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Dogra S, Arabshahi S, Wei J, Saidenberg L, Kang SK, Chung S, Laine A, Lui YW. Functional Connectivity Changes on Resting-State fMRI after Mild Traumatic Brain Injury: A Systematic Review. AJNR Am J Neuroradiol 2024; 45:795-801. [PMID: 38637022 PMCID: PMC11288594 DOI: 10.3174/ajnr.a8204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Mild traumatic brain injury is theorized to cause widespread functional changes to the brain. Resting-state fMRI may be able to measure functional connectivity changes after traumatic brain injury, but resting-state fMRI studies are heterogeneous, using numerous techniques to study ROIs across various resting-state networks. PURPOSE We systematically reviewed the literature to ascertain whether adult patients who have experienced mild traumatic brain injury show consistent functional connectivity changes on resting-state -fMRI, compared with healthy patients. DATA SOURCES We used 5 databases (PubMed, EMBASE, Cochrane Central, Scopus, Web of Science). STUDY SELECTION Five databases (PubMed, EMBASE, Cochrane Central, Scopus, and Web of Science) were searched for research published since 2010. Search strategies used keywords of "functional MR imaging" and "mild traumatic brain injury" as well as related terms. All results were screened at the abstract and title levels by 4 reviewers according to predefined inclusion and exclusion criteria. For full-text inclusion, each study was evaluated independently by 2 reviewers, with discordant screening settled by consensus. DATA ANALYSIS Data regarding article characteristics, cohort demographics, fMRI scan parameters, data analysis processing software, atlas used, data characteristics, and statistical analysis information were extracted. DATA SYNTHESIS Across 66 studies, 80 areas were analyzed 239 times for at least 1 time point, most commonly using independent component analysis. The most analyzed areas and networks were the whole brain, the default mode network, and the salience network. Reported functional connectivity changes varied, though there may be a slight trend toward decreased whole-brain functional connectivity within 1 month of traumatic brain injury and there may be differences based on the time since injury. LIMITATIONS Studies of military, sports-related traumatic brain injury, and pediatric patients were excluded. Due to the high number of relevant studies and data heterogeneity, we could not be as granular in the analysis as we would have liked. CONCLUSIONS Reported functional connectivity changes varied, even within the same region and network, at least partially reflecting differences in technical parameters, preprocessing software, and analysis methods as well as probable differences in individual injury. There is a need for novel rs-fMRI techniques that better capture subject-specific functional connectivity changes.
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Affiliation(s)
- Siddhant Dogra
- From the Department of Radiology (S.D., J.W., S.K.K., S.C., Y.L.), New York University Grossman School of Medicine, New York, New York
| | - Soroush Arabshahi
- Department of Biomedical Engineering (S.A., A.L.), Department of Radiology, Columbia University, New York, New York
| | - Jason Wei
- From the Department of Radiology (S.D., J.W., S.K.K., S.C., Y.L.), New York University Grossman School of Medicine, New York, New York
| | - Lucia Saidenberg
- Department of Neurology (L.S.), Department of Radiology. New York University Grossman School of Medicine, New York, New York
| | - Stella K Kang
- From the Department of Radiology (S.D., J.W., S.K.K., S.C., Y.L.), New York University Grossman School of Medicine, New York, New York
| | - Sohae Chung
- From the Department of Radiology (S.D., J.W., S.K.K., S.C., Y.L.), New York University Grossman School of Medicine, New York, New York
| | - Andrew Laine
- Department of Biomedical Engineering (S.A., A.L.), Department of Radiology, Columbia University, New York, New York
| | - Yvonne W Lui
- From the Department of Radiology (S.D., J.W., S.K.K., S.C., Y.L.), New York University Grossman School of Medicine, New York, New York
