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Cunningham HA, Dovek L, Recoder N, Bryant-Ekstrand MD, Ligman BR, Piantino J, Lim MM, Elliott JE. Heart rate variability impairment during sleep in Veterans with REM sleep behavior disorder, traumatic brain injury, and posttraumatic stress disorder: An early potential window into autonomic dysfunction? BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.20.614142. [PMID: 39386663 PMCID: PMC11463592 DOI: 10.1101/2024.09.20.614142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Individuals with comorbid REM sleep behavior disorder (RBD) and neurotrauma (defined by traumatic brain injury and post-traumatic stress disorder) have an earlier age of RBD symptom onset, increased RBD-related symptom severity and more neurological features indicative of prodromal synucleinopathy compared to RBD only. An early sign of neurodegenerative condition is autonomic dysfunction, which we sought to evaluate by examining heart rate variability during sleep. Participants with overnight polysomnography were recruited from the VA Portland Health Care System. Veterans without neurotrauma or RBD (controls; n=19), with RBD only (RBD, n=14), and with RBD and neurotrauma (RBD+NT, n=19) were evaluated. Eligible 5-minute NREM and REM epochs without apneas/hypopneas, microarousals, and ectopic beats were analyzed for frequency and time domain (e.g. low frequency power, LF; high frequency power, HF; root mean square of successive RR intervals, RMSSD; % of RR intervals that vary ≥50 ms, pNN50) heart rate variability outcomes. Heart rate did not significantly differ between groups in any sleep stage. Time domain and frequency domain variables (e.g., LF power, HF power, RMSSD, and pNN50) were significantly reduced in the RBD and RBD+NT groups compared to controls and RBD only during NREM sleep. There were no group differences detected during REM sleep. These data suggest significant reductions in heart rate variability during NREM sleep in RBD+NT participants, suggesting greater autonomic dysfunction compared to controls or RBD alone. Heart rate variability during sleep may be an early, promising biomarker, yielding mechanistic insight for diagnosis and prognosis of early neurodegeneration in this vulnerable population. STATEMENT OF SIGNIFICANCE Comorbid REM sleep behavior disorder (RBD) and neurotrauma (NT, traumatic brain injury + post-traumatic stress disorder; RBD+NT) is associated with increased neurodegenerative symptom burden and worsened health. Sleep and autonomic function are integrally and bidirectionally related to neurodegenerative processes. In the current study, we sought to determine if early signs of autonomic dysfunction, measured via heart rate variability (HRV), were present during sleep in comorbid RBD+NT compared to RBD only and controls. Our data show reduced time and frequency domain HRV during NREM sleep in RBD+NT Veterans compared to RBD only and controls. These data contribute evidence that participants with RBD and comorbid NT demonstrate significantly worse autonomic dysfunction compared to age/sex matched participants with RBD alone.
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Mendez M, Logan J, Filipčíková M, McDonald S, Wearne T. Disinhibition, rather than moderate-to-severe traumatic brain injury, moderates the impact of anger provocation on subjective emotional experience. Clin Neuropsychol 2024:1-21. [PMID: 39318118 DOI: 10.1080/13854046.2024.2406042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE Altered reactivity to emotional stimuli is common after traumatic brain injury (TBI), which is suggested to reflect difficulties with emotion regulation. While disinhibition is common after moderate-to-severe TBI, limited research has investigated the link between disinhibition and emotional reactivity in this clinical group. The aim of this research, therefore, was to investigate the relationship between disinhibition and TBI to anger provocation. METHOD Thirty-five individuals with moderate-to-severe TBI and thirty-one controls completed an anger induction task. Participants rated their experience of emotions and subjective arousal before and after the induction. Heart rate, respiration and skin conductance were also measured. Disinhibition was measured using the Frontal Systems Behavior Scale. RESULTS In the full sample, the mood induction led to increased skin conductance, respiration, and self-reported anger, tension, arousal and negative mood. There were no differences between those with TBI and controls. Disinhibition interacted with the impact of anger provocation on subjective, but not objective, outcomes such that those elevated in disinhibition reported increased feelings of anger and tension in response to the mood induction. Disinhibition did not interact with TBI across any subjective and objective emotional measures examined in response to mood induction. CONCLUSIONS While anger causes emotional changes for all individuals, these changes are particularly pronounced among those who are disinhibited, irrespective of whether an individual has sustained a TBI. This is an important consideration when examining emotional regulation post-TBI as the degree of disinhibition appears to alter subjective interpretations of emotional events, which could lead to emotion dysregulation.
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Affiliation(s)
- Michelle Mendez
- School of Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Jodie Logan
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | | | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Travis Wearne
- School of Psychology, Western Sydney University, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, NSW, Australia
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Talbert LD, Kaelberer Z, Gleave E, Driggs A, Driggs AS, Baldwin SA, Steffen PR, Larson MJ. A Systematic Review of the Relationship Between Traumatic Brain Injury and Disruptions in Heart Rate Variability. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09663-0. [PMID: 39222209 DOI: 10.1007/s10484-024-09663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
Autonomic nervous system dysfunction is increasingly recognized as a common sequela of traumatic brain injury (TBI). Heart rate variability (HRV) is a specific measure of autonomic nervous system functioning that can be used to measure beat-to-beat changes in heart rate following TBI. The objective of this systematic review was to determine the state of the literature on HRV dysfunction following TBI, assess the level of support for HRV dysfunction following TBI, and determine if HRV dysfunction predicts mortality and the severity and subsequent recovery of TBI symptoms. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two raters coded each article and provided quality ratings with discrepancies resolved by consensus. Eighty-nine papers met the inclusion criteria. Findings indicated that TBI of any severity is associated with decreased (i.e., worse) HRV; the severity of TBI appears to moderate the relationship between HRV and recovery; decreased HRV following TBI predicts mortality beyond age; HRV disturbances may persist beyond return-to-play and symptom resolution following mild TBI. Overall, current literature suggests HRV is decreased following TBI and may be a good indicator of physiological change and predictor of important outcomes including mortality and symptom improvement following TBI.
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Affiliation(s)
- Leah D Talbert
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA.
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Zoey Kaelberer
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Emma Gleave
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Annie Driggs
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Ammon S Driggs
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Scott A Baldwin
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Patrick R Steffen
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
| | - Michael J Larson
- Department of Psychology, Brigham Young University, Provo, UT, 244 TLRB84602, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
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Ediga PK, Saradhi MV, Alugolu R, Maddury J. Correlation of head injury with ECG and echo changes. Surg Neurol Int 2024; 15:296. [PMID: 39246793 PMCID: PMC11380885 DOI: 10.25259/sni_559_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2024] [Indexed: 09/10/2024] Open
Abstract
Background Abnormal electrocardiogram (ECG) findings can be seen in traumatic brain injury (TBI) patients. ECG may be an inexpensive tool to identify patients at high risk for developing cardiac dysfunction after TBI. This study aimed to examine abnormal ECG findings after isolated TBI and their association with true cardiac dysfunction based on echocardiogram. Methods This prospective observational study examined the data from adult patients with isolated and non-operated TBI between 2020 and 2021. Patients aged <18 years and >65 years with and presence of extracranial injuries including orthopedic, chest, cardiac, abdominal, and pelvis, pre-existing cardiac disease, patients who have undergone cardiothoracic surgery, with inotrope drugs, acute hemorrhage, and brain death were excluded from the study. Results We examined data from 100 patients with isolated TBI who underwent ECG and echocardiographic evaluation. ECG changes among 53% of mild cases showed a heart rate of 60-100/min, and 2% of cases showed more than 100/min. Prolonged pulse rate (PR) interval was observed in 8%, 11%, and 16% of mild, moderate, and severe cases, while no changes in PR interval were observed in 65% of cases. A prolonged QRS pattern was observed in 5%, 7%, and 15% of mild, moderate, and severe cases. A normal QRS complex was observed in 71% of cases. Prolonged QTc was observed in 3%, 10%, and 15% of cases in mild, moderate, and severe cases, respectively. Conclusion Repolarization abnormalities, but not ischemic-like ECG changes, are associated with cardiac dysfunction after isolated TBI. 12-lead ECG may be an inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction.
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Affiliation(s)
| | | | - Rajesh Alugolu
- Department of Cardiology, NIMS, Hyderabad, Telangana, India
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Pinto SM, Wright B, Annaswamy S, Nwana O, Nguyen M, Wilmoth K, Moralez G. Heart rate variability (HRV) after traumatic brain injury (TBI): a scoping review. Brain Inj 2024; 38:585-606. [PMID: 38590161 DOI: 10.1080/02699052.2024.2328310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Heart rate variability (HRV), defined as the variability between successive heart beats, is a noninvasive measure of autonomic nervous system (ANS) function, which may be altered following traumatic brain injury (TBI). This scoping review summarizes the existing literature regarding changes in HRV after TBI as well as the association between measures of HRV and outcomes following TBI. METHODS A literature search for articles assessing 'heart rate variability' and 'brain injury' or 'concussion' was completed. Articles were included if HRV was measured in human subjects with TBI or concussion. Review articles, protocol papers, and studies including non-traumatic injuries were excluded. RESULTS Sixty-three articles were included in this review. Varied methods were used to measure HRV in the different studies. Forty articles included information about differences in HRV measures after TBI and/or longitudinal changes after TBI. Fifteen studies assessed HRV and symptoms following TBI, and 15 studies assessed HRV and either functional or cognitive outcomes after TBI. CONCLUSIONS HRV has been studied in the context of mortality, clinical symptoms, and medical, functional, or cognitive outcomes following TBI. Methods used to measure HRV have varied amongst the different studies, which may impact findings, standardized protocols are needed for future research.
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Affiliation(s)
- Shanti M Pinto
- Department of Physical Medicine and Rehabilitation, O'Donnell Brain Institute Clinical Neuroscience Scholar, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brittany Wright
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shreyas Annaswamy
- National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - Ola Nwana
- Department of Neurology, Houston Methodist Neuroscience Center Team at Willowbrook, Houston, Texas, USA
| | - Michael Nguyen
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Brain Injury and Stroke Medicine, TIRR Memorial Hermann, Houston, Texas, USA
| | - Kristin Wilmoth
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gilbert Moralez
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sirant LW, Singh J, Martin S, Gaul CA, Stuart-Hill L, Candow DG, Mang C, Patrick Neary J. Long-term effects of multiple concussions on prefrontal cortex oxygenation during a hypercapnic challenge in retired contact sport athletes. Brain Res 2024; 1826:148735. [PMID: 38110074 DOI: 10.1016/j.brainres.2023.148735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023]
Abstract
This exploratory study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a five-minute hypercapnic challenge using Near Infrared Spectroscopy (NIRS). 55 physically active retired contact sport male athletes with three or more previous concussions (mTBI) were recruited along with 29 physically active males with no concussions history (CTRL). Participants completed five minutes of seated rest prior to the five-minute hypercapnic challenge (20-second breath-hold, 40-second recovery breathing; five times). NIRS measured right and left side oxygenated (O2Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) with all parameters analysed through changes in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations. Right prefrontal cortex HbDiff ΔMAX was significantly higher in the mTBI compared to CTRL (p = 0.045) group. Left prefrontal cortex O2Hb ΔMAX (p = 0.040), HHb Z-Scores (p = 0.008), and HbDiff ΔMAX(p = 0.014) were significantly higher in the mTBI group. Within-group right vs left analyses demonstrated significantly lower left HbDiff ΔMAX (p = 0.048) and HbDiff Z-scores (p = 0.002) in the mTBI group, while the CTRL group had significantly lower left HHb Z-scores (p = 0.003) and left tHb Z-scores (p = 0.042). This study provides preliminary evidence that athletes with a history of three or more concussions may have impaired prefrontal cortex oxygenation parameters during a hypercapnic challenge.
