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Studer M, Heussler M, Romano F, Lidzba K, Bigi S. Processing speed and its association with working memory and episodic memory 3-6 months after pediatric mild traumatic brain injury. Brain Inj 2024; 38:928-937. [PMID: 38819316 DOI: 10.1080/02699052.2024.2361626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/01/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Following mild traumatic brain injury (mTBI), children show reduced processing speed (PS). Evidence suggests that slowed PS after TBI is associated with working memory deficits. Our aim was to investigate several forms of PS and to examine its impact on working and episodic memory performance in children after mTBI. METHOD We included data of 64 children after mTBI and 57 healthy control children aged 8-16 years. PS (Color Naming, Coding, Symbol Search, Alertness) was compared between groups 1 week (T1) and 3-6 months (T2) after the injury; working and episodic memory outcome was compared between groups at T2. RESULTS Alertness at T1 and Color Naming at T1 and T2 were significantly reduced following mTBI compared to controls, although most group differences in PS disappeared when patients with previous impairments and mTBI were excluded. PS was predictive for episodic and working memory performance 3-6 months after injury, whereas group was a significant predictor of working memory. CONCLUSIONS Compared to healthy controls, children after mTBI showed reduced performance in verbal PS, which was associated with working memory. In children who are symptomatic after mTBI, diagnostic screening of PS could be helpful in identifying patients that could profit from speed-improving strategies.
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Affiliation(s)
- Martina Studer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel UKBB, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Milena Heussler
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fabrizio Romano
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Karen Lidzba
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sandra Bigi
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Central Switzerland, Lucerne, Switzerland
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Ware AL, Lebel C, Onicas A, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson BH, Craig W, Dehaes M, Doan Q, Deschenes S, Freedman SB, Goodyear BG, Gravel J, Ledoux AA, Zemek R, Yeates KO. Longitudinal Gray Matter Trajectories in Pediatric Mild Traumatic Brain Injury. Neurology 2023; 101:e728-e739. [PMID: 37353339 PMCID: PMC10437012 DOI: 10.1212/wnl.0000000000207508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/24/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This prospective, longitudinal cohort study examined trajectories of brain gray matter macrostructure after pediatric mild traumatic brain injury (mTBI). METHODS Children aged 8-16.99 years with mTBI or mild orthopedic injury (OI) were recruited from 5 pediatric emergency departments. Reliable change between preinjury and 1 month postinjury symptom ratings was used to classify mTBI with or without persistent symptoms. Children completed postacute (2-33 days) and/or chronic (3 or 6 months) postinjury T1-weighted MRI, from which macrostructural metrics were derived using automated segmentation. Linear mixed-effects models were used, with multiple comparisons correction. RESULTS Groups (N = 623; 407 mTBI/216 OI; 59% male; age mean = 12.03, SD = 2.38 years) did not differ in total brain, white, or gray matter volumes or regional subcortical gray matter volumes. However, time postinjury, age at injury, and biological sex-moderated differences among symptom groups in cortical thickness of the angular gyrus, basal forebrain, calcarine cortex, gyrus rectus, medial and posterior orbital gyrus, and the subcallosal area all corrected p < 0.05. Gray matter macrostructural metrics did not differ between groups postacutely. However, cortical thinning emerged chronically after mTBI relative to OI in the angular gyrus in older children (d [95% confidence interval] = -0.61 [-1.15 to -0.08]); and in the basal forebrain (-0.47 [-0.94 to -0.01]), subcallosal area (-0.55 [-1.01 to -0.08]), and the posterior orbital gyrus (-0.55 [-1.02 to -0.08]) in females. Cortical thinning was demonstrated for frontal and occipital regions 3 months postinjury in males with mTBI with persistent symptoms vs without persistent symptoms (-0.80 [-1.55 to -0.05] to -0.83 [-1.56 to -0.10]) and 6 months postinjury in females and younger children with mTBI with persistent symptoms relative to mTBI without persistent symptoms and OI (-1.42 [-2.29 to -0.45] to -0.91 [-1.81 to -0.01]). DISCUSSION These findings signal little diagnostic and prognostic utility of postacute gray matter macrostructure in pediatric mTBI. However, mTBI altered the typical course of cortical gray matter thinning up to 6 months postinjury, even after symptoms typically abate in most children. Collapsing across symptom status obscured the neurobiological heterogeneity of discrete clinical outcomes after pediatric mTBI. The results illustrate the need to examine neurobiology in relation to clinical outcomes and within a neurodevelopmental framework.
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Affiliation(s)
- Ashley L Ware
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada.
| | - Catherine Lebel
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Adrian Onicas
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Nishard Abdeen
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Miriam H Beauchamp
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Christian Beaulieu
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Bruce H Bjornson
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - William Craig
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Mathieu Dehaes
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Quynh Doan
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Sylvain Deschenes
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Stephen B Freedman
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Bradley G Goodyear
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Jocelyn Gravel
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Andrée-Anne Ledoux
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Roger Zemek
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
| | - Keith Owen Yeates
- From the Department of Psychology (A.L.W.), Georgia State University, Atlanta; Department of Neurology (A.L.W.), University of Utah, Salt Lake City; Departments of Psychology (A.L.W., A.O., K.O.Y.) and Radiology (C.L., B.G.G.), Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; Computer Vision Group (A.O.), Sano Centre for Computational Medicine, Kraków 30-054, Poland; Department of Radiology (N.A.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute; Department of Psychology (M.H.B.), University of Montreal & CHU Sainte-Justine Hospital Research Center, Québec; Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton; Division of Neurology (B.H.B.), Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver; University of Alberta and Stollery Children's Hospital (W.C.), Edmonton; Department of Radiology (M.D.), Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal; CHU Sainte-Justine Research Center, Québec; Department of Pediatrics (Q.D.), University of British Columbia, BC Children's Hospital Research Institute, Vancouver; CHU Sainte-Justine Research Center (S.D.), Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec; Departments of Pediatrics and Emergency Medicine (S.B.F.), Cumming School of Medicine, University of Calgary, Alberta; Department of Pediatric Emergency Medicine (J.G.); CHU Sainte-Justine, Department of Pediatrics, University of Montréal, Québec; Children's Hospital of Eastern Ontario Research Institute (A.-A.L., R.Z.); Department of Cellular and Molecular Medicine (A.-A.L.) and Pediatrics and Emergency Medicine (R.Z.), University of Ottawa; and Department of Pediatrics and Emergency Medicine (R.Z.), University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Canada
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3
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Takagi M, Ball G, Babl FE, Anderson N, Chen J, Clarke C, Davis GA, Hearps SJC, Pascouau R, Cheng N, Rausa VC, Seal M, Shapiro JS, Anderson V. Examining post-concussion white matter change in a pediatric sample. Neuroimage Clin 2023; 39:103486. [PMID: 37634376 PMCID: PMC10474493 DOI: 10.1016/j.nicl.2023.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
Diffusion-Weight Imaging (DWI) is increasingly used to explore a range of outcomes in pediatric concussion, particularly the neurobiological underpinnings of symptom recovery. However, the DWI findings within the broader pediatric concussion literature are mixed, which can largely be explained by methodological heterogeneity. To address some of these limitations, the aim of the present study was to utilize internationally- recognized criteria for concussion and a consistent imaging timepoint to conduct a comprehensive, multi-parametric survey of white matter microstructure after concussion. Forty-three children presenting with concussion to the emergency department of a tertiary level pediatric hospital underwent neuroimaging and were classified as either normally recovering (n = 27), or delayed recovering (n = 14) based on their post-concussion symptoms at 2 weeks post-injury.We combined multiple DWI metrics across four modeling approaches using Linked Independent Component Analysis (LICA) to extract several independent patterns of covariation in tissue microstructure present in the study cohort. Our analysis did not identify significant differences between the symptomatic and asymptomatic groups and no component significantly predicted delayed recovery. If white matter microstructure changes are implicated in delayed recovery from concussion, these findings, alongside previous work, suggest that current diffusion techniques are insufficient to detect those changes at this time.
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Affiliation(s)
- Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Rehabilitation Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Gareth Ball
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jian Chen
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia
| | | | - Renee Pascouau
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Nicholas Cheng
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Jesse S Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia; Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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4
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Brown JC, Goldszer IM, Brooks MC, Milano NJ. An Evaluation of the Emerging Techniques in Sports-Related Concussion. J Clin Neurophysiol 2023; 40:384-390. [PMID: 36930205 PMCID: PMC10329722 DOI: 10.1097/wnp.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sports-related concussion is now in public awareness more than ever before. Investigations into underlying pathophysiology and methods of assessment have correspondingly increased at an exponential rate. In this review, we aim to highlight some of the evidence supporting emerging techniques in the fields of neurophysiology, neuroimaging, vestibular, oculomotor, autonomics, head sensor, and accelerometer technology in the setting of the current standard: clinical diagnosis and management. In summary, the evidence we reviewed suggests that (1) head impact sensors and accelerometers may detect possible concussions that would not otherwise receive evaluation; (2) clinical diagnosis may be aided by sideline vestibular, oculomotor, and portable EEG techniques; (3) clinical decisions on return-to-play eligibility are currently not sensitive at capturing the neurometabolic, cerebrovascular, neurophysiologic, and microstructural changes that biomarkers have consistently detected days and weeks after clinical clearance. Such biomarkers include heart rate variability, quantitative electroencephalography, as well as functional, metabolic, and microstructural neuroimaging. The current challenge is overcoming the lack of consistency and replicability of any one particular technique to reach consensus.
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Affiliation(s)
- Joshua C. Brown
- Dept. of Neurology, Medical University of South Carolina
- Dept. of Psychiatry and Behavioral Sciences, Medical University of South Carolina
- Department of Psychiatry and Human Behavior, Department of Neurology, Alpert Medical School of Brown University
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5
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Steiner M, Lidzba K, Bigi S. Processing Speed in Children with Traumatic Brain Injury. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2023. [DOI: 10.1024/1016-264x/a000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Abstract: Traumatic brain injury (TBI) is a common cause of childhood morbidity and mortality. Information processing speed (IPS) is a central construct of neuropsychology and a mediator for a range of cognitive functions. In adults, the negative effects of TBI on IPS are well documented. This review qualitatively describes the impact of TBI on IPS in children and adolescents and examines various influencing factors. We included a total of 37 studies in the review that explored IPS using various clinical assessments. These clinical assessments often examine other neuropsychological functions besides IPS. In 29 of these studies, we found a negative effect of TBI on IPS. While injury severity has small but consistent effects on IPS, the effects of age at injury, time since injury, and gender were less evident. Because it is a central construct of neuropsychological functions, IPS should be assessed after TBI.
