The participants also completed a personality inventory, measures of psychological resilience, depression, anxiety and post-traumatic symptoms. One-year outcome was measured by the Rivermead Post Concussion Symptoms and the Rivermead Head Injury Follow-Up questionnaires. RESULTS The psychiatric assessment revealed more symptoms of anxiety, depression and post-traumatic symptoms in the acute stage for patients who later developed PCS.After 1 year, 94 participants were still in the programme (male/female 57/37) and 12% matched the extended criteria for PCS (≥3 symptoms and ≥2 disabilities). PCS patients reported more preinjury and concurrent psychiatric problems, lower level of functioning before the injury and experienced more stress. They showed higher somatic trait anxiety, embitterment, mistrust and lower level of psychological resilience than recovered participants. CONCLUSION Intrapersonal emotional reserve shape the emergence and persistence of PCS after mTBI.
Collapse
Affiliation(s)
- Christian Oldenburg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lundin
- Neuropsychiatry Section, Dizziness Center, Stockholm, Sweden
| | - Gunnar Edman
- Tiohundra AB, Norrtälje sjukhus, Norrtälje, Sweden
| | - Catharina Nygren Deboussard
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Aniko Bartfai
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
21
|
Thompson EC, Krizman J, White-Schwoch T, Nicol T, LaBella CR, Kraus N. Difficulty hearing in noise: a sequela of concussion in children. Brain Inj 2018. [DOI: 10.1080/02699052.2018.1447686] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Elaine C Thompson
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Cynthia R LaBella
- Division of Pediatric Orthopaedics & Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
- Institute for Neuroscience, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Evanston, IL, USA
| |
Collapse
|
22
|
Chong CD, Schwedt TJ. Research Imaging of Brain Structure and Function After Concussion. Headache 2018; 58:827-835. [DOI: 10.1111/head.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
|
23
|
Galili SF, Bech BH, Vestergaard C, Fenger-Gron M, Christensen J, Vestergaard M, Ahrensberg J. Use of general practice before and after mild traumatic brain injury: a nationwide population-based cohort study in Denmark. BMJ Open 2017; 7:e017735. [PMID: 29248884 PMCID: PMC5778290 DOI: 10.1136/bmjopen-2017-017735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/02/2017] [Accepted: 10/03/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Traumatic brain injury (TBI) is commonly seen in the emergency department (ED). Approximately 85%-90% of TBIs are mild (mTBI). Some cause symptoms such as headache, dizziness, anxiety, blurred vision, insomnia and concentration difficulties, collectively known as postconcussion syndrome (PCS). Some studies suggest that recovery from mTBI is complete. Others find that symptoms persist for months, even years. The aim of this study was to describe the use of general practice, before and after mTBI, as a proxy for symptoms in a large cohort. DESIGN Nationwide population-based matched cohort study. SETTING Danish EDs and general practice. PARTICIPANTS All patients (aged ≥18 years), first-time diagnosed with mTBI in a Danish ED between 1 January 1998 and 31 December 2010 (n=93 517). Ten reference persons per patient with mTBI were randomly matched on gender, age and general practice (n=935 170). PRIMARY OUTCOME Overall use of general practice; consultations relating to mental and physical health. RESULTS We found higher use of general practice during the first year after mTBI for all ages, both genders and all types of contacts. Age 18-40 years: women, incidence rate ratio (IRR) 1.59 (95% CI 1.57 to 1.61); men, IRR 1.82 (95% CI 1.80 to 1.85). Age 41-65 years: women, IRR 1.75 (95% CI 1.72 to 1.78); men, IRR 1.85(95% CI 1.82 to 1.89). Age 66+ years: women, IRR 1.55 (95% CI 1.52 to 1.58); men, IRR 1.55 (95% CI 1.51 to 1.59). After the first year, the use decreased to the level before mTBI. Individuals with mTBI and higher use of general practice before mTBI had lower socioeconomic status and more comorbidities (P<0.001). CONCLUSIONS The use of general practice was higher in the first year after mTBI, specifically in the first 3 months. Patients with mTBI had different healthcare-seeking behaviour several years before diagnosis than their matched reference persons. Pretraumatic morbidity should be considered in the evaluation of PCS.
