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Sarma AK, Popli G, Anzalone A, Contillo N, Cornell C, Nunn AM, Rowland JA, Godwin DW, Flashman LA, Couture D, Stapleton-Kotloski JR. Use of magnetic source imaging to assess recovery after severe traumatic brain injury-an MEG pilot study. Front Neurol 2023; 14:1257886. [PMID: 38020602 PMCID: PMC10656620 DOI: 10.3389/fneur.2023.1257886] [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: 07/14/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale Severe TBI (sTBI) is a devastating neurological injury that comprises a significant global trauma burden. Early comprehensive neurocritical care and rehabilitation improve outcomes for such patients, although better diagnostic and prognostic tools are necessary to guide personalized treatment plans. Methods In this study, we explored the feasibility of conducting resting state magnetoencephalography (MEG) in a case series of sTBI patients acutely after injury (~7 days), and then about 1.5 and 8 months after injury. Synthetic aperture magnetometry (SAM) was utilized to localize source power in the canonical frequency bands of delta, theta, alpha, beta, and gamma, as well as DC-80 Hz. Results At the first scan, SAM source maps revealed zones of hypofunction, islands of preserved activity, and hemispheric asymmetry across bandwidths, with markedly reduced power on the side of injury for each patient. GCS scores improved at scan 2 and by scan 3 the patients were ambulatory. The SAM maps for scans 2 and 3 varied, with most patients showing increasing power over time, especially in gamma, but a continued reduction in power in damaged areas and hemispheric asymmetry and/or relative diminishment in power at the site of injury. At the group level for scan 1, there was a large excess of neural generators operating within the delta band relative to control participants, while the number of neural generators for beta and gamma were significantly reduced. At scan 2 there was increased beta power relative to controls. At scan 3 there was increased group-wise delta power in comparison to controls. Conclusion In summary, this pilot study shows that MEG can be safely used to monitor and track the recovery of brain function in patients with severe TBI as well as to identify patient-specific regions of decreased or altered brain function. Such MEG maps of brain function may be used in the future to tailor patient-specific rehabilitation plans to target regions of altered spectral power with neurostimulation and other treatments.
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Affiliation(s)
- Anand Karthik Sarma
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Neurocritical Care, Piedmont Atlanta Hospital, Atlanta, GA, United States
| | - Gautam Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Anthony Anzalone
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States
| | - Nicholas Contillo
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cassandra Cornell
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Andrew M. Nunn
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jared A. Rowland
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Research and Education Department, W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
| | - Dwayne W. Godwin
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Research and Education Department, W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
| | - Laura A. Flashman
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Daniel Couture
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jennifer R. Stapleton-Kotloski
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Simonovic M, Nedovic B, Radisavljevic M, Stojanovic N. The Co-Occurrence of Post-Traumatic Stress Disorder and Depression in Individuals with and without Traumatic Brain Injury: A Comprehensive Investigation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1467. [PMID: 37629756 PMCID: PMC10456657 DOI: 10.3390/medicina59081467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that often occurs following war trauma. Despite its high prevalence, there is still a lack of comprehensive understanding regarding the mechanisms underlying its progression and treatment resistance. Recent research has shed light on the biological basis of PTSD, with neuroimaging studies revealing altered brain connectivity patterns in affected individuals. In war contexts, traumatic brain injury (TBI) is a common occurrence and is associated with a high prevalence of PTSD. This study aimed to compare the severity of PTSD and depression in patients with and without a history of TBI to shed light on the impact of comorbid TBI on the presentation of PTSD symptoms. To achieve this goal, a cross-sectional study was conducted involving a sample of 60 outpatients who were diagnosed with both PTSD and Depressive Disorder. The inclusion criteria required participants to meet the diagnostic criteria for both disorders using validated tools. The severities of PTSD and depressive symptoms were assessed using scales that have been widely used and validated in previous research. By utilizing these standardized assessment tools, this study aimed to ensure the reliability and validity of the obtained data. The results of this study revealed that patients with comorbid PTSD and TBI exhibited a significantly higher severity of PTSD symptoms compared to those with PTSD only. Specifically, the comorbid group demonstrated higher ratings of symptom intensity across all symptom clusters. These findings are consistent with previous research that has highlighted the impact of comorbid TBI on the intensity and persistence of PTSD symptoms. When controlling for PTSD severity, no significant differences were observed in the severity of depressive symptoms between the two groups. This suggests that the increased depressive symptoms observed in the comorbid group may be primarily driven by the presence of more intense PTSD symptoms rather than TBI per se. The findings highlight the need for an accurate diagnosis of TBI in individuals with PTSD to guide appropriate treatment interventions. Further research is warranted to delve into the underlying mechanisms that contribute to the interaction between TBI and PTSD and to develop targeted interventions for individuals with comorbid PTSD and TBI.