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Affiliation(s)
- Michelle Steiner
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Karen Lidzba
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sandra Bigi
- Department of Pediatrics, Division of Neuropediatrics, Development, and Rehabilitation, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Neurology, Bern University Hospital, University of Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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6
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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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Dégeilh F, von Soest T, Ferschmann L, Beer JC, Gaubert M, Koerte IK, Tamnes CK. Social problems and brain structure development following childhood mild traumatic brain injury. Cortex 2023; 162:26-37. [PMID: 36965337 DOI: 10.1016/j.cortex.2023.02.003] [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: 09/05/2022] [Revised: 12/12/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Childhood mild traumatic brain injury (mTBI) is associated with elevated risk of developing social problems, which may be underpinned by changes in the structural developmental trajectory of the social brain, a network of cortical regions supporting social cognition and behavior. However, limited sample sizes and cross-sectional designs generally used in neuroimaging studies of pediatric TBI have prevented explorations of this hypothesis. This longitudinal retrospective study examined the development of parent-reported social problems and cortical thickness in social brain regions following childhood mTBI using data from the large population-based Adolescent Brain Cognitive Development (ABCD) Study. Two-group latent change score models revealed different developmental trajectories from ages 10-12 years in the level of social problems between children with (n = 345) and without (n = 7,089) mTBI. Children with mTBI showed higher, but non-clinical, levels of social problems than controls at age 10. Then, social problems decreased over 2 years, but still remained higher, but non-clinical, than in controls in which they stayed stable. Both groups showed similar decreases in social brain cortical thickness between ages 10 and 12 years. Further studies providing detailed information on the injury mechanism and acute symptoms are needed to better understand individual differences in social functioning and brain development in pediatric TBI.
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Affiliation(s)
- Fanny Dégeilh
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France; Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Lia Ferschmann
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Joanne C Beer
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Malo Gaubert
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France; Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany; Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian K Tamnes
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway; NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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8
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Mayer AR, Meier TB, Dodd AB, Stephenson DD, Robertson-Benta CR, Ling JM, Pabbathi Reddy S, Zotev V, Vakamudi K, Campbell RA, Sapien RE, Erhardt EB, Phillips JP, Vakhtin AA. Prospective Study of Gray Matter Atrophy Following Pediatric Mild Traumatic Brain Injury. Neurology 2023; 100:e516-e527. [PMID: 36522161 PMCID: PMC9931084 DOI: 10.1212/wnl.0000000000201470] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The clinical and physiologic time course for recovery following pediatric mild traumatic brain injury (pmTBI) remains actively debated. The primary objective of the current study was to prospectively examine structural brain changes (cortical thickness and subcortical volumes) and age-at-injury effects. A priori study hypotheses predicted reduced cortical thickness and hippocampal volumes up to 4 months postinjury, which would be inversely associated with age at injury. METHODS Prospective cohort study design with consecutive recruitment. Study inclusion adapted from American Congress of Rehabilitation Medicine (upper threshold) and Zurich Concussion in Sport Group (minimal threshold) and diagnosed by Emergency Department and Urgent Care clinicians. Major neurologic, psychiatric, or developmental disorders were exclusionary. Clinical (Common Data Element) and structural (3 T MRI) evaluations within 11 days (subacute visit [SA]) and at 4 months (early chronic visit [EC]) postinjury. Age- and sex-matched healthy controls (HC) to control for repeat testing/neurodevelopment. Clinical outcomes based on self-report and cognitive testing. Structural images quantified with FreeSurfer (version 7.1.1). RESULTS A total of 208 patients with pmTBI (age = 14.4 ± 2.9; 40.4% female) and 176 HC (age = 14.2 ± 2.9; 42.0% female) were included in the final analyses (>80% retention). Reduced cortical thickness (right rostral middle frontal gyrus; d = -0.49) and hippocampal volumes (d = -0.24) observed for pmTBI, but not associated with age at injury. Hippocampal volume recovery was mediated by loss of consciousness/posttraumatic amnesia. Significantly greater postconcussive symptoms and cognitive deficits were observed at SA and EC visits, but were not associated with the structural abnormalities. Structural abnormalities slightly improved balanced classification accuracy above and beyond clinical gold standards (∆+3.9%), with a greater increase in specificity (∆+7.5%) relative to sensitivity (∆+0.3%). DISCUSSION Current findings indicate that structural brain abnormalities may persist up to 4 months post-pmTBI and are partially mediated by initial markers of injury severity. These results contribute to a growing body of evidence suggesting prolonged physiologic recovery post-pmTBI. In contrast, there was no evidence for age-at-injury effects or physiologic correlates of persistent symptoms in our sample.
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Affiliation(s)
- Andrew R Mayer
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque.
| | - Timothy B Meier
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Andrew B Dodd
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - David D Stephenson
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Cidney R Robertson-Benta
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Josef M Ling
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Sharvani Pabbathi Reddy
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Vadim Zotev
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Kishore Vakamudi
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Richard A Campbell
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Robert E Sapien
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Erik B Erhardt
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - John P Phillips
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
| | - Andrei A Vakhtin
- From the The Mind Research Network/Lovelace Biomedical Research Institute (A.R.M., A.B.D., D.D.S., C.R.R.-B., J.M.L., S.P.R., V.Z., K.V., J.P.P., A.A.V.); Department of Psychology (A.R.M.), Department of Neurology (A.R.M., J.P.P.), and Department of Psychiatry & Behavioral Sciences (A.R.M., R.A.C.), University of New Mexico, Albuquerque; Department of Neurosurgery (T.B.M.), Department of Cell Biology, Neurobiology and Anatomy (T.B.M.), and Department of Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; and Department of Emergency Medicine (R.E.S.), and Department of Mathematics and Statistics (E.B.E.), University of New Mexico, Albuquerque
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9
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Cao M, Wu K, Halperin JM, Li X. Abnormal structural and functional network topological properties associated with left prefrontal, parietal, and occipital cortices significantly predict childhood TBI-related attention deficits: A semi-supervised deep learning study. Front Neurosci 2023; 17:1128646. [PMID: 36937671 PMCID: PMC10017753 DOI: 10.3389/fnins.2023.1128646] [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: 12/21/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is a major public health concern in children. Children with TBI have elevated risk in developing attention deficits. Existing studies have found that structural and functional alterations in multiple brain regions were linked to TBI-related attention deficits in children. Most of these existing studies have utilized conventional parametric models for group comparisons, which have limited capacity in dealing with large-scale and high dimensional neuroimaging measures that have unknown nonlinear relationships. Nevertheless, none of these existing findings have been successfully implemented to clinical practice for guiding diagnoses and interventions of TBI-related attention problems. Machine learning techniques, especially deep learning techniques, are able to handle the multi-dimensional and nonlinear information to generate more robust predictions. Therefore, the current research proposed to construct a deep learning model, semi-supervised autoencoder, to investigate the topological alterations in both structural and functional brain networks in children with TBI and their predictive power for post-TBI attention deficits. Methods Functional magnetic resonance imaging data during sustained attention processing task and diffusion tensor imaging data from 110 subjects (55 children with TBI and 55 group-matched controls) were used to construct the functional and structural brain networks, respectively. A total of 60 topological properties were selected as brain features for building the model. Results The model was able to differentiate children with TBI and controls with an average accuracy of 82.86%. Functional and structural nodal topological properties associated with left frontal, inferior temporal, postcentral, and medial occipitotemporal regions served as the most important brain features for accurate classification of the two subject groups. Post hoc regression-based machine learning analyses in the whole study sample showed that among these most important neuroimaging features, those associated with left postcentral area, superior frontal region, and medial occipitotemporal regions had significant value for predicting the elevated inattentive and hyperactive/impulsive symptoms. Discussion Findings of this study suggested that deep learning techniques may have the potential to help identifying robust neurobiological markers for post-TBI attention deficits; and the left superior frontal, postcentral, and medial occipitotemporal regions may serve as reliable targets for diagnosis and interventions of TBI-related attention problems in children.
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Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Kai Wu
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Jeffery M. Halperin
- Department of Psychology, Queens College, City University of New York, New York, NY, United States
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, NJ, United States
- *Correspondence: Xiaobo Li, ,
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10
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Braga MFM, Juranek J, Eiden LE, Li Z, Figueiredo TH, de Araujo Furtado M, Marini AM. GABAergic circuits of the basolateral amygdala and generation of anxiety after traumatic brain injury. Amino Acids 2022; 54:1229-1249. [PMID: 35798984 DOI: 10.1007/s00726-022-03184-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) has reached epidemic proportions around the world and is a major public health concern in the United States. Approximately 2.8 million individuals sustain a traumatic brain injury and are treated in an Emergency Department yearly in the U.S., and about 50,000 of them die. Persistent symptoms develop in 10-15% of the cases including neuropsychiatric disorders. Anxiety is the second most common neuropsychiatric disorder that develops in those with persistent neuropsychiatric symptoms after TBI. Abnormalities or atrophy in the temporal lobe has been shown in the overwhelming number of TBI cases. The basolateral amygdala (BLA), a temporal lobe structure that consolidates, stores and generates fear and anxiety-based behavioral outputs, is a critical brain region in the anxiety circuitry. In this review, we sought to capture studies that characterized the relationship between human post-traumatic anxiety and structural/functional alterations in the amygdala. We compared the human findings with results obtained with a reproducible mild TBI animal model that demonstrated a direct relationship between the alterations in the BLA and an anxiety-like phenotype. From this analysis, both preliminary insights, and gaps in knowledge, have emerged which may open new directions for the development of rational and more efficacious treatments.