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Kagialis A, Simos N, Manolitsi K, Vakis A, Simos P, Papadaki E. Functional connectivity-hemodynamic (un)coupling changes in chronic mild brain injury are associated with mental health and neurocognitive indices: a resting state fMRI study. Neuroradiology 2024; 66:985-998. [PMID: 38605104 PMCID: PMC11133187 DOI: 10.1007/s00234-024-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To examine hemodynamic and functional connectivity alterations and their association with neurocognitive and mental health indices in patients with chronic mild traumatic brain injury (mTBI). METHODS Resting-state functional MRI (rs-fMRI) and neuropsychological assessment of 37 patients with chronic mTBI were performed. Intrinsic connectivity contrast (ICC) and time-shift analysis (TSA) of the rs-fMRI data allowed the assessment of regional hemodynamic and functional connectivity disturbances and their coupling (or uncoupling). Thirty-nine healthy age- and gender-matched participants were also examined. RESULTS Patients with chronic mTBI displayed hypoconnectivity in bilateral hippocampi and parahippocampal gyri and increased connectivity in parietal areas (right angular gyrus and left superior parietal lobule (SPL)). Slower perfusion (hemodynamic lag) in the left anterior hippocampus was associated with higher self-reported symptoms of depression (r = - 0.53, p = .0006) and anxiety (r = - 0.484, p = .002), while faster perfusion (hemodynamic lead) in the left SPL was associated with lower semantic fluency (r = - 0.474, p = .002). Finally, functional coupling (high connectivity and hemodynamic lead) in the right anterior cingulate cortex (ACC)) was associated with lower performance on attention and visuomotor coordination (r = - 0.50, p = .001), while dysfunctional coupling (low connectivity and hemodynamic lag) in the left ventral posterior cingulate cortex (PCC) and right SPL was associated with lower scores on immediate passage memory (r = - 0.52, p = .001; r = - 0.53, p = .0006, respectively). Uncoupling in the right extrastriate visual cortex and posterior middle temporal gyrus was negatively associated with cognitive flexibility (r = - 0.50, p = .001). CONCLUSION Hemodynamic and functional connectivity differences, indicating neurovascular (un)coupling, may be linked to mental health and neurocognitive indices in patients with chronic mTBI.
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Affiliation(s)
- Antonios Kagialis
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece
| | - Nicholas Simos
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Efrosini Papadaki
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece.
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
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Arabshahi S, Chung S, Alivar A, Amorapanth PX, Flanagan SR, Foo FYA, Laine AF, Lui YW. A Comprehensive and Broad Approach to Resting-State Functional Connectivity in Adult Patients with Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2024; 45:637-646. [PMID: 38604737 PMCID: PMC11288538 DOI: 10.3174/ajnr.a8193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND PURPOSE Several recent works using resting-state fMRI suggest possible alterations of resting-state functional connectivity after mild traumatic brain injury. However, the literature is plagued by various analysis approaches and small study cohorts, resulting in an inconsistent array of reported findings. In this study, we aimed to investigate differences in whole-brain resting-state functional connectivity between adult patients with mild traumatic brain injury within 1 month of injury and healthy control subjects using several comprehensive resting-state functional connectivity measurement methods and analyses. MATERIALS AND METHODS A total of 123 subjects (72 patients with mild traumatic brain injury and 51 healthy controls) were included. A standard fMRI preprocessing pipeline was used. ROI/seed-based analyses were conducted using 4 standard brain parcellation methods, and the independent component analysis method was applied to measure resting-state functional connectivity. The fractional amplitude of low-frequency fluctuations was also measured. Group comparisons were performed on all measurements with appropriate whole-brain multilevel statistical analysis and correction. RESULTS There were no significant differences in age, sex, education, and hand preference between groups as well as no significant correlation between all measurements and these potential confounders. We found that each resting-state functional connectivity measurement revealed various regions or connections that were different between groups. However, after we corrected for multiple comparisons, the results showed no statistically significant differences between groups in terms of resting-state functional connectivity across methods and analyses. CONCLUSIONS Although previous studies point to multiple regions and networks as possible mild traumatic brain injury biomarkers, this study shows that the effect of mild injury on brain resting-state functional connectivity has not survived after rigorous statistical correction. A further study using subject-level connectivity analyses may be necessary due to both subtle and variable effects of mild traumatic brain injury on brain functional connectivity across individuals.