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Affiliation(s)
- Maja Simonovic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
- Center for Mental Health, University Clinical Center, Nis 18000, Serbia
| | - Bojan Nedovic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
| | - Misa Radisavljevic
- Faculty of Medicine, University of Nis, Nis 18000, Serbia; (B.N.)
- Clinic for Neurosurgery, University Clinical Center, Nis 18000, Serbia
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Kim E, Seo HG, Seong MY, Kang MG, Kim H, Lee MY, Yoo RE, Hwang I, Choi SH, Oh BM. An exploratory study on functional connectivity after mild traumatic brain injury: Preserved global but altered local organization. Brain Behav 2022; 12:e2735. [PMID: 35993893 PMCID: PMC9480924 DOI: 10.1002/brb3.2735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study aimed to investigate alterations in whole-brain functional connectivity after a concussion using graph-theory analysis from global and local perspectives and explore the association between changes in the functional network properties and cognitive performance. METHODS Individuals with mild traumatic brain injury (mTBI, n = 29) within a month after injury, and age- and sex-matched healthy controls (n = 29) were included. Graph-theory measures on functional connectivity assessed using resting state functional magnetic resonance imaging data were acquired from each participant. These included betweenness centrality, strength, clustering coefficient, local efficiency, and global efficiency. Multi-domain cognitive functions were correlated with the graph-theory measures. RESULTS In comparison to the controls, the mTBI group showed preserved network characteristics at a global level. However, in the local network, we observed decreased betweenness centrality, clustering coefficient, and local efficiency in several brain areas, including the fronto-parietal attention network. Network strength at the local level showed mixed-results in different areas. The betweenness centrality of the right parahippocampus showed a significant positive correlation with the cognitive scores of the verbal learning test only in the mTBI group. CONCLUSION The intrinsic functional connectivity after mTBI is preserved globally, but is suboptimally organized locally in several areas. This possibly reflects the neurophysiological sequelae of a concussion. The present results may imply that the network property could be used as a potential indicator for clinical outcomes after mTBI.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
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4
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Contextual Effects of Traumatic Brain Injury on the Connectome: Differential Effects of Deployment- and Non-Deployment-Acquired Injuries. J Head Trauma Rehabil 2022; 37:E449-E457. [PMID: 35862901 DOI: 10.1097/htr.0000000000000803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify differential effects of mild traumatic brain injury (TBI) occurring in a deployment or nondeployment setting on the functional brain connectome. SETTING Veterans Affairs Medical Center. PARTICIPANTS In total, 181 combat-exposed veterans of the wars in Iraq and Afghanistan (n = 74 with deployment-related mild TBI, average time since injury = 11.0 years, SD = 4.1). DESIGN Cross-sectional observational study. MAIN MEASURES Mid-Atlantic MIRECC (Mid-Atlantic Mental Illness Research, Education, and Clinical Center) Assessment of TBI, Clinician-Administered PTSD Scale, connectome metrics. RESULTS Linear regression adjusting for relevant covariates demonstrates a significant (P < .05 corrected) association between deployment mild TBI with reduced global efficiency (nonstandardized β = -.011) and degree of the K-core (nonstandardized β = -.79). Nondeployment mild TBI was significantly associated with a reduced number of modules within the connectome (nonstandardized β = -2.32). Finally, the interaction between deployment and nondeployment mild TBIs was significantly (P < .05 corrected) associated with increased mean (nonstandardized β = 9.92) and mode (nonstandardized β = 14.02) frequency at which connections occur. CONCLUSIONS These results demonstrate distinct effects of mild TBI on the functional brain connectome when sustained in a deployment versus nondeployment context. This is consistent with findings demonstrating differential effects in other areas such as psychiatric diagnoses and severity, pain, sleep, and cognitive function. Furthermore, participants were an average of 11 years postinjury, suggesting these represent chronic effects of the injury. Overall, these findings add to the growing body of evidence, suggesting the effects of mild TBI acquired during deployment are different and potentially longer lasting than those of mild TBI acquired in a nondeployment context.