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Affiliation(s)
- Maria F M Braga
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jenifer Juranek
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Lee E Eiden
- Section On Molecular Neuroscience, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Zheng Li
- Section On Synapse Development and Plasticity, National Institute of Mental Health, Intramural Research Program, Bethesda, MD, 20814, USA
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Marcio de Araujo Furtado
- Department of Anatomy, Physiology and Genetics and Program in Neuroscience, Uniformed Services University of the Health Science School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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11
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Cao M, Luo Y, Wu Z, Wu K, Li X. Abnormal neurite density and orientation dispersion in frontal lobe link to elevated hyperactive/impulsive behaviors in young adults with traumatic brain injury. Brain Commun 2022; 4:fcac011. [PMID: 35187485 PMCID: PMC8853727 DOI: 10.1093/braincomms/fcac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
Traumatic brain injury is a major public health concern. A significant proportion of individuals experience post-traumatic brain injury behavioural impairments, especially in attention and inhibitory control domains. Traditional diffusion-weighted MRI techniques, such as diffusion tensor imaging, have provided tools to assess white matter structural disruptions reflecting the long-term brain tissue alterations associated with traumatic brain injury. The recently developed neurite orientation dispersion and density imaging is a more advanced diffusion MRI modality, which provides more refined characterization of brain tissue microstructures by assessing the neurite orientation dispersion and neurite density properties. In this study, neurite orientation dispersion and density imaging data from 44 young adults with chronic traumatic brain injury (who had no prior-injury diagnoses of any sub-presentation of attention deficits/hyperactivity disorder or experience of severe inattentive and/or hyperactive behaviours) and 45 group-matched normal controls were investigated, to assess the post-injury morphometrical and microstructural brain alterations and their relationships with the behavioural outcomes. Maps of fractional anisotropy, neurite orientation dispersion index and neurite density index were calculated. Vertex-wise and voxel-wise analyses were conducted for grey matter and white matter, respectively. Post hoc region-of-interest-based analyses were also performed. Compared to the controls, the group of traumatic brain injury showed significantly increased orientation dispersion index and significantly decreased neurite density index in various grey matter regions, as well as significantly decreased orientation dispersion index in several white matter regions. Brain–behavioural association analyses indicated that the reduced neurite density index of the left precentral gyrus and the reduced orientation dispersion index of the left superior longitudinal fasciculus were significantly associated with elevated hyperactive/impulsive symptoms in the patients with traumatic brain injury. These findings suggest that post-injury chronical neurite intracellular volume and angular distribution anomalies in the frontal lobe, practically the precentral area, can significantly contribute to the onset of hyperactive/impulsive behaviours in young adults with traumatic brain injury.
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Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
| | - Yuyang Luo
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
| | - Ziyan Wu
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, NJ, USA
| | - Kai Wu
- Department of Electrical and Computer Engineering, School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, NJ, USA
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12
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Greer KM, Snyder A, Junge C, Reading M, Jarvis S, Squires C, Bigler ED, Popuri K, Beg MF, Taylor HG, Vannatta K, Gerhardt CA, Rubin K, Yeates KO, Cobia D. Surface-based abnormalities of the executive frontostriatial circuit in pediatric TBI. NEUROIMAGE: CLINICAL 2022; 35:103136. [PMID: 36002959 PMCID: PMC9421496 DOI: 10.1016/j.nicl.2022.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
Cortical thickness of the dorsolateral prefrontal cortex is reduced in pediatric TBI. Shape abnormalities of the caudate and mediodorsal nucleus of the thalamus are a feature of pediatric TBI. Surface-based abnormalities of the dorsolateral prefrontal loop do not appear to relate to executive functioning.
Childhood traumatic brain injury (TBI) is one of the most common causes of acquired disability and has significant implications for executive functions (EF), such as impaired attention, planning, and initiation that are predictive of everyday functioning. Evidence has suggested attentional features of executive functioning require behavioral flexibility that is dependent on frontostriatial circuitry. The purpose of this study was to evaluate surface-based deformation of a specific frontostriatial circuit in pediatric TBI and its role in EF. Regions of interest included: the dorsolateral prefrontal cortex (DLPFC), caudate nucleus, globus pallidus, and the mediodorsal nucleus of the thalamus (MD). T1-weighted magnetic resonance images were obtained in a sample of children ages 8–13 with complicated mild, moderate, or severe TBI (n = 32) and a group of comparison children with orthopedic injury (OI; n = 30). Brain regions were characterized using high-dimensional surface-based brain mapping procedures. Aspects of EF were assessed using select subtests from the Test of Everyday Attention for Children (TEA-Ch). General linear models tested group and hemisphere differences in DLPFC cortical thickness and subcortical shape of deep-brain regions; Pearson correlations tested relationships with EF. Main effects for group were found in both cortical thickness of the DLPFC (F1,60 = 4.30, p = 0.042) and MD mean deformation (F1,60 = 6.50, p = 0.01) all with lower values in the TBI group. Statistical surface maps revealed significant inward deformation on ventral-medial aspects of the caudate in TBI relative to OI, but null results in the globus pallidus. No significant relationships between EF and any region of interest were observed. Overall, findings revealed abnormalities in multiple aspects of a frontostriatial circuit in pediatric TBI, which may reflect broader pathophysiological mechanisms. Increased consideration for the role of deep-brain structures in pediatric TBI can aid in the clinical characterization of anticipated long-term developmental effects of these individuals.
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13
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Muller AM, Panenka WJ, Lange RT, Iverson GL, Brubacher JR, Virji-Babul N. Longitudinal changes in brain parenchyma due to mild traumatic brain injury during the first year after injury. Brain Behav 2021; 11:e2410. [PMID: 34710284 PMCID: PMC8671787 DOI: 10.1002/brb3.2410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022] Open
Abstract
Chronic gray matter (GM) atrophy is a known consequence of moderate and severe traumatic brain injuries but has not been consistently shown in mild traumatic brain injury (mTBI). The aim of this study was to investigate the longitudinal effect of uncomplicated mTBI on the brain's GM and white matter (WM) from 6 weeks to 12 months after injury. Voxel-based-morphometry (VBM) was computed with the T1-weighted images of 48 uncomplicated mTBI patients and 37 orthopedic controls. Over the period from 6 weeks to 12 months, only patients who experienced uncomplicated mTBI, but not control participants, showed significant GM decrease predominantly in the right hemisphere along the GM-CSF border in lateral and medial portions of the sensorimotor cortex extending into the rolandic operculum, middle frontal gyrus, insula, and temporal pole. Additionally, only mTBI patients, but not controls, experienced significant WM decrease predominantly in the right hemisphere in the superior fasciculus longitudinalis, arcuate fasciculus, and cortical-pontine tracts as well as a significant WM increase in left arcuate fasciculus and left capsula extrema. We did not observe any significant change in the controls for the same time interval or any significant group differences in GM and WM probability at each of the two timepoints. This suggests that the changes along the brain tissue borders observed in the mTBI group represent a reorganization associated with subtle microscopical changes in intracortical myelin and not a direct degenerative process as a result of mTBI.
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Affiliation(s)
- Angela M Muller
- Faculty of Medicine, Department of Physical Therapy, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Rael T Lange
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Naznin Virji-Babul
- Faculty of Medicine, Department of Physical Therapy, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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14
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Quinn de Launay K, Martino A, Riggs L, Reed N, Beal DS. Pediatric concussion working memory outcomes: a scoping review. Brain Inj 2021; 35:1121-1133. [PMID: 34506212 DOI: 10.1080/02699052.2021.1972148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Characterize the working memory (WM) profile of children and youth who have experienced concussion by systematically synthesizing existing literature on the neuropsychological outcomes of these injuries.Methods: Implemented a peer-reviewed search strategy combining key concepts of concussion/mild traumatic brain injury (mTBI), WM, and pediatrics across MedLine, Embase, PsycINFO, and CINAHL. Included studies written in English with extractable results on a WM outcome measure in individuals aged 21 and under who experienced concussion. Applied narrative synthesis to identify trends in the literature. Assessed risk of bias and quality using the NHLBI's Quality Assessment of Observational Cohort and Cross-Sectional Studies.Results: 40 articles met inclusion criteria. 34/40 studies compared WM performance in children or youth with concussion to healthy controls, pre-injury performance, or normative values, of which 15 reported significantly lower WM performance in the concussion sample. Visual/spatial WM was more consistently impacted than verbal WM. Cognitive demanding dual-task conditions were also reliably impacted.Conclusion: Literature indicated that WM is vulnerable to negative outcomes following pediatric concussion, yet the nature of outcomes is variable. Clinicians and researchers should implement comprehensive and theoretically motivated WM assessments to better understand the WM components impacted by injury.
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Affiliation(s)
- Keelia Quinn de Launay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Amanda Martino
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Lily Riggs
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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15
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Abstracts from The 38 th Annual National Neurotrauma Symposium July 11–14, 2021 Virtual Conference. J Neurotrauma 2021. [DOI: 10.1089/neu.2021.29111.abstracts] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Cao M, Luo Y, Wu Z, Mazzola CA, Catania L, Alvarez TL, Halperin JM, Biswal B, Li X. Topological Aberrance of Structural Brain Network Provides Quantitative Substrates of Post-Traumatic Brain Injury Attention Deficits in Children. Brain Connect 2021; 11:651-662. [PMID: 33765837 DOI: 10.1089/brain.2020.0866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Traumatic brain injury (TBI)-induced attention deficits are among the most common long-term cognitive consequences in children. Most of the existing studies attempting to understand the neuropathological underpinnings of cognitive and behavioral impairments in TBI have utilized heterogeneous samples and resulted in inconsistent findings. The current research proposed to investigate topological properties of the structural brain network in children with TBI and their relationship with post-TBI attention problems in a more homogeneous subgroup of children who had severe post-TBI attention deficits (TBI-A). Materials and Methods: A total of 31 children with TBI-A and 35 group-matched controls were involved in the study. Diffusion tensor imaging-based probabilistic tractography and graph theoretical techniques were used to construct the structural brain network in each subject. Network topological properties were calculated in both global level and regional (nodal) level. Between-group comparisons among the topological network measures and analyses for searching brain-behavioral were all corrected for multiple comparisons using Bonferroni method. Results: Compared with controls, the TBI-A group showed significantly higher nodal local efficiency and nodal clustering coefficient in left inferior frontal gyrus and right transverse temporal gyrus, whereas significantly lower nodal clustering coefficient in left supramarginal gyrus and lower nodal local efficiency in left parahippocampal gyrus. The temporal lobe topological alterations were significantly associated with the post-TBI inattentive and hyperactive symptoms in the TBI-A group. Conclusion: The results suggest that TBI-related structural re-modularity in the white matter subnetworks associated with temporal lobe may play a critical role in the onset of severe post-TBI attention deficits in children. These findings provide valuable input for understanding the neurobiological substrates of post-TBI attention deficits, and have the potential to serve as quantitatively measurable criteria guiding the development of more timely and tailored strategies for diagnoses and treatments to the affected individuals. Impact statement This study provides a new insight into the neurobiological substrates associated with post-traumatic brain injury attention deficits (TBI-A) in children, by evaluating topological alterations of the structural brain network. The results demonstrated that relative to group-matched controls, the children with TBI-A had significantly altered nodal local efficiency and nodal clustering coefficient in temporal lobe, which strongly linked to elevated inattentive and hyperactive symptoms in the TBI-A group. These findings suggested that white matter structural re-modularity in subnetworks associated with temporal lobe may serve as quantitatively measurable biomarkers for early prediction and diagnosis of post-TBI attention deficits in children.