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Affiliation(s)
- Luke W Sirant
- University of Regina, Faculty of Kinesiology and Health Studies, Regina, SK, Canada
| | - Jyotpal Singh
- University of Regina, Faculty of Kinesiology and Health Studies, Regina, SK, Canada
| | - Steve Martin
- University of Victoria, School of Exercise Science, Physical and Health Education, Victoria, BC, Canada
| | - Catherine A Gaul
- University of Victoria, School of Exercise Science, Physical and Health Education, Victoria, BC, Canada
| | - Lynneth Stuart-Hill
- University of Victoria, School of Exercise Science, Physical and Health Education, Victoria, BC, Canada
| | - Darren G Candow
- University of Regina, Faculty of Kinesiology and Health Studies, Regina, SK, Canada
| | - Cameron Mang
- University of Regina, Faculty of Kinesiology and Health Studies, Regina, SK, Canada
| | - J Patrick Neary
- University of Regina, Faculty of Kinesiology and Health Studies, Regina, SK, Canada.
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Ostergaard JR. Treatment of non-epileptic episodes of anxious, fearful behavior in adolescent juvenile neuronal ceroid lipofuscinosis (CLN3 disease). Front Neurol 2023; 14:1216861. [PMID: 37771451 PMCID: PMC10523314 DOI: 10.3389/fneur.2023.1216861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Recurrent non-epileptic episodes of frightened facial and body expression occur in more than half of post-adolescent patients with juvenile neuronal ceroid lipofuscinosis (JNCL, CLN3 disease). Clinically, the episodes look similar to the attacks of paroxysmal sympathetic hyperactivity (PSH) commonly seen following traumatic brain injury (TBI). The episodes occur when the patients are exposed to separation, hear loud sounds or are otherwise bothered by discomfort and as in PSH following TBI, the attacks are difficult to prevent and/or treat. Aim and methods Based on present knowledge of triggering factors, the neural anxiety/fear circuit, its afferent and efferent pathways and documented CLN3 disease-impact on these tracks, the current study discusses a rational approach how to prevent and/or treat the attacks. Results Patients with JNCL have a disturbed somatosensory modulation leading to a reduced threshold of pain; a degeneration within the neural anxiety/fear circuit leading to an imbalance of central network inhibition and excitation pathways; and finally, an, with advancing age, increasing autonomic imbalance leading to a significant dominance of the sympathetic neural system. Discussion Theoretically, there are three points of attack how to prevent or treat the episodes: (1) increase in threshold of discomfort impact; (2) modulation of imbalance of central network inhibition and excitation, and (3) restoring the balance between the sympathetic and parasympathetic neural systems prompted by a parasympathetic withdrawal. As to (1) and (2), prevention should have the greatest priority. As regards (3), research of transcutaneous vagal stimulation treatment in JNCL is warranted.
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Affiliation(s)
- John R. Ostergaard
- Department of Child and Adolescence, Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
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Sarah A, Ownsworth T, Clough B, Neumann DL. Impairments in Physiological Reactivity to Emotive Stimuli After Traumatic Brain Injury: A Systematic Review of Skin Conductance and Heart Rate Variability Evidence. J Head Trauma Rehabil 2023; 38:214-230. [PMID: 35862893 DOI: 10.1097/htr.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine evidence of impairments in physiological reactivity to emotive stimuli following traumatic brain injury (TBI). METHODS A search of PsychINFO, CINAHL (Cumulative Index to Allied Health Literature), Web of Science, EMBASE (Excerpta Medica dataBASE), and Scopus databases was conducted from 1991 to June 24, 2021, for studies comparing changes in skin conductance or heart rate variability to emotive stimuli between adults with TBI and controls. Two reviewers independently assessed eligibility and rated methodological quality. RESULTS Twelve eligible studies examined physiological reactivity to laboratory-based emotive stimuli, which included nonpersonal pictures/videos, posed emotion, stressful events, and personal event recall. Overall, 9 reported evidence that individuals with TBI experience lower physiological reactivity to emotive stimuli compared with healthy controls, although the findings varied according to the type and valence of emotional stimuli and physiological parameter. Most studies using nonpersonal pictures or videos found evidence of lower physiological reactivity in TBI participants compared with controls. CONCLUSIONS Based on laboratory-based studies, individuals with TBI may experience lower physiological reactivity to emotive stimuli. Further research is needed to investigate physiological responses to personally relevant emotional stimuli in real-world settings and to understand the interplay between physiological reactivity, subjective experiences, and behavior.
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Affiliation(s)
- Alysha Sarah
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia (Ms Sarah and Drs Ownsworth, Clough, and Neumann); and The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Nathan, Australia (Ms Sarah and Dr Ownsworth)
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Abstract
OBJECTIVE Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning. METHOD In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests. RESULTS In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments. CONCLUSION We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of Western Sydney, Penrith South, Australia
| | - Michelle Kelly
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
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Liuzzi P, Campagnini S, Hakiki B, Burali R, Scarpino M, Macchi C, Cecchi F, Mannini A, Grippo A. Heart rate variability for the evaluation of patients with disorders of consciousness. Clin Neurophysiol 2023; 150:31-39. [PMID: 37002978 DOI: 10.1016/j.clinph.2023.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/12/2022] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Clinical responsiveness of patients with a Disorder of Consciousness (DoC) correlates to sympathetic/parasympathetic homeostatic balance. Heart Rate Variability (HRV) metrics result in non-invasive proxies of modulation capabilities of visceral states. In this work, our aim was to evaluate whether HRV measures could improve the differential diagnosis between Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS) with respect to multivariate models based on standard clinical electroencephalography (EEG) labeling only in a rehabilitation setting. METHODS A prospective observational study was performed consecutively enrolling 82 DoC patients. Polygraphic recordings were performed. HRV-metrics and EEG descriptors derived from the American Clinical Neurophysiology Society's Standardized Critical Care terminology were included. Descriptors entered univariate and then multivariate logistic regressions with the target set to the UWS/MCS diagnosis. RESULTS HRV measures resulted significantly different between UWS and MCS patients, with higher values being associated with better consciousness levels. Specifically, adding HRV-related metrics to ACNS EEG descriptors increased the Nagelkerke R2 from 0.350 (only EEG descriptors) to 0.565 (HRV-EEG combination) with the outcome set to the consciousness diagnosis. CONCLUSIONS HRV changes across the lowest states of consciousness. Rapid changes in heart rate, occurring in better consciousness levels, confirm the mutual correlation between visceral state functioning patterns and consciousness alterations. SIGNIFICANCE Quantitative analysis of heart rate in patients with a DoC paves the way for the implementation of low-cost pipelines supporting medical decisions within multimodal consciousness assessments.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy; Scuola Superiore Sant'Anna, Istituto di BioRobotica, Pontedera, Viale Rinaldo Piaggio 34, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy; Scuola Superiore Sant'Anna, Istituto di BioRobotica, Pontedera, Viale Rinaldo Piaggio 34, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy.
| | - Rachele Burali
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy; Università di Firenze, Dipartimento di Medicina Sperimentale e Clinica, Firenze, Largo Brambilla 3, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy; Università di Firenze, Dipartimento di Medicina Sperimentale e Clinica, Firenze, Largo Brambilla 3, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Via di Scandicci 269, Italy
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Liuzzi P, Grippo A, Draghi F, Hakiki B, Macchi C, Cecchi F, Mannini A. Can Respiration Complexity Help the Diagnosis of Disorders of Consciousness in Rehabilitation? Diagnostics (Basel) 2023; 13:diagnostics13030507. [PMID: 36766612 PMCID: PMC9914359 DOI: 10.3390/diagnostics13030507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Autonomic Nervous System (ANS) activity, as cardiac, respiratory and electrodermal activity, has been shown to provide specific information on different consciousness states. Respiration rates (RRs) are considered indicators of ANS activity and breathing patterns are currently already included in the evaluation of patients in critical care. OBJECTIVE The aim of this work was to derive a proxy of autonomic functions via the RR variability and compare its diagnostic capability with known neurophysiological biomarkers of consciousness. METHODS In a cohort of sub-acute patients with brain injury during post-acute rehabilitation, polygraphy (ECG, EEG) recordings were collected. The EEG was labeled via descriptors based on American Clinical Neurophysiology Society terminology and the respiration variability was extracted by computing the Approximate Entropy (ApEN) of the ECG-derived respiration signal. Competing logistic regressions were applied to evaluate the improvement in model performances introduced by the RR ApEN. RESULTS Higher RR complexity was significantly associated with higher consciousness levels and improved diagnostic models' performances in contrast to the ones built with only electroencephalographic descriptors. CONCLUSIONS Adding a quantitative, instrumentally based complexity measure of RR variability to multimodal consciousness assessment protocols may improve diagnostic accuracy based only on electroencephalographic descriptors. Overall, this study promotes the integration of biomarkers derived from the central and the autonomous nervous system for the most comprehensive diagnosis of consciousness in a rehabilitation setting.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
- Istituto di BioRobotica, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
- Correspondence: ; Tel.: +39-333-401-8388
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
- Dipartimento di Medicina Sperimentale e Clinica, Universita di Firenze, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
- Istituto di BioRobotica, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
- Dipartimento di Medicina Sperimentale e Clinica, Universita di Firenze, Largo Brambilla 3, 50134 Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143 Firenze, Italy
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Ziadia H, Sassi I, Trudeau F, Fait P. Normative values of resting heart rate variability in young male contact sport athletes: Reference values for the assessment and treatment of concussion. Front Sports Act Living 2023; 4:730401. [PMID: 36699983 PMCID: PMC9869270 DOI: 10.3389/fspor.2022.730401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Objective The objective of this study was to identify the main determinants of heart rate variability (HRV) in male athletes aged 14 to 21 years who practice competitive contact sports and to integrate these determinants with the aim of defining normative values of short-term HRV in the time and frequency domains. Methods Participants (n = 369) were aged 14 to 21 years and included 221 football players and 148 ice hockey players. HRV was measured for 5 min at rest, and standard HRV parameters in the time and frequency domains were calculated. Heart rate (HR), age, body mass index (BMI), number of sports weekly practices (WSP) and concussion history (mTBI) were considered determinants potentially able to influence HRV. Results Multiple regression analysis revealed that HR was the primary determinant of standard HRV parameters. The models accounted for 13% to 55% of the total variance of HRV and the contribution of HR to this model was the strongest (β ranged from -0.34 to -0.75). HR was the only determinant that significantly contributes to all HRV parameters. To counteract this dependence, we calculated HRV corrected by the mean RR interval (RRm). Such corrections do not remove any physiological differences in HRV; they simply remove the mathematical bias. HRV parameters were therefore normalized, and their normative limits were developed relative to the mean heart rate. After correction, the correlation coefficients between HR and all corrected HRV parameters were not statistically significant and ranged from -0.001 to 0.045 (p > 0.40 for all). The automatically corrected HRV calculator, which recalculates standard HRV parameters and converts them into corrected parameters in addition to determining whether a given value is within normal limits, facilitates clinical interpretation. Conclusion This study provides for the first time corrected normative values of short-term and resting state HRV parameters in competitive contact sport athletes aged 14 to 21 years. These values were developed independently of the major determinants of HRV. The baseline values for HRV parameters given here could be used in clinical practice when assessing and monitoring cerebral concussions. They may assist in decision making for a safe return to play.