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5
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James LM, Leuthold AF, Georgopoulos AP. Classification of posttraumatic stress disorder and related outcomes in women veterans using magnetoencephalography. Exp Brain Res 2022; 240:1117-1125. [PMID: 35133447 DOI: 10.1007/s00221-022-06320-y] [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: 11/18/2021] [Accepted: 01/30/2022] [Indexed: 12/17/2022]
Abstract
Women veterans represent a unique population whose experiences and neurobiology differ from that of their male counterparts. Thus, while previous research has demonstrated the utility of synchronous neural interactions (SNI) as a biomarker of posttraumatic stress disorder (PTSD) in male veterans, the utility of SNI as a biomarker of PTSD in women veterans is unclear. Here we extend that line of research to evaluate classification of women veterans with and without PTSD and other trauma-related outcomes based on functional connectivity using magnetoencephalography (MEG). A total of 121 U.S. women veterans completed diagnostic interviews and underwent a task-free MEG scan from which SNI was computed. Linear discriminant analysis was used to classify PTSD and control groups according to SNI. That discriminant function was then used to classify each individual in the partial recovery and full recovery diagnostic groups as PTSD or control. All individuals were classified correctly (100% accuracy) according to their SNI in their PTSD and control groups. Seventy-seven percent of the full recovery group and 69% of the partial recovery group were classified as control. Individual staging in PTSD recovery was captured by the Mahalanobis D2 distances from the center of the control and PTSD centroid clusters. These findings provide compelling evidence supporting the utility of task-free SNI as a biomarker of PTSD and related outcomes in women veterans.
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Affiliation(s)
- Lisa M James
- Department of Veterans Affairs Health Care System,The PTSD Research Group, Brain Sciences Center (11B), Minneapolis VAHCS, One Veterans Drive, Minneapolis, MN, USA. .,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA. .,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA. .,Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Arthur F Leuthold
- Department of Veterans Affairs Health Care System,The PTSD Research Group, Brain Sciences Center (11B), Minneapolis VAHCS, One Veterans Drive, Minneapolis, MN, USA.,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- Department of Veterans Affairs Health Care System,The PTSD Research Group, Brain Sciences Center (11B), Minneapolis VAHCS, One Veterans Drive, Minneapolis, MN, USA.,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.,Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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6
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Rowland JA, Stapleton-Kotloski JR, Martindale SL, Rogers EE, Ord AS, Godwin DW, Taber KH. Alterations in the Topology of Functional Connectomes Are Associated with Post-Traumatic Stress Disorder and Blast-Related Mild Traumatic Brain Injury in Combat Veterans. J Neurotrauma 2021; 38:3086-3096. [PMID: 34435885 DOI: 10.1089/neu.2020.7450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common condition in post-deployment service members (SM). SMs of the conflicts in Iraq and Afghanistan also frequently experience traumatic brain injury (TBI) and exposure to blasts during deployments. This study evaluated the effect of these conditions and experiences on functional brain connectomes in post-deployment, combat-exposed veterans. Functional brain connectomes were created using 5-min resting-state magnetoencephalography data. Well-established clinical interviews determined current PTSD diagnosis, as well as deployment-acquired mild TBI and history of exposure to blast. Linear regression examined the effect of these conditions on functional brain connectomes beyond covariates. There were significant interactions between blast-related mild TBI and PTSD after correction for multiple comparisons including number of nodes (non-standardized parameter estimate [PE] = -12.47), average degree (PE = 0.05), and connection strength (PE = 0.05). A main effect of blast-related mild TBI was observed on the threshold level. These results demonstrate a distinct functional connectome presentation associated with the presence of both blast-related mild TBI and PTSD. These findings suggest the possibility that blast-related mild TBI alterations in functional brain connectomes affect the presentation or progression of recovery from PTSD. The current results offer mixed support for hyper-connectivity in the chronic phase of deployment TBI.