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Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Yuyang Luo
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Ziyan Wu
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | | | - Lori Catania
- North Jersey Neurodevelopmental Center, North Haledon, New Jersey, USA
| | - Tara L Alvarez
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Jeffrey M Halperin
- Department of Psychology, Queens College, City University of New York, New York, New York, USA
| | - Bharat Biswal
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Xiaobo Li
- Department of Biomedical Engineering and New Jersey Institute of Technology, Newark, New Jersey, USA.,Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
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17
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Zivanovic N, Virani S, Rajaram AA, Lebel C, Yeates KO, Brooks BL. Cortical Volume and Thickness in Youth Several Years After Concussion. J Child Neurol 2021; 36:186-194. [PMID: 33059521 DOI: 10.1177/0883073820962930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The long-term effects of pediatric concussion on brain morphometry remain poorly delineated. This study used magnetic resonance imaging (MRI) to investigate cortical volume and thickness in youth several years after concussion. METHODS Participants aged 8-19 years old with a history of concussion (n = 37) or orthopedic injury (n = 20) underwent MRI, rated their postconcussion symptoms, and completed cognitive testing on average 2.6 years (SD = 1.6) after injury. FreeSurfer was used to obtain cortical volume and thickness measurements as well as determine any significant correlations between brain morphometry, postconcussion symptoms (parent and self-report), and cognitive functioning. RESULTS No significant group differences were found for either cortical volume or thickness. Youth with a history of concussion had higher postconcussion symptom scores (both parent and self-report Postconcussion Symptom Inventory) than the orthopedic injury group, but symptom ratings did not significantly correlate with cortical volume or thickness. Across both groups, faster reaction time on a computerized neurocognitive test battery (CNS Vital Signs) was associated with a thinner cortex in the left pars triangularis of the inferior frontal gyrus and the left caudal anterior cingulate. Better verbal memory was associated with a thinner cortex in the left rostral middle frontal gyrus. CONCLUSION Findings do not support differences in cortical volume or thickness approximately 2.5 years postconcussion in youth, suggesting either long-term cortical recovery or no cortical differences as a result of injury. Further research using a longitudinal study design and larger samples is needed.
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Affiliation(s)
- Nikola Zivanovic
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Shane Virani
- 70402Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Neurosciences Program, 157744Alberta Children's Hospital, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Alysha A Rajaram
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Lebel
- 157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Radiology, 2129University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- 432222Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Neurosciences Program, 157744Alberta Children's Hospital, Calgary, Alberta, Canada.,157744Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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18
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A Systematic Review of Cognitive Functioning After Traumatic Brain Injury in Individuals Aged 10-30 Years. Cogn Behav Neurol 2021; 33:233-252. [PMID: 33264151 DOI: 10.1097/wnn.0000000000000236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Given the importance of the period of life from 10 to 30 years in terms of cognitive development and education, combined with the high incidence of traumatic brain injury (TBI) during this period, and limited consensus as to the pattern and degree of cognitive impairment post TBI during this period, we conducted a systematic review to investigate cognitive performance across a range of domains among individuals between the ages of 10 and 30 years who had sustained a TBI. We searched five databases and identified 799 unique records; 52 met our inclusion criteria. These studies reported cognitive function for intelligence, attention, memory, processing speed, and executive function. The majority of the studies reported significant effects, suggesting that TBI is associated with cognitive impairments in these domains. Nine of the studies used physiological tests (EEG and fMRI), the outcomes of which supported behaviorally demonstrated cognitive deficits. In the studies we reviewed, individuals aged 10-30 years who had experienced a TBI performed worse than healthy controls on cognitive function measures-specifically for attention, memory, processing speed, and executive function. In the studies that subjected the individuals with TBI to EEG and fMRI, atypical activation in associated brain regions was demonstrated while the individuals were undergoing cognitive tasks. However, caution should be taken when interpreting the overall results due to the high risk of bias across the majority of the studies. The broader implications of reduced cognitive performance after TBI across this age range are yet to be fully understood.
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19
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Iyer KK, Zalesky A, Cocchi L, Barlow KM. Neural Correlates of Sleep Recovery following Melatonin Treatment for Pediatric Concussion: A Randomized Controlled Trial. J Neurotrauma 2020; 37:2647-2655. [DOI: 10.1089/neu.2020.7200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kartik K. Iyer
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luca Cocchi
- QIMR Berghofer Medical Research Institute, Clinical Brain Networks Group, Brisbane, Queensland, Australia
| | - Karen M. Barlow
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
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20
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Dodd AB, Lu H, Wertz CJ, Ling JM, Shaff NA, Wasserott BC, Meier TB, Park G, Oglesbee SJ, Phillips JP, Campbell RA, Liu P, Mayer AR. Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury. J Cereb Blood Flow Metab 2020; 40:2491-2504. [PMID: 31903838 PMCID: PMC7820694 DOI: 10.1177/0271678x19896883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Much attention has been paid to the effects of mild traumatic brain injury (mTBI) on cerebrovascular reactivity in adult populations, yet it remains understudied in pediatric injury. In this study, 30 adolescents (12-18 years old) with pediatric mTBI (pmTBI) and 35 age- and sex-matched healthy controls (HC) underwent clinical and neuroimaging assessments during sub-acute (6.9 ± 2.2 days) and early chronic (120.4 ± 11.7 days) phases of injury. Relative to controls, pmTBI reported greater initial post-concussion symptoms, headache, pain, and anxiety, resolving by four months post-injury. Patients reported increased sleep issues and exhibited deficits in processing speed and attention across both visits. In grey-white matter interface areas throughout the brain, pmTBI displayed increased maximal fit/amplitude of a time-shifted end-tidal CO2 regressor to blood oxygen-level dependent response relative to HC, as well as increased latency to maximal fit. The alterations persisted through the early chronic phase of injury, with maximal fit being associated with complaints of ongoing sleep disturbances during post hoc analyses but not cognitive measures of processing speed or attention. Collectively, these findings suggest that deficits in the speed and degree of cerebrovascular reactivity may persist longer than current conceptualizations about clinical recovery within 30 days.
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Affiliation(s)
- Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Benjamin C Wasserott
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grace Park
- Department of Pediatric Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Scott J Oglesbee
- Department of Pediatric Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Andrew R Mayer, The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA.
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21
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King DJ, Novak J, Shephard AJ, Beare R, Anderson VA, Wood AG. Lesion Induced Error on Automated Measures of Brain Volume: Data From a Pediatric Traumatic Brain Injury Cohort. Front Neurosci 2020; 14:491478. [PMID: 33424529 PMCID: PMC7793828 DOI: 10.3389/fnins.2020.491478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
Structural segmentation of T1-weighted (T1w) MRI has shown morphometric differences, both compared to controls and longitudinally, following a traumatic brain injury (TBI). While many patients with TBI present with abnormalities on structural MRI images, most neuroimaging software packages have not been systematically evaluated for accuracy in the presence of these pathology-related MRI abnormalities. The current study aimed to assess whether acute MRI lesions (MRI acquired 7–71 days post-injury) cause error in the estimates of brain volume produced by the semi-automated segmentation tool, Freesurfer. More specifically, to investigate whether this error was global, the presence of lesion-induced error in the contralesional hemisphere, where no abnormal signal was present, was measured. A dataset of 176 simulated lesion cases was generated using actual lesions from 16 pediatric TBI (pTBI) cases recruited from the emergency department and 11 typically-developing controls. Simulated lesion cases were compared to the “ground truth” of the non-lesion control-case T1w images. Using linear mixed-effects models, results showed that hemispheric measures of cortex volume were significantly lower in the contralesional-hemisphere compared to the ground truth. Interestingly, however, cortex volume (and cerebral white matter volume) were not significantly different in the lesioned hemisphere. However, percent volume difference (PVD) between the simulated lesion and ground truth showed that the magnitude of difference of cortex volume in the contralesional-hemisphere (mean PVD = 0.37%) was significantly smaller than that in the lesioned hemisphere (mean PVD = 0.47%), suggesting a small, but systematic lesion-induced error. Lesion characteristics that could explain variance in the PVD for each hemisphere were investigated. Taken together, these results suggest that the lesion-induced error caused by simulated lesions was not focal, but globally distributed. Previous post-processing approaches to adjust for lesions in structural analyses address the focal region where the lesion was located however, our results suggest that focal correction approaches are insufficient for the global error in morphometric measures of the injured brain.
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Affiliation(s)
- Daniel J King
- College of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Jan Novak
- College of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Adam J Shephard
- College of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Richard Beare
- Developmental Imaging, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Medicine, Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Vicki A Anderson
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Psychology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Amanda G Wood
- College of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom.,Faculty of Health, School of Psychology, Deakin University Melbourne Burwood Campus, Geelong, VIC, Australia
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22
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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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23
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Bai L, Bai G, Wang S, Yang X, Gan S, Jia X, Yin B, Yan Z. Strategic white matter injury associated with long-term information processing speed deficits in mild traumatic brain injury. Hum Brain Mapp 2020; 41:4431-4441. [PMID: 32657510 PMCID: PMC7502829 DOI: 10.1002/hbm.25135] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/07/2020] [Accepted: 06/26/2020] [Indexed: 12/21/2022] Open
Abstract
Deficits in information processing speed (IPS) are among the earliest and most prominent cognitive manifestations in mild traumatic brain injury (mTBI). We investigated the impact of white matter fiber location on IPS outcome in an individual basis assessment. A total of 112 acute mild TBI with all CT negative underwent brain DTI and blood sampling for inflammation cytokines within 7 days postinjury and 72 age- and sex matched healthy controls with same assessments were enrolled. IPS outcome was assessed by the trail making test at 6-12 month postinjury in mild TBI. Fractional anisotropy (FA) features were extracted using a novel lesion-load analytical strategy to capture spatially heterogeneous white matter injuries and minimize implicit assumptions of uniform injury across diverse clinical presentations. Acute mild TBI exhibited a general pattern of increased and decreased FA in specific white matter tracts. The power of acute FA measures to identify patients developing IPS deficits with 92% accuracy and further improved to 96% accuracy by adding inflammation cytokines. The classifiers predicted individual's IPS and working memory ratings (r = .74 and .80, respectively, p < .001). The thalamo-cortical circuits and commissural tracts projecting or connecting frontal regions became important predictors. This prognostic model was also verified by an independent replicate sample. Our findings highlighted damage to frontal interhemispheric and thalamic projection fiber tracts harboring frontal-subcortical neuronal circuits as a predictor for processing speed performance in mild TBI.