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Affiliation(s)
- Hatem Ziadia
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Correspondence: Hatem Ziadia
| | - Idriss Sassi
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Trudeau
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Philippe Fait
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Research Group on Neuromusculoskeletal Conditions (GRAN), Trois-rivieres, QC, Canada,Centre for Research in Neuropsychology and Cognition (CERNEC), Montreal, QC, Canada,Cortex Concussion Clinic, Quebec City, QC, Canada
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13
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Hendryckx C, Nalder E, Drake E, Leclaire É, Pituch E, Gouin-Vallerand C, Wang RH, Poulin V, Paquet V, Bottari C. Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions. J Rehabil Assist Technol Eng 2023; 10:20556683231191975. [PMID: 37614442 PMCID: PMC10443634 DOI: 10.1177/20556683231191975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.
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Affiliation(s)
- Charlotte Hendryckx
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Research Center from CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, QC, Canada
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Éliane Leclaire
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Evelina Pituch
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Charles Gouin-Vallerand
- Centre de Recherche Createch sur les Organisations Intelligentes, Université de Sherbrooke, Sherbrooke, QC, Canada
- DOMUS Laboratory, Université de Sherbrooke, Sherbrooke, QC, Canada
- University of Sherbrooke, Sherbrooke, QC, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Valérie Poulin
- Department Of Occupational therapy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, QC, Canada
| | - Virginie Paquet
- Bibliothèque Marguerite-D’Youville, Université de Montréal, Montréal, QC, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
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14
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Huerta de la Cruz S, Santiago-Castañeda CL, Rodríguez-Palma EJ, Medina-Terol GJ, López-Preza FI, Rocha L, Sánchez-López A, Freeman K, Centurión D. Targeting hydrogen sulfide and nitric oxide to repair cardiovascular injury after trauma. Nitric Oxide 2022; 129:82-101. [PMID: 36280191 PMCID: PMC10644383 DOI: 10.1016/j.niox.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
The systemic cardiovascular effects of major trauma, especially neurotrauma, contribute to death and permanent disability in trauma patients and treatments are needed to improve outcomes. In some trauma patients, dysfunction of the autonomic nervous system produces a state of adrenergic overstimulation, causing either a sustained elevation in catecholamines (sympathetic storm) or oscillating bursts of paroxysmal sympathetic hyperactivity. Trauma can also activate innate immune responses that release cytokines and damage-associated molecular patterns into the circulation. This combination of altered autonomic nervous system function and widespread systemic inflammation produces secondary cardiovascular injury, including hypertension, damage to cardiac tissue, vascular endothelial dysfunction, coagulopathy and multiorgan failure. The gasotransmitters nitric oxide (NO) and hydrogen sulfide (H2S) are small gaseous molecules with potent effects on vascular tone regulation. Exogenous NO (inhaled) has potential therapeutic benefit in cardio-cerebrovascular diseases, but limited data suggests potential efficacy in traumatic brain injury (TBI). H2S is a modulator of NO signaling and autonomic nervous system function that has also been used as a drug for cardio-cerebrovascular diseases. The inhaled gases NO and H2S are potential treatments to restore cardio-cerebrovascular function in the post-trauma period.
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Affiliation(s)
- Saúl Huerta de la Cruz
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico; Department of Pharmacology, University of Vermont, Burlington, VT, USA.
| | | | - Erick J Rodríguez-Palma
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, Sede Sur, Mexico City, Mexico.
| | | | | | - Luisa Rocha
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico.
| | | | - Kalev Freeman
- Department of Emergency Medicine, University of Vermont, Burlington, VT, USA.
| | - David Centurión
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico.
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15
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Lu VM, Kreuger E, Cordeiro JG, Niazi TN, Jagid JR, McCrea HJ. Clinical complications of surviving gunshot wounds to the head in children and adolescents: the Miami experience. Childs Nerv Syst 2022; 38:1735-1742. [PMID: 35606660 DOI: 10.1007/s00381-022-05558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gunshot wounds (GSWs) to the head in the pediatric population are both rare and devastating, with the clinical course of pediatric survivors poorly understood. Correspondingly, the aim of this study was to summarize the clinical complications clinicians can expect of survivors of GSW to the head in children and adolescents in hospital and after discharge. METHODS A retrospective review of our Level 1 trauma center database between 2011 and 2021 was performed. Clinical data was extracted for those patients aged ≤ 18 years old who survived initial hospitalization with at least one documented follow-up. Categorical data were then compared using Chi-squared test. RESULTS A total of 19 pediatric survivors of GSW to the head satisfied all selection criteria with an average age was 15.3 years. The majority of cases were isolated head injuries (63%), with an average Glasgow Coma Score (GCS) of 11.9. Bullet trajectory was intraparenchymal in 11 (58%) cases and extraparenchymal in 8 (42%) cases, with 15 (79%) patients treated by surgical intervention. A total of 13 (68%) patients experienced a complication during their hospitalization, with the most common being sympathetic hypertension and endocrinologic salt wasting, each occurring in 5 (26%) patients. With respect to complication categories, the intraparenchymal patients experienced statistically more complications than extraparenchymal patients that were infectious (54% vs 0%, P = 0.01) and sympathetic (45% vs 0%, P = 0.03) in nature. However, with respect to overall neurologic (P = 0.24), endocrinologic (P = 0.24), and traumatic (P = 0.24) complications, their incidences were statistically comparable. All patients were successfully discharged on average post-injury day 22 with an average GCS of 14.0. Mean follow-up for the cohort was 42.6 months, with an average GCS of 14.3. A total of 6 (32%) patients experienced a complication relatable to their initial GSW injury after discharge. The most common individual complication was new-onset seizures in 3 (16%) patients. CONCLUSIONS Survivors of pediatric GSW to the head can experience multi-systemic complications during both initial hospitalization and afterwards, and bullet trajectory involving the parenchyma may be associated with specific complications more than others. Dedicated inpatient management and outpatient follow-up involving surveillance for complications across all systems, not just neurological, are recommended to ensure patients receive the best care possible.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.
| | - Evan Kreuger
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Joacir G Cordeiro
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.,Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA
| | - Jonathan R Jagid
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Heather J McCrea
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.,Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA
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16
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Nabasny A, Rabinowitz A, Wright B, Wang J, Preminger S, Terhorst L, Juengst SB. Neurobehavioral Symptoms and Heart Rate Variability: Feasibility of Remote Collection Using Mobile Health Technology. J Head Trauma Rehabil 2022; 37:178-188. [PMID: 35125433 PMCID: PMC9203863 DOI: 10.1097/htr.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the covariance of heart rate variability (HRV) and self-reported neurobehavioral symptoms after traumatic brain injury (TBI) collected using mobile health (mHealth) technology. SETTING Community. PARTICIPANTS Adults with lifetime history of TBI (n = 52) and adults with no history of brain injury (n = 12). DESIGN Two-week prospective ecological momentary assessment study. MAIN MEASURES Behavioral Assessment Screening Tool (BASTmHealth) subscales (Negative Affect, Fatigue, Executive Dysfunction, Substance Abuse, and Impulsivity) measured frequency of neurobehavioral symptoms via a RedCap link sent by text message. Resting HRV (root mean square of successive R-R interval differences) was measured for 5 minutes every morning upon waking using a commercially available heart rate monitor (Polar H10, paired with Elite HRV app). RESULTS Data for n = 48 (n = 38 with TBI; n = 10 without TBI) participants were included in covariance analyses, with average cross-correlation coefficients (0-day lag) varying greatly across participants. We found that the presence and direction of the relationship between HRV and neurobehavioral symptoms varied from person to person. Cross-correlation coefficients r ≤ -0.30, observed in 27.1% to 29.2% of participants for Negative Affect, Executive Dysfunction, and Fatigue, 22.9% of participants for Impulsivity, and only 10.4% of participants for Substance Abuse, supported our hypothesis that lower HRV would covary with more frequent symptoms. However, we also found 2.0% to 20.8% of participants had positive cross-correlations (r ≥ 0.30) across all subscales, indicating that higher HRV may sometimes correlate with more neurobehavioral symptoms, and 54.2% to 87.5% had no significant cross-correlations. CONCLUSIONS It is generally feasible for community-dwelling adults with and without TBI to use a commercially available wearable device to capture daily HRV measures and to complete a short, electronic self-reported neurobehavioral symptom measure for a 2-week period. The covariance of HRV and neurobehavioral symptoms over time suggests that HRV could be used as a relevant physiological biomarker of neurobehavioral symptoms, though how it would be interpreted and used in practice would vary on a person-by-person and symptom domain basis and requires further study.