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Affiliation(s)
- Jared A Rowland
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer R Stapleton-Kotloski
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah L Martindale
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily E Rogers
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna S Ord
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dwayne W Godwin
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine H Taber
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Division of Biomedical Sciences, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA
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7
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Teasing apart trauma: neural oscillations differentiate individual cases of mild traumatic brain injury from post-traumatic stress disorder even when symptoms overlap. Transl Psychiatry 2021; 11:345. [PMID: 34088901 PMCID: PMC8178364 DOI: 10.1038/s41398-021-01467-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent and closely related disorders. Affected individuals often exhibit substantially overlapping symptomatology - a major challenge for differential diagnosis in both military and civilian contexts. According to our symptom assessment, the PTSD group exhibited comparable levels of concussion symptoms and severity to the mTBI group. An objective and reliable system to uncover the key neural signatures differentiating these disorders would be an important step towards translational and applied clinical use. Here we explore use of MEG (magnetoencephalography)-multivariate statistical learning analysis in identifying the neural features for differential PTSD/mTBI characterisation. Resting state MEG-derived regional neural activity and coherence (or functional connectivity) across seven canonical neural oscillation frequencies (delta to high gamma) were used. The selected features were consistent and largely confirmatory with previously established neurophysiological markers for the two disorders. For regional power from theta, alpha and high gamma bands, the amygdala, hippocampus and temporal areas were identified. In line with regional activity, additional connections within the occipital, parietal and temporal regions were selected across a number of frequency bands. This study is the first to employ MEG-derived neural features to reliably and differentially stratify the two disorders in a multi-group context. The features from alpha and beta bands exhibited the best classification performance, even in cases where distinction by concussion symptom profiles alone were extremely difficult. We demonstrate the potential of using 'invisible' neural indices of brain functioning to understand and differentiate these debilitating conditions.
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Rowland JA, Stapleton-Kotloski JR, Alberto GE, Davenport AT, Epperly PM, Godwin DW, Daunais JB. Rich Club Characteristics of Alcohol-Naïve Functional Brain Networks Predict Future Drinking Phenotypes in Rhesus Macaques. Front Behav Neurosci 2021; 15:673151. [PMID: 34149371 PMCID: PMC8206638 DOI: 10.3389/fnbeh.2021.673151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: A fundamental question for Alcohol use disorder (AUD) is how and when naïve brain networks are reorganized in response to alcohol consumption. The current study aimed to determine the progression of alcohol’s effect on functional brain networks during transition from the naïve state to chronic consumption. Procedures: Resting-state brain networks of six female rhesus macaque (Macaca mulatta) monkeys were acquired using magnetoencephalography (MEG) prior to alcohol exposure and after free-access to alcohol using a well-established model of chronic heavy alcohol consumption. Functional brain network metrics were derived at each time point. Results: The average connection frequency (p < 0.024) and membership of the Rich Club (p < 0.022) changed significantly over time. Metrics describing network topology remained relatively stable from baseline to free-access drinking. The minimum degree of the Rich Club prior to alcohol exposure was significantly predictive of future free-access drinking (r = −0.88, p < 0.001). Conclusions: Results suggest naïve brain network characteristics may be used to predict future alcohol consumption, and that alcohol consumption alters functional brain networks, shifting hubs and Rich Club membership away from previous regions in a non-systematic manner. Further work to refine these relationships may lead to the identification of a high-risk drinking phenotype.