Collapse
Affiliation(s)
- Stine Fjendbo Galili
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for General Practice and Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Claus Vestergaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Gron
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Vestergaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Jette Ahrensberg
- Department of Clinical Medicine, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
24
|
Huang MX, Swan AR, Quinto AA, Matthews S, Harrington DL, Nichols S, Bruder BJ, Snook CC, Huang CW, Baker DG, Lee RR. A pilot treatment study for mild traumatic brain injury: Neuroimaging changes detected by MEG after low-intensity pulse-based transcranial electrical stimulation. Brain Inj 2017; 31:1951-1963. [DOI: 10.1080/02699052.2017.1363409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Ashley Robb Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Annemarie Angeles Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Scott Matthews
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Deborah L. Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | | | | | - Charles W. Huang
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Dewleen G. Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Roland R. Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
25
|
Rowley DA, Rogish M, Alexander T, Riggs KJ. Cognitive correlates of pragmatic language comprehension in adult traumatic brain injury: A systematic review and meta-analyses. Brain Inj 2017; 31:1564-1574. [DOI: 10.1080/02699052.2017.1341645] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dane A Rowley
- Clinical Psychology Programme, University of Hull, Hull, UK
| | - Miles Rogish
- Brain Injury Rehabilitation Trust, The Disabilities Trust, West Sussex, UK
| | | | - Kevin J Riggs
- Department of Psychology, University of Hull, Hull, UK
| |
Collapse
|
26
|
Yang CC, Chiu HC, Xiao SH, Tsai YH, Lee YC, Ku YT, Lin RS, Lin WC, Huang SJ. Iatrogenic Effect? Cautions when Utilizing an Early Health Education for Post-concussion Symptoms. Arch Clin Neuropsychol 2017; 33:131-142. [DOI: 10.1093/arclin/acx060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 06/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Hsiao-Chun Chiu
- Pediatric Psychiatry, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Huang Xiao
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Yi-Hsin Tsai
- Department of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Chien Lee
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Ting Ku
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Rong-Syuan Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Chi Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
27
|
Yates NJ, Lydiard S, Fehily B, Weir G, Chin A, Bartlett CA, Alderson J, Fitzgerald M. Repeated mild traumatic brain injury in female rats increases lipid peroxidation in neurons. Exp Brain Res 2017; 235:2133-2149. [PMID: 28417146 DOI: 10.1007/s00221-017-4958-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/07/2017] [Indexed: 11/30/2022]
Abstract
Negative outcomes of mild traumatic brain injury (mTBI) can be exacerbated by repeated insult. Animal models of repeated closed-head mTBI provide the opportunity to define acute pathological mechanisms as the number of mTBI increases. Furthermore, little is known about the effects of mTBI impact site, and how this may affect brain function. We use a closed head, weight drop model of mTBI that allows head movement following impact, in adult female rats to determine the role of the number and location of mTBI on brain pathology and behaviour. Biomechanical assessment of two anatomically well-defined mTBI impact sites were used, anterior (bregma) and posterior (lambda). Location of the impact had no significant effect on impact forces (450 N), and the weight impact locations were on average 5.4 mm from the desired impact site. No between location vertical linear head kinematic differences were observed immediately following impact, however, in the 300 ms post-impact, significantly higher mean vertical head displacement and velocity were observed in the mTBI lambda trials. Breaches of the blood brain barrier were observed with three mTBI over bregma, associated with immunohistochemical indicators of damage. However, an increased incidence of hairline fractures of the skull and macroscopic haemorrhaging made bregma an unsuitable impact location to model repeated mTBI. Repeated mTBI over lambda did not cause skull fractures and were examined more comprehensively, with outcomes following one, two or three mTBI or sham, delivered at 1 day intervals, assessed on days 1-4. We observe a mild behavioural phenotype, with subtle deficits in cognitive function, associated with no identifiable neuroanatomical or inflammatory changes. However, an increase in lipid peroxidation in a subset of cortical neurons following two mTBI indicates increasing oxidative damage with repeated injury in female rats, supported by increased amyloid precursor protein immunoreactivity with three mTBI. This study of acute events following closed head mTBI identifies lipid peroxidation in neurons at the same time as cognitive deficits. Our study adds to existing literature, providing biomechanics data and demonstrating mild cognitive disturbances associated with diffuse injury, predominantly to grey matter, acutely following repeated mTBI.
Collapse
Affiliation(s)
- Nathanael J Yates
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Stephen Lydiard
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Brooke Fehily
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Gillian Weir
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, 6009, Australia
| | - Aaron Chin
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, 6009, Australia
| | - Carole A Bartlett
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Australia
| | - Jacqueline Alderson
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, 6009, Australia.,Auckland University of Technology, Sports Performance Research Institute New Zealand (SPRINZ), Auckland, New Zealand
| | - Melinda Fitzgerald
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Australia. .,Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia. .,Perron Institute for Nerurological and Translational Science, Sarich Neuroscience Research Institute, Verdun St, Nedlands, WA, 6009, Australia.