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Affiliation(s)
- Soroush Arabshahi
- From Biomedical Engineering Department (S.A., A.F.L.), Columbia University, New York, New York
| | - Sohae Chung
- Departments of Radiology (S.C., A.A., Y.W.L.), NYU Grossman School of Medicine, New York, New York
| | - Alaleh Alivar
- Departments of Radiology (S.C., A.A., Y.W.L.), NYU Grossman School of Medicine, New York, New York
| | - Prin X Amorapanth
- Rehabilitation Medicine (P.X.A., S.R.F.), NYU Grossman School of Medicine, New York, New York
| | - Steven R Flanagan
- Rehabilitation Medicine (P.X.A., S.R.F.), NYU Grossman School of Medicine, New York, New York
| | - Farng-Yang A Foo
- Department of Neurology (F.-Y.A.F.), NYU Grossman School of Medicine, New York, New York
| | - Andrew F Laine
- From Biomedical Engineering Department (S.A., A.F.L.), Columbia University, New York, New York
| | - Yvonne W Lui
- Departments of Radiology (S.C., A.A., Y.W.L.), NYU Grossman School of Medicine, New York, New York
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Siddiqi SH, Kandala S, Hacker CD, Trapp NT, Leuthardt EC, Carter AR, Brody DL. Individualized precision targeting of dorsal attention and default mode networks with rTMS in traumatic brain injury-associated depression. Sci Rep 2023; 13:4052. [PMID: 36906616 PMCID: PMC10008633 DOI: 10.1038/s41598-022-21905-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/05/2022] [Indexed: 03/13/2023] Open
Abstract
At the group level, antidepressant efficacy of rTMS targets is inversely related to their normative connectivity with subgenual anterior cingulate cortex (sgACC). Individualized connectivity may yield better targets, particularly in patients with neuropsychiatric disorders who may have aberrant connectivity. However, sgACC connectivity shows poor test-retest reliability at the individual level. Individualized resting-state network mapping (RSNM) can reliably map inter-individual variability in brain network organization. Thus, we sought to identify individualized RSNM-based rTMS targets that reliably target the sgACC connectivity profile. We used RSNM to identify network-based rTMS targets in 10 healthy controls and 13 individuals with traumatic brain injury-associated depression (TBI-D). These "RSNM targets" were compared with consensus structural targets and targets based on individualized anti-correlation with a group-mean-derived sgACC region ("sgACC-derived targets"). The TBI-D cohort was also randomized to receive active (n = 9) or sham (n = 4) rTMS to RSNM targets with 20 daily sessions of sequential high-frequency left-sided stimulation and low-frequency right-sided stimulation. We found that the group-mean sgACC connectivity profile was reliably estimated by individualized correlation with default mode network (DMN) and anti-correlation with dorsal attention network (DAN). Individualized RSNM targets were thus identified based on DAN anti-correlation and DMN correlation. These RSNM targets showed greater test-retest reliability than sgACC-derived targets. Counterintuitively, anti-correlation with the group-mean sgACC connectivity profile was also stronger and more reliable for RSNM-derived targets than for sgACC-derived targets. Improvement in depression after RSNM-targeted rTMS was predicted by target anti-correlation with the portions of sgACC. Active treatment also led to increased connectivity within and between the stimulation sites, the sgACC, and the DMN. Overall, these results suggest that RSNM may enable reliable individualized rTMS targeting, although further research is needed to determine whether this personalized approach can improve clinical outcomes.
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Affiliation(s)
- Shan H Siddiqi
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA. .,Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA. .,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| | - Sridhar Kandala
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Carl D Hacker
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa Carver College of Medicine, 500 Newton Rd, Iowa City, IA, 52246, USA
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Alexandre R Carter
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - David L Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.,Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
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Liu Y, Li F, Shang S, Wang P, Yin X, Krishnan Muthaiah VP, Lu L, Chen YC. Functional-structural large-scale brain networks are correlated with neurocognitive impairment in acute mild traumatic brain injury. Quant Imaging Med Surg 2023; 13:631-644. [PMID: 36819289 PMCID: PMC9929413 DOI: 10.21037/qims-22-450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022]
Abstract
Background This study was conducted to investigate topological changes in large-scale functional connectivity (FC) and structural connectivity (SC) networks in acute mild traumatic brain injury (mTBI) and determine their potential relevance to cognitive impairment. Methods Seventy-one patients with acute mTBI (29 males, 42 females, mean age 43.54 years) from Nanjing First Hospital and 57 matched healthy controls (HC) (33 males, 24 females, mean age 46.16 years) from the local community were recruited in this prospective study. Resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) were acquired within 14 days (mean 3.29 days) after the onset of mTBI. Then, large-scale FC and SC networks with 116 regions from the automated anatomical labeling (AAL) brain atlas were constructed. Graph theory analysis was used to analyze global and nodal metrics. Finally, correlations were assessed between topological properties and neurocognitive performances evaluated by the Montreal Cognitive Assessment (MoCA). Bonferroni correction was performed out for multiple comparisons in all involved analyses. Results Compared with HC, acute mTBI patients had a higher normalized clustering coefficient (γ) for FC (Cohen's d=4.076), and higher γ and small worldness (σ) for SC (Cohen's d=0.390 and Cohen's d=0.395). The mTBI group showed aberrant nodal degree (Dc), nodal efficiency (Ne), and nodal local efficiency (Nloc) for FC and aberrant Dc, nodal betweenness (Bc), nodal clustering coefficient (NCp) and Ne for SC mainly in the frontal and temporal, cerebellum, and subcortical areas. Acute mTBI patients also had higher functional-structural coupling strength at both the group and individual levels (Cohen's d=0.415). These aberrant global and nodal topological properties at functional and structural levels were associated with attention, orientation, memory, and naming performances (all P<0.05). Conclusions Our findings suggested that large-scale FC and SC network changes, higher correlation between FC and SC and cognitive impairment can be detected in the acute stage of mTBI. These network aberrances may be a compensatory mechanism for cognitive impairment in acute mTBI patients.