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Affiliation(s)
- Jared A Rowland
- Research and Academic Affairs Service Line, Mid-Atlantic Mental Illness Research Education and Clinical Center, Salisbury VA Medical Center, Salisbury, NC, United States.,Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer R Stapleton-Kotloski
- Research and Academic Affairs Service Line, Mid-Atlantic Mental Illness Research Education and Clinical Center, Salisbury VA Medical Center, Salisbury, NC, United States.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Greg E Alberto
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - April T Davenport
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Phillip M Epperly
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Dwayne W Godwin
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - James B Daunais
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Allen CM, Halsey L, Topcu G, Rier L, Gascoyne LE, Scadding JW, Furlong PL, Dunkley BT, das Nair R, Brookes MJ, Evangelou N. Magnetoencephalography abnormalities in adult mild traumatic brain injury: A systematic review. Neuroimage Clin 2021; 31:102697. [PMID: 34010785 PMCID: PMC8141472 DOI: 10.1016/j.nicl.2021.102697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The global incidence of traumatic brain injuries is rising, with at least 80% being classified as mild. These mild injuries are not visible on routine clinical imaging. The potential clinical role of a specific imaging biomarker be it diagnostic, prognostic or directing and monitoring progress of personalised treatment and rehabilitation has driven the exploration of several new neuroimaging modalities. This systematic review examined the evidence for magnetoencephalography (MEG) to provide an imaging biomarker in mild traumatic brain injury (mTBI). METHODS Our review was prospectively registered on PROSPERO: CRD42019151387. We searched EMBASE, MEDLINE, trial registers, PsycINFO, Cochrane Library and conference abstracts and identified 37 papers describing MEG changes in mTBI eligible for inclusion. Since meta-analysis was not possible, based on the heterogeneity of reported outcomes, we provide a narrative synthesis of results. RESULTS The two most promising MEG biomarkers are excess resting state low frequency power, and widespread connectivity changes in all frequency bands. These may represent biomarkers with potential for diagnostic application, which reflect time sensitive changes, or may be capable of offering clinically relevant prognostic information. In addition, the rich data that MEG produces are well-suited to new methods of machine learning analysis, which is now being actively explored. INTERPRETATION MEG reveals several promising biomarkers, in the absence of structural abnormalities demonstrable with either computerised tomography or magnetic resonance imaging. This review has not identified sufficient evidence to support routine clinical use of MEG in mTBI currently. However, verifying MEG's potential would help meet an urgent clinical need within civilian, sports and military medicine.
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Affiliation(s)
- Christopher M Allen
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
| | - Lloyd Halsey
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Gogem Topcu
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Lauren E Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - John W Scadding
- National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
| | - Paul L Furlong
- College of Health and Life Sciences, Institute of Health and Neurodevelopment, Aston University, The Aston Triangle, Birmingham B4 7ET, United Kingdom
| | - Benjamin T Dunkley
- Department of Medical Imaging, University of Toronto. 263 McCaul Street, Toronto M5T 1W7, Canada
| | - Roshan das Nair
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
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10
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Philippi CL, Velez CS, Wade BSC, Drennon AM, Cooper DB, Kennedy JE, Bowles AO, Lewis JD, Reid MW, York GE, Newsome MR, Wilde EA, Tate DF. Distinct patterns of resting-state connectivity in U.S. service members with mild traumatic brain injury versus posttraumatic stress disorder. Brain Imaging Behav 2021; 15:2616-2626. [PMID: 33759113 DOI: 10.1007/s11682-021-00464-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/27/2022]
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent in military populations, with many service members suffering from long-term symptoms. Posttraumatic stress disorder (PTSD) often co-occurs with mTBI and predicts worse clinical outcomes. Functional neuroimaging research suggests there are both overlapping and distinct patterns of resting-state functional connectivity (rsFC) in mTBI versus PTSD. However, few studies have directly compared rsFC of cortical networks in military service members with these two conditions. In the present study, U.S. service members (n = 137; ages 19-59; 120 male) underwent resting-state fMRI scans. Participants were divided into three study groups: mTBI only, PTSD only, and orthopedically injured (OI) controls. Analyses investigated group differences in rsFC for cortical networks: default mode (DMN), frontoparietal (FPN), salience, somatosensory, motor, auditory, and visual. Analyses were family-wise error (FWE) cluster-corrected and Bonferroni-corrected for number of network seeds regions at the whole brain level (pFWE < 0.002). Both mTBI and PTSD groups had reduced rsFC for DMN and FPN regions compared with OI controls. These group differences were largely driven by diminished connectivity in the PTSD group. rsFC with the middle frontal gyrus of the FPN was increased in mTBI, but decreased in PTSD. Overall, these results suggest that PTSD symptoms may have a more consistent signal than mTBI. Our novel findings of opposite patterns of connectivity with lateral prefrontal cortex highlight a potential biomarker that could be used to differentiate between these conditions.