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Affiliation(s)
- Lijun Bai
- Department of RadiologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical EngineeringSchool of Life Science and Technology, Xi' an Jiaotong UniversityXi'anChina
| | - Guanghui Bai
- Department of RadiologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical EngineeringSchool of Life Science and Technology, Xi' an Jiaotong UniversityXi'anChina
| | - Xuefei Yang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical EngineeringSchool of Life Science and Technology, Xi' an Jiaotong UniversityXi'anChina
| | - Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical EngineeringSchool of Life Science and Technology, Xi' an Jiaotong UniversityXi'anChina
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical EngineeringSchool of Life Science and Technology, Xi' an Jiaotong UniversityXi'anChina
| | - Bo Yin
- Department of Neurosurgerythe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Zhihan Yan
- Department of RadiologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
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24
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Meningher I, Bernstein-Eliav M, Rubovitch V, Pick CG, Tavor I. Alterations in Network Connectivity after Traumatic Brain Injury in Mice. J Neurotrauma 2020; 37:2169-2179. [PMID: 32434427 DOI: 10.1089/neu.2020.7063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Victims of mild traumatic brain injury (mTBI) usually do not display clear morphological brain defects, but frequently have long-lasting cognitive deficits, emotional difficulties, and behavioral disturbances. In the present study we used diffusion magnetic resonance imaging (dMRI) combined with graph theory measurements to investigate the effects of mTBI on brain network connectivity. We employed a non-invasive closed-head weight-drop mouse model to produce mTBI. Mice were scanned at two time points, 24 h before the injury and either 7 or 30 days following the injury. Connectivity matrices were computed for each animal at each time point, and these were subsequently used to extract graph theory measures reflecting network integration and segregation, on both the global (i.e., whole brain) and local (i.e., single regions) levels. We found that cluster coefficient, reflecting network segregation, decreased 7 days post-injury and then returned to baseline level 30 days following the injury. Global efficiency, reflecting network integration, demonstrated opposite patterns in the left and right hemispheres, with an increase of right hemisphere efficiency at 7 days and then a decrease in efficiency following 30 days, and vice versa in the left hemisphere. These findings suggest a possible compensation mechanism acting to moderate the influence of mTBI on the global network. Moreover, these results highlight the importance of tracking the dynamic changes in mTBI over time, and the potential of structural connectivity as a promising approach for studying network integrity and pathology progression in mTBI.
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Affiliation(s)
- Inbar Meningher
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Bernstein-Eliav
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Vardit Rubovitch
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chaim G Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Dr. Miriam and Sheldon G. Adelson Chair and Center for the Biology of Addictive Diseases, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Tavor
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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25
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Ware AL, Goodrich-Hunsaker NJ, Lebel C, Shukla A, Wilde EA, Abildskov TJ, Bigler ED, Cohen DM, Mihalov LK, Bacevice A, Bangert BA, Taylor HG, Yeates KO. Post-Acute Cortical Thickness in Children with Mild Traumatic Brain Injury versus Orthopedic Injury. J Neurotrauma 2020; 37:1892-1901. [PMID: 32178577 DOI: 10.1089/neu.2019.6850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Studies of brain morphometry may illuminate the effects of pediatric mild traumatic brain injury (TBI; e.g., concussion). However, no published studies have examined cortical thickness in the early injury phases of pediatric mild TBI using an appropriate comparison group. The current study used an automated approach (i.e., FreeSurfer) to determine whether cortical thickness differed in children following a mild TBI or a mild orthopedic injury (OI), and to examine whether post-acute cortical thickness predicted post-acute and chronic post-concussive symptoms (PCS). Children ages 8.00-16.99 years with mild TBI (n = 136) or OI (n = 70) were recruited at emergency department visits to two children's hospitals, during which parents rated children's pre-injury symptoms retrospectively. Children completed a post-acute (3-24 days post-injury) assessment, which included a 3 Tesla MRI, and 3- and 6-month post-injury assessments. Parents and children rated PCS at each assessment. Cortical thickness was estimated using FreeSurfer. Linear mixed effects and multi-variable negative binomial regression models were used to test study aims, with false discovery rate (FDR) correction for multiple comparisons. Groups differed significantly on left parietal cortical thickness (TBI > OI) after FDR correction. Cortical thickness also varied by brain subregion and age, but not sex. Groups differed significantly on PCS post-acutely (TBI > OI), but not at 3 or 6 months. Right frontal thickness was positively related to post-acute PCS in both groups. Right cingulum thickness predicted chronic PCS in the OI group only. Results highlight the complexity of predicting outcomes of pediatric mild TBI from post-acute neuroimaging biomarkers.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Catherine Lebel
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Ayushi Shukla
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Tracy J Abildskov
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Daniel M Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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26
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Beelen C, Phan TV, Wouters J, Ghesquière P, Vandermosten M. Investigating the Added Value of FreeSurfer's Manual Editing Procedure for the Study of the Reading Network in a Pediatric Population. Front Hum Neurosci 2020; 14:143. [PMID: 32390814 PMCID: PMC7194167 DOI: 10.3389/fnhum.2020.00143] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/30/2020] [Indexed: 01/08/2023] Open
Abstract
Insights into brain anatomy are important for the early detection of neurodevelopmental disorders, such as dyslexia. FreeSurfer is one of the most frequently applied automatized software tools to study brain morphology. However, quality control of the outcomes provided by FreeSurfer is often ignored and could lead to wrong statistical inferences. Additional manual editing of the data may be a solution, although not without a cost in time and resources. Past research in adults on comparing the automatized method of FreeSurfer with and without additional manual editing indicated that although editing may lead to significant differences in morphological measures between the methods in some regions, it does not substantially change the sensitivity to detect clinical differences. Given that automated approaches are more likely to fail in pediatric-and inherently more noisy-data, we investigated in the current study whether FreeSurfer can be applied fully automatically or additional manual edits of T1-images are needed in a pediatric sample. Specifically, cortical thickness and surface area measures with and without additional manual edits were compared in six regions of interest (ROIs) of the reading network in 5-to-6-year-old children with and without dyslexia. Results revealed that additional editing leads to statistical differences in the morphological measures, but that these differences are consistent across subjects and that the sensitivity to reveal statistical differences in the morphological measures between children with and without dyslexia is not affected, even though conclusions of marginally significant findings can differ depending on the method used. Thereby, our results indicate that additional manual editing of reading-related regions in FreeSurfer has limited gain for pediatric samples.
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Affiliation(s)
- Caroline Beelen
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | - Jan Wouters
- Research Group ExpORL, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Maaike Vandermosten
- Research Group ExpORL, Department of Neuroscience, KU Leuven, Leuven, Belgium
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27
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King DJ, Seri S, Beare R, Catroppa C, Anderson VA, Wood AG. Developmental divergence of structural brain networks as an indicator of future cognitive impairments in childhood brain injury: Executive functions. Dev Cogn Neurosci 2020; 42:100762. [PMID: 32072940 PMCID: PMC6996014 DOI: 10.1016/j.dcn.2020.100762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/01/2019] [Accepted: 01/19/2020] [Indexed: 11/29/2022] Open
Abstract
Brain insults during childhood can perturb the already non-linear trajectory of typical brain maturation. The diffuse effects of injury can be modelled using structural covariance networks (SCN), which change as a function of neurodevelopment. However, SCNs are estimated at the group-level, limiting applicability to predicting individual-subject outcomes. This study aimed to measure the divergence of the brain networks in paediatric traumatic brain injury (pTBI) patients and controls, and investigate relationships with executive functioning (EF) at 24 months post-injury. T1-weighted MRI acquired acutely in 78 child survivors of pTBI and 33 controls underwent 3D-tissue segmentation to estimate cortical thickness (CT) across 68 atlas-based regions-of-interest (ROIs). Using an 'add-one-patient' approach, we estimate a developmental divergence index (DDI). Our approach adopts a novel analytic framework in which age-appropriate reference networks to calculate the DDI were generated from control participants from the ABIDE dataset using a sliding-window approach. Divergence from the age-appropriate SCN was related to reduced EF performance and an increase in behaviours related to executive dysfunctions. The DDI measure showed predictive value with regard to executive functions, highlighting that early imaging can assist in prognosis for cognition.
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Affiliation(s)
- Daniel J King
- School of Life and Health Sciences & Aston Neuroscience Institute, Aston University, Birmingham, B4 7ET, UK; Department of Clinical Neurophysiology, Birmingham Women's and Children's Hospital NHS Foundation Trust, UK
| | - Stefano Seri
- School of Life and Health Sciences & Aston Neuroscience Institute, Aston University, Birmingham, B4 7ET, UK; Department of Clinical Neurophysiology, Birmingham Women's and Children's Hospital NHS Foundation Trust, UK
| | - Richard Beare
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Cathy Catroppa
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia
| | - Vicki A Anderson
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology, Royal Children's Hospital, Melbourne, Australia
| | - Amanda G Wood
- School of Life and Health Sciences & Aston Neuroscience Institute, Aston University, Birmingham, B4 7ET, UK; Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, Geelong, Victoria, Australia.