| |
Collapse
|
28
|
Tucker B, Aston J, Dines M, Caraman E, Yacyshyn M, McCarthy M, Olson JE. Early Brain Edema is a Predictor of In-Hospital Mortality in Traumatic Brain Injury. J Emerg Med 2017; 53:18-29. [PMID: 28343797 DOI: 10.1016/j.jemermed.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identifying patients who may progress to a poor clinical outcome will encourage earlier appropriate therapeutic interventions. Brain edema may contribute to secondary injury in traumatic brain injury (TBI) and thus, may be a useful prognostic indicator. OBJECTIVE We determined whether the presence of brain edema on the initial computed tomography (CT) scan of TBI patients would predict poor in-hospital outcome. METHODS We performed a retrospective review of all trauma patients with nonpenetrating head trauma at a Level I Trauma Center. International Classification of Diseases, Ninth Revision codes indicated the presence of brain edema and we evaluated the validity of this pragmatic assessment quantitatively in a random subset of patients. In-hospital mortality was the primary outcome variable. Univariate analysis and logistic regression identified predictors of mortality in all TBI patients and those with mild TBI. RESULTS Over 7200 patients were included in the study, including 6225 with mild TBI. Measurements of gray and white matter CT density verified radiological assessments of brain edema. Patients with documented brain edema had a mortality rate over 10 times that of the entire study population. With logistic regression accounting for Injury Severity Score, Glasgow Coma Scale score, other CT findings, and clinical variables, brain edema predicted an eightfold greater mortality rate in all patients (odds ratio 8.0, 95% confidence interval 4.6-14.0) and fivefold greater mortality rate for mild TBI patients (odds ratio 4.9, 95% confidence interval 2.0-11.7). CONCLUSIONS Brain edema is an independent prognostic variable across all categories of TBI severity. By alerting emergency physicians to patients with poor predicted clinical outcomes, this finding will drive better resource allocation, earlier intervention, and reduced patient mortality.
Collapse
Affiliation(s)
- Brian Tucker
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Jill Aston
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Megan Dines
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Elena Caraman
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Marianne Yacyshyn
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Mary McCarthy
- Department of Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - James E Olson
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio; Department of Neuroscience, Cell Biology and Physiology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| |
Collapse
|
29
|
Stricker NH, Lippa SM, Green DL, McGlynn SM, Grande LJ, Milberg WP, McGlinchey RE. Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder. J Clin Exp Neuropsychol 2016; 39:768-785. [PMID: 27976973 DOI: 10.1080/13803395.2016.1264575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample. METHOD This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups. RESULTS Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression. CONCLUSIONS Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.
Collapse
Affiliation(s)
- Nikki H Stricker
- a VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA.,c Department of Psychiatry and Psychology , Mayo Clinic , Rochester , MN , USA
| | - Sara M Lippa
- d Defense and Veterans Brain Injury Center , Bethesda , MD , USA
| | | | - Susan M McGlynn
- a VA Boston Healthcare System , Boston , MA , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Laura J Grande
- b Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - William P Milberg
- e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.,f Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| | - Regina E McGlinchey
- e Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric; Research, Education and Clinical Center (GRECC) , Boston , MA , USA.,f Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| |
Collapse
|
30
|
Vakorin VA, Doesburg SM, da Costa L, Jetly R, Pang EW, Taylor MJ. Detecting Mild Traumatic Brain Injury Using Resting State Magnetoencephalographic Connectivity. PLoS Comput Biol 2016; 12:e1004914. [PMID: 27906973 PMCID: PMC5131899 DOI: 10.1371/journal.pcbi.1004914] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/11/2016] [Indexed: 01/05/2023] Open
Abstract
Accurate means to detect mild traumatic brain injury (mTBI) using objective and quantitative measures remain elusive. Conventional imaging typically detects no abnormalities despite post-concussive symptoms. In the present study, we recorded resting state magnetoencephalograms (MEG) from adults with mTBI and controls. Atlas-guided reconstruction of resting state activity was performed for 90 cortical and subcortical regions, and calculation of inter-regional oscillatory phase synchrony at various frequencies was performed. We demonstrate that mTBI is associated with reduced network connectivity in the delta and gamma frequency range (>30 Hz), together with increased connectivity in the slower alpha band (8–12 Hz). A similar temporal pattern was associated with correlations between network connectivity and the length of time between the injury and the MEG scan. Using such resting state MEG network synchrony we were able to detect mTBI with 88% accuracy. Classification confidence was also correlated with clinical symptom severity scores. These results provide the first evidence that imaging of MEG network connectivity, in combination with machine learning, has the potential to accurately detect and determine the severity of mTBI. Detecting concussion is typically not possible using currently clinically used brain imaging, such as MRI and CT scans. Magnetoencephalographic (MEG) imaging is able to directly measure brain activity at fast time scales, and this can be used to map how various areas of the brain interact. We recorded MEG from individuals who had suffered a concussion, as well as control subjects who had not. We found characteristic alterations of inter-regional interactions associated with concussion. Moreover, using a machine learning approach, we were able to detect concussion with 88% accuracy from MEG connectivity, and confidence of classification correlated with symptom severity. This potentially provides new quantitative and objective methods for detecting and assessing the severity of concussion using neuroimaging.
Collapse
Affiliation(s)
- Vasily A. Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
| | - Sam M. Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Leodante da Costa
- Department of Surgery, Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces Health Services, Directorate of Mental Health, Ottawa, Ontario, Canada
| | - Elizabeth W. Pang
- Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J. Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
McAllister TW. Mild Traumatic Brain Injury. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:410-421. [PMID: 31975821 DOI: 10.1176/appi.focus.20160025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (MTBI) is a significant public health problem worldwide. Injured individuals have an increased relative risk of developing a variety of neuropsychiatric conditions associated with the profile of brain regions typically affected in TBI. Within a neurobiopsychosocial framework, this article reviews what is known about the neuropsychiatric sequelae of MTBI, with an emphasis on recent advances.