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Affiliation(s)
- Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Carmen S Velez
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.,University of Utah, Salt Lake City, UT, USA
| | - Benjamin S C Wade
- University of Utah, Salt Lake City, UT, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, CA, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jan E Kennedy
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Amy O Bowles
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Jeffrey D Lewis
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Matthew W Reid
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | | | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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11
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Maleki N, Finkel A, Cai G, Ross A, Moore RD, Feng X, Androulakis XM. Post-traumatic Headache and Mild Traumatic Brain Injury: Brain Networks and Connectivity. Curr Pain Headache Rep 2021; 25:20. [PMID: 33674899 DOI: 10.1007/s11916-020-00935-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Post-traumatic headache (PTH) consequent to mild traumatic brain injury (mTBI) is a complex, multidimensional, chronic neurological disorder. The purpose of this review is to evaluate the current neuroimaging studies on mTBI and PTH with a specific focus on brain networks and connectivity patterns. RECENT FINDINGS We present findings on PTH incidence and prevalence, as well as the latest neuroimaging research findings on mTBI and PTH. Additionally, we propose a new strategy in studying PTH following mTBI. The diversity and heterogeneity of pathophysiological mechanisms underlying mild traumatic brain injury pose unique challenges on how we interpret neuroimaging findings in PTH. Evaluating alterations in the intrinsic brain network connectivity patterns using novel imaging and analytical techniques may provide additional insights into PTH disease state and therefore inform effective treatment strategies.
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Affiliation(s)
- Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Alan Finkel
- Carolina Headache Institute, 6114 Fayetteville Rd, Suite 109, Durham, NC, USA
| | - Guoshuai Cai
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Alexandra Ross
- University of South Carolina School of Medicine, Columbia, SC, 29209, USA
| | - R Davis Moore
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xuesheng Feng
- Navy Region Mid-Atlantic, Reserve Component Command, 1683 Gilbert Street, Norfolk, VA, 23511, USA
| | - X Michelle Androulakis
- University of South Carolina School of Medicine, Columbia, SC, 29209, USA. .,Columbia VA Health Care System, Columbia, SC, 20208, USA.
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12
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Magnetoencephalography in the Detection and Characterization of Brain Abnormalities Associated with Traumatic Brain Injury: A Comprehensive Review. Med Sci (Basel) 2021; 9:medsci9010007. [PMID: 33557219 PMCID: PMC7930962 DOI: 10.3390/medsci9010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/29/2021] [Indexed: 01/18/2023] Open
Abstract
Magnetoencephalography (MEG) is a functional brain imaging technique with high temporal resolution compared with techniques that rely on metabolic coupling. MEG has an important role in traumatic brain injury (TBI) research, especially in mild TBI, which may not have detectable features in conventional, anatomical imaging techniques. This review addresses the original research articles to date that have reported on the use of MEG in TBI. Specifically, the included studies have demonstrated the utility of MEG in the detection of TBI, characterization of brain connectivity abnormalities associated with TBI, correlation of brain signals with post-concussive symptoms, differentiation of TBI from post-traumatic stress disorder, and monitoring the response to TBI treatments. Although presently the utility of MEG is mostly limited to research in TBI, a clinical role for MEG in TBI may become evident with further investigation.
