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Kwiatkowski A, Weidler C, Habel U, Coverdale NS, Hirad AA, Manning KY, Rauscher A, Bazarian JJ, Cook DJ, Li DKB, Mahon BZ, Menon RS, Taunton J, Reetz K, Romanzetti S, Huppertz C. Uncovering the hidden effects of repetitive subconcussive head impact exposure: A mega-analytic approach characterizing seasonal brain microstructural changes in contact and collision sports athletes. Hum Brain Mapp 2024; 45:e26811. [PMID: 39185683 PMCID: PMC11345636 DOI: 10.1002/hbm.26811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/27/2024] Open
Abstract
Repetitive subconcussive head impacts (RSHI) are believed to induce sub-clinical brain injuries, potentially resulting in cumulative, long-term brain alterations. This study explores patterns of longitudinal brain white matter changes across sports with RSHI-exposure. A systematic literature search identified 22 datasets with longitudinal diffusion magnetic resonance imaging data. Four datasets were centrally pooled to perform uniform quality control and data preprocessing. A total of 131 non-concussed active athletes (American football, rugby, ice hockey; mean age: 20.06 ± 2.06 years) with baseline and post-season data were included. Nonparametric permutation inference (one-sample t tests, one-sided) was applied to analyze the difference maps of multiple diffusion parameters. The analyses revealed widespread lateralized patterns of sports-season-related increases and decreases in mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) across spatially distinct white matter regions. Increases were shown across one MD-cluster (3195 voxels; mean change: 2.34%), one AD-cluster (5740 voxels; mean change: 1.75%), and three RD-clusters (817 total voxels; mean change: 3.11 to 4.70%). Decreases were shown across two MD-clusters (1637 total voxels; mean change: -1.43 to -1.48%), two RD-clusters (1240 total voxels; mean change: -1.92 to -1.93%), and one AD-cluster (724 voxels; mean change: -1.28%). The resulting pattern implies the presence of strain-induced injuries in central and brainstem regions, with comparatively milder physical exercise-induced effects across frontal and superior regions of the left hemisphere, which need further investigation. This article highlights key considerations that need to be addressed in future work to enhance our understanding of the nature of observed white matter changes, improve the comparability of findings across studies, and promote data pooling initiatives to allow more detailed investigations (e.g., exploring sex- and sport-specific effects).
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Affiliation(s)
- Anna Kwiatkowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Carmen Weidler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
- Institute of Neuroscience and Medicine 10, Research Centre JülichJülichGermany
- JARA‐BRAIN Institute Brain Structure Function Relationship, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | | | - Adnan A. Hirad
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of NeuroscienceUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Del Monte Neuroscience Institute, University of RochesterNew YorkUSA
| | - Kathryn Y. Manning
- Department of RadiologyUniversity of Calgary and Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
| | - Alexander Rauscher
- Department of Radiology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Pediatrics, Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Physics and AstronomyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- UBC MRI Research Centre, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jeffrey J. Bazarian
- Department of Emergency MedicineUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Douglas J. Cook
- Centre for Neuroscience Studies, Queen's UniversityKingstonOntarioCanada
- Division of Neurosurgery, Department of SurgeryQueen's UniversityKingstonOntarioCanada
| | - David K. B. Li
- Department of Radiology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Bradford Z. Mahon
- Department of PsychologyCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
- Carnegie Mellon Neuroscience InstitutePittsburghPennsylvaniaUSA
- Department of NeurosurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ravi S. Menon
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western OntarioLondonOntarioCanada
| | - Jack Taunton
- Allan McGavin Sports Medicine Centre, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kathrin Reetz
- Department of Neurology, Medical FacultyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | - Sandro Romanzetti
- Department of Neurology, Medical FacultyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | - Charlotte Huppertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
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Lima Santos JP, Kontos AP, Holland CL, Suss SJ, Stiffler RS, Bitzer HB, Colorito AT, Shaffer M, Skeba A, Iyengar S, Manelis A, Brent D, Shirtcliff EA, Ladouceur CD, Phillips ML, Collins MW, Versace A. The Role of Puberty and Sex on Brain Structure in Adolescents With Anxiety Following Concussion. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:285-297. [PMID: 36517369 DOI: 10.1016/j.bpsc.2022.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adolescence represents a window of vulnerability for developing psychological symptoms following concussion, especially in girls. Concussion-related lesions in emotion regulation circuits may help explain these symptoms. However, the contribution of sex and pubertal maturation remains unclear. Using the neurite density index (NDI) in emotion regulation tracts (left/right cingulum bundle [CB], forceps minor [FMIN], and left/right uncinate fasciculus), we sought to elucidate these relationships. METHODS No adolescent had a history of anxiety and/or depression. The Screen for Child Anxiety Related Emotional Disorders and Children's Depression Rating Scale were used at scan to assess anxiety and depressive symptoms in 55 concussed adolescents (41.8% girls) and 50 control adolescents with no current/history of concussion (44% girls). We evaluated if a mediation-moderation model including the NDI (mediation) and sex or pubertal status (moderation) could help explain this relationship. RESULTS Relative to control adolescents, concussed adolescents showed higher anxiety (p = .003) and lower NDI, with those at more advanced pubertal maturation showing greater abnormalities in 4 clusters: the left CB frontal (p = .002), right CB frontal (p = .011), FMIN left-sided (p = .003), and FMIN right-sided (p = .003). Across all concussed adolescents, lower NDI in the left CB frontal and FMIN left-sided clusters partially mediated the association between concussion and anxiety, with the CB being specific to female adolescents. These effects did not explain depressive symptoms. CONCLUSIONS Our findings indicate that lower NDI in the CB and FMIN may help explain anxiety following concussion and that adolescents at more advanced (vs less advanced) status of pubertal maturation may be more vulnerable to concussion-related injuries, especially in girls.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P Kontos
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Cynthia L Holland
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Stephen J Suss
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Richelle S Stiffler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hannah B Bitzer
- Department of Psychology, Florida International University, Miami, Florida
| | - Adam T Colorito
- Department of Psychology, Florida International University, Miami, Florida
| | - Madelyn Shaffer
- Department of Psychology, Florida International University, Miami, Florida
| | - Alexander Skeba
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna Manelis
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Brent
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Elizabeth A Shirtcliff
- Center for Translational Neuroscience and Department of Psychology, University of Oregon, Eugene, Oregon
| | - Cecile D Ladouceur
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W Collins
- Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pennsylvania
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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Neumann KD, Broshek DK, Newman BT, Druzgal TJ, Kundu BK, Resch JE. Concussion: Beyond the Cascade. Cells 2023; 12:2128. [PMID: 37681861 PMCID: PMC10487087 DOI: 10.3390/cells12172128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Sport concussion affects millions of athletes each year at all levels of sport. Increasing evidence demonstrates clinical and physiological recovery are becoming more divergent definitions, as evidenced by several studies examining blood-based biomarkers of inflammation and imaging studies of the central nervous system (CNS). Recent studies have shown elevated microglial activation in the CNS in active and retired American football players, as well as in active collegiate athletes who were diagnosed with a concussion and returned to sport. These data are supportive of discordance in clinical symptomology and the inflammatory response in the CNS upon symptom resolution. In this review, we will summarize recent advances in the understanding of the inflammatory response associated with sport concussion and broader mild traumatic brain injury, as well as provide an outlook for important research questions to better align clinical and physiological recovery.
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Affiliation(s)
- Kiel D. Neumann
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Donna K. Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22903, USA;
| | - Benjamin T. Newman
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - T. Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - Bijoy K. Kundu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - Jacob E. Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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Esopenko C, Sollmann N, Bonke EM, Wiegand TLT, Heinen F, de Souza NL, Breedlove KM, Shenton ME, Lin AP, Koerte IK. Current and Emerging Techniques in Neuroimaging of Sport-Related Concussion. J Clin Neurophysiol 2023; 40:398-407. [PMID: 36930218 PMCID: PMC10329721 DOI: 10.1097/wnp.0000000000000864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sport-related concussion (SRC) affects an estimated 1.6 to 3.8 million Americans each year. Sport-related concussion results from biomechanical forces to the head or neck that lead to a broad range of neurologic symptoms and impaired cognitive function. Although most individuals recover within weeks, some develop chronic symptoms. The heterogeneity of both the clinical presentation and the underlying brain injury profile make SRC a challenging condition. Adding to this challenge, there is also a lack of objective and reliable biomarkers to support diagnosis, to inform clinical decision making, and to monitor recovery after SRC. In this review, the authors provide an overview of advanced neuroimaging techniques that provide the sensitivity needed to capture subtle changes in brain structure, metabolism, function, and perfusion after SRC. This is followed by a discussion of emerging neuroimaging techniques, as well as current efforts of international research consortia committed to the study of SRC. Finally, the authors emphasize the need for advanced multimodal neuroimaging to develop objective biomarkers that will inform targeted treatment strategies after SRC.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Nico Sollmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena M. Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tim L. T. Wiegand
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Felicitas Heinen
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nicola L. de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Katherine M. Breedlove
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Alexander P. Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K. Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Hsu PS, Cheng CM, Chao HT, Lin MW, Li WC, Lee LC, Liu CH, Chen LF, Hsieh JC. OPRM1 A118G polymorphism modulating motor pathway for pain adaptability in women with primary dysmenorrhea. Front Neurosci 2023; 17:1179851. [PMID: 37378013 PMCID: PMC10291086 DOI: 10.3389/fnins.2023.1179851] [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: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Primary dysmenorrhea (PDM) is a common condition among women of reproductive age, characterized by menstrual pain in the absence of any organic causes. Previous research has established a link between the A118G polymorphism in the mu-opioid receptor (OPRM1) gene and pain experience in PDM. Specifically, carriers of the G allele have been found to exhibit maladaptive functional connectivity between the descending pain modulatory system and the motor system in young women with PDM. This study aims to explore the potential relationship between the OPRM1 A118G polymorphism and changes in white matter in young women with PDM. Methods The study enrolled 43 individuals with PDM, including 13 AA homozygotes and 30 G allele carriers. Diffusion tensor imaging (DTI) scans were performed during both the menstrual and peri-ovulatory phases, and tract-based spatial statistics (TBSS) and probabilistic tractography were used to explore variations in white matter microstructure related to the OPRM1 A118G polymorphism. The short-form McGill Pain Questionnaire (MPQ) was used to access participants' pain experience during the MEN phase. Results Two-way ANOVA on TBSS analysis revealed a significant main effect of genotype, with no phase effect or phase-gene interaction detected. Planned contrast analysis showed that during the menstrual phase, G allele carriers had higher fractional anisotropy (FA) and lower radial diffusivity in the corpus callosum and the left corona radiata compared to AA homozygotes. Tractographic analysis indicated the involvement of the left internal capsule, left corticospinal tract, and bilateral medial motor cortex. Additionally, the mean FA of the corpus callosum and the corona radiata was negatively correlated with MPQ scales in AA homozygotes, but this correlation was not observed in G allele carriers. No significant genotype difference was found during the pain-free peri-ovulary phase. Discussion OPRM1 A118G polymorphism may influence the connection between structural integrity and dysmenorrheic pain, where the G allele could impede the pain-regulating effects of the A allele. These novel findings shed light on the underlying mechanisms of both adaptive and maladaptive structural neuroplasticity in PDM, depending on the specific OPRM1 polymorphism.