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Affiliation(s)
- Yin Liu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song’an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Vijaya Prakash Krishnan Muthaiah
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Vedaei F, Mashhadi N, Zabrecky G, Monti D, Navarreto E, Hriso C, Wintering N, Newberg AB, Mohamed FB. Identification of chronic mild traumatic brain injury using resting state functional MRI and machine learning techniques. Front Neurosci 2023; 16:1099560. [PMID: 36699521 PMCID: PMC9869678 DOI: 10.3389/fnins.2022.1099560] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a major public health concern that can result in a broad spectrum of short-term and long-term symptoms. Recently, machine learning (ML) algorithms have been used in neuroscience research for diagnostics and prognostic assessment of brain disorders. The present study aimed to develop an automatic classifier to distinguish patients suffering from chronic mTBI from healthy controls (HCs) utilizing multilevel metrics of resting-state functional magnetic resonance imaging (rs-fMRI). Sixty mTBI patients and forty HCs were enrolled and allocated to training and testing datasets with a ratio of 80:20. Several rs-fMRI metrics including fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), degree centrality (DC), voxel-mirrored homotopic connectivity (VMHC), functional connectivity strength (FCS), and seed-based FC were generated from two main analytical categories: local measures and network measures. Statistical two-sample t-test was employed comparing between mTBI and HCs groups. Then, for each rs-fMRI metric the features were selected extracting the mean values from the clusters showing significant differences. Finally, the support vector machine (SVM) models based on separate and multilevel metrics were built and the performance of the classifiers were assessed using five-fold cross-validation and via the area under the receiver operating characteristic curve (AUC). Feature importance was estimated using Shapley additive explanation (SHAP) values. Among local measures, the range of AUC was 86.67-100% and the optimal SVM model was obtained based on combined multilevel rs-fMRI metrics and DC as a separate model with AUC of 100%. Among network measures, the range of AUC was 80.42-93.33% and the optimal SVM model was obtained based on the combined multilevel seed-based FC metrics. The SHAP analysis revealed the DC value in the left postcentral and seed-based FC value between the motor ventral network and right superior temporal as the most important local and network features with the greatest contribution to the classification models. Our findings demonstrated that different rs-fMRI metrics can provide complementary information for classifying patients suffering from chronic mTBI. Moreover, we showed that ML approach is a promising tool for detecting patients with mTBI and might serve as potential imaging biomarker to identify patients at individual level. Clinical trial registration [clinicaltrials.gov], identifier [NCT03241732].