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13
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Dunkley BT, Jetly R, Pang EW, Taylor MJ. New perspectives on the neurobiology of PTSD: High-resolution imaging of neural circuit (dys)function with magnetoencephalography. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh.2019-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Combat-related posttraumatic stress disorder (PTSD) is increasingly conceptualized in psychiatry as a disorder of dysfunctional neural circuits. Advances in neuroimaging have enabled the study of those networks non-invasively. PTSD is currently assessed using subjective self-reporting to inform crucial decisions, such as fitness to deploy, but objective markers would aid in diagnosis and return-to-deployment decisions. Methods: Magnetoencephalography (MEG) allows investigation of neural circuit function via imaging of brain waves (known as neural oscillations) that index information processing in the brain and would prove a reliable, objective, biomarker. These measures of brain function establish how regions communicate to form brain circuits that support thinking and behaviour. Results: Studies into intrinsic brain function, both during rest and when engaged in a task designed to tap into cognitive dysfunction, have found these neurobiological mechanisms are disrupted in PTSD and are a reliable objective marker of illness. We now know that these alterations in brain function are directly related to core symptoms of PTSD and comorbid cognitive-behavioural challenges. Discussion: Continued characterization of neural function using MEG and related methods will advance understanding of the neurobiology underlying PTSD; allow for the identification of biomarkers that, coupled with machine learning, will aid in diagnoses; provide individualized therapeutic targets for neurostimulation; predict treatment outcomes; and track disorder remission in military personnel and Veterans who are disproportionately affected by this devastating illness.
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Affiliation(s)
- Benjamin T. Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto
- Department of Medical Imaging, University of Toronto, Toronto
- Department of National Defence, Canadian Forces Health Services Group, Department of National Defence, Ottawa
- Division of Neurology, The Hospital for Sick Children (SickKids), Toronto
| | - Rakesh Jetly
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto
- Department of Medical Imaging, University of Toronto, Toronto
- Department of National Defence, Canadian Forces Health Services Group, Department of National Defence, Ottawa
- Division of Neurology, The Hospital for Sick Children (SickKids), Toronto
| | - Elizabeth W. Pang
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto
- Department of Medical Imaging, University of Toronto, Toronto
- Department of National Defence, Canadian Forces Health Services Group, Department of National Defence, Ottawa
- Division of Neurology, The Hospital for Sick Children (SickKids), Toronto
| | - Margot J. Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children (SickKids), Toronto
- Neurosciences & Mental Health, The Hospital for Sick Children (SickKids) Research Institute, Toronto
- Department of Medical Imaging, University of Toronto, Toronto
- Department of National Defence, Canadian Forces Health Services Group, Department of National Defence, Ottawa
- Division of Neurology, The Hospital for Sick Children (SickKids), Toronto
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14
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Labyt E, Corsi MC, Fourcault W, Palacios Laloy A, Bertrand F, Lenouvel F, Cauffet G, Le Prado M, Berger F, Morales S. Magnetoencephalography With Optically Pumped 4He Magnetometers at Ambient Temperature. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:90-98. [PMID: 30010553 DOI: 10.1109/tmi.2018.2856367] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this paper, we present the first proof of concept confirming the possibility to record magnetoencephalographic (MEG) signals with optically pumped magnetometers (OPMs) based on the parametric resonance of 4He atoms. The main advantage of this kind of OPM is the possibility to provide a tri-axis vector measurement of the magnetic field at room-temperature (the 4He vapor is neither cooled nor heated). The sensor achieves a sensitivity of 210 fT/ √ Hz in the bandwidth [2-300 Hz]. MEG simulation studies with a brain phantom were cross-validated with real MEG measurements on a healthy subject. For both studies, MEG signal was recorded consecutively with OPMs and superconducting quantum interference devices (SQUIDs) used as reference sensors. For healthy subject MEG recordings, three MEG proofs of concept were carried out: auditory evoked fields, visual evoked fields, and spontaneous activity. M100 peaks have been detected on evoked responses recorded by both OPMs and SQUIDs with no significant difference in latency. Concerning spontaneous activity, an attenuation of the signal power between 8-12 Hz (alpha band) related to eyes opening has been observed with OPM similarly to SQUID. All these results confirm that the room temperature vector 4He OPMs can record MEG signals and provide reliable information on brain activity.