Collapse
Affiliation(s)
- Thomas W McAllister
- Dr. McAllister is with the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (e-mail: )
| |
Collapse
|
32
|
O'Connor C, Colantonio A, Polatajko H. Long Term Symptoms and Limitations of Activity of People with Traumatic Brain Injury: A Ten-Year Follow-up. Psychol Rep 2016; 97:169-79. [PMID: 16279322 DOI: 10.2466/pr0.97.1.169-179] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the effect of Traumatic Brain Injury 10 years post-injury. Frequencies of head injury symptoms and activity limitation by level of severity were measured in a consecutive series of 61 adults who were admitted to a tertiary-care center for traumatic brain injury. Irritability and Anxiety were the most frequently reported symptoms from the Head Injury Symptom Checklist. Bothered by noise and Bothered by light were the least frequently reported. Trouble hearing what is said in a group conversation and Trouble hearing what is said in a one-to-one conversation were the most commonly reported limitations of activity from the Health and Activity Limitations Survey. Overall, this study illustrates that symptoms remain many years following brain injury, irrespective of the injury's severity.
Collapse
Affiliation(s)
- C O'Connor
- Rotman Research Institute, Baycrest Centre for Geriatric Care, Department of Psychology, University of Toronto, Canada
| | | | | |
Collapse
|
33
|
Abstract
Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.
Collapse
Affiliation(s)
- Joana Ramalho
- Centro Hospitalar de Lisboa Central, Lisboa, Portugal; University of North Carolina at Chapel Hill, Chapel Hill, NC, US
| | | |
Collapse
|
34
|
Gaines KD, Soper HV, Berenji GR. Executive Functioning of Combat Mild Traumatic Brain Injury. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:115-24. [PMID: 26496530 DOI: 10.1080/23279095.2015.1012762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigates neuropsychological deficits in recently deployed veterans with mild traumatic brain injury (mTBI). Veterans discharged from 2007 to 2012 were recruited from Veterans Affairs clinics. Independent groups of participants with mTBI (n = 57) and those without TBI (n = 57) were administered the Beck Depression Inventory-II, Combat Exposure Scale, Word Memory Test, and the Self-Awareness of Deficits Interview. Neuropsychological instruments included the Rey-Osterrieth Complex Figure Test, Letter and Category Fluency, Trail-Making Test-Parts A and B, Christiansen H-abbreviated, Soper Neuropsychology Screen, Wechsler Memory Scale subtests Logical Memory I and II, and the Street Completion Test. The mTBI group performed significantly worse on all of the executive and nonexecutive measurements with the exception of Category Fluency, after controlling for age, depression effort, and combat exposure. Depression and combat exposure were greater for the mTBI group. The mTBI group scored poorer on effort, but only the Multiple Choice subtest was significant. The mTBI group had good awareness of their deficits.
Collapse
Affiliation(s)
- Katy D Gaines
- a Nuclear Medicine , Veterans Affairs of Greater Los Angeles Healthcare System , Los Angeles , California
| | - Henry V Soper
- b School of Psychology , Fielding Graduate University , Santa Barbara , California
| | - Gholam R Berenji
- a Nuclear Medicine , Veterans Affairs of Greater Los Angeles Healthcare System , Los Angeles , California
| |
Collapse
|
35
|
Chen YH, Huang EYK, Kuo TT, Ma HI, Hoffer BJ, Tsui PF, Tsai JJ, Chou YC, Chiang YH. Dopamine Release Impairment in Striatum after Different Levels of Cerebral Cortical Fluid Percussion Injury. Cell Transplant 2015; 24:2113-28. [DOI: 10.3727/096368914x683584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To investigate the role of dopamine release in cognitive impairment and motor learning deficits after brain injury, different levels of traumatic brain injury (TBI) were made in rats by using fluid percussion at two different atmospheres (2 Psi and 6 Psi). Tonic and phasic bursting dopamine release and behavior tests followed at several time points. We used in vitro fast-scan cyclic voltammetry to survey dopamine release in the striatum and analyzed the rats’ behavior using novel object recognition (NOR) and rotarod tests. Both tonic and bursting dopamine release were greatly depressed in the severely (6 Psi) injured group, which persisted up to 8 weeks later. However, in the 2 Psi-injured group, the suppression of bursting dopamine release occurred at 1~2 weeks after injury, but there were no significant differences after 4 weeks. Tonic dopamine release was also diminished significantly at 1~2 weeks after the injury; partial recovery could then be seen 4 weeks after injury. A significant deficiency in the fixed speed rotarod test and NOR test were noted in both 2 Psi and 6 Psi groups initially; however, the changes recovered in the 2 Psi group 2 weeks after injury while persisting in the 6 Psi group. In conclusion, striatal evoked dopamine release was affected by fluid percussion injury, with behavioral deficits showing differences as a function of injury severity. The severe fluid percussion injury (6 Psi) group showed more dopamine release defects, as well as cognitive and motor deficiencies. Recovery of dopamine release and improvement in behavioral impairment were better in the mild TBI group.