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Affiliation(s)
- Pei-Shan Hsu
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chou-Ming Cheng
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Tai Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chi Li
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Lin-Chien Lee
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Ching-Hsiung Liu
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Li-Fen Chen
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Chuen Hsieh
- Integrated Brain Research Unit, Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Crasta JE, Nebel MB, Svingos A, Tucker RN, Chen HW, Busch T, Caffo BS, Stephens J, Suskauer SJ. Rethinking recovery in adolescent concussions: Network-level functional connectivity alterations associated with motor deficits. Hum Brain Mapp 2023; 44:3271-3282. [PMID: 36999674 PMCID: PMC10171516 DOI: 10.1002/hbm.26280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Adolescents who are clinically recovered from concussion continue to show subtle motor impairment on neurophysiological and behavioral measures. However, there is limited information on brain-behavior relationships of persistent motor impairment following clinical recovery from concussion. We examined the relationship between subtle motor performance and functional connectivity of the brain in adolescents with a history of concussion, status post-symptom resolution, and subjective return to baseline. Participants included 27 adolescents who were clinically recovered from concussion and 29 never-concussed, typically developing controls (10-17 years); all participants were examined using the Physical and Neurologic Examination of Subtle Signs (PANESS). Functional connectivity between the default mode network (DMN) or dorsal attention network (DAN) and regions of interest within the motor network was assessed using resting-state functional magnetic resonance imaging (rsfMRI). Compared to controls, adolescents clinically recovered from concussion showed greater subtle motor deficits as evaluated by the PANESS and increased connectivity between the DMN and left lateral premotor cortex. DMN to left lateral premotor cortex connectivity was significantly correlated with the total PANESS score, with more atypical connectivity associated with more motor abnormalities. This suggests that altered functional connectivity of the brain may underlie subtle motor deficits in adolescents who have clinically recovered from concussion. More investigation is required to understand the persistence and longer-term clinical relevance of altered functional connectivity and associated subtle motor deficits to inform whether functional connectivity may serve as an important biomarker related to longer-term outcomes after clinical recovery from concussion.
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Affiliation(s)
- Jewel E. Crasta
- Occupational Therapy DivisionThe Ohio State UniversityColumbusOhioUSA
| | - Mary Beth Nebel
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Adrian Svingos
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Robert N. Tucker
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Carle Illinois College of MedicineUniversity of Illinois at Urbana‐ChampaignChampaignILUSA
| | - Hsuan Wei Chen
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Tyler Busch
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Brian S. Caffo
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jaclyn Stephens
- Department of Occupational TherapyColorado State UniversityFort CollinsColoradoUSA
| | - Stacy J. Suskauer
- Brain Injury Clinical Research CenterKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Brown O, Healey K, Fang Z, Zemek R, Smith A, Ledoux AA. Associations between psychological resilience and metrics of white matter microstructure in pediatric concussion. Hum Brain Mapp 2023. [PMID: 37126608 DOI: 10.1002/hbm.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
This study investigated associations between psychological resilience and characteristics of white matter microstructure in pediatric concussion. This is a case control study and a planned substudy of a larger randomized controlled trial. Children with an acute concussion or orthopedic injury were recruited from the emergency department. Participants completed both the Connor-Davidson Resilience Scale 10 and an MRI at 72 h and 4-weeks post-injury. The association between resiliency and fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) at both timepoints were examined. We examined whether these associations were moderated by group. The association between resiliency captured at 72 h and diffusion tensor imaging metrics at 4 weeks was also investigated. Clusters were extracted using a significance threshold of threshold-free cluster enhancement corrected p < .05. A total of 66 children with concussion (median (IQR) age = 12.88 (IQR: 11.80-14.36); 47% female) and 29 children with orthopedic-injury (median (IQR) age = 12.49 (IQR: 11.18-14.01); 41% female) were included. A negative correlation was identified in the concussion group between 72 h resilience and 72 h FA. Meanwhile, positive correlations were identified in the concussion group with concussion between 72 h resilience and both 72 h MD and 72 h RD. These findings suggest that 72 h resilience is associated with white matter microstructure of the forceps minor, superior longitudinal fasciculus, and anterior thalamic radiation at 72 h post-concussion. Resilience seems to be associated with neural integrity only in the acute phase of concussion and thus may be considered when researching concussion recovery.
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Affiliation(s)
- Olivier Brown
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine Healey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Zhuo Fang
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics and Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra Smith
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
- Department of Cellular Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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9
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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10
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Mayer AR, Ling JM, Dodd AB, Stephenson DD, Pabbathi Reddy S, Robertson-Benta CR, Erhardt EB, Harms RL, Meier TB, Vakhtin AA, Campbell RA, Sapien RE, Phillips JP. Multicompartmental models and diffusion abnormalities in paediatric mild traumatic brain injury. Brain 2022; 145:4124-4137. [PMID: 35727944 DOI: 10.1093/brain/awac221] [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: 11/23/2021] [Revised: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 01/23/2023] Open
Abstract
The underlying pathophysiology of paediatric mild traumatic brain injury and the time-course for biological recovery remains widely debated, with clinical care principally informed by subjective self-report. Similarly, clinical evidence indicates that adolescence is a risk factor for prolonged recovery, but the impact of age-at-injury on biomarkers has not been determined in large, homogeneous samples. The current study collected diffusion MRI data in consecutively recruited patients (n = 203; 8-18 years old) and age and sex-matched healthy controls (n = 170) in a prospective cohort design. Patients were evaluated subacutely (1-11 days post-injury) as well as at 4 months post-injury (early chronic phase). Healthy participants were evaluated at similar times to control for neurodevelopment and practice effects. Clinical findings indicated persistent symptoms at 4 months for a significant minority of patients (22%), along with residual executive dysfunction and verbal memory deficits. Results indicated increased fractional anisotropy and reduced mean diffusivity for patients, with abnormalities persisting up to 4 months post-injury. Multicompartmental geometric models indicated that estimates of intracellular volume fractions were increased in patients, whereas estimates of free water fractions were decreased. Critically, unique areas of white matter pathology (increased free water fractions or increased neurite dispersion) were observed when standard assumptions regarding parallel diffusivity were altered in multicompartmental models to be more biologically plausible. Cross-validation analyses indicated that some diffusion findings were more reproducible when ∼70% of the total sample (142 patients, 119 controls) were used in analyses, highlighting the need for large-sample sizes to detect abnormalities. Supervised machine learning approaches (random forests) indicated that diffusion abnormalities increased overall diagnostic accuracy (patients versus controls) by ∼10% after controlling for current clinical gold standards, with each diffusion metric accounting for only a few unique percentage points. In summary, current results suggest that novel multicompartmental models are more sensitive to paediatric mild traumatic brain injury pathology, and that this sensitivity is increased when using parameters that more accurately reflect diffusion in healthy tissue. Results also indicate that diffusion data may be insufficient to achieve a high degree of objective diagnostic accuracy in patients when used in isolation, which is to be expected given known heterogeneities in pathophysiology, mechanism of injury and even criteria for diagnoses. Finally, current results indicate ongoing clinical and physiological recovery at 4 months post-injury.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, NM 87106, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA.,Department of Neurology, University of New Mexico, Albuquerque, NM 87131, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Josef M Ling
- The Mind Research Network/LBERI, Albuquerque, NM 87106, USA
| | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, NM 87106, USA
| | | | | | | | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM 87131, USA
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - John P Phillips
- The Mind Research Network/LBERI, Albuquerque, NM 87106, USA.,Department of Neurology, University of New Mexico, Albuquerque, NM 87131, USA
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11
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Pinky NN, Debert CT, Dukelow SP, Benson BW, Harris AD, Yeates KO, Emery CA, Goodyear BG. Multimodal magnetic resonance imaging of youth sport-related concussion reveals acute changes in the cerebellum, basal ganglia, and corpus callosum that resolve with recovery. Front Hum Neurosci 2022; 16:976013. [PMID: 36337852 PMCID: PMC9626521 DOI: 10.3389/fnhum.2022.976013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) can provide a number of measurements relevant to sport-related concussion (SRC) symptoms; however, most studies to date have used a single MRI modality and whole-brain exploratory analyses in attempts to localize concussion injury. This has resulted in highly variable findings across studies due to wide ranging symptomology, severity and nature of injury within studies. A multimodal MRI, symptom-guided region-of-interest (ROI) approach is likely to yield more consistent results. The functions of the cerebellum and basal ganglia transcend many common concussion symptoms, and thus these regions, plus the white matter tracts that connect or project from them, constitute plausible ROIs for MRI analysis. We performed diffusion tensor imaging (DTI), resting-state functional MRI, quantitative susceptibility mapping (QSM), and cerebral blood flow (CBF) imaging using arterial spin labeling (ASL), in youth aged 12-18 years following SRC, with a focus on the cerebellum, basal ganglia and white matter tracts. Compared to controls similar in age, sex and sport (N = 20), recent SRC youth (N = 29; MRI at 8 ± 3 days post injury) exhibited increased susceptibility in the cerebellum (p = 0.032), decreased functional connectivity between the caudate and each of the pallidum (p = 0.035) and thalamus (p = 0.021), and decreased diffusivity in the mid-posterior corpus callosum (p < 0.038); no changes were observed in recovered asymptomatic youth (N = 16; 41 ± 16 days post injury). For recent symptomatic-only SRC youth (N = 24), symptom severity was associated with increased susceptibility in the superior cerebellar peduncles (p = 0.011) and reduced activity in the cerebellum (p = 0.013). Fewer days between injury and MRI were associated with reduced cerebellar-parietal functional connectivity (p < 0.014), reduced activity of the pallidum (p = 0.002), increased CBF in the caudate (p = 0.005), and reduced diffusivity in the central corpus callosum (p < 0.05). Youth SRC is associated with acute cerebellar inflammation accompanied by reduced cerebellar activity and cerebellar-parietal connectivity, as well as structural changes of the middle regions of the corpus callosum accompanied by functional changes of the caudate, all of which resolve with recovery. Early MRI post-injury is important to establish objective MRI-based indicators for concussion diagnosis, recovery assessment and prediction of outcome.