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Riccardi N, Yourganov G, Rorden C, Fridriksson J, Desai R. Degradation of Praxis Brain Networks and Impaired Comprehension of Manipulable Nouns in Stroke. J Cogn Neurosci 2020; 32:467-483. [PMID: 31682566 PMCID: PMC10274171 DOI: 10.1162/jocn_a_01495] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Distributed brain systems contribute to representation of semantic knowledge. Whether sensory and motor systems of the brain are causally involved in representing conceptual knowledge is an especially controversial question. Here, we tested 57 chronic left-hemisphere stroke patients using a semantic similarity judgment task consisting of manipulable and nonmanipulable nouns. Three complementary methods were used to assess the neuroanatomical correlates of semantic processing: voxel-based lesion-symptom mapping, resting-state functional connectivity, and gray matter fractional anisotropy. The three measures provided converging evidence that injury to the brain networks required for action observation, execution, planning, and visuomotor coordination are associated with specific deficits in manipulable noun comprehension relative to nonmanipulable items. Damage or disrupted connectivity of areas such as the middle posterior temporal gyrus, anterior inferior parietal lobe, and premotor cortex was related specifically to the impairment of manipulable noun comprehension. These results suggest that praxis brain networks contribute especially to the comprehension of manipulable object nouns.
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Lindsey HM, Wilde EA, Caeyenberghs K, Dennis EL. Longitudinal Neuroimaging in Pediatric Traumatic Brain Injury: Current State and Consideration of Factors That Influence Recovery. Front Neurol 2019; 10:1296. [PMID: 31920920 PMCID: PMC6927298 DOI: 10.3389/fneur.2019.01296] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability for children and adolescents in the U.S. and other developed and developing countries. Injury to the immature brain varies greatly from that of the mature, adult brain due to numerous developmental, pre-injury, and injury-related factors that work together to influence the trajectory of recovery during the course of typical brain development. Substantial damage to brain structure often underlies subsequent functional limitations that persist for years following pediatric TBI. Advances in neuroimaging have established an important role in the acute management of pediatric TBI, and magnetic resonance imaging (MRI) techniques have a particular relevance for the sequential assessment of long-term consequences from injuries sustained to the developing brain. The present paper will discuss the various factors that influence recovery and review the findings from the present neuroimaging literature to assess altered development and long-term outcome following pediatric TBI. Four MR-based neuroimaging modalities have been used to examine recovery from pediatric TBI longitudinally: (1) T1-weighted structural MRI is sensitive to morphological changes in gray matter volume and cortical thickness, (2) diffusion-weighted MRI is sensitive to changes in the microstructural integrity of white matter, (3) MR spectroscopy provides a sensitive assessment of metabolic and neurochemical alterations in the brain, and (4) functional MRI provides insight into the functional changes that occur as a result of structural damage and typical developmental processes. As reviewed in this paper, 13 cohorts have contributed to only 20 studies published to date using neuroimaging to examine longitudinal changes after TBI in pediatric patients. The results of these studies demonstrate considerable heterogeneity in post-injury outcome; however, the existing literature consistently shows that alterations in brain structure, function, and metabolism can persist for an extended period of time post-injury. With larger sample sizes and multi-site cooperation, future studies will be able to further examine potential moderators of outcome, such as the developmental, pre-injury, and injury-related factors discussed in the present review.
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Affiliation(s)
- Hannah M. Lindsey
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Emily L. Dennis
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
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Abstract
PURPOSE OF REVIEW The concussion public health burden has increased alongside our knowledge of the pathophysiology of mild traumatic brain injury (mTBI). The purpose of this review is to summarize our current understanding of mTBI pathophysiology and biomechanics and how these underlying principles correlate with clinical manifestations of mTBI. RECENT FINDINGS Changes in post-mTBI glutamate and GABA concentrations seem to be region-specific and time-dependent. Genetic variability may predict recovery and symptom severity while gender differences appear to be associated with the neuroinflammatory response and neuroplasticity. Ongoing biomechanical research has shown a growing body of evidence in support of an "individual-specific threshold" for mTBI that varies based on individual intrinsic factors. The literature demonstrates a well-characterized timeframe for mTBI pathophysiologic changes in animal models while work in this area continues to grow in humans. Current human research shows that these underlying post-mTBI effects are multifactorial and may correlate with symptomatology and recovery. While wearable sensor technology has advanced biomechanical impact research, a definitive concussion threshold remains elusive.
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Affiliation(s)
- Rafael Romeu-Mejia
- Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- UCLA Brain Injury Research Center, Los Angeles, CA, USA
| | - Christopher C Giza
- Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- UCLA Brain Injury Research Center, Los Angeles, CA, USA
- Department of Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
| | - Joshua T Goldman
- Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA.
- Department of Family Medicine, Division of Sports Medicine, UCLA, Los Angeles, CA, USA.
- Department of Orthopedic Surgery, UCLA, Los Angeles, CA, USA.
- Department of Intercollegiate Athletics, UCLA, Los Angeles, CA, USA.
- Center for Sports Medicine, Orthopedic Institute for Children, Los Angeles, CA, USA.
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King DJ, Ellis KR, Seri S, Wood AG. A systematic review of cross-sectional differences and longitudinal changes to the morphometry of the brain following paediatric traumatic brain injury. Neuroimage Clin 2019; 23:101844. [PMID: 31075554 PMCID: PMC6510969 DOI: 10.1016/j.nicl.2019.101844] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 01/27/2023]
Abstract
Paediatric traumatic brain injury (pTBI) is a leading cause of disability for children and young adults. Children are a uniquely vulnerable group with the disease process that occurs following a pTBI interacting with the trajectory of normal brain development. Quantitative MRI post-injury has suggested a long-term, neurodegenerative effect of TBI on the morphometry of the brain, in both adult and childhood TBI. Changes to the brain beyond that of anticipated, age-dependant differences may allow us to estimate the state of the brain post-injury and produce clinically relevant predictions for long-term outcome. The current review synthesises the existing literature to assess whether, following pTBI, the morphology of the brain exhibits either i) longitudinal change and/or ii) differences compared to healthy controls and outcomes. The current literature suggests that morphometric differences from controls are apparent cross-sectionally at both acute and late-chronic timepoints post-injury, thus suggesting a non-transient effect of injury. Developmental trajectories of morphometry are altered in TBI groups compared to patients, and it is unlikely that typical maturation overcomes damage post-injury, or even 'catches up' with that of typically-developing peers. However, there is limited evidence for diverted developmental trajectories being associated with cognitive impairment post-injury. The current review also highlights the apparent challenges to the existing literature and potential methods by which these can be addressed.
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Affiliation(s)
- D J King
- School of Life and Health Sciences & Aston Brain Centre, Aston University, Birmingham, UK
| | - K R Ellis
- School of Life and Health Sciences & Aston Brain Centre, Aston University, Birmingham, UK
| | - S Seri
- School of Life and Health Sciences & Aston Brain Centre, Aston University, Birmingham, UK
| | - A G Wood
- School of Life and Health Sciences & Aston Brain Centre, Aston University, Birmingham, UK; Child Neuropsychology, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
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Neuroanatomical and functional alterations of insula in mild traumatic brain injury patients at the acute stage. Brain Imaging Behav 2019; 14:907-916. [PMID: 30734204 DOI: 10.1007/s11682-019-00053-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cognitive impairment is a major cause of disability and decline in quality of life in mild traumatic brain injury (mTBI) survivors, but the underlying pathophysiology is still poorly understood. The insula has extensive connections to other cortex and is believed to responsible for integrating external and internal processes and controlling cognitive functions. To explore this hypothesis, we investigated early alterations in the gray matter volume (GMV) and brain functional connectivity (FC) of insula in mTBI patients within 7 days after injury and any possible correlations with cognitive function. A total of 58 mTBI patients at the acute stage and 32 matched healthy controls were recruited and underwentT1-weighted magnetic resonance imaging (MRI)andresting-state functional MRI scans within 7 days of injury. FC was characterized using seed-based region of interest analysis method. The patients' cognitive function was evaluated with Montreal Cognitive Assessment (MoCA) score. The resulting of GMV and FC of insula were correlated with cognitive alterations. We found that the GMV was significantly reduced only in the right insula in mTBI patients and no significant GMV increase was observed in either hemisphere. mTBI patients demonstrated decreased FC in the right parahippocampal gyrus and increased FC in the right supramargianl gyrus. In addition, compared to the healthy controls, the mTBI patients in the acute stage presented a decline in the visuospatial/executive (p = 0.013) and attention (p = 0.038) subcategories. In the mTBI group, the changes in GMV in the right insula were positively correlated with poor attention performance (r = 0.316, p = 0.016). Our data demonstrated alterations of the GMV and resting-stateFC of the right insula in mTBI patients at the acute stage. These early changes in GMV and resting-state FC perhaps serve as a potential biomarker for improving the understanding of cognitive decline for mTBI in the acute setting.
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Santhanam P, Wilson SH, Oakes TR, Weaver LK. Accelerated age-related cortical thinning in mild traumatic brain injury. Brain Behav 2019; 9:e01161. [PMID: 30488646 PMCID: PMC6346670 DOI: 10.1002/brb3.1161] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) can result in many structural abnormalities in the cerebral cortex. While thinning of the cortex has been shown in mTBI patients, there is high regional variability in reported findings. High-resolution imaging can elucidate otherwise unnoticed changes in cortical measures following injury. This study examined age-related patterns of cortical thickness in U.S. active duty service members and veterans with a history of mTBI (n = 66) as compared to a normative population (n = 67). METHODS Using a fully automated cortical parcellation methodology, cortical thickness measures were extracted from 31 bilateral cortical regions for all participants. RESULTS The effect of diagnosis and age on cortical thickness (group × age interaction) was found to be significant (p < 0.05) for many regions, including bilateral parietal and left frontal and temporal cortices. Findings held for a male-only subset, and there was no effect of time since injury in any regions. CONCLUSIONS The presence of mTBI appeared to accelerate age-related cortical thinning across the cortex in our study population.