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Affiliation(s)
- Faezeh Vedaei
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Najmeh Mashhadi
- Department of Computer Science and Engineering, University of California Santa Cruz, Santa Cruz, CA, United States
| | - George Zabrecky
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Emily Navarreto
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chloe Hriso
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Wintering
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrew B. Newberg
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B. Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
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Adolescents with a concussion have altered brain network functional connectivity one month following injury when compared to adolescents with orthopedic injuries. Neuroimage Clin 2022; 36:103211. [PMID: 36182818 PMCID: PMC9668608 DOI: 10.1016/j.nicl.2022.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
Concussion is a mild traumatic brain injury (mTBI) with increasing prevalence among children and adolescents. Functional connectivity (FC) within and between the default mode network (DMN), central executive network (CEN) and salience network (SN) has been shown to be altered post-concussion. Few studies have investigated connectivity within and between these 3 networks following a pediatric concussion. The present study explored whether within and between-network FC differs between a pediatric concussion and orthopedic injury (OI) group aged 10-18. Participants underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan at 4 weeks post-injury. One-way ANCOVA analyses were conducted between groups with the seed-based FC of the 3 networks. A total of 55 concussion and 27 OI participants were included in the analyses. Increased within-network FC of the CEN and decreased between-network FC of the DMN-CEN was found in the concussion group when compared to the OI group. Secondary analyses using spherical SN regions of interest revealed increased within-network FC of the SN and increased between-network FC of the DMN-SN and CEN-SN in the concussion group when compared to the OI group. This study identified differential connectivity patterns following a pediatric concussion as compared to an OI 4 weeks post-injury. These differences indicate potential adaptive brain mechanisms that may provide insight into recovery trajectories and appropriate timing of treatment within the first month following a concussion.
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Kim E, Seo HG, Seong MY, Kang MG, Kim H, Lee MY, Yoo RE, Hwang I, Choi SH, Oh BM. An exploratory study on functional connectivity after mild traumatic brain injury: Preserved global but altered local organization. Brain Behav 2022; 12:e2735. [PMID: 35993893 PMCID: PMC9480924 DOI: 10.1002/brb3.2735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study aimed to investigate alterations in whole-brain functional connectivity after a concussion using graph-theory analysis from global and local perspectives and explore the association between changes in the functional network properties and cognitive performance. METHODS Individuals with mild traumatic brain injury (mTBI, n = 29) within a month after injury, and age- and sex-matched healthy controls (n = 29) were included. Graph-theory measures on functional connectivity assessed using resting state functional magnetic resonance imaging data were acquired from each participant. These included betweenness centrality, strength, clustering coefficient, local efficiency, and global efficiency. Multi-domain cognitive functions were correlated with the graph-theory measures. RESULTS In comparison to the controls, the mTBI group showed preserved network characteristics at a global level. However, in the local network, we observed decreased betweenness centrality, clustering coefficient, and local efficiency in several brain areas, including the fronto-parietal attention network. Network strength at the local level showed mixed-results in different areas. The betweenness centrality of the right parahippocampus showed a significant positive correlation with the cognitive scores of the verbal learning test only in the mTBI group. CONCLUSION The intrinsic functional connectivity after mTBI is preserved globally, but is suboptimally organized locally in several areas. This possibly reflects the neurophysiological sequelae of a concussion. The present results may imply that the network property could be used as a potential indicator for clinical outcomes after mTBI.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
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Lv Q, Zhang J, Pan Y, Liu X, Miao L, Peng J, Song L, Zou Y, Chen X. Somatosensory Deficits After Stroke: Insights From MRI Studies. Front Neurol 2022; 13:891283. [PMID: 35911919 PMCID: PMC9328992 DOI: 10.3389/fneur.2022.891283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Abstract
Somatosensory deficits after stroke are a major health problem, which can impair patients' health status and quality of life. With the developments in human brain mapping techniques, particularly magnetic resonance imaging (MRI), many studies have applied those techniques to unravel neural substrates linked to apoplexy sequelae. Multi-parametric MRI is a vital method for the measurement of stroke and has been applied to diagnose stroke severity, predict outcome and visualize changes in activation patterns during stroke recovery. However, relatively little is known about the somatosensory deficits after stroke and their recovery. This review aims to highlight the utility and importance of MRI techniques in the field of somatosensory deficits and synthesizes corresponding articles to elucidate the mechanisms underlying the occurrence and recovery of somatosensory symptoms. Here, we start by reviewing the anatomic and functional features of the somatosensory system. And then, we provide a discussion of MRI techniques and analysis methods. Meanwhile, we present the application of those techniques and methods in clinical studies, focusing on recent research advances and the potential for clinical translation. Finally, we identify some limitations and open questions of current imaging studies that need to be addressed in future research.