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Affiliation(s)
- Najratun Nayem Pinky
- Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Chantel T. Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian W. Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Canadian Sport Institute Calgary, University of Calgary, Calgary, AB, Canada
- Benson Concussion Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley D. Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Keith O. Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Carolyn A. Emery
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Sports Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Bradley G. Goodyear
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
- *Correspondence: Bradley G. Goodyear,
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12
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Crasta JE, Tucker RN, Robinson J, Chen HW, Crocetti D, Suskauer SJ. Altered white matter diffusivity and subtle motor function in a pilot cohort of adolescents with sports-related concussion. Brain Inj 2022; 36:393-400. [PMID: 35157539 PMCID: PMC9133076 DOI: 10.1080/02699052.2022.2034181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and objective: Adolescents with sports-related concussion (SRC) demonstrate acute and persistent deficits in subtle motor function. However, there is limited research examining related neurological underpinnings. This pilot study examined changes in motor-associated white matter pathways using diffusion tensor imaging (DTI) and their relationship with subtle motor function. Methods: Twelve adolescents with SRC (12–17 years) within two-weeks post-injury and 13 never-injured neurotypical peers completed DTI scanning. A subset of 6 adolescents with SRC returned for a follow-up visit post-medical clearance from concussion. Subtle motor function was evaluated using the Physical and Neurological Examination of Subtle Signs (PANESS). Results: Adolescents with SRC showed higher mean diffusivity (MD) of the superior corona radiata and greater subtle motor deficits compared to controls. Across all participants, greater subtle motor deficits were associated with higher (more atypical) MD of the superior corona radiata. Preliminary longitudinal analysis indicated reduction in fractional anisotropy of the corpus callosum but no change in the MD of the superior corona radiata from the initial visit to the follow-up visit post-medical clearance. Conclusions: These findings support preliminary evidence for a brain–behavior relationship between superior corona radiata microstructure and subtle motor deficits in adolescents with SRC that merits further investigation.
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Affiliation(s)
- Jewel E Crasta
- Occupational Therapy Division, The Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Dennis EL, Baron D, Bartnik‐Olson B, Caeyenberghs K, Esopenko C, Hillary FG, Kenney K, Koerte IK, Lin AP, Mayer AR, Mondello S, Olsen A, Thompson PM, Tate DF, Wilde EA. ENIGMA brain injury: Framework, challenges, and opportunities. Hum Brain Mapp 2022; 43:149-166. [PMID: 32476212 PMCID: PMC8675432 DOI: 10.1002/hbm.25046] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability worldwide, but the heterogeneous nature of TBI with respect to injury severity and health comorbidities make patient outcome difficult to predict. Injury severity accounts for only some of this variance, and a wide range of preinjury, injury-related, and postinjury factors may influence outcome, such as sex, socioeconomic status, injury mechanism, and social support. Neuroimaging research in this area has generally been limited by insufficient sample sizes. Additionally, development of reliable biomarkers of mild TBI or repeated subconcussive impacts has been slow, likely due, in part, to subtle effects of injury and the aforementioned variability. The ENIGMA Consortium has established a framework for global collaboration that has resulted in the largest-ever neuroimaging studies of multiple psychiatric and neurological disorders. Here we describe the organization, recent progress, and future goals of the Brain Injury working group.
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Affiliation(s)
- Emily L. Dennis
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - David Baron
- Western University of Health SciencesPomonaCaliforniaUSA
| | - Brenda Bartnik‐Olson
- Department of RadiologyLoma Linda University Medical CenterLoma LindaCaliforniaUSA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of PsychologyDeakin UniversityBurwoodVictoriaAustralia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement SciencesRutgers Biomedical Health SciencesNewarkNew JerseyUSA
| | - Frank G. Hillary
- Department of PsychologyPennsylvania State UniversityUniversity ParkPennsylvaniaUSA
- Social Life and Engineering Sciences Imaging CenterUniversity ParkPennsylvaniaUSA
| | - Kimbra Kenney
- Department of NeurologyUniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Alexander P. Lin
- Center for Clinical SpectroscopyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Andrew R. Mayer
- Mind Research NetworkAlbuquerqueNew MexicoUSA
- Department of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alexander Olsen
- Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Paul M. Thompson
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - David F. Tate
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
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14
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Examining brain white matter after pediatric mild traumatic brain injury using neurite orientation dispersion and density imaging: An A-CAP study. Neuroimage Clin 2021; 32:102887. [PMID: 34911193 PMCID: PMC8633364 DOI: 10.1016/j.nicl.2021.102887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022]
Abstract
We examined white matter microstructure after pediatric mTBI using NODDI and DTI. Children with mTBI did not significantly differ from those with OI on any metrics. Minor alterations, if any, may be present in children at the post-acute stage after mTBI. Large longitudinal studies are needed to understand long-term brain changes post injury.
Background Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods Children (mTBI n = 320, OI n = 176) aged 8–16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3 T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions Overall, there were no significant differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.
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15
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Thanjavur K, Hristopulos DT, Babul A, Yi KM, Virji-Babul N. Deep Learning Recurrent Neural Network for Concussion Classification in Adolescents Using Raw Electroencephalography Signals: Toward a Minimal Number of Sensors. Front Hum Neurosci 2021; 15:734501. [PMID: 34899212 PMCID: PMC8654150 DOI: 10.3389/fnhum.2021.734501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Artificial neural networks (ANNs) are showing increasing promise as decision support tools in medicine and particularly in neuroscience and neuroimaging. Recently, there has been increasing work on using neural networks to classify individuals with concussion using electroencephalography (EEG) data. However, to date the need for research grade equipment has limited the applications to clinical environments. We recently developed a deep learning long short-term memory (LSTM) based recurrent neural network to classify concussion using raw, resting state data using 64 EEG channels and achieved high accuracy in classifying concussion. Here, we report on our efforts to develop a clinically practical system using a minimal subset of EEG sensors. EEG data from 23 athletes who had suffered a sport-related concussion and 35 non-concussed, control athletes were used for this study. We tested and ranked each of the original 64 channels based on its contribution toward the concussion classification performed by the original LSTM network. The top scoring channels were used to train and test a network with the same architecture as the previously trained network. We found that with only six of the top scoring channels the classifier identified concussions with an accuracy of 94%. These results show that it is possible to classify concussion using raw, resting state data from a small number of EEG sensors, constituting a first step toward developing portable, easy to use EEG systems that can be used in a clinical setting.
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Affiliation(s)
- Karun Thanjavur
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | | | - Arif Babul
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Kwang Moo Yi
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Naznin Virji-Babul
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Lees B, Earls NE, Meares S, Batchelor J, Oxenham V, Rae CD, Jugé L, Cysique LA. Diffusion Tensor Imaging in Sport-Related Concussion: A Systematic Review Using an a priori Quality Rating System. J Neurotrauma 2021; 38:3032-3046. [PMID: 34309410 DOI: 10.1089/neu.2021.0154] [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: 11/12/2022] Open
Abstract
Diffusion tensor imaging (DTI) of brain white matter (WM) may be useful for characterizing the nature and degree of brain injury after sport-related concussion (SRC) and assist in establishing objective diagnostic and prognostic biomarkers. This study aimed to conduct a systematic review using an a priori quality rating strategy to determine the most consistent DTI-WM changes post-SRC. Articles published in English (until June 2020) were retrieved by standard research engine and gray literature searches (N = 4932), using PRISMA guidelines. Eligible studies were non-interventional naturalistic original studies that conducted DTI within 6 months of SRC in current athletes from all levels of play, types of sports, and sex. A total of 29 articles were included in the review, and after quality appraisal by two raters, data from 10 studies were extracted after being identified as high quality. High-quality studies showed widespread moderate-to-large WM differences when SRC samples were compared to controls during the acute to early chronic stage (days to weeks) post-SRC, including both increased and decreased fractional anisotropy and axial diffusivity and decreased mean diffusivity and radial diffusivity. WM differences remained stable in the chronic stage (2-6 months post-SRC). DTI metrics were commonly associated with SRC symptom severity, although standardized SRC diagnostics would improve future research. This indicates that microstructural recovery is often incomplete at return to play and may lag behind clinically assessed recovery measures. Future work should explore interindividual trajectories to improve understanding of the heterogeneous and dynamic WM patterns post-SRC.