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Affiliation(s)
| | | | - Terrence R. Oakes
- Madison School of Medicine and Public HealthUniversity of WisconsinMadisonWisconsin
| | - Lindell K. Weaver
- Division of Hyperbaric Medicine Intermountain Medical CenterMurray, UT and Intermountain LDS HospitalSalt Lake CityUtah
- Department of MedicineUniversity of Utah School of MedicineSalt LakeUtah
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Goldman-Yassen AE, Chen KX, Edasery D, Hsu K, Ye K, Lipton ML. Near-Term Decrease in Brain Volume following Mild Traumatic Injury Is Detectible in the Context of Preinjury Volumetric Stability: Neurobiologic Insights from Analysis of Historical Imaging Examinations. AJNR Am J Neuroradiol 2018; 39:1821-1826. [PMID: 30190258 DOI: 10.3174/ajnr.a5769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Neurodegeneration after mild traumatic brain injury may manifest as decreasing regional brain volume that evolves from months to years following mild traumatic brain injury and is associated with worse clinical outcomes. We hypothesized that quantitative brain volume derived from CT of the head, performed for clinical indications during routine care, would change with time and provide insights into the putative neuroinflammatory response to mild traumatic brain injury. MATERIALS AND METHODS We searched the electronic medical record of our institution for NCCTs of the head performed in patients with mild traumatic brain injury and included those who also underwent NCCTs of the head 1 month to 1 year before and after mild traumatic brain injury for an indication unrelated to trauma. Controls underwent 3 sequential NCCTs of the head with indications unrelated to trauma. The whole-brain and intracranial volume groups were computed using ITK-SNAP. Brain volumes normalized to intracranial volumes were compared across time points using the Wilcoxon signed-rank test. RESULTS We identified 48 patients from 2005 to 2015 who underwent NCCTs of the head in the emergency department for mild traumatic brain injury and had NCCTs of the head performed both before and after mild traumatic brain injury. Median normalized brain volumes significantly decreased on the follow-up study post-mild traumatic brain injury (0.86 versus 0.84, P < .001) and were similar compared with pre-mild traumatic brain injury studies (0.87 versus 0.86, P = .927). There was no significant difference between normalized brain volumes in the 48 controls. CONCLUSIONS A decrease in brain volume following mild traumatic brain injury is detectable on CT and is not seen in similar patients with non-mild traumatic brain injury during a similar timeframe. Given the stability of brain volume before mild traumatic brain injury, CT volume loss may represent the subtle effects of neurodegeneration.
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Affiliation(s)
- A E Goldman-Yassen
- From the Department of Radiology (A.E.G.-Y., K.X.C., D.E., K.H.), Montefiore Medical Center, Bronx, New York
| | - K X Chen
- From the Department of Radiology (A.E.G.-Y., K.X.C., D.E., K.H.), Montefiore Medical Center, Bronx, New York
| | - D Edasery
- From the Department of Radiology (A.E.G.-Y., K.X.C., D.E., K.H.), Montefiore Medical Center, Bronx, New York
| | - K Hsu
- From the Department of Radiology (A.E.G.-Y., K.X.C., D.E., K.H.), Montefiore Medical Center, Bronx, New York
| | - K Ye
- Department of Epidemiology and Population Health (K.Y.), Albert Einstein College of Medicine, Bronx, New York
| | - M L Lipton
- Gruss Magnetic Resonance Research Center Departments of Radiology, Psychiatry and Behavioral Sciences and Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine, Bronx, New York.
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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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Abstract
Conventional neuroimaging examinations are typically normal in concussed young athletes. A current focus of research is the characterization of subtle abnormalities after concussion using advanced neuroimaging techniques. These techniques have the potential to identify biomarkers of concussion. In the future, such biomarkers will likely provide important clinical information regarding the appropriate time interval before return to play, as well as the risk for prolonged postconcussive symptoms and long-term cognitive impairment. This article discusses results from advanced imaging techniques and emphasizes imaging modalities that will likely become available in the near future for the clinical evaluation of concussed young athletes.
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Affiliation(s)
- Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; VA Boston Healthcare System, Brockton Division, 940 Belmont Street, Brockton, MA 02301, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-Universität, Nußbaumstr 5a, Munich 80336, Germany.
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España LY, Lee RM, Ling JM, Jeromin A, Mayer AR, Meier TB. Serial Assessment of Gray Matter Abnormalities after Sport-Related Concussion. J Neurotrauma 2017; 34:3143-3152. [DOI: 10.1089/neu.2017.5002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Lezlie Y. España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ryan M. Lee
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - 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
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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Dall'Acqua P, Johannes S, Mica L, Simmen HP, Glaab R, Fandino J, Schwendinger M, Meier C, Ulbrich EJ, Müller A, Jäncke L, Hänggi J. Prefrontal Cortical Thickening after Mild Traumatic Brain Injury: A One-Year Magnetic Resonance Imaging Study. J Neurotrauma 2017; 34:3270-3279. [PMID: 28847215 DOI: 10.1089/neu.2017.5124] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to evaluate group-by-time interactions between gray matter morphology of healthy controls and that of patients with mild traumatic brain injury (mTBI) as they transitioned from acute to chronic stages, and to relate these findings to long-term cognitive alterations to identify distinct recovery trajectories between good outcome (GO) and poor outcome (PO). High-resolution T1-weighted magnetic resonance images were acquired in 49 mTBI patients within 7 days and 1 year post-injury and at equivalent times in 49 healthy controls. Using linear mixed-effects models, we performed mass-univariate analyses and associated the results of the interaction with changes in cognitive performance. Morphological alterations indexed by increased or decreased cortical thickness have been expected mainly in frontal, parietal, and temporal brain regions. A significant interaction was found in cortical thickness, spatially restricted to bilateral structures of the prefrontal cortex, showing thickening in mTBI and normal developmental thinning in controls. A discrete thickness increase that can interpreted as the absence of cortical thinning typically seen in the healthy population was associated with cognitive recovery in the GO subgroup, while the exaggerated cortical thickening in the PO patients was linked to worsening cognitive performance. Thickness of the prefrontal cortex is subject to structural alterations during the first year after mTBI. Beside beneficial neuroplasticity, a prolonged state of neuroinflammation for symptomatic patients (maladaptive neuroplasticity) cannot be excluded. If the underlying cellular processes responsible for cortical thickening following mTBI have been determined, brain stimulation or even pharmacological intervention targeting the prefrontal cortex might promote endogenous neural restoration.
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Affiliation(s)
- Patrizia Dall'Acqua
- 1 Bellikon Rehabilitation Clinic , Bellikon, Switzerland .,2 Department of Psychology, University of Zurich , Zurich, Switzerland
| | - Sönke Johannes
- 1 Bellikon Rehabilitation Clinic , Bellikon, Switzerland
| | - Ladislav Mica
- 3 Division of Trauma Surgery, University Hospital Zurich , Zurich, Switzerland
| | - Hans-Peter Simmen
- 3 Division of Trauma Surgery, University Hospital Zurich , Zurich, Switzerland
| | | | - Javier Fandino
- 5 Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Markus Schwendinger
- 6 Interdisciplinary Emergency Center , Baden Cantonal Hospital, Baden, Switzerland
| | - Christoph Meier
- 7 Department of Surgery, Waid Hospital Zurich , Zurich, Switzerland
| | - Erika Jasmin Ulbrich
- 8 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich , Zurich, Switzerland
| | - Andreas Müller
- 9 Brain and Trauma Foundation Grisons , Chur, Switzerland
| | - Lutz Jäncke
- 2 Department of Psychology, University of Zurich , Zurich, Switzerland .,10 International Normal Aging and Plasticity Imaging Center, University of Zurich , Zurich, Switzerland .,11 University Research Priority Program, Dynamic of Healthy Aging, University of Zurich , Zurich, Switzerland
| | - Jürgen Hänggi
- 2 Department of Psychology, University of Zurich , Zurich, Switzerland
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Leh SE, Schroeder C, Chen JK, Mallar Chakravarty M, Park MTM, Cheung B, Huntgeburth SC, Gosselin N, Hock C, Ptito A, Petrides M. Microstructural Integrity of Hippocampal Subregions Is Impaired after Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:1402-1411. [DOI: 10.1089/neu.2016.4591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Sandra E. Leh
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Clemens Schroeder
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Jen-Kai Chen
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University Health Centre, Montreal, Quebec, Canada
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Departments of Psychiatry and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Min Tae M. Park
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bob Cheung
- Defense Research and Development Canada (DRDC) Toronto, Ontario, Canada
| | - Sonja C. Huntgeburth
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Christoph Hock
- Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Alain Ptito
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Petrides
- Cognitive Neuroscience Unit, Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Wu X, Kirov II, Gonen O, Ge Y, Grossman RI, Lui YW. MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update. Radiology 2016; 279:693-707. [PMID: 27183405 DOI: 10.1148/radiol.16142535] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with three-dimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen level-dependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition. (©) RSNA, 2016.
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Affiliation(s)
- Xin Wu
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Ivan I Kirov
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Oded Gonen
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yulin Ge
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Robert I Grossman
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
| | - Yvonne W Lui
- From the Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016
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42
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Urban KJ, Riggs L, Wells GD, Keightley M, Chen JK, Ptito A, Fait P, Taha T, Sinopoli KJ. Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth. J Neurotrauma 2016; 34:816-823. [PMID: 27629883 DOI: 10.1089/neu.2016.4502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.
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Affiliation(s)
- Karolina J Urban
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Lily Riggs
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Greg D Wells
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada .,4 Department of Physiology and Experimental Medicine, the Hospital for Sick Children , Toronto, Ontario, Canada
| | - Michelle Keightley
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Jen-Kai Chen
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Alain Ptito
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Philippe Fait
- 6 Department of Human Kinetic, University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada .,7 Research Group on Neuromusculoskeletal Dysfunctions (GRAN), University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada
| | - Tim Taha
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada
| | - Katia J Sinopoli
- 8 Department of Psychology, Division of Neurology, the Hospital for Sick Children , Toronto, Ontario, Canada
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43
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Tate DF, Wade BSC, Velez CS, Drennon AM, Bolzenius J, Gutman BA, Thompson PM, Lewis JD, Wilde EA, Bigler ED, Shenton ME, Ritter JL, York GE. Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury. J Neurol 2016; 263:2065-79. [PMID: 27435967 PMCID: PMC5564450 DOI: 10.1007/s00415-016-8236-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
Mild traumatic brain injury (mTBI) is a significant health concern. The majority who sustain mTBI recover, although ~20 % continue to experience symptoms that can interfere with quality of life. Accordingly, there is a critical need to improve diagnosis, prognostic accuracy, and monitoring (recovery trajectory over time) of mTBI. Volumetric magnetic resonance imaging (MRI) has been successfully utilized to examine TBI. One promising improvement over standard volumetric approaches is to analyze high-dimensional shape characteristics of brain structures. In this study, subcortical shape and volume in 76 Service Members with mTBI was compared to 59 Service Members with orthopedic injury (OI) and 17 with post-traumatic stress disorder (PTSD) only. FreeSurfer was used to quantify structures from T1-weighted 3 T MRI data. Radial distance (RD) and Jacobian determinant (JD) were defined vertex-wise on parametric mesh-representations of subcortical structures. Linear regression was used to model associations between morphometry (volume and shape), TBI status, and time since injury (TSI) correcting for age, sex, intracranial volume, and level of education. Volumetric data was not significantly different between the groups. JD was significantly increased in the accumbens and caudate and significantly reduced in the thalamus of mTBI participants. Additional significant associations were noted between RD of the amygdala and TSI. Positive trend-level associations between TSI and the amygdala and accumbens were observed, while a negative association was observed for third ventricle. Our findings may aid in the initial diagnosis of mTBI, provide biological targets for functional examination, and elucidate regions that may continue remodeling after injury.