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Affiliation(s)
- Qiuyi Lv
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Junning Zhang
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Yuxing Pan
- Institute of Neuroscience, Chinese Academy of Science, Shanghai, China
| | - Xiaodong Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | | | - Jing Peng
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Lei Song
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yihuai Zou
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xing Chen
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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10
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Li F, Liu Y, Lu L, Shang S, Chen H, Haidari NA, Wang P, Yin X, Chen YC. Rich-club reorganization of functional brain networks in acute mild traumatic brain injury with cognitive impairment. Quant Imaging Med Surg 2022; 12:3932-3946. [PMID: 35782237 PMCID: PMC9246720 DOI: 10.21037/qims-21-915] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/30/2022] [Indexed: 06/12/2024]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is typically characterized by temporally limited cognitive impairment and regarded as a brain connectome disorder. Recent findings have suggested that a higher level of organization named the "rich-club" may play a central role in enabling the integration of information and efficient communication across different systems of the brain. However, the alterations in rich-club organization and hub topology in mTBI and its relationship with cognitive impairment after mTBI have been scarcely elucidated. METHODS Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected from 88 patients with mTBI and 85 matched healthy controls (HCs). Large-scale functional brain networks were established for each participant. Rich-club organizations and network properties were assessed and analyzed between groups. Finally, we analyzed the correlations between the cognitive performance and changes in rich-club organization and network properties. RESULTS Both mTBI and HCs groups showed significant rich-club organization. Meanwhile, the rich-club organization was aberrant, with enhanced functional connectivity (FC) among rich-club nodes and peripheral regions in acute mTBI. In addition, significant differences in partial global and local network topological property measures were found between mTBI patients and HCs (P<0.01). In patients with mTBI, changes in rich-club organization and network properties were found to be related to early cognitive impairment after mTBI (P<0.05). CONCLUSIONS Our findings suggest that such patterns of disruption and reorganization will provide the basic functional architecture for cognitive function, which may subsequently be used as an earlier biomarker for cognitive impairment after mTBI.
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Affiliation(s)
| | | | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song’an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nasir Ahmad Haidari
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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11
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Medeiros GC, Twose C, Weller A, Dougherty JW, Goes FS, Sair HI, Smith GS, Roy D. Neuroimaging correlates of depression after traumatic brain injury: A systematic review. J Neurotrauma 2022; 39:755-772. [PMID: 35229629 DOI: 10.1089/neu.2021.0374] [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] [Indexed: 11/12/2022] Open
Abstract
Depression is the most frequent neuropsychiatric complication after traumatic brain injury (TBI) and is associated with poorer outcomes. Neuroimaging has the potential to improve our understanding of the neural correlates of depression after TBI and may improve our capacity to accurately predict and effectively treat this condition. We conducted a systematic review of structural and functional neuroimaging studies that examined the association between depression after TBI, and neuroimaging measures. Electronic searches were conducted in four databases and were complemented by manual searches. In total, 2,035 citations were identified and, ultimately, 38 articles were included totaling 1,793 individuals (median [25%-75%] sample size of 38.5 (21.8-54.3) individuals). The most frequently used modality was structural magnetic resonance imaging (MRI) (n=17, 45%), followed by diffusion tensor imaging (n=11, 29%), resting-state functional MRI (n=10, 26%), task-based functional MRI (n=4, 8%), and positron emission tomography (n=2, 4%). Most studies (n=27, 71%) were cross-sectional. Overall, depression after TBI was associated with lower grey matter measures (volume, thickness, and/or density) and greater white matter damage. However, identification of specific brain areas was somewhat inconsistent. Findings that were replicated in more than one study included reduced grey matter in the rostral anterior cingulate cortex, prefrontal cortex and hippocampus, and damage in five white matter tracts (cingulum, internal capsule, superior longitudinal fasciculi, anterior, and posterior corona radiata). This systematic review found that the available data did not converge on a clear neuroimaging biomarker for depression after TBI. However, there are promising targets that warrant further study.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Weller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W Dougherty
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Vedaei F, Newberg AB, Alizadeh M, Muller J, Shahrampour S, Middleton D, Zabrecky G, Wintering N, Bazzan AJ, Monti DA, Mohamed FB. Resting-State Functional MRI Metrics in Patients With Chronic Mild Traumatic Brain Injury and Their Association With Clinical Cognitive Performance. Front Hum Neurosci 2022; 15:768485. [PMID: 35027887 PMCID: PMC8751629 DOI: 10.3389/fnhum.2021.768485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022] Open
Abstract
Mild traumatic brain injury (mTBI) accounts for more than 80% of people experiencing brain injuries. Symptoms of mTBI include short-term and long-term adverse clinical outcomes. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) was conducted to measure voxel-based indices including fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and functional connectivity (FC) in patients suffering from chronic mTBI; 64 patients with chronic mTBI at least 3 months post injury and 40 healthy controls underwent rs-fMRI scanning. Partial correlation analysis controlling for age and gender was performed within mTBI cohort to explore the association between rs-fMRI metrics and neuropsychological scores. Compared with controls, chronic mTBI patients showed increased fALFF in the left middle occipital cortex (MOC), right middle temporal cortex (MTC), and right angular gyrus (AG), and increased ReHo in the left MOC and left posterior cingulate cortex (PCC). Enhanced FC was observed from left MOC to right precuneus; from right MTC to right superior temporal cortex (STC), right supramarginal, and left inferior parietal cortex (IPC); and from the seed located at right AG to left precuneus, left superior medial frontal cortex (SMFC), left MTC, left superior temporal cortex (STC), and left MOC. Furthermore, the correlation analysis revealed a significant correlation between neuropsychological scores and fALFF, ReHo, and seed-based FC measured from the regions with significant group differences. Our results demonstrated that alterations of low-frequency oscillations in chronic mTBI could be representative of disruption in emotional circuits, cognitive performance, and recovery in this cohort.