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Affiliation(s)
- Briana Lees
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicola E Earls
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Susanne Meares
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Batchelor
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Vincent Oxenham
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,St. Vincent's Hospital Applied Medical Research Centre, Peter Duncan Neuroscience, Sydney, New South Wales, Australia.,School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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17
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Benjamini D, Iacono D, Komlosh ME, Perl DP, Brody DL, Basser PJ. Diffuse axonal injury has a characteristic multidimensional MRI signature in the human brain. Brain 2021; 144:800-816. [PMID: 33739417 DOI: 10.1093/brain/awaa447] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 02/01/2023] Open
Abstract
Axonal injury is a major contributor to the clinical symptomatology in patients with traumatic brain injury. Conventional neuroradiological tools, such as CT and MRI, are insensitive to diffuse axonal injury (DAI) caused by trauma. Diffusion tensor MRI parameters may change in DAI lesions; however, the nature of these changes is inconsistent. Multidimensional MRI is an emerging approach that combines T1, T2, and diffusion, and replaces voxel-averaged values with distributions, which allows selective isolation of specific potential abnormal components. By performing a combined post-mortem multidimensional MRI and histopathology study, we aimed to investigate T1-T2-diffusion changes linked to DAI and to define their histopathological correlates. Corpora callosa derived from eight subjects who had sustained traumatic brain injury, and three control brain donors underwent post-mortem ex vivo MRI at 7 T. Multidimensional, diffusion tensor, and quantitative T1 and T2 MRI data were acquired and processed. Following MRI acquisition, slices from the same tissue were tested for amyloid precursor protein (APP) immunoreactivity to define DAI severity. A robust image co-registration method was applied to accurately match MRI-derived parameters and histopathology, after which 12 regions of interest per tissue block were selected based on APP density, but blind to MRI. We identified abnormal multidimensional T1-T2, diffusion-T2, and diffusion-T1 components that are strongly associated with DAI and used them to generate axonal injury images. We found that compared to control white matter, mild and severe DAI lesions contained significantly larger abnormal T1-T2 component (P = 0.005 and P < 0.001, respectively), and significantly larger abnormal diffusion-T2 component (P = 0.005 and P < 0.001, respectively). Furthermore, within patients with traumatic brain injury the multidimensional MRI biomarkers differentiated normal-appearing white matter from mild and severe DAI lesions, with significantly larger abnormal T1-T2 and diffusion-T2 components (P = 0.003 and P < 0.001, respectively, for T1-T2; P = 0.022 and P < 0.001, respectively, for diffusion-T2). Conversely, none of the conventional quantitative MRI parameters were able to differentiate lesions and normal-appearing white matter. Lastly, we found that the abnormal T1-T2, diffusion-T1, and diffusion-T2 components and their axonal damage images were strongly correlated with quantitative APP staining (r = 0.876, P < 0.001; r = 0.727, P < 0.001; and r = 0.743, P < 0.001, respectively), while producing negligible intensities in grey matter and in normal-appearing white matter. These results suggest that multidimensional MRI may provide non-invasive biomarkers for detection of DAI, which is the pathological substrate for neurological disorders ranging from concussion to severe traumatic brain injury.
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Affiliation(s)
- Dan Benjamini
- Section on Quantitative Imaging and Tissue Sciences, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA
| | - Diego Iacono
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA.,Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA.,Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA.,Motor Neuron Disorders Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Michal E Komlosh
- Section on Quantitative Imaging and Tissue Sciences, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA
| | - Daniel P Perl
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA
| | - David L Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, MD, USA.,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Peter J Basser
- Section on Quantitative Imaging and Tissue Sciences, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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18
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Brooks JS, Allison W, Harriss A, Bian K, Mao H, Dickey JP. Purposeful Heading Performed by Female Youth Soccer Players Leads to Strain Development in Deep Brain Structures. Neurotrauma Rep 2021; 2:354-362. [PMID: 34901935 PMCID: PMC8655815 DOI: 10.1089/neur.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Head impacts in soccer have been associated with both short- and long-term neurological consequences. Youth players' brains are especially vulnerable given that their brains are still developing, and females are at an increased risk of traumatic brain injury (TBI) compared to males. Approximately 90% of head impacts in soccer occur from purposeful heading. Accordingly, this study assessed the relationship between kinematic variables and brain strain during purposeful headers in female youth soccer players. A convenience sample of 36 youth female soccer players (13.4 [0.9] years of age) from three elite youth soccer teams wore wireless sensors to quantify head impact magnitudes during games. Purposeful heading events were categorized by game scenario (e.g., throw-in, goal kick) for 60 regular season games (20 games per team). A total of 434 purposeful headers were identified. Finite element model simulations were performed to calculate average peak maximum principal strain (APMPS) in the corpus callosum, thalamus, and brainstem on a subset of 110 representative head impacts. Rotational velocity was strongly associated with APMPS in these three regions of the brain (r = 0.83-0.87). Linear acceleration was weakly associated with APMPS (r = 0.13-0.31). Game scenario did not predict APMPS during soccer games (p > 0.05). Results demonstrated considerable APMPS in the corpus callosum (mean = 0.102) and thalamus (mean = 0.083). In addition, the results support the notion that rotational velocity is a better predictor of brain strain than linear acceleration and may be a potential indicator of changes to the brain.
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Affiliation(s)
- Jeffrey S. Brooks
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Wayne Allison
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alexandra Harriss
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kewei Bian
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - James P. Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
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19
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Thanjavur K, Babul A, Foran B, Bielecki M, Gilchrist A, Hristopulos DT, Brucar LR, Virji-Babul N. Recurrent neural network-based acute concussion classifier using raw resting state EEG data. Sci Rep 2021; 11:12353. [PMID: 34117309 PMCID: PMC8196170 DOI: 10.1038/s41598-021-91614-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
Concussion is a global health concern. Despite its high prevalence, a sound understanding of the mechanisms underlying this type of diffuse brain injury remains elusive. It is, however, well established that concussions cause significant functional deficits; that children and youths are disproportionately affected and have longer recovery time than adults; and that individuals suffering from a concussion are more prone to experience additional concussions, with each successive injury increasing the risk of long term neurological and mental health complications. Currently, the most significant challenge in concussion management is the lack of objective, clinically- accepted, brain-based approaches for determining whether an athlete has suffered a concussion. Here, we report on our efforts to address this challenge. Specifically, we introduce a deep learning long short-term memory (LSTM)-based recurrent neural network that is able to distinguish between non-concussed and acute post-concussed adolescent athletes using only short (i.e. 90 s long) samples of resting state EEG data as input. The athletes were neither required to perform a specific task nor expected to respond to a stimulus during data collection. The acquired EEG data were neither filtered, cleaned of artefacts, nor subjected to explicit feature extraction. The LSTM network was trained and validated using data from 27 male, adolescent athletes with sports related concussion, benchmarked against 35 non-concussed adolescent athletes. During rigorous testing, the classifier consistently identified concussions with an accuracy of > 90% and achieved an ensemble median Area Under the Receiver Operating Characteristic Curve (ROC/AUC) equal to 0.971. This is the first instance of a high-performing classifier that relies only on easy-to-acquire resting state, raw EEG data. Our concussion classifier represents a promising first step towards the development of an easy-to-use, objective, brain-based, automatic classification of concussion at an individual level.
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Affiliation(s)
- Karun Thanjavur
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, V8P 5C2, Canada.
| | - Arif Babul
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, V8P 5C2, Canada
| | - Brandon Foran
- Department of Computer Science, Middlesex College, Western University, London, ON, N6A 5B7, Canada
| | - Maya Bielecki
- Department of Computer Science, Middlesex College, Western University, London, ON, N6A 5B7, Canada
| | - Adam Gilchrist
- Department of Computer Science, Middlesex College, Western University, London, ON, N6A 5B7, Canada
| | - Dionissios T Hristopulos
- School of Electrical and Computer Engineering, Technical University of Crete, 73100, Chania, Greece
| | - Leyla R Brucar
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Naznin Virji-Babul
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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20
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Wright DK, Symons GF, O'Brien WT, McDonald SJ, Zamani A, Major B, Chen Z, Costello D, Brady RD, Sun M, Law M, O'Brien TJ, Mychasiuk R, Shultz SR. Diffusion Imaging Reveals Sex Differences in the White Matter Following Sports-Related Concussion. Cereb Cortex 2021; 31:4411-4419. [PMID: 33860291 DOI: 10.1093/cercor/bhab095] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sports-related concussion (SRC) is a serious health concern. However, the temporal profile of neuropathophysiological changes after SRC and how these relate to biological sex are still poorly understood. This preliminary study investigated whether diffusion-weighted magnetic resonance imaging (dMRI) was sensitive to neuropathophysiological changes following SRC; whether these changes were sex-specific; and whether they persisted beyond the resolution of self-reported symptoms. Recently concussed athletes (n = 14), and age- and education-matched nonconcussed control athletes (n = 16), underwent MRI 24-48-h postinjury and again at 2-week postinjury (i.e., when cleared to return-to-play). Male athletes reported more symptoms and greater symptom severity compared with females. dMRI revealed white matter differences between athletes with SRC and their nonconcussed counterparts at 48-h postinjury. These differences were still present at 2-week postinjury, despite SRC athletes being cleared to return to play and may indicate increased cerebral vulnerability beyond the resolution of subjective symptoms. Furthermore, we identified sex-specific differences, with male SRC athletes having significantly greater white matter disruption compared with female SRC athletes. These results have important implications for the management of concussion, including guiding return-to-play decisions, and further improve our understanding regarding the role of sex in SRC outcomes.
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Affiliation(s)
- David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Georgia F Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC 3086, Australia
| | - Akram Zamani
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Brendan Major
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia.,Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Daniel Costello
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Mujun Sun
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Clayton, VIC 3800, Australia.,Departments of Neurological Surgery and Biomedical Engineering, University of Southern California, Los Angeles, CA 90033, USA
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3010, Australia
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21
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Tayebi M, Holdsworth SJ, Champagne AA, Cook DJ, Nielsen P, Lee TR, Wang A, Fernandez J, Shim V. The role of diffusion tensor imaging in characterizing injury patterns on athletes with concussion and subconcussive injury: a systematic review. Brain Inj 2021; 35:621-644. [PMID: 33843389 DOI: 10.1080/02699052.2021.1895313] [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: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem. The majority of TBIs are in the form of mild TBI (also known as concussion) with sports-related concussion (SRC) receiving public attention in recent years.Here we have performed a systematic review of the literature on the use of Diffusion Tensor Imaging (DTI) on sports-related concussion and subconcussive injuries. Our review found different patterns of change in DTI parameters between concussed and subconcussed groups. The Fractional Anisotropy (FA) was either unchanged or increased for the concussion group, while the subconcussed group generally experienced a decrease in FA. A reverse pattern was observed for Mean Diffusivity (MD) - where the concussed group experienced a decrease in MD while the subconcussed group showed an increase in MD. However, in general, discrepancies were observed in the results reported in the literature - likely due to the huge variations in DTI acquisition parameters, and image processing and analysis methods used in these studies. This calls for more comprehensive and well-controlled studies in this field, including those that combine the advanced brain imaging with biomechancial modeling and kinematic sensors - to shed light on the underlying mechanisms behind the structural changes observed from the imaging studies.