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Affiliation(s)
- David F Tate
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA.
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | - Benjamin S C Wade
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Carmen S Velez
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Centers, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri, St. Louis, 4633 World Parkway Circle, Berkeley, MO, 63134-3115, USA
| | - Boris A Gutman
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA, USA
| | - Jeffrey D Lewis
- Department of Neurology, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Erin D Bigler
- Departments of Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Brockton Division, VA Boston Healthcare System, Brockton, MA, USA
| | - John L Ritter
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Gerald E York
- Alaska Radiology Associates, TBI Imaging and Research, Anchorage, AK, USA
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Harris NG, Verley DR, Gutman BA, Sutton RL. Bi-directional changes in fractional anisotropy after experiment TBI: Disorganization and reorganization? Neuroimage 2016; 133:129-143. [PMID: 26975556 PMCID: PMC4889542 DOI: 10.1016/j.neuroimage.2016.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022] Open
Abstract
The current dogma to explain the extent of injury-related changes following rodent controlled cortical impact (CCI) injury is a focal injury with limited axonal pathology. However, there is in fact good, published histologic evidence to suggest that axonal injury is far more widespread in this model than generally thought. One possibility that might help to explain this is the often-used region-of-interest data analysis approach taken by experimental traumatic brain injury (TBI) diffusion tensor imaging (DTI) or histologic studies that might miss more widespread damage, when compared to the whole brain, statistically robust method of tract-based analysis used more routinely in clinical research. To determine the extent of DTI changes in this model, we acquired in vivo DTI data before and at 1 and 4weeks after CCI injury in 17 adult male rats and analyzed parametric maps of fractional anisotropy (FA), axial, radial, and mean diffusivity (AD, RD, MD), tensor mode (MO), and fiber tract density (FTD) using tract-based spatial statistics. Contusion volume was used as a surrogate marker of injury severity and as a covariate for investigating severity dependence of the data. Mean fiber tract length was also computed from seeds in the cortical spinal tract regions. In parallel experiments (n=3-5/group), we investigated corpus callosum neurofilaments and demyelination using immunohistochemistry (IHC) at 3days and 6weeks, callosal tract patency using dual-label retrograde tract tracing at 5weeks, and the contribution of gliosis to DTI parameter maps using GFAP IHC at 4weeks post-injury. The data show widespread ipsilateral regions of significantly reduced FA at 1week post-injury, driven by temporally changing values of AD, RD, and MD that persist to 4weeks. Demyelination, retrograde label tract loss, and reductions in MO (tract degeneration) and FTD were shown to underpin these data. Significant FA increases occurred in subcortical and corticospinal tract regions that were spatially distinct from regions of FA decrease, grossly affected gliotic areas, and MO changes. However, there was good spatial correspondence between regions of increased FA and areas of increased FTD and mean fiber length. We discuss these widespread changes in DTI parameters in terms of axonal degeneration and potential reorganization, with reference to a resting state fMRI companion paper (Harris et al., 2016, Exp. Neurol. 227:124-138) that demonstrated altered functional connectivity data acquired from the same rats used in this study.
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Affiliation(s)
- N G Harris
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.
| | - D R Verley
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - B A Gutman
- Department of Neurology, Imaging Genetics Center, Keck/USC School of Medicine, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
| | - R L Sutton
- UCLA Brain injury Research Center, Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
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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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Dall'Acqua P, Johannes S, Mica L, Simmen HP, Glaab R, Fandino J, Schwendinger M, Meier C, Ulbrich EJ, Müller A, Jäncke L, Hänggi J. Connectomic and Surface-Based Morphometric Correlates of Acute Mild Traumatic Brain Injury. Front Hum Neurosci 2016; 10:127. [PMID: 27065831 PMCID: PMC4809899 DOI: 10.3389/fnhum.2016.00127] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/09/2016] [Indexed: 02/01/2023] Open
Abstract
Reduced integrity of white matter (WM) pathways and subtle anomalies in gray matter (GM) morphology have been hypothesized as mechanisms in mild traumatic brain injury (mTBI). However, findings on structural brain changes in early stages after mTBI are inconsistent and findings related to early symptoms severity are rare. Fifty-one patients were assessed with multimodal neuroimaging and clinical methods exclusively within 7 days following mTBI and compared to 53 controls. Whole-brain connectivity based on diffusion tensor imaging was subjected to network-based statistics, whereas cortical surface area, thickness, and volume based on T1-weighted MRI scans were investigated using surface-based morphometric analysis. Reduced connectivity strength within a subnetwork of 59 edges located predominantly in bilateral frontal lobes was significantly associated with higher levels of self-reported symptoms. In addition, cortical surface area decreases were associated with stronger complaints in five clusters located in bilateral frontal and postcentral cortices, and in the right inferior temporal region. Alterations in WM and GM were localized in similar brain regions and moderately-to-strongly related to each other. Furthermore, the reduction of cortical surface area in the frontal regions was correlated with poorer attentive-executive performance in the mTBI group. Finally, group differences were detected in both the WM and GM, especially when focusing on a subgroup of patients with greater complaints, indicating the importance of classifying mTBI patients according to severity of symptoms. This study provides evidence that mTBI affects not only the integrity of WM networks by means of axonal damage but also the morphology of the cortex during the initial post-injury period. These anomalies might be greater in the acute period than previously believed and the involvement of frontal brain regions was consistently pronounced in both findings. The dysconnected subnetwork suggests that mTBI can be conceptualized as a dysconnection syndrome. It remains unclear whether reduced WM integrity is the trigger for changes in cortical surface area or whether tissue deformations are the direct result of mechanical forces acting on the brain. The findings suggest that rapid identification of high-risk patients with the use of clinical scales should be assessed acutely as part of the mTBI protocol.
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Affiliation(s)
- Patrizia Dall'Acqua
- Bellikon Rehabilitation ClinicBellikon, Switzerland; Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
| | | | - Ladislav Mica
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Richard Glaab
- Department of Traumatology, Cantonal Hospital Aarau Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau Aarau, Switzerland
| | - Markus Schwendinger
- Interdisciplinary Emergency Centre, Baden Cantonal Hospital Baden, Switzerland
| | - Christoph Meier
- Department of Surgery, Waid Hospital Zurich Zurich, Switzerland
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich Zurich, Switzerland
| | | | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland; International Normal Aging and Plasticity Imaging Center, University of ZurichZurich, Switzerland; Center for Integrative Human Physiology, University of ZurichZurich, Switzerland; University Research Priority Program, Dynamic of Healthy Aging, University of ZurichZurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich Zurich, Switzerland
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47
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Talavage TM, Nauman EA, Leverenz LJ. The Role of Medical Imaging in the Recharacterization of Mild Traumatic Brain Injury Using Youth Sports as a Laboratory. Front Neurol 2016; 6:273. [PMID: 26834695 PMCID: PMC4717183 DOI: 10.3389/fneur.2015.00273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/28/2015] [Indexed: 11/13/2022] Open
Abstract
The short- and long-term impact of mild traumatic brain injury (TBI) is an increasingly vital concern for both military and civilian personnel. Such injuries produce significant social and financial burdens and necessitate improved diagnostic and treatment methods. Recent integration of neuroimaging and biomechanical studies in youth collision-sport athletes has revealed that significant alterations in brain structure and function occur even in the absence of traditional clinical markers of "concussion." While task performance is maintained, athletes exposed to repetitive head accelerations exhibit structural changes to the underlying white matter, altered glial cell metabolism, aberrant vascular response, and marked changes in functional network behavior. Moreover, these changes accumulate with accrued years of exposure, suggesting a cumulative trauma mechanism that may culminate in categorization as "concussion" and long-term neurological deficits. The goal of this review is to elucidate the role of medical imaging in recharacterizing TBI, as a whole, to better identify at-risk individuals and improve the development of preventative and interventional approaches.
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Affiliation(s)
- Thomas M Talavage
- School of Electrical and Computer Engineering, Weldon School of Biomedical Engineering, Purdue University , West Lafayette, IN , USA
| | - Eric A Nauman
- Department of Basic Medical Sciences, School of Mechanical Engineering, Weldon School of Biomedical Engineering, Purdue University , West Lafayette, IN , USA
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University , West Lafayette, IN , USA
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48
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Zagorchev L, Meyer C, Stehle T, Wenzel F, Young S, Peters J, Weese J, Paulsen K, Garlinghouse M, Ford J, Roth R, Flashman L, McAllister T. Differences in Regional Brain Volumes Two Months and One Year after Mild Traumatic Brain Injury. J Neurotrauma 2015; 33:29-34. [PMID: 25970552 DOI: 10.1089/neu.2014.3831] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Conventional structural imaging is often normal after mild traumatic brain injury (mTBI). There is a need for structural neuroimaging biomarkers that facilitate detection of milder injuries, allow recovery trajectory monitoring, and identify those at risk for poor functional outcome and disability. We present a novel approach to quantifying volumes of candidate brain regions at risk for injury. Compared to controls, patients with mTBI had significantly smaller volumes in several regions including the caudate, putamen, and thalamus when assessed 2 months after injury. These differences persisted but were reduced in magnitude 1 year after injury, suggesting the possibility of normalization over time in the affected regions. More pronounced differences, however, were found in the amygdala and hippocampus, suggesting the possibility of regionally specific responses to injury.
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Affiliation(s)
- Lyubomir Zagorchev
- 1 Philips Research North America , Briarcliff Manor, New York.,2 Thayer School of Engineering, Dartmouth College , Hanover, New Hampshire
| | - Carsten Meyer
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Thomas Stehle
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Fabian Wenzel
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Stewart Young
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Jochen Peters
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Juergen Weese
- 3 Digital Imaging, Philips Research Hamburg , Hamburg, Germany
| | - Keith Paulsen
- 2 Thayer School of Engineering, Dartmouth College , Hanover, New Hampshire
| | | | - James Ford
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Robert Roth
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Laura Flashman
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
| | - Thomas McAllister
- 4 Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire
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