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Affiliation(s)
- Andrew Nabasny
- Departments of Applied Clinical Research (Mr Nabasny and Drs Wright, Wang, and Juengst) and Physical Medicine and Rehabilitation (Drs Wright and Juengst and Mr Preminger), University of Texas Southwestern Medical Center, Dallas; Moss Rehabilitation, Philadelphia, Pennsylvania (Dr Rabinowitz); and Department of Occupational Therapy, University of Pittsburgh, and Center for Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Terhorst)
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17
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Leveraging Continuous Vital Sign Measurements for Real-Time Assessment of Autonomic Nervous System Dysfunction After Brain Injury: A Narrative Review of Current and Future Applications. Neurocrit Care 2022; 37:206-219. [PMID: 35411542 DOI: 10.1007/s12028-022-01491-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
Subtle and profound changes in autonomic nervous system (ANS) function affecting sympathetic and parasympathetic homeostasis occur as a result of critical illness. Changes in ANS function are particularly salient in neurocritical illness, when direct structural and functional perturbations to autonomic network pathways occur and may herald impending clinical deterioration or intervenable evolving mechanisms of secondary injury. Sympathetic and parasympathetic balance can be measured quantitatively at the bedside using multiple methods, most readily by extracting data from electrocardiographic or photoplethysmography waveforms. Work from our group and others has demonstrated that data-analytic techniques can identify quantitative physiologic changes that precede clinical detection of meaningful events, and therefore may provide an important window for time-sensitive therapies. Here, we review data-analytic approaches to measuring ANS dysfunction from routine bedside physiologic data streams and integrating this data into multimodal machine learning-based model development to better understand phenotypical expression of pathophysiologic mechanisms and perhaps even serve as early detection signals. Attention will be given to examples from our work in acute traumatic brain injury on detection and monitoring of paroxysmal sympathetic hyperactivity and prediction of neurologic deterioration, and in large hemispheric infarction on prediction of malignant cerebral edema. We also discuss future clinical applications and data-analytic challenges and future directions.
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18
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Forstenpointner J, Elman I, Freeman R, Borsook D. The Omnipresence of Autonomic Modulation in Health and Disease. Prog Neurobiol 2022; 210:102218. [PMID: 35033599 DOI: 10.1016/j.pneurobio.2022.102218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
The Autonomic Nervous System (ANS) is a critical part of the homeostatic machinery with both central and peripheral components. However, little is known about the integration of these components and their joint role in the maintenance of health and in allostatic derailments leading to somatic and/or neuropsychiatric (co)morbidity. Based on a comprehensive literature search on the ANS neuroanatomy we dissect the complex integration of the ANS: (1) First we summarize Stress and Homeostatic Equilibrium - elucidating the responsivity of the ANS to stressors; (2) Second we describe the overall process of how the ANS is involved in Adaptation and Maladaptation to Stress; (3) In the third section the ANS is hierarchically partitioned into the peripheral/spinal, brainstem, subcortical and cortical components of the nervous system. We utilize this anatomical basis to define a model of autonomic integration. (4) Finally, we deploy the model to describe human ANS involvement in (a) Hypofunctional and (b) Hyperfunctional states providing examples in the healthy state and in clinical conditions.
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Affiliation(s)
- Julia Forstenpointner
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, SH, Germany.
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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19
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Jafari AA, Shah M, Mirmoeeni S, Hassani MS, Nazari S, Fielder T, Godoy DA, Seifi A. Paroxysmal sympathetic hyperactivity during traumatic brain injury. Clin Neurol Neurosurg 2021; 212:107081. [PMID: 34861468 DOI: 10.1016/j.clineuro.2021.107081] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of disability, morbidity, and mortality worldwide. Some of the more common etiologies of TBI include closed head injury, penetrating head injury, or an explosive blast head injury. Neuronal damage in TBI is related to both primary injury (caused by mechanical forces), and secondary injury (caused by the subsequent tissue and cellular damages). Recently, it has been well established that Paroxysmal Sympathetic Hyperactivity (PSH), also known as "Sympathetic Storm", is one of the main causes of secondary neuronal injury in TBI patients. The clinical manifestations of PSH include recurrent episodes of sympathetic hyperactivity characterized by tachycardia, systolic hypertension, hyperthermia, tachypnea with hyperpnea, and frank diaphoresis. Given the diverse manifestations of PSH and its notable impact on the outcome of TBI patients, we have comprehensively reviewed the current evidence and discussed the pathophysiology, clinical manifestations, time of onset and duration of PSH during TBI. This article reviews the different types of head injuries that most commonly lead to PSH, possible approaches to manage and minimize PSH complications in TBI and the current prognosis and outcomes of PSH in TBI patients.
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Affiliation(s)
- Amirhossein Azari Jafari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Muffaqam Shah
- Deccan College of Medical Sciences, Hyderabad, Telangana State, India
| | | | - Maryam Sadat Hassani
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahrzad Nazari
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tristan Fielder
- University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur; Hospital Carlos Malbran, Catamarca, Argentina
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA.
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20
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Wearne TA, Logan JA, Trimmer EM, Wilson E, Filipcikova M, Kornfeld E, Rushby JA, McDonald S. Regulating emotion following severe traumatic brain injury: a randomized controlled trial of heart-rate variability biofeedback training. Brain Inj 2021; 35:1390-1401. [PMID: 34487459 DOI: 10.1080/02699052.2021.1972337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND While difficulties regulating emotions are almost ubiquitous after traumatic brain injury (TBI), remediation techniques are limited. Heart-rate variability (HRV) is a physiological measure of emotion regulation and can be modified using biofeedback training. The aim of the current study was to evaluate the efficacy of repeated biofeedback training for improving emotion regulation difficulties following TBI. DESIGN Fifty adults with severe TBI were allocated to either biofeedback or waitlist conditions. Treatment consisted of six biofeedback sessions whereby participants were taught to breathe at their resonant frequency. Outcomes included changes in physiological and subjective reactivity to anger-induction, emotional well-being, and physiology at rest, together with symptoms of psychological distress and sleep disturbances (ACTRN12618002031246). RESULTS While biofeedback led to reduced skin conductance, it did not affect any other objective or subjective response to the mood induction procedure. Biofeedback led to fewer sleep disturbances, and reduced negative mood valence and depression during follow-up. CONCLUSIONS HRV biofeedback training is a feasible technique following TBI that transfers to improved symptoms of general emotional well-being, psychological distress, and sleep. Biofeedback does not transfer to a laboratory-based emotional provocation task. HRV biofeedback training may represent a novel adjunct for generalized emotional difficulties following injury.
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Affiliation(s)
- T A Wearne
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Logan
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E M Trimmer
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Wilson
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - M Filipcikova
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - E Kornfeld
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - J A Rushby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - S McDonald
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
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21
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Sabet N, Soltani Z, Khaksari M. Multipotential and systemic effects of traumatic brain injury. J Neuroimmunol 2021; 357:577619. [PMID: 34058510 DOI: 10.1016/j.jneuroim.2021.577619] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of disability and mortality of people at all ages. Biochemical, cellular and physiological events that occur during primary injury lead to a delayed and long-term secondary damage that can last from hours to years. Secondary brain injury causes tissue damage in the central nervous system and a subsequent strong and rapid inflammatory response that may lead to persistent inflammation. However, this inflammatory response is not limited to the brain. Inflammatory mediators are transferred from damaged brain tissue to the bloodstream and produce a systemic inflammatory response in peripheral organs, including the cardiovascular, pulmonary, gastrointestinal, renal and endocrine systems. Complications of TBI are associated with its multiple and systemic effects that should be considered in the treatment of TBI patients. Therefore, in this review, an attempt was made to examine the systemic effects of TBI in detail. It is hoped that this review will identify the mechanisms of injury and complications of TBI, and open a window for promising treatment in TBI complications.
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Affiliation(s)
- Nazanin Sabet
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Soltani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Khaksari
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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22
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Balestrini CS, Moir ME, Abbott KC, Klassen SA, Fischer LK, Fraser DD, Shoemaker JK. Autonomic Dysregulation in Adolescent Concussion Is Sex- and Posture-Dependent. Clin J Sport Med 2021; 31:257-265. [PMID: 30908327 PMCID: PMC8061339 DOI: 10.1097/jsm.0000000000000734] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study autonomic responses to postural changes in concussed adolescents. The influence of sex was also studied. DESIGN Longitudinal cohort observational study. PARTICIPANTS Concussed adolescents (CONC; n = 65; 26 male adolescents; age 15 ± 1 years, range = 12-18 years) and a control (CTRL) group of nonconcussed adolescents of similar age and sport (CTRL; n = 54; 29 male adolescents; age 14 ± 1 years, range = 12-18 years). INTERVENTIONS Concussed participants were monitored through 6 weekly visits throughout usual physician care. Control participants underwent 2 visits separated by at least 1 week to account for intrapersonal variation in testing measures. MAIN OUTCOME MEASURES Heart rate variability as the root mean square of successive differences in R-R intervals (RMSSD), heart rate (HR), and blood pressure [mean arterial pressure (MAP) and diastolic blood pressure (DBP)] were measured in supine, sitting, and standing postures. RESULTS A mixed analysis of variance revealed a group × sex × posture interaction (P = 0.04) where seated values of RMSSD were less in concussed female participants versus control female participants (42 ± 4 vs 61 ± 7 ms; P = 0.01; Mann-Whitney rank test). Compared with CTRL, CONC exhibited increased pretesting seated DBP (69 ± 1 vs 74 ± 1 mm Hg; P < 0.01), MAP (83 ± 1 vs 86 ± 1 mm Hg; P = 0.02), and baseline seated HR (72 ± 1 vs 77 ± 2 bpm; P = 0.03). Values of DBP (P = 0.03) and MAP (P < 0.01) improved at clinical discharge, whereas the RMSSD in female participants did not (P > 0.5). Data are mean ± SEM. CONCLUSIONS A modest reduction in female cardiac autonomic regulation was observed during seated postures. Alterations in seated concussed DBP and MAP, but not RMSSD, resolved at clinical discharge (median = 37 days). The results indicate that, in adolescents, concussion may impair cardiovagal function in a sex- and posture-dependent manner. The findings also suggest that BP metrics, but not RMSSD, are associated with clinical concussion recovery.
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Affiliation(s)
| | - Marcy Erin Moir
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
| | - Kolten C Abbott
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada ; and
| | - Stephen A Klassen
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
| | - Lisa K Fischer
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
| | - Douglas D Fraser
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada ; and
| | - Joel Kevin Shoemaker
- School of Kinesiology, Faculty of Health Sciences, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
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Huerta de la Cruz S, Rocha L, Santiago-Castañeda C, Sánchez-López A, Pinedo-Rodríguez AD, Medina-Terol GJ, Centurión D. Hydrogen Sulfide Subchronic Treatment Improves Hypertension Induced by Traumatic Brain Injury in Rats through Vasopressor Sympathetic Outflow Inhibition. J Neurotrauma 2021; 39:181-195. [PMID: 33626966 DOI: 10.1089/neu.2020.7552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) represents a critical public health problem around the world. To date, there are no accurate therapeutic approaches for the management of cardiovascular impairments induce by TBI. In this regard, hydrogen sulfide (H2S), a novel gasotransmitter, has been proposed as a neuro- and cardioprotective molecule. This study was designed to determine the effect of subchronic management with sodium hydrosulfide (NaHS) on hemodynamic, vasopressor sympathetic outflow and sensorimotor alterations produced by TBI. Animals underwent a lateral fluid percussion injury, and changes in hemodynamic variables were measured by pletismographic methods. In addition, vasopressor sympathetic outflow was assessed by a pithed rat model. Last, sensorimotor impairments were evaluated by neuroscore test and beam-walking test. At seven, 14, 21, and 28 days after moderate-severe TBI, the animals showed: (1) a decrease on sensorimotor function in the neuroscore test and beam-walking test; (2) an increase in heart rate, systolic, diastolic, and mean blood pressure; (3) progressive sympathetic hyperactivity; and (4) a decrease in vasopressor responses induced by noradrenaline (α1/2-adrenoceptors agonist) and UK 14,304 (selective α2-adrenoceptor agonist). Interestingly, intraperitoneal daily injections of NaHS, an H2S donor (3.1 and 5.6 mg/kg), during seven days after TBI prevented the development of the impairments in hemodynamic variables, which were similar to those obtained in sham animals. Moreover, NaHS treatment prevented the sympathetic hyperactivity and decreased noradrenaline-induced vasopressor responses. No effects on sensorimotor dysfunction were observed, however. Taken together, our results suggest that H2S ameliorates the hemodynamic and sympathetic system impairments observed after TBI.