Collapse
Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Eagle Yi-Kung Huang
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan, R.O.C
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Barry J. Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pi-Fen Tsui
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Jing-Jr Tsai
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yung-Hsiao Chiang
- Graduate Program on Neuroregeneration, Taipei Medical University, Taipei, Taiwan, R.O.C
| |
Collapse
|
36
|
Huang M, Lee RR. Magnetoencephalography (MEG) Slow-Wave Imaging for Diagnosing Non-acute Mild Traumatic Brain Injury. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Chiou KS, Sandry J, Chiaravalloti ND. Cognitive contributions to differences in learning after moderate to severe traumatic brain injury. J Clin Exp Neuropsychol 2015; 37:1074-85. [DOI: 10.1080/13803395.2015.1078293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
38
|
Kulkarni P, Kenkel W, Finklestein SP, Barchet TM, Ren J, Davenport M, Shenton ME, Kikinis Z, Nedelman M, Ferris CF. Use of Anisotropy, 3D Segmented Atlas, and Computational Analysis to Identify Gray Matter Subcortical Lesions Common to Concussive Injury from Different Sites on the Cortex. PLoS One 2015; 10:e0125748. [PMID: 25955025 PMCID: PMC4425537 DOI: 10.1371/journal.pone.0125748] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/26/2015] [Indexed: 01/15/2023] Open
Abstract
Traumatic brain injury (TBI) can occur anywhere along the cortical mantel. While the cortical contusions may be random and disparate in their locations, the clinical outcomes are often similar and difficult to explain. Thus a question that arises is, do concussions at different sites on the cortex affect similar subcortical brain regions? To address this question we used a fluid percussion model to concuss the right caudal or rostral cortices in rats. Five days later, diffusion tensor MRI data were acquired for indices of anisotropy (IA) for use in a novel method of analysis to detect changes in gray matter microarchitecture. IA values from over 20,000 voxels were registered into a 3D segmented, annotated rat atlas covering 150 brain areas. Comparisons between left and right hemispheres revealed a small population of subcortical sites with altered IA values. Rostral and caudal concussions were of striking similarity in the impacted subcortical locations, particularly the central nucleus of the amygdala, laterodorsal thalamus, and hippocampal complex. Subsequent immunohistochemical analysis of these sites showed significant neuroinflammation. This study presents three significant findings that advance our understanding and evaluation of TBI: 1) the introduction of a new method to identify highly localized disturbances in discrete gray matter, subcortical brain nuclei without postmortem histology, 2) the use of this method to demonstrate that separate injuries to the rostral and caudal cortex produce the same subcortical, disturbances, and 3) the central nucleus of the amygdala, critical in the regulation of emotion, is vulnerable to concussion.
Collapse
Affiliation(s)
- Praveen Kulkarni
- Northeastern University, Boston, Massachusetts, United States of America
| | - William Kenkel
- Northeastern University, Boston, Massachusetts, United States of America
| | | | - Thomas M. Barchet
- Northeastern University, Boston, Massachusetts, United States of America
| | - JingMei Ren
- Biotrofix, Waltham, Massachusetts, United States of America
| | | | - Martha E. Shenton
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Zora Kikinis
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Mark Nedelman
- Ekam Imaging, Boston, Massachusetts, United States of America
| | - Craig F. Ferris
- Northeastern University, Boston, Massachusetts, United States of America
| |
Collapse
|
39
|
Chong CD, Schwedt TJ. White Matter Damage and Brain Network Alterations in Concussed Patients: A Review of Recent Diffusion Tensor Imaging and Resting-State Functional Connectivity Data. Curr Pain Headache Rep 2015; 19:485. [DOI: 10.1007/s11916-015-0485-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
40
|
Examining postconcussion symptoms of dizziness and imbalance on neurocognitive performance in collegiate football players. Otol Neurotol 2015; 35:1111-7. [PMID: 24853238 DOI: 10.1097/mao.0000000000000432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the effects of symptom reports of dizziness and imbalance on cognitive function in concussed collegiate football players. DESIGN Retrospective, descriptive. SETTING University athletic medicine facility. SUBJECTS Twenty-seven collegiate football players were included in the final analysis: 16 with symptoms of dizziness/imbalance resulting from concussion and 11 without dizziness/imbalance resulting from concussion. MAIN OUTCOME MEASURES Participants completed the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) at baseline, at 1 to 2 days postconcussion and 5 to 7 days postconcussion. The ImPACT neurocognitive assessment consists of 6 modules, yielding 4 composite scores: verbal memory, visual memory, visual-motor processing speed, and reaction time. In addition, it includes a postconcussion symptom scale total score. RESULTS Results revealed that participants with reports of dizziness and imbalance had significantly lower scores on the ImPACT composite scores; however, these individuals also had an overall higher symptom inventory. When accounting for the additional postconcussion symptoms, time was the only significant effect. CONCLUSION Dizziness and imbalance are common symptoms postconcussion; however, these symptoms did not predict performance on acute ImPACT scores. Further research is needed to understand the mechanisms causing postconcussion symptoms, including symptoms of dizziness and imbalance, and influence on outcomes postconcussion.