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Affiliation(s)
- Faezeh Vedaei
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrew B Newberg
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mahdi Alizadeh
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jennifer Muller
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Shiva Shahrampour
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Devon Middleton
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - George Zabrecky
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Wintering
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anthony J Bazzan
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel A Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
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13
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Vaughn KA, DeMaster D, Kook JH, Vannucci M, Ewing-Cobbs L. Effective connectivity in the default mode network after paediatric traumatic brain injury. Eur J Neurosci 2022; 55:318-336. [PMID: 34841600 PMCID: PMC9198945 DOI: 10.1111/ejn.15546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 01/03/2023]
Abstract
Children who experience a traumatic brain injury (TBI) are at elevated risk for a range of negative cognitive and neuropsychological outcomes. Identifying which children are at greatest risk for negative outcomes can be difficult due to the heterogeneity of TBI. To address this barrier, the current study applied a novel method of characterizing brain connectivity networks, Bayesian multi-subject vector autoregressive modelling (BVAR-connect), which used white matter integrity as priors to evaluate effective connectivity-the time-dependent relationship in functional magnetic resonance imaging (fMRI) activity between two brain regions-within the default mode network (DMN). In a prospective longitudinal study, children ages 8-15 years with mild to severe TBI underwent diffusion tensor imaging and resting state fMRI 7 weeks after injury; post-concussion and anxiety symptoms were assessed 7 months after injury. The goals of this study were to (1) characterize differences in positive effective connectivity of resting-state DMN circuitry between healthy controls and children with TBI, (2) determine if severity of TBI was associated with differences in DMN connectivity and (3) evaluate whether patterns of DMN effective connectivity predicted persistent post-concussion symptoms and anxiety. Healthy controls had unique positive connectivity that mostly emerged from the inferior temporal lobes. In contrast, children with TBI had unique effective connectivity among orbitofrontal and parietal regions. These positive orbitofrontal-parietal DMN effective connectivity patterns also differed by TBI severity and were associated with persisting behavioural outcomes. Effective connectivity may be a sensitive neuroimaging marker of TBI severity as well as a predictor of chronic post-concussion symptoms and anxiety.