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Affiliation(s)
| | - Luisa Rocha
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico
| | | | | | | | | | - David Centurión
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico
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24
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Dolce G, Quintieri M, Leto E, Milano M, Pileggi A, Lagani V, Pignolo L. Dysautonomia and Clinical Outcome in Vegetative State. J Neurotrauma 2021; 38:1441-1444. [PMID: 18771395 DOI: 10.1089/neu.2008.0536] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A dramatic disorder tentatively attributed to diencephalic-hypothalamic damage or dysfunction, dysautonomia, affects recovery from brain injury. Its incidence, correlation with etiology, and relevance as a predictor of outcome were retrospectively surveyed in 333 patients in vegetative state (VS) for more than 2 weeks at admission. Outcome was assessed according to the Glasgow Outcome Scale. Data were treated statistically by multi-variate analyses. Dysautonomia occurred in 26.1% of patients, with greater incidence among post-traumatic (31.9%) than non-traumatic (15.8%) patients. Outcome was worse among non-traumatic than post-traumatic patients irrespective of dysautonomia, and worst among non-traumatic patients with dysautonomia. Dysautonomia proved common among patients in VS (with incidence depending on etiology and age) and influenced the patients' outcome through mechanisms still to be defined, but conceivably mediated by diencephalic-hypothalamic unbalance.
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Affiliation(s)
| | | | | | | | | | - Vincenzo Lagani
- Department of Electronic, Informatics and Systemistics, University of Calabria, Cosenza, Italy
| | - Loris Pignolo
- Department of Electronic, Informatics and Systemistics, University of Calabria, Cosenza, Italy
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25
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Florez-Perdomo WA, García-Ballestas E, Moscote-Salazar LR, Konar SK, Raj S, Chouksey P, Shrivastava A, Mishra R, Agrawal A. Heart Rate Variability as a Predictor of Mortality in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 148:80-89. [PMID: 33412317 DOI: 10.1016/j.wneu.2020.12.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To systematically review the medical literature to determine the utility of heart rate variability in predicting mortality for moderate to severe traumatic brain injury. METHODS A search for randomized controlled trials, nonrandomized trials, and prospective and retrospective cohort studies was carried out using PubMed, SCOPUS, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Reference lists of included studies were also searched to identify potentially eligible studies. RESULTS Five articles comprising 542 patients met inclusion criteria. Heart rate variability as low-frequency/high-frequency ratio (area under the curve [AUC] receiver operating characteristic [ROC]) for predicting mortality was found to be statistically significant (AUC ROC 0.810, P < 0.001) with high heterogeneity (I2 = 61.98%, P = 0.032). Meta-analysis of low-frequency/high-frequency ratio, High frequency peak, and total power were statistically significant for predicting mortality. Odd's ratio for predicting mortality for LF/HF ratio, HF peak, and TP were 16.17, 19.09, 22.59 respectively. High-frequency peak in predicting mortality showed an AUC ROC of 0.986 (P ≤ 0.001) with a low level of heterogeneity. Total power (TP) showed an AUC ROC of 0.93 (P < 0.001) in predicting mortality with a high level of heterogeneity (I2 = 83.16%, P = 0.002). Funnel plot analysis to assess the presence of publication bias for TP showed a high level of heterogeneity and asymmetry among studies. CONCLUSIONS This meta-analysis predicted high mortality based on odds ratio for variables low-frequency/high-frequency ratio, high-frequency peak, and TP. However, the statistical analysis was weakened owing to the high level of heterogeneity in the included studies. Further research is needed to generate high-quality recommendations regarding heart rate variability as a predictor of mortality after traumatic brain injury.
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Affiliation(s)
- William Andres Florez-Perdomo
- Medicina General-Universidad Surcolombiana, Medico Investigador Concejo Latinoamericano de Neurointensivismo-CLaNi, Clinica Sahagún IPS SA, Córdoba, Colombia
| | - Ezequiel García-Ballestas
- Center for Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | | | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India.
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McDonald S, Genova H. The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:235-260. [PMID: 34389120 DOI: 10.1016/b978-0-12-822290-4.00011-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Genova
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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27
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Silva MJ, Antunes N. The utility of heart rate variability as a prognostic factor in children with traumatic brain injury. Brain Inj 2020; 34:1693-1700. [PMID: 33190529 DOI: 10.1080/02699052.2020.1836401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to do a literature review to prove the hypothesis that a change in autonomous nervous system regulation, more precisely a decrease in heart rate variability (HRV), is associated with a worse outcome and could be used as a prognostic factor in children with TBI. METHODS Databases (Pubmed, World of Science and Scopus) studies were conducted from 1996 to 2017, considering HRV in children with TBI. Seven studies were analyzed. RESULTS Patients that became brain dead had a markedly lower LF/HF ratio, with a significant decrease after the first few hours of hospitalization. Patients with a more favorable prognosis had significantly higher LF/HF ratios. DISCUSSION The HRV can be useful when determining the severity of neurological damage and a prognostic factor in the evaluation of its recovery. However, to assess the true value of HRV monitoring in children with TBI, a prospective study with identified thresholds for HRV, comparison to the standard methods of assessment and predictions should be made blinded to outcome at admission and then through the clinical course including the post-acute phase of rehabilitation. In the absence of this, any recommendation for its use as a prognostic tool may be premature.
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Affiliation(s)
- Marta João Silva
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João , Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Natália Antunes
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto , Porto, Portugal
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28
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Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury. J Head Trauma Rehabil 2020; 34:E1-E10. [PMID: 30608311 DOI: 10.1097/htr.0000000000000465] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation. DESIGN Retrospective cohort. SETTING Six TBI Model Systems (TBIMS) centers. PARTICIPANTS In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. RESULTS At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. CONCLUSIONS People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.
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29
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Brandt E, Wilson JK, Rieger RE, Gill D, Mayer AR, Cavanagh JF. Respiratory Sinus Arrhythmia Correlates With Depressive Symptoms Following Mild Traumatic Brain Injury. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Depression is a pervasive psychiatric problem following mild traumatic brain injury (mTBI). However, the onset and course of symptom expression following mTBI can differ from that of spontaneous episodes of depression. Here, we aimed to assess a physiological metric closely linked to depression: respiratory sinus arrhythmia (RSA), a measure of high frequency heart rate variability. RSA is reduced during depressive episodes, and higher resting RSA has been shown to predict future recovery from depression. In this study, we investigated if these patterns were observed throughout the typical timeframe of sub-acute mTBI recovery. Although RSA did not differ between mTBI ( n = 50) and control ( n = 27) groups, depressive symptoms were reliably correlated with RSA only in the mTBI group. This pattern was consistent 2 weeks, 2 months, and 4 months post-injury. Furthermore, resting RSA shortly following injury predicted the trajectory of depressive symptoms 2 months later. These findings generalize the connection between RSA and depression to a clinical population where depressive symptoms are common but often difficult to parse from other post-trauma consequences.
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Affiliation(s)
- Emma Brandt
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - J. Kevin Wilson
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Rebecca E. Rieger
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Darbi Gill
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Andrew R. Mayer
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
- Mind Research Network, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
| | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
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30
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Krese K, Ingraham B, O'Brien MK, Mummidisetty CK, McNulty M, Srdanovic N, Kocherginsky M, Ripley D. The impact of a yoga-based physical therapy group for individuals with traumatic brain injury: results from a pilot study. Brain Inj 2020; 34:1118-1126. [PMID: 32530717 DOI: 10.1080/02699052.2020.1776394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare the impacts of yoga-based physical therapy versus a seated rest within the context of standard rehabilitation practice on sleep, heart rate variability (HRV), anxiety, and fatigue during acute traumatic brain injury (TBI) rehabilitation. METHODS Eleven individuals participated in this crossover study involving the following interventions in a randomized order: group yoga-based physical therapy (YPT), conventional physical therapy (CPT), and group seated rest in a relaxing environment (SR). HRV and self-reported anxiety and fatigue were measured immediately before and after each group, and sleep after each condition and at baseline. Data was analyzed using generalized linear mixed models with repeated measures. RESULTS The interaction between time and treatment was statistically significant (p = .0203). For the SR treatment, wake after sleep onset (WASO) rate was reduced from 14.99 to 10.60 (IRR = 0.71; p = .006). Time and treatment were not found to be statistically significantly associated with any of the secondary outcomes. CONCLUSION Yoga-based physical therapy is feasible and safe in the inpatient rehabilitation setting following TBI. Sleep quality improved following the addition of a one-hour seated rest in a relaxing environment to a standard rehabilitation daily schedule, suggesting that structured rest time may be beneficial to sleep hygiene during inpatient rehabilitation following TBI. ClinicalTrials.Gov Registration Number: NCT03701594.