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Affiliation(s)
- Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Insitute, Gisborne, New Zealand
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Poul Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tae-Rin Lee
- Advanced Institute of Convergence Technology, Seoul National University, Seoul, Republic of Korea
| | - Alan Wang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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22
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Development of brain atlases for early-to-middle adolescent collision-sport athletes. Sci Rep 2021; 11:6440. [PMID: 33742031 PMCID: PMC7979742 DOI: 10.1038/s41598-021-85518-6] [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: 06/02/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Human brains develop across the life span and largely vary in morphology. Adolescent collision-sport athletes undergo repetitive head impacts over years of practices and competitions, and therefore may exhibit a neuroanatomical trajectory different from healthy adolescents in general. However, an unbiased brain atlas targeting these individuals does not exist. Although standardized brain atlases facilitate spatial normalization and voxel-wise analysis at the group level, when the underlying neuroanatomy does not represent the study population, greater biases and errors can be introduced during spatial normalization, confounding subsequent voxel-wise analysis and statistical findings. In this work, targeting early-to-middle adolescent (EMA, ages 13-19) collision-sport athletes, we developed population-specific brain atlases that include templates (T1-weighted and diffusion tensor magnetic resonance imaging) and semantic labels (cortical and white matter parcellations). Compared to standardized adult or age-appropriate templates, our templates better characterized the neuroanatomy of the EMA collision-sport athletes, reduced biases introduced during spatial normalization, and exhibited higher sensitivity in diffusion tensor imaging analysis. In summary, these results suggest the population-specific brain atlases are more appropriate towards reproducible and meaningful statistical results, which better clarify mechanisms of traumatic brain injury and monitor brain health for EMA collision-sport athletes.
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23
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Mahan MY, Rafter DJ, Truwit CL, Oswood M, Samadani U. Evaluation of diffusion measurements reveals radial diffusivity indicative of microstructural damage following acute, mild traumatic brain injury. Magn Reson Imaging 2020; 77:137-147. [PMID: 33359428 DOI: 10.1016/j.mri.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/25/2020] [Accepted: 12/20/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Mild TBI, characterized by microstructural damage, often undetectable on conventional imaging techniques, is a pervasive condition that disturbs brain function and can potentially result in long-term deficits. Deciphering the underlying microstructural damage in mild TBI is crucial for establishing a reliable diagnosis and enabling effective therapeutics. Efforts to capture this damage have been extensive, but results have been inconsistent and incomplete. METHODS To that effect, we set out to examine the shape of the diffusion tensor in mild TBI during the acute phase of injury. We inspected diffusivity and geometric measurements describing the diffusion tensor's shape and compared mild TBI (N = 34, 20.4-66.6 yo) measurements with those from healthy control (N = 42, 20.7-67.2 yo) participants using voxelwise tract-based spatial statistics. Subsequently, to explore associations between the diffusion measurements in mild TBI, we performed nonparametric statistics and machine learning techniques. RESULTS Overall, mild TBI displayed a diffuse increase in Dλ2, Dλ3, Dradial, Dmean, and Cspherical, with a diffuse decrease in Afractional, Amode, and Clinear, in addition to no change in Daxial or Cplanar. Most notably, our results provide evidence for Dradial as a potential biomarker for microstructural damage, specifically its main component Dλ2, based on their performance in discriminating between mild TBI and control groups. Afractional was also found to be important for discriminating between groups. CONCLUSION Our results revealed the importance of a diffusion measurement often overlooked, Dradial, in assessing TBI and suggest differentiating diffusion measurements has the potential utility to detect variations in the underlying pathophysiology after injury.
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Affiliation(s)
- Margaret Y Mahan
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA.
| | - Daniel J Rafter
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA
| | - Charles L Truwit
- Diagnostic Imaging, Philips Global, 6655 Wedgwood Rd N #105, Maple Grove, MN 55311, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Mark Oswood
- Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Radiology, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN 55415, USA.
| | - Uzma Samadani
- Department of Biomedical Informatics and Computational Biology, University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455, USA; Department of Neurosurgery, Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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24
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Fong AK, Allen MD, Waltzman D, Sarmiento K, Yeates KO, Suskauer S, Wintermark M, Lindberg DM, Tate DF, Wilde EA, Loewen JL. Neuroimaging in Pediatric Patients with Mild Traumatic Brain Injury: Relating the Current 2018 Centers for Disease Control Guideline and the Potential of Advanced Neuroimaging Modalities for Research and Clinical Biomarker Development. J Neurotrauma 2020; 38:44-52. [PMID: 32640874 DOI: 10.1089/neu.2020.7100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Center for Disease Control and Prevention (CDC)'s 2018 Guideline for current practices in pediatric mild traumatic brain injury (mTBI; also referred to as concussion herein) systematically identified the best up-to-date practices based on current evidence and, specifically, identified recommended practices regarding computed tomography (CT), magnetic resonance imaging (MRI), and skull radiograph imaging. In this article, we discuss types of neuroimaging not discussed in the guideline in terms of their safety for pediatric populations, their potential application, and the research investigating the future use of certain modalities to aid in the diagnosis and treatment of mTBI in children. The role of neuroimaging in pediatric mTBI cases should be considered for the potential contribution to children's neural and social development, in addition to the immediate clinical value (as in the case of acute structural findings). Selective use of specific neuroimaging modalities in research has already been shown to detect aspects of diffuse brain injury, disrupted cerebral blood flow, and correlate physiological factors with persistent symptoms, such as fatigue, cognitive decline, headache, and mood changes, following mTBI. However, these advanced neuroimaging modalities are currently limited to the research arena, and any future clinical application of advanced imaging modalities in pediatric mTBI will require robust evidence for each modality's ability to provide measurement of the subtle conditions of brain development, disease, damage, or degeneration, while accounting for variables at both non-injury and time-post-injury epochs. Continued collaboration and communication between researchers and healthcare providers is essential to investigate, develop, and validate the potential of advanced imaging modalities in pediatric mTBI diagnostics and management.
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Affiliation(s)
| | | | - Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | | - Max Wintermark
- Department of Neuroradiology, Stanford University, Stanford, California, USA
| | - Daniel M Lindberg
- Emergency Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - David F Tate
- Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, Missouri, USA
| | - Elizabeth A Wilde
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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25
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Muftuler LT, Meier TB, Keith M, Budde MD, Huber DL, McCrea MA. Serial Diffusion Kurtosis Magnetic Resonance Imaging Study during Acute, Subacute, and Recovery Periods after Sport-Related Concussion. J Neurotrauma 2020; 37:2081-2092. [PMID: 32253977 DOI: 10.1089/neu.2020.6993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sport-related concussion (SRC) is common in contact sports, but there remains a lack of reliable, unbiased biomarkers of brain injury and recovery. Although the symptoms of SRC generally resolve over a period of days to weeks, the lack of a biomarker impairs detection and return-to-play decisions. To this date, the pathophysiological recovery profile and relationships between brain changes and symptoms remained unclear. In the current study, diffusion kurtosis imaging (DKI) was used to monitor the effects of SRC on the brain and the trajectory of recovery in concussed American football players (n = 96) at <48 h, and 8, 15, and 45 days post-injury, who were compared with a matched group of uninjured players (n = 82). The concussed group reported significantly higher symptoms within 48 h after injury than controls, which resolved by the 8-day follow-up. The concussed group also demonstrated poorer performance on balance testing at <48 h and 8 days than controls. There were no significant differences between the groups in the Standardized Assessment of Concussion (SAC), a cognitive screening measure. DKI data were acquired with 3 mm isotropic resolution, and analyzed using tract-based spatial statistics (TBSS). Additionally, voxel- and region of interest-based analyses were also conducted. At <48 h, the concussed group showed significantly higher axial kurtosis than the control group. These differences increased in extent and magnitude at 8 days, then receded at 15 days, and returned to the normal levels by 45 days. Kurtosis fractional anisotropy (FA) exhibited a delayed response, with a consistent increase by days 15 and 45. The results indicate that changes detected in the acute period appear to be prolonged compared with clinical recovery, but additional brain changes not observable acutely appear to progress. Although further studies are needed to understand the pathological features of DKI changes after SRC, these findings highlight a potential disparity between clinical symptoms and pathophysiological recovery after SRC.
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Affiliation(s)
- L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Monica Keith
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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26
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A Look Ahead. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
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27
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Hristopulos DT, Babul A, Babul S, Brucar LR, Virji-Babul N. Disrupted Information Flow in Resting-State in Adolescents With Sports Related Concussion. Front Hum Neurosci 2019; 13:419. [PMID: 31920584 PMCID: PMC6920175 DOI: 10.3389/fnhum.2019.00419] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022] Open
Abstract
Children and youths are at a greater risk of concussions than adults, and once injured, take longer to recover. A key feature of concussion is an increase in functional connectivity, yet it remains unclear how changes in functional connectivity relate to the patterns of information flow within resting state networks following concussion and how these relate to brain function. We applied a data-driven measure of directed effective brain connectivity to compare the patterns of information flow in healthy adolescents and adolescents with subacute concussion during the resting state condition. Data from 32 healthy adolescents (mean age =16 years) and 21 concussed adolescents (mean age = 15 years) within 1 week of injury were included in the study. Five minutes of resting state data EEG were collected while participants sat quietly with their eyes closed. We applied the information flow rate to measure the transfer of information between the EEG time series of each individual at different source locations, and therefore between different brain regions. Based on the ensemble means of the magnitude of normalized information flow rate, our analysis shows that the dominant nexus of information flow in healthy adolescents is primarily left lateralized and anterior-centric, characterized by strong bidirectional information exchange between the frontal regions, and between the frontal and the central/temporal regions. In contrast, adolescents with concussion show distinct differences in information flow marked by a more left-right symmetrical, albeit still primarily anterior-centric, pattern of connections, diminished activity along the central-parietal midline axis, and the emergence of inter-hemispheric connections between the left and right frontal and the left and right temporal regions of the brain. We also find that the statistical distribution of the normalized information flow rates in each group (control and concussed) is significantly different. This paper is the first to describe the characteristics of the source space information flow and the effective connectivity patterns between brain regions in healthy adolescents in juxtaposition with the altered spatial pattern of information flow in adolescents with concussion, statistically quantifying the differences in the distribution of the information flow rate between the two populations. We hypothesize that the observed changes in information flow in the concussed group indicate functional reorganization of resting state networks in response to brain injury.