Collapse
|
41
|
Abstract
Mild traumatic brain injury (TBI) is common but accurate diagnosis and defining criteria for mild TBI and its clinical consequences have been problematic. Mild TBI causes transient neurophysiologic brain dysfunction, sometimes with structural axonal and neuronal damage. Biomarkers, such as newer imaging technologies and protein markers, are promising indicators of brain injury but are not ready for clinical use. Diagnosis relies on clinical criteria regarding depth and duration of impaired consciousness and amnesia. These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals. The clinical consequences of mild TBI can be conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms that might be termed early phase post-traumatic disorder (e.g., headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition), that typically resolve in days to weeks and are largely related to brain trauma and concomitant injuries; (2) a later set of symptoms, a late phase post-traumatic disorder, evolving out of the early phase in a minority of patients, with a more prolonged (months to years), sometimes worsening set of somatic, emotional, and cognitive symptoms. The later phase disorder is highly influenced by a variety of psychosocial factors and has little specificity for brain injury, although a history of multiple concussions seems to increase the risk of more severe and longer duration symptoms. Effective early phase management may prevent or limit the later phase disorder and should include education about symptoms and expectations for recovery, as well as recommendations for activity modifications. Later phase treatment should be informed by thoughtful differential diagnosis and the multiplicity of premorbid and comorbid conditions that may influence symptoms. Treatment should incorporate a hierarchical, sequential approach to symptom management, prioritizing problems with significant functional impact and effective, available interventions (e.g., headache, depression, anxiety, insomnia, vertigo).
Collapse
Affiliation(s)
- Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Acquired Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA, USA.
| | - Sara I Cohen
- Acquired Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA, USA; Department of Physical Medicine and Rehabilitation, Tufts Medical School, Boston, MA, USA
| | - Michael P Alexander
- Concussion/TBI Program, Beth Israel Deaconess Medical Center, Boston, MA, USA; Spaulding Hospital Cambridge, Cambridge, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
42
|
Tator CH, Davis H. The Postconcussion Syndrome in Sports and Recreation. Neurosurgery 2014; 75 Suppl 4:S106-12. [DOI: 10.1227/neu.0000000000000484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
43
|
Anxiety sensitivity and alexithymia as mediators of postconcussion syndrome following mild traumatic brain injury. J Head Trauma Rehabil 2014; 29:E9-E17. [PMID: 23381020 DOI: 10.1097/htr.0b013e31827eabba] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the influence of anxiety sensitivity (AS) and alexithymia as potential mediators for the development of psychological distress and postconcussion syndrome after mild traumatic brain injury (mTBI). PARTICIPANTS Sixty-one patients with mTBI assessed at a mean of 2.38 weeks after injury and demographically matched healthy controls (n = 61). MEASURES Twenty-item Toronto Alexithymia Scale, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Rivermead Post Concussion Questionnaire. RESULTS The mTBI group reported significantly higher levels of AS, alexithymia, psychological distress, and postconcussion (PC) symptom scores than controls. High AS and alexithymia in the mTBI group were associated with a greater number of PC symptoms and higher levels of psychological distress than patients scoring low on these measures and controls. In the mTBI group, a combination of AS and low mood explained 52.6% of the variance in PC symptom reporting. A combination of trait-anxiety, alexithymia, and PC symptoms explained 77.2% of the variance in levels of mood. CONCLUSION A combination of low mood and high AS may act as a psychological diathesis for the development of persisting PC symptoms. Early identification could provide a focus for early intervention to prevent the development of postconcussion syndrome after mTBI.
Collapse
|
44
|
Huang MX, Nichols S, Baker DG, Robb A, Angeles A, Yurgil KA, Drake A, Levy M, Song T, McLay R, Theilmann RJ, Diwakar M, Risbrough VB, Ji Z, Huang CW, Chang DG, Harrington DL, Muzzatti L, Canive JM, Christopher Edgar J, Chen YH, Lee RR. Single-subject-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mild traumatic brain injury. NEUROIMAGE-CLINICAL 2014; 5:109-19. [PMID: 25009772 PMCID: PMC4087185 DOI: 10.1016/j.nicl.2014.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 01/13/2023]
Abstract
Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild TBI (mTBI) can be difficult to detect using conventional MRI or CT. Injured brain tissues in mTBI patients generate abnormal slow-waves (1–4 Hz) that can be measured and localized by resting-state magnetoencephalography (MEG). In this study, we develop a voxel-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mTBI on a single-subject basis. A normative database of resting-state MEG source magnitude images (1–4 Hz) from 79 healthy control subjects was established for all brain voxels. The high-resolution MEG source magnitude images were obtained by our recent Fast-VESTAL method. In 84 mTBI patients with persistent post-concussive symptoms (36 from blasts, and 48 from non-blast causes), our method detected abnormalities at the positive detection rates of 84.5%, 86.1%, and 83.3% for the combined (blast-induced plus with non-blast causes), blast, and non-blast mTBI groups, respectively. We found that prefrontal, posterior parietal, inferior temporal, hippocampus, and cerebella areas were particularly vulnerable to head trauma. The result also showed that MEG slow-wave generation in prefrontal areas positively correlated with personality change, trouble concentrating, affective lability, and depression symptoms. Discussion is provided regarding the neuronal mechanisms of MEG slow-wave generation due to deafferentation caused by axonal injury and/or blockages/limitations of cholinergic transmission in TBI. This study provides an effective way for using MEG slow-wave source imaging to localize affected areas and supports MEG as a tool for assisting the diagnosis of mTBI. A voxel-based whole-brain MEG slow-wave source imaging method for mild TBI. The new approach showed 84.5% positive detection rate in 84 mild TBI patients. The new approach detected loci of injury in mild TBI patients on a single-subject basis. MEG slow-wave source imaging revealed brain areas vulnerable to mild TBI. MEG slow-wave generations correlated with mild TBI symptoms.