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Affiliation(s)
- Kelly Krese
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Benjamin Ingraham
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Division of Physical Medicine and Rehabilitation, University of Utah , Salt Lake City, Utah, USA
| | - Megan K O'Brien
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Mary McNulty
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Department of Occupational Therapy, Midwestern University , Glendale, Arizona, USA
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - Masha Kocherginsky
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - David Ripley
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
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Physical Activity Intolerance and Cardiorespiratory Dysfunction in Patients with Moderate-to-Severe Traumatic Brain Injury. Sports Med 2020; 49:1183-1198. [PMID: 31098990 DOI: 10.1007/s40279-019-01122-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Moderate-to-severe traumatic brain injury (TBI) is a chronic health condition with multi-systemic effects. Survivors face significant long-term functional limitations, including physical activity intolerance and disordered sleep. Persistent cardiorespiratory dysfunction is a potentially modifiable yet often overlooked major contributor to the alarmingly high long-term morbidity and mortality rates in these patients. This narrative review was developed through systematic and non-systematic searches for research relating cardiorespiratory function to moderate-to-severe TBI. The literature reveals patients who have survived moderate-to-severe TBI have ~ 25-35% reduction in maximal aerobic capacity 6-18 months post-injury, resting pulmonary capacity parameters that are reduced 25-40% for weeks to years post-injury, increased sedentary behavior, and elevated risk of cardiorespiratory-related morbidity and mortality. Synthesis of data from other patient populations reveals that cardiorespiratory dysfunction is likely a consequence of ventilator-induced diaphragmatic dysfunction (VIDD), which is not currently addressed in TBI management. Thus, cardiopulmonary exercise testing should be routinely performed in this patient population and those with cardiorespiratory deficits should be further evaluated for diaphragmatic dysfunction. Lack of targeted treatment for underlying cardiorespiratory dysfunction, including VIDD, likely contributes to physical activity intolerance and poor functional outcomes in these patients. Interventional studies have demonstrated that short-term exercise training programs are effective in patients with moderate-to-severe TBI, though improvement is variable. Inspiratory muscle training is beneficial in other patient populations with diaphragmatic dysfunction, and may be valuable for patients with TBI who have been mechanically ventilated. Thus, clinicians with expertise in cardiorespiratory fitness assessment and exercise training interventions should be included in patient management for individuals with moderate-to-severe TBI.
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32
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Zheng RZ, Lei ZQ, Yang RZ, Huang GH, Zhang GM. Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury. Front Neurol 2020; 11:81. [PMID: 32161563 PMCID: PMC7052349 DOI: 10.3389/fneur.2020.00081] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/22/2020] [Indexed: 12/12/2022] Open
Abstract
Paroxysmal sympathetic hyperactivity (PSH) has predominantly been described after traumatic brain injury (TBI), which is associated with hyperthermia, hypertension, tachycardia, tachypnea, diaphoresis, dystonia (hypertonia or spasticity), and even motor features such as extensor/flexion posturing. Despite the pathophysiology of PSH not being completely understood, most researchers gradually agree that PSH is driven by the loss of the inhibition of excitation in the sympathetic nervous system without parasympathetic involvement. Recently, advances in the clinical and diagnostic features of PSH in TBI patients have reached a broad clinical consensus in many neurology departments. These advances should provide a more unanimous foundation for the systematic research on this clinical syndrome and its clear management. Clinically, a great deal of attention has been paid to the definition and diagnostic criteria, epidemiology and pathophysiology, symptomatic treatment, and prevention and control of secondary brain injury of PSH in TBI patients. Potential benefits of treatment for PSH may result from the three main goals: eliminating predisposing causes, mitigating excessive sympathetic outflow, and supportive therapy. However, individual pathophysiological differences, therapeutic responses and outcomes, and precision medicine approaches to PSH management are varied and inconsistent between studies. Further, many potential therapeutic drugs might suppress manifestations of PSH in the process of TBI treatment. The purpose of this review is to present current and comprehensive studies of the identification of PSH after TBI in the early stage and provide a framework for symptomatic management of TBI patients with PSH.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong-Qi Lei
- Department of Neurosurgery, The 901th Hospital of the Joint Logistics Support Force of PLA, Anhui, China
| | - Run-Ze Yang
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guang-Ming Zhang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Paroxysmal Sympathetic Hyperactivity After Severe Traumatic Brain Injury in Children: Prevalence, Risk Factors, and Outcome. Pediatr Crit Care Med 2019; 20:252-258. [PMID: 30489486 DOI: 10.1097/pcc.0000000000001811] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe paroxysmal sympathetic hyperactivity in pediatric patients with severe traumatic brain injury using the new consensus definition, the risk factors associated with developing paroxysmal sympathetic hyperactivity, and the outcomes associated with paroxysmal sympathetic hyperactivity. DESIGN Retrospective cohort study. SETTING Academic children's hospital PICU. PATIENTS All pediatric patients more than 1 month and less than 18 years old with severe traumatic brain injury between 2000 and 2016. We excluded patients if they had a history of five possible confounders for paroxysmal sympathetic hyperactivity diagnosis or if they died within 24 hours of admission for traumatic brain injury. MEASUREMENTS AND MAIN RESULTS Our primary outcome was PICU mortality. One hundred seventy-nine patients met inclusion criteria. Thirty-six patients (20%) had at least eight criteria and therefore met classification of "likelihood of paroxysmal sympathetic hyperactivity." Older age was the only factor independently associated with developing paroxysmal sympathetic hyperactivity (odds ratio, 1.08; 95% CI, 1.00-1.16). PICU mortality was significantly lower for those with paroxysmal sympathetic hyperactivity compared with those without paroxysmal sympathetic hyperactivity (odds ratio, 0.08; 95% CI, 0.01-0.52), but PICU length of stay was greater in those with paroxysmal sympathetic hyperactivity (odds ratio, 4.36; 95% CI, 2.94-5.78), and discharge to an acute care or rehabilitation setting versus home was higher in those with paroxysmal sympathetic hyperactivity (odds ratio, 5.59; 95% CI, 1.26-24.84; odds ratio, 5.39; 95% CI, 1.87-15.57, respectively). When paroxysmal sympathetic hyperactivity was diagnosed in the first week of admission, it was not associated with discharge disposition. CONCLUSIONS Our study suggests that the rate of paroxysmal sympathetic hyperactivity in patients with severe traumatic brain injury is higher than previously reported. Older age was associated with an increased risk for developing paroxysmal sympathetic hyperactivity, but severity of the trauma and the brain injury were not. For survivors of severe traumatic brain injury beyond 24 hours who developed paroxysmal sympathetic hyperactivity, there was a lower PICU mortality but also greater PICU length of stay and a lower likelihood of discharge home from the admitting hospital, suggesting that functional outcome in survivors with paroxysmal sympathetic hyperactivity is worse than survivors without paroxysmal sympathetic hyperactivity.
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Honoré H, Eggertsen K, Sondergaard S. A study into the feasibility of using HRV variables to guide treatment in patients with paroxystic sympathetic hyperactivity in a neurointensive step-down unit. NeuroRehabilitation 2019; 44:141-155. [PMID: 30741702 DOI: 10.3233/nre-182557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients suffering brain injury may experience paroxystic sympathetic hyperactivity, presenting diagnostic and therapeutic challenges in neurointensive rehabilitation. The syndrome has been modelled as peripheral and central excitatory:inhibitory ratios of autonomous nervous activity. Another model represents the symptoms as oscillations of the two components of the autonomous nervous system. In therapeutic framework, the syndrome is perceived as the patient misconstruing sensory input relating to body positioning. OBJECTIVE To investigate whether changes in frequency domain of heart rate variability reflect pharmacological and/or therapeutic measures in rehabilitation. METHODS ECG was recorded before and after pharmacological and therapeutic interventions in eight patients with high probability of the syndrome in a neurointensive step-down unit. Recordings were analysed off-line in frequency parameters. Appropriate statistical methods were applied. RESULTS Low, high frequency and the LF/HF ratio changed significantly following therapeutic as well as pharmacological interventions. DISCUSSION The cohort was small, the setting the immediate postictal period of intensive care with multidisciplinary rehabilitation. Still, changes in frequency domain were detected following therapeutic efforts. This opens up the venue of on-line monitoring of the intended therapeutic effect.
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Affiliation(s)
- H Honoré
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - K Eggertsen
- Department of Intensive Care and Neurointensive Stepdown Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark
| | - S Sondergaard
- Department of Intensive Care and Neurointensive Stepdown Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark
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Estévez-Báez M, Machado C, García-Sánchez B, Rodríguez V, Alvarez-Santana R, Leisman G, Carrera JME, Schiavi A, Montes-Brown J, Arrufat-Pié E. Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. Brain Inj 2019; 33:496-516. [PMID: 30755043 DOI: 10.1080/02699052.2018.1553312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. DESIGN AND METHODS Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert-Huang method in the spectral range 0.02-0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. RESULTS Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. CONCLUSIONS HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
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Affiliation(s)
- Mario Estévez-Báez
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | - Calixto Machado
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | | | | | | | - Gerry Leisman
- d Faculty of Health Sciences , University of Haifa , Haifa , Israel
| | | | - Adam Schiavi
- e Anesthesiology and Critical Care Medicine, Neurosciences Critical Care Division , Johns Hopkins Hospital , Baltimore , MD , USA
| | - Julio Montes-Brown
- f Department of Medicine & Health Science , University of Sonora , Sonora , Mexico
| | - Eduardo Arrufat-Pié
- g Institute of Basic and Preclinical Sciences, "Victoria de Girón" , Havana , Cuba
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Melinosky C, Yang S, Hu P, Li H, Miller CHT, Khan I, Mackenzie C, Chang WT, Parikh G, Stein D, Badjatia N. Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury. Front Neurol 2018; 9:761. [PMID: 30319521 PMCID: PMC6167472 DOI: 10.3389/fneur.2018.00761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023] Open
Abstract
Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI). Methods: Retrospective analysis of ND in TBI patients enrolled in the prospective Oximetry and Noninvasive Predictors Of Intervention Need after Trauma (ONPOINT) study. ND was defined as any of the following occurring in the first 48 h: new asymmetric pupillary dilatation (>2 mm), 2 point GCS decline, interval worsening of CT scan as assessed by the Marshall score, or intervention for cerebral edema. Beat-to-beat variation of ECG or PPG, as well as waveform features during the first 15 and 60 min after arrival in the TRU were analyzed to determine physiologic parameters associated with future ND. Physiologic and admission clinical variables were combined in multivariable logistic regression models predicting ND and inpatient mortality. Results: There were 33 (17%) patients with ND among 191 patients (mean age 43 years old, GCS 13, ISS 12, 69% men) who met study criteria. ND was associated with ICU admission (P < 0.001) and inpatient mortality (P < 0.001). Both ECG (AUROC: 0.84, 95% CI: 0.76,0.93) and PPG (AUROC: 0.87, 95% CI: 0.80, 0.93) analyses during the first 15 min of resuscitation demonstrated a greater ability to predict ND then clinical characteristics alone (AUROC: 0.69, 95% CI: 0.59, 0.8). Age (P = 0.02), Marshall score (P = 0.001), penetrating injury (P = 0.02), and predictive probability for ND by PPG analysis at 15 min (P = 0.03) were independently associated with inpatient mortality. Conclusions: Analysis of variability and ECG or PPG waveform in the first minutes of resuscitation may represent a non-invasive early marker of future ND.