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Affiliation(s)
- Dionissios T Hristopulos
- Telecommunication Systems Research Institute, Technical University of Crete, Chania, Greece.,School of Mineral Resources Engineering, Technical University of Crete, Chania, Greece
| | - Arif Babul
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Shazia'Ayn Babul
- Rockefeller College, Princeton University, Princeton, NJ, United States
| | - Leyla R Brucar
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Naznin Virji-Babul
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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28
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Oddo A, O'Conor E, Shore S, Piraino M, Gibney K, Tsao J, Stanfill AG. Making Headway for Discussions About Concussions: Experiences of Former High School and Collegiate Student-Athletes. Front Neurol 2019; 10:698. [PMID: 31333560 PMCID: PMC6624741 DOI: 10.3389/fneur.2019.00698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/14/2019] [Indexed: 12/03/2022] Open
Abstract
In order to better understand how to identify and treat student-athletes who experience concussions, better insight into reporting behavior of athletes is needed. This study aims to identify information influencing athletes' attitudes toward reporting their concussions and the perceived trajectory of their recovery both athletically and academically. Twenty-five former high school and collegiate athletes who experienced concussions in a wide variety of sports, organizational levels, and time periods gave insight through structured, qualitative interviews. A number of factors regarding education about concussions, proper diagnosis of concussions, and motivational pressures within high school and collegiate athletics were assessed. Eight major themes were identified regarding the participants' experiences with sport-related concussion: optimism bias, invisibility of the injury, diagnostic barriers, desire to play, external support and pressures, uncertainty of long-term prognosis, generational factors, and protection of future athletes. The findings support that underreporting of concussions among those players interviewed is related to misperceived risk, lack of education, and a struggle between internal and external pressures to play through injury. However, those who did seek medical and academic support, often did receive the necessary aid.
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Affiliation(s)
- Anthony Oddo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ellen O'Conor
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sarah Shore
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mary Piraino
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kyla Gibney
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jack Tsao
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ansley Grimes Stanfill
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
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29
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Narayana S, Charles C, Collins K, Tsao JW, Stanfill AG, Baughman B. Neuroimaging and Neuropsychological Studies in Sports-Related Concussions in Adolescents: Current State and Future Directions. Front Neurol 2019; 10:538. [PMID: 31178818 PMCID: PMC6542940 DOI: 10.3389/fneur.2019.00538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/07/2019] [Indexed: 12/21/2022] Open
Abstract
Sports-related concussion, is a serious neurological concern that many adolescent athletes will face during their athletic careers. In some instances, the effects of sports-related head injury are long-lasting. Due to their still-developing brains, adolescents appear to be more vulnerable to long-term repercussions of these injuries. As all sports-related concussions are mild traumatic brain injuries (mTBI), this review we will examine the pathophysiology of mTBI, its acute effects and long-term risks from sustaining injury, and current and needed advancements in the areas of neuropsychological testing, accelerometer telemetry, and neuroimaging. Current methods do not adequately measure the extent of an injury that an athlete may sustain, potentially putting these athletes at a much greater risk for long-term effects. To better understand mTBI, neuropsychological testing best practices need to be developed, standardized, and implemented based on sound scientific evidence in order to be propagated as clinical guidelines. Wearable accelerometers can be used to assess thresholds for mTBI and cumulative effects of concussive and subconcussive injuries. Novel neuroimaging methods that can detect anatomical abnormalities and functional deficits with more specificity and sensitivity should be developed. Young athletes are particularly a vulnerable population warranting immediate and significant research aimed at protecting them against sports related injury and mitigating their long-term deficits.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States.,Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, The Neuroscience Institute, Memphis, TN, United States
| | - Christopher Charles
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kassondra Collins
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jack W Tsao
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, United States.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Foundation Research Institute, Memphis, TN, United States.,Department of Neurology, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
| | - Ansley Grimes Stanfill
- Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Brandon Baughman
- Semmes Murphey Neurologic and Spine Institute, Memphis, TN, United States.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
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30
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Wu T, Merkley TL, Wilde EA, Barnes A, Li X, Chu ZD, McCauley SR, Hunter JV, Levin HS. A preliminary report of cerebral white matter microstructural changes associated with adolescent sports concussion acutely and subacutely using diffusion tensor imaging. Brain Imaging Behav 2019; 12:962-973. [PMID: 28812290 DOI: 10.1007/s11682-017-9752-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging (DTI) has demonstrated its utility in detecting microscopic post-concussion cerebral white matter structural changes, which are not routinely evident on conventional neuroimaging modalities. In this study, we compared 10 adolescents with sports concussion (SC) to 12 orthopedically-injured (OI) individuals within 96 h and three months post injury to 12 typically-developing (TD) participants using DTI and volumetric analyses. In terms of volume, no group differences were noted between SC, OI and TD groups at both 96 h and three months post concussion. Results did not show significant differences between SC, OI, and TD groups for both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in all regions of interest within 96 h post concussion. However, at three months post-injury, the SC group exhibited significantly lower FA than the TD group in various regions of interest. In terms of ADC, significant group differences between SC and TD groups were found in some regions, with SC group having higher ADC than TD. No group differences for FA and ADC were noted between SC and OI groups at three months post-injury. However, several moderate effect sizes on between-group analyses were noted such that FA was lower and ADC was higher in SC relative to OI. Longitudinally, the SC group demonstrated decreased FA and increased ADC in some areas. The findings highlight the fact that the brain continues to change during the post-injury recovery period, and raises the possibility that adverse changes may result from the neurometabolic cascade that purportedly ensues following SC. DTI may potentially be used to characterize the nature of brain changes that occur following sports-related concussions.
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Affiliation(s)
- Trevor Wu
- Mercy Health St. Mary's, Michigan State University, 220 Cherry St SE, Grand Rapids, MI, 49503, USA
| | - Tricia L Merkley
- Barrow Neurological Institute, 222 W. Thomas Road, Suite 315, Phoenix, AZ, 85013, USA
| | - Elisabeth A Wilde
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA.
| | - Amanda Barnes
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1440, Miami, FL, 33136, USA
| | - Xiaoqi Li
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Zili David Chu
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Stephen R McCauley
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Jill V Hunter
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Harvey S Levin
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
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31
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Mayer AR, Kaushal M, Dodd AB, Hanlon FM, Shaff NA, Mannix R, Master CL, Leddy JJ, Stephenson D, Wertz CJ, Suelzer EM, Arbogast KB, Meier TB. Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils. Neurosci Biobehav Rev 2018; 94:149-165. [PMID: 30098989 DOI: 10.1016/j.neubiorev.2018.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, 02115, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States; Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, 14214, United States
| | - David Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Elizabeth M Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
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32
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Lancaster MA, Meier TB, Olson DV, McCrea MA, Nelson LD, Muftuler LT. Chronic differences in white matter integrity following sport-related concussion as measured by diffusion MRI: 6-Month follow-up. Hum Brain Mapp 2018; 39:4276-4289. [PMID: 29964356 DOI: 10.1002/hbm.24245] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/19/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022] Open
Abstract
Recent studies demonstrated evidence of physiological changes in the brain following sport-related concussion (SRC) that persisted beyond the point at which athletes achieved full symptom recovery. Diffusion MRI techniques have been used to study brain white matter (WM) changes following SRC; however, longitudinal studies that follow injured athletes from the acute to chronic stages of injury are sparse. The current study explores potential persisting effects of the injury, which serves as a follow-up to our previous work that reported WM changes in the acute and subacute phase of SRC recovery. Concussed high school and collegiate football players (n = 17) and well-matched teammate controls (n = 20) were followed up at 6 months postinjury with diffusion tensor (DTI) and diffusion kurtosis imaging (DKI) as well as measures of self-reported symptoms, cognitive functioning, and balance. Results of tract-based spatial statistics (TBSS) analyses revealed continued widespread decreased mean and axial diffusivity compared to control subjects in 6-month follow-up scans. On the other hand, kurtosis metrics, which were significantly higher in concussed athletes in the acute phase, had normalized. WM tract regions-of-interest (ROIs) were created from significant clusters in the TBSS analysis, and linear mixed effects (LME) analyses were used to look at longitudinal changes in these ROIs over time. LME analyses revealed few time × group interactions indicating findings were relatively stable over time. In addition, acute concussion symptoms predicted diffusivity measures at 6 months postinjury. Findings indicate that DTI and DKI may be useful tools in assessing concussion severity, recovery, and possible long-term effects of concussion.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Center for Imaging Research Medical College of Wisconsin, Milwaukee, Wisconsin
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33
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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34
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Chamard E, Lichtenstein JD. A systematic review of neuroimaging findings in children and adolescents with sports-related concussion. Brain Inj 2018; 32:816-831. [PMID: 29648462 DOI: 10.1080/02699052.2018.1463106] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sport-related concussion (SRC) generally does not result in structural anomalies revealed through clinical imaging techniques such as MRI and CT. While advanced neuroimaging techniques offer another avenue to investigate the subtle alterations following SRC, the current pediatric literature in this area has yet to be reviewed. The aim of this review is to systematically explore the literature on magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), and cortical thickness following SRC in children and adolescents. METHODS A systematic Pubmed search using the preferred reporting items for systematic reviews and meta-analysis guidelines was conducted independently for each neuroimaging method. Studies were screened for inclusion based on pre-determined criteria. RESULTS A total of 26 studies were included (MRS = 4, DTI = 10, fMRI = 11, cortical thickness = 1). A total of 16 studies were conducted solely with male athletes, while 10 studies recruited an unequal number of male and female athletes. CONCLUSIONS While MRI and CT are generally unrevealing, advanced neuroimaging techniques demonstrated neurometabolic, microstructural, and functional alterations following SRC in athletes younger than 19 years of age in the acute, subacute, and chronic phases of recovery. However, more studies are needed to fully understand the impact of SRC on the developing brain in children and adolescents.