Collapse
Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Ashley Robb
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Annemarie Angeles
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Michael Levy
- Rady Children's Hospital San Diego, University of California, San Diego, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Robert McLay
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Mithun Diwakar
- Department of Radiology, University of California, San Diego, CA, USA
| | - Victoria B Risbrough
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Psychiatry, University of California, San Diego, CA, USA ; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Douglas G Chang
- Department of Orthopaedics, University of California, San Diego, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| | - Laura Muzzatti
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jose M Canive
- Psychiatry Research, New Mexico VA Healthcare System, Albuquerque, NM, USA ; Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA
| | - J Christopher Edgar
- The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Yu-Han Chen
- Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque, NM, USA ; The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA ; Department of Radiology, University of California, San Diego, CA, USA
| |
Collapse
|
45
|
Naeser MA, Zafonte R, Krengel MH, Martin PI, Frazier J, Hamblin MR, Knight JA, Meehan WP, Baker EH. Significant improvements in cognitive performance post-transcranial, red/near-infrared light-emitting diode treatments in chronic, mild traumatic brain injury: open-protocol study. J Neurotrauma 2014; 31:1008-17. [PMID: 24568233 DOI: 10.1089/neu.2013.3244] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This pilot, open-protocol study examined whether scalp application of red and near-infrared (NIR) light-emitting diodes (LED) could improve cognition in patients with chronic, mild traumatic brain injury (mTBI). Application of red/NIR light improves mitochondrial function (especially in hypoxic/compromised cells) promoting increased adenosine triphosphate (ATP) important for cellular metabolism. Nitric oxide is released locally, increasing regional cerebral blood flow. LED therapy is noninvasive, painless, and non-thermal (cleared by the United States Food and Drug Administration [FDA], an insignificant risk device). Eleven chronic, mTBI participants (26-62 years of age, 6 males) with nonpenetrating brain injury and persistent cognitive dysfunction were treated for 18 outpatient sessions (Monday, Wednesday, Friday, for 6 weeks), starting at 10 months to 8 years post- mTBI (motor vehicle accident [MVA] or sports-related; and one participant, improvised explosive device [IED] blast injury). Four had a history of multiple concussions. Each LED cluster head (5.35 cm diameter, 500 mW, 22.2 mW/cm(2)) was applied for 10 min to each of 11 scalp placements (13 J/cm(2)). LEDs were placed on the midline from front-to-back hairline; and bilaterally on frontal, parietal, and temporal areas. Neuropsychological testing was performed pre-LED, and at 1 week, and 1 and 2 months after the 18th treatment. A significant linear trend was observed for the effect of LED treatment over time for the Stroop test for Executive Function, Trial 3 inhibition (p=0.004); Stroop, Trial 4 inhibition switching (p=0.003); California Verbal Learning Test (CVLT)-II, Total Trials 1-5 (p=0.003); and CVLT-II, Long Delay Free Recall (p=0.006). Participants reported improved sleep, and fewer post-traumatic stress disorder (PTSD) symptoms, if present. Participants and family reported better ability to perform social, interpersonal, and occupational functions. These open-protocol data suggest that placebo-controlled studies are warranted.