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Affiliation(s)
- Christopher Melinosky
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Shiming Yang
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Peter Hu
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - HsiaoChi Li
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Catriona H T Miller
- Enroute care Division, Department of Aeromedical Research, U.S. Air Force School of Aerospace Medicine, Wright Patterson AFB, Dayton, OH, United States
| | - Imad Khan
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Colin Mackenzie
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Wan-Tsu Chang
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gunjan Parikh
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Deborah Stein
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Neeraj Badjatia
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
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Szabo J, Smielewski P, Czosnyka M, Jakubicek S, Krebs S, Siarnik P, Sykora M. Heart rate variability is associated with outcome in spontaneous intracerebral hemorrhage. J Crit Care 2018; 48:85-89. [PMID: 30176528 DOI: 10.1016/j.jcrc.2018.08.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Autonomic imbalance as measured by heart rate variability (HRV) has been associated with poor outcome after stroke. Observations on HRV changes in intracerebral hemorrhage (ICH) are scarce. Here, we aimed to investigate HRV in ICH as compared to a control group and to explore associations with stroke severity, hemorrhage volume and outcome after ICH. METHODS We examined the autonomic modulation using frequency domain analysis of HRV during the acute phase of the ICH and in a healthy age- and hypertension-matched control group. Hematoma volume, intraventricular extension, initial stroke severity and baseline demographic, clinical parameters as well as mortality and functional outcome were included in the analysis. RESULTS 47 patients with ICH and 47 age- and hypertension matched controls were analyzed. ICH patients showed significantly lower total high frequency band (HF) and low frequency band (LF) powers (p = 0.01, p < 0.001), higher normalized HF power (p = 0.03), and lower LF/HF ratio (p < 0.001) as compared to the controls. Autonomic parameters showed associations with stroke severity (p = 0.004) and intraventricular involvement (p = 0.01) and predicted poor outcome independently (p = 0.02). CONCLUSIONS Autonomic changes seems to be present in acute ICH and are associated with poor outcome independently. This may have future monitoring and therapeutic implications.
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Affiliation(s)
- Jozef Szabo
- First Dept. of Neurology, University Hospital Bratislava, Comenius University Bratislava, Slovakia
| | - Peter Smielewski
- Div. of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Marek Czosnyka
- Div. of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | | | - Stefan Krebs
- Dept. of Neurology, St. John's Hospital Vienna, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Pavel Siarnik
- First Dept. of Neurology, University Hospital Bratislava, Comenius University Bratislava, Slovakia
| | - Marek Sykora
- Dept. of Neurology, St. John's Hospital Vienna, Medical Faculty, Sigmund Freud University, Vienna, Austria; Dept. of Neurology, University of Heidelberg, Heidelberg, Germany.
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Ostergaard JR. Paroxysmal sympathetic hyperactivity in Juvenile neuronal ceroid lipofuscinosis (Batten disease). Auton Neurosci 2018; 214:15-18. [PMID: 30072301 DOI: 10.1016/j.autneu.2018.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/28/2018] [Indexed: 11/26/2022]
Abstract
Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome of agitation and involuntary motor activity that particularly occurs in patients with severe acquired brain injury. The aim of the present study is to substantiate the assertion that paroxysmal non-epileptic attacks resembling PSH also occur in patients with Juvenile Neuronal Ceroid Lipofuscinosis (JNCL, Batten disease), which is the most common neurodegenerative disease in children. The paper describes a case series of five patients with JNCL which during a period of fifteen years have been followed clinically and by consecutive investigations of the autonomic nervous system using heart rate variability (HRV) investigations. Following adolescence a significant autonomic imbalance with very low parasympathetic activity and an unchanged high sympathetic excitatory activity was documented. In addition, episodes of anxiety and agitation combined with involuntary movements were reported. Beyond the frightened facial expression and involuntary increased motor activity, excessive sweating, increased body temperature, high heart and respiratory rates were reported, and typically, the episodes occurred to stimuli that were either non-nociceptive or only minimally nociceptive. Thus, from a clinical point of view the non-epileptic paroxysmal condition with anxious behavior, agitation and motor hyperactivity seen in patients with JNCL fits to the clinical description of PSH which normally occurs following acutely acquired brain injury, and as the neuropathological basis in JNCL for development of PSH is similar to what is seen in patients with traumatic brain injuries, it seems reasonable to propose that PSH also occurs following adolescence in patients with JNCL.
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Affiliation(s)
- John R Ostergaard
- Centre for Rare Diseases, Department of Pediatrics and Adolescents Medicine, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, DK-Aarhus N, Denmark.
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Samuel S, Lee M, Brown RJ, Choi HA, Baguley IJ. Incidence of paroxysmal sympathetic hyperactivity following traumatic brain injury using assessment tools. Brain Inj 2018; 32:1115-1121. [PMID: 29856656 DOI: 10.1080/02699052.2018.1482002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sophie Samuel
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas, USA
| | - Monica Lee
- Department of Pharmacy, Houston Methodist West Hospital, USA
| | - Robert J Brown
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, USA
| | - Huimahn A. Choi
- Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, USA
| | - Ian J Baguley
- Western Medical School, The University of Sydney, NSW, Australia
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Deepika A, Devi BI, Shukla D, Sathyaprabha TN, Christopher R, Ramesh SS. Neuroimmunology of Traumatic Brain Injury: A Longitudinal Study of Interdependency of Inflammatory Markers and Heart Rate Variability in Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:1124-1131. [DOI: 10.1089/neu.2017.5151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Akhil Deepika
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Talakad N. Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Shruthi S. Ramesh
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
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Paroxysmal Sympathetic Hyperactivity: Diagnostic Criteria, Complications, and Treatment after Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0175-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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42
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Injury of the Hypothalamus in Patients With Hypoxic–Ischemic Brain Injury. Am J Phys Med Rehabil 2018; 97:160-163. [DOI: 10.1097/phm.0000000000000813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Kim SW, Jeon HR, Kim JY, Kim Y. Heart Rate Variability Among Children With Acquired Brain Injury. Ann Rehabil Med 2017; 41:951-960. [PMID: 29354571 PMCID: PMC5773438 DOI: 10.5535/arm.2017.41.6.951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/17/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To find evidence of autonomic imbalance and present the heart rate variability (HRV) parameters that reflect the severity of paroxysmal sympathetic hyperactivity (PSH) in children with acquired brain injury (ABI). Methods Thirteen children with ABI were enrolled and age- and sex-matched children with cerebral palsy were selected as the control group (n=13). The following HRV parameters were calculated: time-domain indices including the mean heart rate, standard deviation of all average R-R intervals (SDNN), root mean square of the successive differences (RMSSD), physical stress index (PSI), approximate entropy (ApEn); successive R-R interval difference (SRD), and frequency domain indices including total power (TP), high frequency (HF), low frequency (LF), normalized HF, normalized LF, and LF/HF ratio. Results There were significant differences between the ABI and control groups in the mean heart rate, RMSSD, PSI and all indices of the frequency domain analysis. The mean heart rate, PSI, normalized LF, and LF/HF ratio increased in the ABI group. The presence of PSH symptoms in the ABI group demonstrated a statistically significant decline of the SDNN, TP, ln TP. Conclusion The differences in the HRV parameters and presence of PSH symptoms are noted among ABI children compared to an age- and sex-matched control group with cerebral palsy. Within the ABI group, the presence of PSH symptoms influenced the parameters of HRV such as SDNN, TP and ln TP.
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Affiliation(s)
- Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ji Yong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yoon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Raimondo F, Rohaut B, Demertzi A, Valente M, Engemann DA, Salti M, Fernandez Slezak D, Naccache L, Sitt JD. Brain-heart interactions reveal consciousness in noncommunicating patients. Ann Neurol 2017; 82:578-591. [PMID: 28892566 DOI: 10.1002/ana.25045] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/28/2017] [Accepted: 09/04/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We here aimed at characterizing heart-brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. METHODS A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS; n = 70) and minimally conscious state (MCS; n = 57) were presented with the local-global auditory oddball paradigm, which distinguishes 2 levels of processing: short-term deviation of local auditory regularities and global long-term rule violations. In addition to previously validated markers of consciousness extracted from electroencephalograms (EEG), we computed autonomic cardiac markers, such as heart rate (HR) and HR variability (HRV), and cardiac cycle phase shifts triggered by the processing of the auditory stimuli. RESULTS HR and HRV were similar in patients across groups. The cardiac cycle was not sensitive to the processing of local regularities in either the VS/UWS or MCS patients. In contrast, global regularities induced a phase shift of the cardiac cycle exclusively in the MCS group. The interval between the auditory stimulation and the following R peak was significantly shortened in MCS when the auditory rule was violated. When the information for the cardiac cycle modulations and other consciousness-related EEG markers were combined, single patient classification performance was enhanced compared to classification with solely EEG markers. INTERPRETATION Our work shows a link between residual cognitive processing and the modulation of autonomic somatic markers. These results open a new window to evaluate patients with disorders of consciousness via the embodied paradigm, according to which body-brain functions contribute to a holistic approach to conscious processing. Ann Neurol 2017;82:578-591.
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Affiliation(s)
- Federico Raimondo
- Department of Computer Science, Faculty of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina.,Institute of Research in Computer Science, National Scientific and Technical Research Council-University of Buenos Aires, Buenos Aires, Argentina.,Brain and Spine Institute, Paris, France.,Pitié-Salpêtrière Faculty of Medicine, Pierre and Marie Curie University, Sorbonne Universities, Paris, France
| | - Benjamin Rohaut
- National Institute of Health and Medical Research, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of Paris, Paris, France
| | - Athena Demertzi
- Brain and Spine Institute, Paris, France.,National Institute of Health and Medical Research, Paris, France
| | - Melanie Valente
- Brain and Spine Institute, Paris, France.,National Institute of Health and Medical Research, Paris, France
| | - Denis A Engemann
- Brain and Spine Institute, Paris, France.,National Institute of Health and Medical Research, Paris, France.,Parietal Project Team, French Institute for Research in Computer Science and Automation, Saclay-Ile de France, France.,Cognitive Neuroimaging Unit, Institute of Biomedical Imaging, Direction of Life Sciences, Alternative Energies and Atomic Energy Commission, National Institute of Health and Medical Research, University of Paris-Sud, University of Paris-Saclay, NeuroSpin Center, Gif-sur-Yvette, France
| | - Moti Salti
- Zlotowski Center for Neuroscience and Brain Imaging Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Diego Fernandez Slezak
- Department of Computer Science, Faculty of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina.,Institute of Research in Computer Science, National Scientific and Technical Research Council-University of Buenos Aires, Buenos Aires, Argentina
| | - Lionel Naccache
- Brain and Spine Institute, Paris, France.,Pitié-Salpêtrière Faculty of Medicine, Pierre and Marie Curie University, Sorbonne Universities, Paris, France.,National Institute of Health and Medical Research, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of Paris, Paris, France.,Department of Neurophysiology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of Paris, Paris, France
| | - Jacobo D Sitt
- Brain and Spine Institute, Paris, France.,National Institute of Health and Medical Research, Paris, France
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Abstract
OBJECTIVE To develop a personalizable algorithm to discriminate between sedation levels in ICU patients based on heart rate variability. DESIGN Multicenter, pilot study. SETTING Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS We gathered 21,912 hours of routine electrocardiogram recordings from a heterogenous group of 70 adult ICU patients. All patients included in the study were mechanically ventilated and were receiving sedatives. MEASUREMENTS AND MAIN RESULTS As "ground truth" for developing our method, we used Richmond Agitation Sedation Scale scores grouped into four levels denoted "comatose" (-5), "deeply sedated" (-4 to -3), "lightly sedated" (-2 to 0), and "agitated" (+1 to +4). We trained a support vector machine learning algorithm to calculate the probability of each sedation level from heart rate variability measures derived from the electrocardiogram. To estimate algorithm performance, we calculated leave-one-subject out cross-validated accuracy. The patient-independent version of the proposed system discriminated between the four sedation levels with an overall accuracy of 59%. Upon personalizing the system supplementing the training data with patient-specific calibration data, consisting of an individual's labeled heart rate variability epochs from the preceding 24 hours, accuracy improved to 67%. The personalized system discriminated between light- and deep-sedation states with an average accuracy of 75%. CONCLUSIONS With further refinement, the methodology reported herein could lead to a fully automated system for depth of sedation monitoring. By enabling monitoring to be continuous, such technology may help clinical staff to monitor sedation levels more effectively and to reduce complications related to over- and under sedation.