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Affiliation(s)
- Emilie Chamard
- a Department of Psychiatry, Geisel School of Medicine at Dartmouth , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
| | - Jonathan D Lichtenstein
- a Department of Psychiatry, Geisel School of Medicine at Dartmouth , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
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35
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Dennis EL, Wilde EA, Newsome MR, Scheibel RS, Troyanskaya M, Velez C, Wade BSC, Drennon AM, York GE, Bigler ED, Abildskov TJ, Taylor BA, Jaramillo CA, Eapen B, Belanger H, Gupta V, Morey R, Haswell C, Levin HS, Hinds SR, Walker WC, Thompson PM, Tate DF. ENIGMA MILITARY BRAIN INJURY: A COORDINATED META-ANALYSIS OF DIFFUSION MRI FROM MULTIPLE COHORTS. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2018; 2018:1386-1389. [PMID: 30034577 PMCID: PMC6049824 DOI: 10.1109/isbi.2018.8363830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity in military Veterans and Service Members. While most individuals recover fully from mild injuries within weeks, some continue to experience symptoms including headaches, disrupted sleep, and other cognitive, behavioral or physical symptoms. Diffusion magnetic resonance imaging (dMRI) shows promise in identifying areas of structural disruption and predicting outcomes. Although some studies suggest widespread structural disruption after brain injury, dMRI studies of military brain injury have yielded mixed results so far, perhaps due to the subtlety of mild injury, individual differences in injury location, severity and mechanism, and comorbidity with other disorders such as post-traumatic stress disorder (PTSD), depression, and substance abuse. We present preliminary dMRI results from the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) military brain injury working group. We found higher fractional anisotropy (FA) in participants with a history of TBI. Understanding the injury and recovery process, along with factors that influence these, will lead to improved diagnosis and treatment.
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Affiliation(s)
- Emily L Dennis
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Elisabeth A Wilde
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Carmen Velez
- University of Missouri-St. Louis, St. Louis, MO, USA
| | - Benjamin S C Wade
- University of Missouri-St. Louis, St. Louis, MO, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, CA, USA
| | | | | | - Erin D Bigler
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Tracy J Abildskov
- Department of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Brian A Taylor
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Blessen Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX
| | - Heather Belanger
- James A. Haley Veterans Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | - Vikash Gupta
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | | | | | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Sidney R Hinds
- Department of Defense/United States Army Medical Research and Materiel Command
| | - William C Walker
- Defense and Veterans Brain Injury Center, San Antonio, TX, USA
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond VA
- Hunter Holmes McGuire VAMC, Richmond VA
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA
| | - David F Tate
- University of Missouri-St. Louis, St. Louis, MO, USA
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36
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Lancaster MA, Olson DV, McCrea MA, Nelson LD, LaRoche AA, Muftuler LT. Acute white matter changes following sport-related concussion: A serial diffusion tensor and diffusion kurtosis tensor imaging study. Hum Brain Mapp 2018; 37:3821-3834. [PMID: 27237455 DOI: 10.1002/hbm.23278] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
Recent neuroimaging studies have suggested that following sport-related concussion (SRC) physiological brain alterations may persist after an athlete has shown full symptom recovery. Diffusion MRI is a versatile technique to study white matter injury following SRC, yet serial follow-up studies in the very acute stages following SRC utilizing a comprehensive set of diffusion metrics are lacking. The aim of the current study was to characterize white matter changes within 24 hours of concussion in a group of high school and collegiate athletes, using Diffusion Tensor and Diffusion Kurtosis Tensor metrics. Participants were reassessed a week later. At 24 hours post-injury, the concussed group reported significantly more concussion symptoms than a well-matched control group and demonstrated poorer performance on a cognitive screening measure, yet these differences were nonsignificant at the 8-day follow-up. Similarly, within 24-hours after injury, the concussed group exhibited a widespread decrease in mean diffusivity, increased axial kurtosis and, to a lesser extent, decreased axial and radial diffusivities compared with control subjects. At 8 days post injury, the differences in these diffusion metrics were even more widespread in the injured athletes, despite improvement of symptoms and cognitive performance. These MRI findings suggest that the athletes might not have reached full physiological recovery a week after the injury. These findings have significant implications for the management of SRC because allowing an athlete to return to play before the brain has fully recovered from injury may have negative consequences. Hum Brain Mapp 37:3821-3834, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Ashley A LaRoche
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.
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Abstract
The assessment and treatment of sport-related concussion (SRC) often requires a multifaceted approach. Vestibular dysfunction represents an important profile of symptoms and pathology following SRC, with high prevalence and association with prolonged recovery. Signs and symptoms of vestibular dysfunction may include dizziness, vertigo, disequilibrium, nausea, and visual impairment. Identifying the central and peripheral vestibular mechanisms responsible for pathology can aid in management of SRC. The most common vestibular disturbances after SRC include benign paroxysmal positional vertigo, vestibulo-ocular reflex impairment, visual motion sensitivity, and balance impairment. A variety of evidence-based screening and assessment tools can help to identify the various types of vestibular pathology in SRC. When vestibular dysfunction is identified, there is emerging support for applying targeted vestibular rehabilitation to manage this condition.
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Muller AM, Virji-Babul N. Stuck in a State of Inattention? Functional Hyperconnectivity as an Indicator of Disturbed Intrinsic Brain Dynamics in Adolescents With Concussion: A Pilot Study. ASN Neuro 2018; 10:1759091417753802. [PMID: 29357675 PMCID: PMC5784460 DOI: 10.1177/1759091417753802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/07/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022] Open
Abstract
Sports-related concussion in youth is a major public health issue. Evaluating the diffuse and often subtle changes in structure and function that occur in the brain, particularly in this population, remains a significant challenge. The goal of this pilot study was to evaluate the relationship between the intrinsic dynamics of the brain using resting-state functional magnetic resonance imaging (rs-fMRI) and relate these findings to structural brain correlates from diffusion tensor imaging in a group of adolescents with sports-related concussions ( n = 6) and a group of healthy adolescent athletes ( n = 6). We analyzed rs-fMRI data using a sliding windows approach and related the functional findings to structural brain correlates by applying graph theory analysis to the diffusion tensor imaging data. Within the resting-state condition, we extracted three separate brain states in both groups. Our analysis revealed that the brain dynamics in healthy adolescents was characterized by a dynamic pattern, shifting equally between three brain states; however, in adolescents with concussion, the pattern was more static with a longer time spent in one brain state. Importantly, this lack of dynamic flexibility in the concussed group was associated with increased nodal strength in the left middle frontal gyrus, suggesting reorganization in a region related to attention. This preliminary report shows that both the intrinsic brain dynamics and structural organization are altered in networks related to attention in adolescents with concussion. This first report in adolescents will be used to inform future studies in a larger cohort.
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Affiliation(s)
- Angela M. Muller
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naznin Virji-Babul
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Dennis EL, Babikian T, Giza CC, Thompson PM, Asarnow RF. Diffusion MRI in pediatric brain injury. Childs Nerv Syst 2017; 33:1683-1692. [PMID: 29149383 PMCID: PMC6482947 DOI: 10.1007/s00381-017-3522-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 12/16/2022]
Abstract
Traumatic brain injury (TBI) is a major public health issue around the world and can be especially devastating in children as TBI can derail cognitive and social development. White matter (WM) is particularly vulnerable to disruption post-TBI, as myelination is ongoing during this period. Diffusion magnetic resonance imaging (dMRI) is a versatile modality for identifying and quantifying WM disruption and can detect diffuse axonal injury (DAI or TAI (traumatic axonal injury)). This review covers dMRI studies of pediatric TBI, including mild to severe injuries, and covering all periods post-injury. While there have been considerable advances in our understanding of pediatric TBI through the use of dMRI, there are still large gaps in our knowledge, which will be filled in by larger studies and more longitudinal studies. Heterogeneity post-injury is an obstacle in all TBI studies, but we expect that larger better-characterized samples will aid in identifying clinically meaningful subgroups within the pediatric TBI patient population.
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Affiliation(s)
- Emily L Dennis
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Christopher C Giza
- UCLA Brain Injury Research Center, Dept of Neurosurgery and Division of Pediatric Neurology, Mattel Children's Hospital, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
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Mayer AR, Ling JM, Dodd AB, Meier TB, Hanlon FM, Klimaj SD. A prospective microstructure imaging study in mixed-martial artists using geometric measures and diffusion tensor imaging: methods and findings. Brain Imaging Behav 2017; 11:698-711. [PMID: 27071950 PMCID: PMC5889053 DOI: 10.1007/s11682-016-9546-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although diffusion magnetic resonance imaging (dMRI) has been widely used to characterize the effects of repetitive mild traumatic brain injury (rmTBI), to date no studies have investigated how novel geometric models of microstructure relate to more typical diffusion tensor imaging (DTI) sequences. Moreover, few studies have evaluated the sensitivity of different registration pipelines (non-linear, linear and tract-based spatial statistics) for detecting dMRI abnormalities in clinical populations. Results from single-subject analyses in healthy controls (HC) indicated a strong negative relationship between fractional anisotropy (FA) and orientation dispersion index (ODI) in both white and gray matter. Equally important, only moderate relationships existed between all other estimates of free/intracellular water volume fractions and more traditional DTI metrics (FA, mean, axial and radial diffusivity). These findings suggest that geometric measures provide differential information about the cellular microstructure relative to traditional DTI measures. Results also suggest greater sensitivity for non-linear registration pipelines that maximize the anatomical information available in T1-weighted images. Clinically, rmTBI resulted in a pattern of decreased FA and increased ODI, largely overlapping in space, in conjunction with increased intracellular and free water fractions, highlighting the potential role of edema following repeated head trauma. In summary, current results suggest that geometric models of diffusion can provide relatively unique information regarding potential mechanisms of pathology that contribute to long-term neurological damage.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA.
- Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Timothy B Meier
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
| | - Stefan D Klimaj
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, 87106, USA
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McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, Manley G, Menon D, Chen JK, Wall R, Schneider KJ, McAllister T. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51:919-929. [DOI: 10.1136/bjsports-2016-097447] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 01/17/2023]
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Bahrami N, Sharma D, Rosenthal S, Davenport EM, Urban JE, Wagner B, Jung Y, Vaughan CG, Gioia GA, Stitzel JD, Whitlow CT, Maldjian JA. Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football. Radiology 2016; 281:919-926. [PMID: 27775478 DOI: 10.1148/radiol.2016160564] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact Telemetry system and quantified as the combined-probability risk-weighted cumulative exposure (RWECP). Twenty-five male participants were evaluated for seasonal fractional anisotropy (FA) changes in specific WM tracts: the inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus, and superior longitudinal fasciculus (SLF). Fiber tracts were segmented into a central core and two fiber terminals. The relationship between seasonal FA change in the whole fiber, central core, and the fiber terminals with RWECP was also investigated. Linear regression analysis was conducted to determine the association between RWECP and change in fiber tract FA during the season. Results There were statistically significant linear relationships between RWEcp and decreased FA in the whole (R2 = 0.433; P = .003), core (R2 = 0.3649; P = .007), and terminals (R2 = 0.5666; P < .001) of left IFOF. A trend toward statistical significance (P = .08) in right SLF was observed. A statistically significant correlation between decrease in FA of the right SLF terminal and RWECP was also observed (R2 = 0.2893; P = .028). Conclusion This study found a statistically significant relationship between head impact exposure and change of FA fractional anisotropy value of whole, core, and terminals of left IFOF and right SLF's terminals where WM and gray matter intersect, in the absence of a clinically diagnosed concussion. © RSNA, 2016.
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Affiliation(s)
- Naeim Bahrami
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Dev Sharma
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Scott Rosenthal
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Elizabeth M Davenport
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Jillian E Urban
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Benjamin Wagner
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Youngkyoo Jung
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Christopher G Vaughan
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Gerard A Gioia
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Joel D Stitzel
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Christopher T Whitlow
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Joseph A Maldjian
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
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Genc S, Anderson V, Ryan NP, Malpas CB, Catroppa C, Beauchamp MH, Silk TJ. Recovery of White Matter following Pediatric Traumatic Brain Injury Depends on Injury Severity. J Neurotrauma 2016; 34:798-806. [PMID: 27468807 DOI: 10.1089/neu.2016.4584] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Previous studies in pediatric traumatic brain injury (TBI) have been variable in describing the effects of injury severity on white-matter development. The present study used diffusion tensor imaging to investigate prospective sub-acute and longitudinal relationships between early clinical indicators of injury severity, diffusion metrics, and neuropsychological outcomes. Pediatric patients with TBI underwent magnetic resonance imaging (MRI) (n = 78, mean [M] = 10.56, standard deviation [SD] = 2.21 years) at the sub-acute stage after injury (M = 5.55, SD = 3.05 weeks), and typically developing children were also included and imaged (n = 30, M = 10.60, SD = 2.88 years). A sub-set of the patients with TBI (n = 15) was followed up with MRI 2 years post-injury. Diffusion MRI images were acquired at sub-acute and 2-year follow-up time points and analyzed using Tract-Based Spatial Statistics. At the sub-acute stage, mean diffusivity and axial diffusivity were significantly higher in the TBI group compared with matched controls (p < 0.05). TBI severity significantly predicted diffusion profiles at the sub-acute and 2-year post-injury MRI. Patients with more severe TBI also exhibited poorer information processing speed at 6-months post-injury, which in turn correlated with their diffusion metrics. These findings highlight that the severity of the injury not only has an impact on white-matter microstructure, it also impacts its recovery over time. Moreover, findings suggest that sub-acute microstructural changes may represent a useful prognostic marker to identify children at elevated risk for longer term deficits.
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Affiliation(s)
- Sila Genc
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia
| | - Vicki Anderson
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Nicholas P Ryan
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Charles B Malpas
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia
| | - Cathy Catroppa
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,2 Melbourne School of Psychological Sciences, The University of Melbourne , Melbourne, Australia
| | - Miriam H Beauchamp
- 3 Department of Psychology, The University of Montreal , Montreal, Quebec, Canada .,4 Ste-Justine Hospital Research Center , Montreal, Quebec, Canada
| | - Timothy J Silk
- 1 Developmental Imaging, Clinical Sciences, Murdoch Childrens Research Institute , Melbourne, Australia .,5 Department of Paediatrics, University of Melbourne , The Royal Children's Hospital, Melbourne, Australia
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45
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A voxel-based meta-analysis of diffusion tensor imaging in mild traumatic brain injury. Neurosci Biobehav Rev 2016; 66:119-26. [PMID: 27133211 DOI: 10.1016/j.neubiorev.2016.04.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 12/22/2022]
Abstract
Microstructural damage to white matter and resultant abnormal structural connectivity are a potential underlying pathophysiological mechanism of mild traumatic brain injury (mTBI). Many Tract-Based Spatial Statics studies have investigated the pathophysiology of mTBI, but they yielded inconsistent results potentially due to insufficient statistical power in spite of methodological homogeneity. We used anisotropic effect size signed differential mapping (AES-SDM) to integrate previous studies that recruited patients without a psychiatric history. AES-SDM revealed that fractional anisotropy values were significantly lower in mTBI patients than in control in three clusters. The peak of the largest cluster was in the left thalamus and the cluster extended to the splenium of the corpus callosum and to the anterior thalamic radiation. The second largest cluster was situated in the left forceps minor, and the third largest cluster was in the right superior longitudinal fasciculus III. These results suggest that the pathophysiology of mTBI includes abnormal structural connectivity between the thalamus and the prefrontal cortex, and abnormal intra- and inter-hemispheric structural connectivity involving the prefrontal cortex.
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Meier TB, Bergamino M, Bellgowan PSF, Teague TK, Ling JM, Jeromin A, Mayer AR. Longitudinal assessment of white matter abnormalities following sports-related concussion. Hum Brain Mapp 2015; 37:833-45. [PMID: 26663463 DOI: 10.1002/hbm.23072] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/23/2015] [Indexed: 01/08/2023] Open
Abstract
There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Patrick S F Bellgowan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, North Bethesda, Maryland
| | - T K Teague
- Departments of Surgery and Psychiatry, University of Oklahoma College of Medicine, Tulsa, Oklahoma.,Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma.,Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Dodd AB, Epstein K, Ling JM, Mayer AR. Diffusion tensor imaging findings in semi-acute mild traumatic brain injury. J Neurotrauma 2015; 31:1235-48. [PMID: 24779720 DOI: 10.1089/neu.2014.3337] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The past 10 years have seen a rapid increase in the use of diffusion tensor imaging to identify biomarkers of traumatic brain injury (TBI). Although the literature generally indicates decreased anisotropic diffusion at more chronic injury periods and in more severe injuries, considerable debate remains regarding the direction (i.e., increased or decreased) of anisotropic diffusion in the acute to semi-acute phase (here defined as less than 3 months post-injury) of mild TBI (mTBI). A systematic review of the literature was therefore performed to (1) determine the prevalence of different anisotropic diffusion findings (increased, decreased, bidirectional, or null) during the semi-acute injury phase of mTBI and to (2) identify clinical (e.g., age of injury, post-injury scan time, etc.) and experimental factors (e.g., number of unique directions, field strength) that may influence these findings. Results from the literature review indicated 31 articles with independent samples of semi-acute mTBI patients, with 13 studies reporting decreased anisotropic diffusion, 11 reporting increased diffusion, 2 reporting bidirectional findings, and 5 reporting null findings. Chi-squared analyses indicated that the total number of diffusion-weighted (DW) images was significantly associated with findings of either increased (DW ≥ 30) versus decreased (DW ≤ 25) anisotropic diffusion. Other clinical and experimental factors were not statistically significant for direction of anisotropic diffusion, but these results may have been limited by the relatively small number of studies within each domain (e.g., pediatric studies). In summary, current results indicate roughly equivalent number of studies reporting increased versus decreased anisotropic diffusion during semi-acute mTBI, with the number of unique diffusion images being statistically associated with the direction of findings.
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Affiliation(s)
- Andrew B Dodd
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
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Chong CD, Schwedt TJ. White Matter Damage and Brain Network Alterations in Concussed Patients: A Review of Recent Diffusion Tensor Imaging and Resting-State Functional Connectivity Data. Curr Pain Headache Rep 2015; 19:485. [DOI: 10.1007/s11916-015-0485-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Mayer AR, Hanlon FM, Ling JM. Gray matter abnormalities in pediatric mild traumatic brain injury. J Neurotrauma 2015; 32:723-30. [PMID: 25313896 DOI: 10.1089/neu.2014.3534] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pediatric mild traumatic brain injury (pmTBI) is the most prevalent neurological insult in children and is associated with both acute and chronic neuropsychiatric sequelae. However, little is known about underlying pathophysiology changes in gray matter diffusion and atrophy from a prospective stand-point. Fifteen semi-acute pmTBI patients and 15 well-matched healthy controls were evaluated with a clinical and neuroimaging battery, with a subset of participants returning for a second visit. Clinical measures included tests of attention, processing speed, executive function, working memory, memory, and self-reported post-concussive symptoms. Measures of diffusion (fractional anisotropy [FA]) and atrophy were also obtained for cortical and subcortical gray matter structures to characterize effects of injury as a function of time. Patients exhibited decreased scores in the domains of attention and processing speed relative to controls during the semi-acute injury stage, in conjunction with increased anisotropic diffusion in the left superior temporal gyrus and right thalamus. Evidence of increased diffusion in these regions was also present at four months post-injury, with performance on cognitive tests partially normalizing. In contrast, signs of cortical atrophy in bilateral frontal areas and other left-hemisphere cortical areas only emerged at four months post-injury for patients. Current results suggest potentially differential time-courses of recovery for neurobehavioral markers, anisotropic diffusion and atrophy following pmTBI. Importantly, these data suggest that relying on patient self-report or standard clinical assessments may underestimate the time for true injury recovery.
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Affiliation(s)
- Andrew R Mayer
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
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Roberts RM, Mathias JL, Rose SE. Diffusion Tensor Imaging (DTI) findings following pediatric non-penetrating TBI: a meta-analysis. Dev Neuropsychol 2015; 39:600-37. [PMID: 25470224 PMCID: PMC4270261 DOI: 10.1080/87565641.2014.973958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study meta-analyzed research examining Diffusion Tensor Imaging following pediatric non-penetrating traumatic brain injury to identify the location and extent of white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data from 20 studies were analyzed. FA increased and ADC decreased in most white matter tracts in the short-term (moderate-to-large effects), and FA decreased and ADC increased in the medium- to long-term (moderate-to-very-large effects). Whole brain (short-term), cerebellum and corpus callosum (medium- to long-term) FA values have diagnostic potential, but the impact of age/developmental stage and injury severity on FA/ADC, and the predictive value, is unclear.
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Affiliation(s)
- R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
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