Collapse
|
46
|
Yang CC, Yuen KM, Huang SJ, Hsiao SH, Tsai YH, Lin WC. “Good-old-days” bias: A prospective follow-up study to examine the preinjury supernormal status in patients with mild traumatic brain injury. J Clin Exp Neuropsychol 2014; 36:399-409. [DOI: 10.1080/13803395.2014.903899] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
47
|
Huang EYK, Tsui PF, Kuo TT, Tsai JJ, Chou YC, Ma HI, Chiang YH, Chen YH. Amantadine ameliorates dopamine-releasing deficits and behavioral deficits in rats after fluid percussion injury. PLoS One 2014; 9:e86354. [PMID: 24497943 PMCID: PMC3907421 DOI: 10.1371/journal.pone.0086354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/08/2013] [Indexed: 12/22/2022] Open
Abstract
Aims To investigate the role of dopamine in cognitive and motor learning skill deficits after a traumatic brain injury (TBI), we investigated dopamine release and behavioral changes at a series of time points after fluid percussion injury, and explored the potential of amantadine hydrochloride as a chronic treatment to provide behavioral recovery. Materials and Methods In this study, we sequentially investigated dopamine release at the striatum and behavioral changes at 1, 2, 4, 6, and 8 weeks after fluid percussion injury. Rats subjected to 6-Pa cerebral cortical fluid percussion injury were treated by using subcutaneous infusion pumps filled with either saline (sham group) or amantadine hydrochloride, with a releasing rate of 3.6mg/kg/hour for 8 weeks. The dopamine-releasing conditions and metabolism were analyzed sequentially by fast scan cyclic voltammetry (FSCV) and high-pressure liquid chromatography (HPLC). Novel object recognition (NOR) and fixed-speed rotarod (FSRR) behavioral tests were used to determine treatment effects on cognitive and motor deficits after injury. Results Sequential dopamine-release deficits were revealed in 6-Pa-fluid-percussion cerebral cortical injured animals. The reuptake rate (tau value) of dopamine in injured animals was prolonged, but the tau value became close to the value for the control group after amantadine therapy. Cognitive and motor learning impairments were shown evidenced by the NOR and FSRR behavioral tests after injury. Chronic amantadine therapy reversed dopamine-release deficits, and behavioral impairment after fluid percussion injuries were ameliorated in the rats treated by using amantadine-pumping infusion. Conclusion Chronic treatment with amantadine hydrochloride can ameliorate dopamine-release deficits as well as cognitive and motor deficits caused by cerebral fluid-percussion injury.
Collapse
Affiliation(s)
| | - Pi-Fen Tsui
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Jing-Jr. Tsai
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, the PhD Program for Neural Regenerative Medicine, Graduate Institute of Neural Regenerative Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
48
|
Wäljas M, Lange RT, Hakulinen U, Huhtala H, Dastidar P, Hartikainen K, Öhman J, Iverson GL. Biopsychosocial Outcome after Uncomplicated Mild Traumatic Brain Injury. J Neurotrauma 2014; 31:108-24. [DOI: 10.1089/neu.2013.2941] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Minna Wäljas
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
- University of Tampere Medical School, Tampere, Finland
| | - Rael T. Lange
- University of British Columbia, Vancouver, Canada
- Defense and Veterans Brain Injury Center, North Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ullamari Hakulinen
- Department of Radiology, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
- Department of Electronics and Communications Engineering, Tampere University of Technology, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Prasun Dastidar
- University of Tampere Medical School, Tampere, Finland
- Department of Radiology, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
| | - Kaisa Hartikainen
- Behavioral Neurology Research Unit, Pirkanmaa Hospital District, Tampere, Finland
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
- University of Tampere Medical School, Tampere, Finland
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
| |
Collapse
|
49
|
Carone DA. Young Child With Severe Brain Volume Loss Easily Passes the Word Memory Test and Medical Symptom Validity Test: Implications for Mild TBI. Clin Neuropsychol 2013; 28:146-62. [DOI: 10.1080/13854046.2013.861019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
50
|
Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PLoS One 2013; 8:e79995. [PMID: 24260334 PMCID: PMC3829860 DOI: 10.1371/journal.pone.0079995] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022] Open
Abstract
Background Traumatic brain injury (TBI) is the leading cause of death and disability in the US. Approximately 70-90% of the TBI cases are classified as mild, and up to 25% of them will not recover and suffer chronic neurocognitive impairments. The main pathology in these cases involves diffuse brain injuries, which are hard to detect by anatomical imaging yet noticeable in metabolic imaging. The current study tested the effectiveness of Hyperbaric Oxygen Therapy (HBOT) in improving brain function and quality of life in mTBI patients suffering chronic neurocognitive impairments. Methods and Findings The trial population included 56 mTBI patients 1–5 years after injury with prolonged post-concussion syndrome (PCS). The HBOT effect was evaluated by means of prospective, randomized, crossover controlled trial: the patients were randomly assigned to treated or crossover groups. Patients in the treated group were evaluated at baseline and following 40 HBOT sessions; patients in the crossover group were evaluated three times: at baseline, following a 2-month control period of no treatment, and following subsequent 2-months of 40 HBOT sessions. The HBOT protocol included 40 treatment sessions (5 days/week), 60 minutes each, with 100% oxygen at 1.5 ATA. “Mindstreams” was used for cognitive evaluations, quality of life (QOL) was evaluated by the EQ-5D, and changes in brain activity were assessed by SPECT imaging. Significant improvements were demonstrated in cognitive function and QOL in both groups following HBOT but no significant improvement was observed following the control period. SPECT imaging revealed elevated brain activity in good agreement with the cognitive improvements. Conclusions HBOT can induce neuroplasticity leading to repair of chronically impaired brain functions and improved quality of life in mTBI patients with prolonged PCS at late chronic stage. Trial Registration ClinicalTrials.gov NCT00715052
Collapse
|