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Abstract
Dysautonomia is a potentially life-threatening syndrome seen in many different types of brain injuries. It involves paroxysmal sympathetic hyperactivity and typically includes a constellation of symptoms, including: tachycardia, tachypnea, hyperthermia, hypertension, diaphoresis, hypertonia, and/or decerebrate or decorticate posturing. It is a clinical diagnosis of exclusion. A multimodal treatment approach is necessary including environmental modifications along with pharmacotherapy. Early management can help prevent comorbidities including secondary brain injury while also improving patient outcomes. This discussion serves as an overview of dysautonomia with a focus on management in the pediatric population including an example of a clinical algorithm and a review of the commonly used medications.
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Affiliation(s)
- Justin M Burton
- Division of Pediatric Rehabilitation Medicine, Children's National Health System, Washington, DC
| | - Olga M Morozova
- Division of Pediatric Rehabilitation Medicine, Children's National Health System, Washington, DC
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47
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Abstract
OBJECTIVE To explore the potential value of heart rate variability features for automated monitoring of sedation levels in mechanically ventilated ICU patients. DESIGN Multicenter, pilot study. SETTING Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS Electrocardiogram recordings from 40 mechanically ventilated adult patients receiving sedatives in an ICU setting were used to develop and test the proposed automated system. MEASUREMENTS AND MAIN RESULTS Richmond Agitation-Sedation Scale scores were acquired prospectively to assess patient sedation levels and were used as ground truth. Richmond Agitation-Sedation Scale scores were grouped into four levels, denoted "unarousable" (Richmond Agitation- Sedation Scale = -5, -4), "sedated" (-3, -2, -1), "awake" (0), "agitated" (+1, +2, +3, +4). A multiclass support vector machine algorithm was used for classification. Classifier training and performance evaluations were carried out using leave-oneout cross validation. An overall accuracy of 69% was achieved for discriminating between the four levels of sedation. The proposed system was able to reliably discriminate (accuracy = 79%) between sedated (Richmond Agitation-Sedation Scale < 0) and nonsedated states (Richmond Agitation-Sedation Scale > 0). CONCLUSIONS With further refinement, the methodology reported herein could lead to a fully automated system for depth of sedation monitoring. By enabling monitoring to be continuous, such technology may help clinical staff to monitor sedation levels more effectively and to reduce complications related to over- and undersedation.
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48
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Hu PJ, Pittet JF, Kerby JD, Bosarge PL, Wagener BM. Acute brain trauma, lung injury, and pneumonia: more than just altered mental status and decreased airway protection. Am J Physiol Lung Cell Mol Physiol 2017; 313:L1-L15. [PMID: 28408366 DOI: 10.1152/ajplung.00485.2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 01/25/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Even when patients survive the initial insult, there is significant morbidity and mortality secondary to subsequent pulmonary edema, acute lung injury (ALI), and nosocomial pneumonia. Whereas the relationship between TBI and secondary pulmonary complications is recognized, little is known about the mechanistic interplay of the two phenomena. Changes in mental status secondary to acute brain injury certainly impair airway- and lung-protective mechanisms. However, clinical and translational evidence suggests that more specific neuronal and cellular mechanisms contribute to impaired systemic and lung immunity that increases the risk of TBI-mediated lung injury and infection. To better understand the cellular mechanisms of that immune impairment, we review here the current clinical data that support TBI-induced impairment of systemic and lung immunity. Furthermore, we also review the animal models that attempt to reproduce human TBI. Additionally, we examine the possible role of damage-associated molecular patterns, the chlolinergic anti-inflammatory pathway, and sex dimorphism in post-TBI ALI. In the last part of the review, we discuss current treatments and future pharmacological therapies, including fever control, tracheostomy, and corticosteroids, aimed to prevent and treat pulmonary edema, ALI, and nosocomial pneumonia after TBI.
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Affiliation(s)
- Parker J Hu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean-Francois Pittet
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey D Kerby
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick L Bosarge
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brant M Wagener
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
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Munoz MJ, Kumar RG, Oh BM, Conley YP, Wang Z, Failla MD, Wagner AK. Cerebrospinal Fluid Cortisol Mediates Brain-Derived Neurotrophic Factor Relationships to Mortality after Severe TBI: A Prospective Cohort Study. Front Mol Neurosci 2017; 10:44. [PMID: 28337122 PMCID: PMC5343043 DOI: 10.3389/fnmol.2017.00044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/09/2017] [Indexed: 01/04/2023] Open
Abstract
Distinct regulatory signaling mechanisms exist between cortisol and brain derived neurotrophic factor (BDNF) that may influence secondary injury cascades associated with traumatic brain injury (TBI) and predict outcome. We investigated concurrent CSF BDNF and cortisol relationships in 117 patients sampled days 0–6 after severe TBI while accounting for BDNF genetics and age. We also determined associations between CSF BDNF and cortisol with 6-month mortality. BDNF variants, rs6265 and rs7124442, were used to create a gene risk score (GRS) in reference to previously published hypothesized risk for mortality in “younger patients” (<48 years) and hypothesized BDNF production/secretion capacity with these variants. Group based trajectory analysis (TRAJ) was used to create two cortisol groups (high and low trajectories). A Bayesian estimation approach informed the mediation models. Results show CSF BDNF predicted patient cortisol TRAJ group (P = 0.001). Also, GRS moderated BDNF associations with cortisol TRAJ group. Additionally, cortisol TRAJ predicted 6-month mortality (P = 0.001). In a mediation analysis, BDNF predicted mortality, with cortisol acting as the mediator (P = 0.011), yielding a mediation percentage of 29.92%. Mediation effects increased to 45.45% among younger patients. A BDNF*GRS interaction predicted mortality in younger patients (P = 0.004). Thus, we conclude 6-month mortality after severe TBI can be predicted through a mediation model with CSF cortisol and BDNF, suggesting a regulatory role for cortisol with BDNF's contribution to TBI pathophysiology and mortality, particularly among younger individuals with severe TBI. Based on the literature, cortisol modulated BDNF effects on mortality after TBI may be related to known hormone and neurotrophin relationships to neurological injury severity and autonomic nervous system imbalance.
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Affiliation(s)
- Miranda J Munoz
- Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Department of Biological Sciences, Carnegie Mellon UniversityPittsburgh, PA, USA
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Department of Epidemiology, University of PittsburghPittsburgh, PA, USA
| | - Byung-Mo Oh
- Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Department of Rehabilitation Medicine, Seoul National University HospitalSeoul, South Korea
| | - Yvette P Conley
- Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Department of Epidemiology, University of PittsburghPittsburgh, PA, USA
| | - Zhensheng Wang
- Department of Nursing, University of PittsburghPittsburgh, PA, USA; Safar Center for Resuscitation Research, University of PittsburghPittsburgh, PA, USA
| | - Michelle D Failla
- Department of Psychiatry, Vanderbilt University Medical Center Nashville, TN, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Safar Center for Resuscitation Research, University of PittsburghPittsburgh, PA, USA; Department of Neuroscience, University of PittsburghPittsburgh, PA, USA; Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
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Tang Q, Wu X, Weng W, Li H, Feng J, Mao Q, Gao G, Jiang J. The preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe traumatic brain injury patients who have undergone surgery: a retrospective study. PeerJ 2017; 5:e2986. [PMID: 28229021 PMCID: PMC5314954 DOI: 10.7717/peerj.2986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/12/2017] [Indexed: 11/20/2022] Open
Abstract
Background Paroxysmal sympathetic hyperactivity (PSH) results and aggravates in secondary brain injury, which seriously affects the prognosis of severe traumatic brain injury patients. Although several studies have focused on the treatment of PSH, few have concentrated on its prevention. Methods Ninety post-operation (post-op) severe traumatic brain injury (sTBI) patients admitted from October 2014 to April 2016 were chosen to participate in this study. Fifty of the post-op sTBI patients were sedated with dexmedetomidine and were referred as the “dexmedetomidine group” (admitted from May 2015 to April 2016). The other 40 patients (admitted from October 2014 to May 2015) received other sedations and were referred as the “control group.” The two groups were then compared based on their PSH scores and the scores and ratios of those patients who met the criteria of “probable,” “possible” and “unlikely” using the PSH assessment measure (PSH-AM) designed by Baguley et al. (2014). The durations of the neurosurgery intensive care unit (NICU) and hospital stays and the Glasgow outcome scale (GOS) values for the two groups were also compared to evaluate the therapeutic effects and the patients’ prognosis. Results The overall PSH score for the dexmedetomidine group was 5.26 ± 4.66, compared with 8.58 ± 8.09 for the control group. The difference between the two groups’ PSH scores was significant (P = 0.017). The score of the patients who met the criterion of “probable” was 18.33 ± 1.53 in the dexmedetomidine group and 22.63 ± 2.97 in the control group, and the difference was statistically significant (P = 0.045). The ratio of patients who were classified as “unlikely” between the two groups was statistically significant (P = 0.028); that is, 42 (84%) in the dexmedetomidine group and 25 (62.5%) in the control group. The differences in NICU, hospital stays and GOS values between the two groups were not significant. Conclusion Dexmedetomidine has a preventive effect on PSH in sTBI patients who have undergone surgery.
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Affiliation(s)
- Qilin Tang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Xiang Wu
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Weiji Weng
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Hongpeng Li
- Department of Neurosurgery, Rizhao City Hospital of Traditional Chinese Medicine , Rizhao , Shandong Province , China
| | - Junfeng Feng
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Qing Mao
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Guoyi Gao
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
| | - Jiyao Jiang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Head Trauma, Shanghai, China
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