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15
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Magnetoencephalography: Clinical and Research Practices. Brain Sci 2018; 8:brainsci8080157. [PMID: 30126121 PMCID: PMC6120049 DOI: 10.3390/brainsci8080157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/07/2018] [Accepted: 08/11/2018] [Indexed: 11/25/2022] Open
Abstract
Magnetoencephalography (MEG) is a neurophysiological technique that detects the magnetic fields associated with brain activity. Synthetic aperture magnetometry (SAM), a MEG magnetic source imaging technique, can be used to construct both detailed maps of global brain activity as well as virtual electrode signals, which provide information that is similar to invasive electrode recordings. This innovative approach has demonstrated utility in both clinical and research settings. For individuals with epilepsy, MEG provides valuable, nonredundant information. MEG accurately localizes the irritative zone associated with interictal spikes, often detecting epileptiform activity other methods cannot, and may give localizing information when other methods fail. These capabilities potentially greatly increase the population eligible for epilepsy surgery and improve planning for those undergoing surgery. MEG methods can be readily adapted to research settings, allowing noninvasive assessment of whole brain neurophysiological activity, with a theoretical spatial range down to submillimeter voxels, and in both humans and nonhuman primates. The combination of clinical and research activities with MEG offers a unique opportunity to advance translational research from bench to bedside and back.
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16
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Rowland JA, Stapleton-Kotloski JR, Dobbins DL, Rogers E, Godwin DW, Taber KH. Increased Small-World Network Topology Following Deployment-Acquired Traumatic Brain Injury Associated with the Development of Post-Traumatic Stress Disorder. Brain Connect 2018; 8:205-211. [PMID: 29634322 DOI: 10.1089/brain.2017.0556] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cross-sectional and longitudinal studies in active duty and veteran cohorts have both demonstrated that deployment-acquired traumatic brain injury (TBI) is an independent risk factor for developing post-traumatic stress disorder (PTSD), beyond confounds such as combat exposure, physical injury, predeployment TBI, and pre-deployment psychiatric symptoms. This study investigated how resting-state brain networks differ between individuals who developed PTSD and those who did not following deployment-acquired TBI. Participants included postdeployment veterans with deployment-acquired TBI history both with and without current PTSD diagnosis. Graph metrics, including small-worldness, clustering coefficient, and modularity, were calculated from individually constructed whole-brain networks based on 5-min eyes-open resting-state magnetoencephalography (MEG) recordings. Analyses were adjusted for age and premorbid IQ. Results demonstrated that participants with current PTSD displayed higher levels of small-worldness, F(1,12) = 5.364, p < 0.039, partial eta squared = 0.309, and Cohen's d = 0.972, and clustering coefficient, F(1, 12) = 12.204, p < 0.004, partial eta squared = 0.504, and Cohen's d = 0.905, than participants without current PTSD. There were no between-group differences in modularity or the number of modules present. These findings are consistent with a hyperconnectivity hypothesis of the effect of TBI history on functional networks rather than a disconnection hypothesis, demonstrating increased levels of clustering coefficient rather than a decrease as might be expected; however, these results do not account for potential changes in brain structure. These results demonstrate the potential pathological sequelae of changes in functional brain networks following deployment-acquired TBI and represent potential neurobiological changes associated with deployment-acquired TBI that may increase the risk of subsequently developing PTSD.
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Affiliation(s)
- Jared A Rowland
- 1 Research and Academic Affairs Service Line, W.G. "Bill" Hefner VA Medical Center , Salisbury, North Carolina.,2 Mid Atlantic Mental Illness Research Education and Clinical Center , Durham, North Carolina.,3 Department of Neurobiology & Anatomy, Wake Forest School of Medicine , Winston-Salem, North Carolina.,4 Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Jennifer R Stapleton-Kotloski
- 1 Research and Academic Affairs Service Line, W.G. "Bill" Hefner VA Medical Center , Salisbury, North Carolina.,5 Department of Neurology, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Dorothy L Dobbins
- 3 Department of Neurobiology & Anatomy, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Emily Rogers
- 3 Department of Neurobiology & Anatomy, Wake Forest School of Medicine , Winston-Salem, North Carolina.,5 Department of Neurology, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Dwayne W Godwin
- 3 Department of Neurobiology & Anatomy, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Katherine H Taber
- 1 Research and Academic Affairs Service Line, W.G. "Bill" Hefner VA Medical Center , Salisbury, North Carolina.,2 Mid Atlantic Mental Illness Research Education and Clinical Center , Durham, North Carolina.,6 Division of Biomedical Sciences, Edward Via College of Osteopathic Medicine , Blacksburg, Virginia.,7 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas
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