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Affiliation(s)
- Kelly A. Vaughn
- University of Texas Health Science Center at Houston,,Corresponding Author
| | - Dana DeMaster
- University of Texas Health Science Center at Houston
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14
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Jahed S, Daneshvari NO, Liang AL, Richey LN, Bryant BR, Krieg A, Bray MJC, Pradeep T, Luna LP, Trapp NT, Jones MB, Stevens DA, Roper C, Goldwaser EL, Berich-Anastasio E, Pletnikova A, Lobner K, Lee DJ, Lauterbach M, Sair HI, Peters ME. Neuroimaging Correlates of Syndromal Anxiety Following Traumatic Brain Injury: A Systematic Review of the Literature. J Acad Consult Liaison Psychiatry 2021; 63:119-132. [PMID: 34534701 DOI: 10.1016/j.jaclp.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) can precipitate new-onset psychiatric symptoms or worsen existing psychiatric conditions. To elucidate specific mechanisms for this interaction, neuroimaging is often used to study both psychiatric conditions and TBI. This systematic review aims to synthesize the existing literature of neuroimaging findings among patients with anxiety after TBI. METHODS We conducted a Preferred Reporting Items for Systematic Review and Meta-Analyses-compliant literature search via PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases before May, 2019. We included studies that clearly defined TBI, measured syndromic anxiety as a primary outcome, and statistically analyzed the relationship between neuroimaging findings and anxiety symptoms. RESULTS A total of 5982 articles were retrieved from the systematic search, of which 65 studied anxiety and 13 met eligibility criteria. These studies were published between 2004 and 2017, collectively analyzing 764 participants comprised of 470 patients with TBI and 294 non-TBI controls. Imaging modalities used included magnetic resonance imaging, functional magnetic resonance imaging, diffusion tensor imaging, electroencephalogram, magnetic resonance spectrometry, and magnetoencephalography. Eight of 13 studies presented at least one significant finding and together reflect a complex set of changes that lead to anxiety in the setting of TBI. The left cingulate gyrus in particular was found to be significant in 2 studies using different imaging modalities. Two studies also revealed perturbances in functional connectivity within the default mode network. CONCLUSIONS This is the first systemic review of neuroimaging changes associated with anxiety after TBI, which implicated multiple brain structures and circuits, such as the default mode network. Future research with consistent, rigorous measurements of TBI and syndromic anxiety, as well as attention to control groups, previous TBIs, and time interval between TBI and neuroimaging, are warranted. By understanding neuroimaging correlates of psychiatric symptoms, this work could inform future post-TBI screening and surveillance, preventative efforts, and early interventions to improve neuropsychiatric outcomes.
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Affiliation(s)
- Sahar Jahed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas O Daneshvari
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angela L Liang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tejus Pradeep
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Licia P Luna
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Melissa B Jones
- Menninger Department of Psychiatry and Behavioral Sciences, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX
| | - Daniel A Stevens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Eric L Goldwaser
- Sheppard Pratt, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD
| | | | - Alexandra Pletnikova
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Daniel J Lee
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease & Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Margo Lauterbach
- Sheppard Pratt, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD
| | - Haris I Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
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15
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Long-term changes in the small-world organization of brain networks after concussion. Sci Rep 2021; 11:6862. [PMID: 33767293 PMCID: PMC7994718 DOI: 10.1038/s41598-021-85811-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022] Open
Abstract
There is a growing body of literature using functional MRI to study the acute and long-term effects of concussion on functional brain networks. To date, studies have largely focused on changes in pairwise connectivity strength between brain regions. Less is known about how concussion affects whole-brain network topology, particularly the “small-world” organization which facilitates efficient communication at both local and global scales. The present study addressed this knowledge gap by measuring local and global efficiency of 26 concussed athletes at acute injury, return to play (RTP) and one year post-RTP, along with a cohort of 167 athletic controls. On average, concussed athletes showed no alterations in local efficiency but had elevated global efficiency at acute injury, which had resolved by RTP. Athletes with atypically long recovery, however, had reduced global efficiency at 1 year post-RTP, suggesting long-term functional abnormalities for this subgroup. Analyses of nodal efficiency further indicated that global network changes were driven by high-efficiency visual and sensorimotor regions and low-efficiency frontal and subcortical regions. This study provides evidence that concussion causes subtle acute and long-term changes in the small-world organization of the brain, with effects that are related to the clinical profile of recovery.
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Affiliation(s)
- N W Churchill
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada. .,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.
| | - M G Hutchison
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Science Center, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - T A Schweizer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada.,The Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto, ON, Canada
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16
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Wang S, Gan S, Yang X, Li T, Xiong F, Jia X, Sun Y, Liu J, Zhang M, Bai L. Decoupling of structural and functional connectivity in hubs and cognitive impairment after mild traumatic brain injury. Brain Connect 2021; 11:745-758. [PMID: 33605188 DOI: 10.1089/brain.2020.0852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mild TBI) exhibited abnormal brain network topologies associated with cognitive dysfunction. However, it was still unclear which aspects of network organization were critical underlying the key pathology of mild TBI. Here, a multi-imaging strategy was applied to capture dynamic topological features of both structural and functional connectivity networks (SCN and FCN), to provide more sensitive detection of altered FCN from its anatomical backbone and identify novel biomarkers of mild TBI outcomes. METHODS 62 mild TBI patients (30 subjects as an original sample with 3-12 months follow-up, 32 subjects as independent replicated sample), and 37 healthy controls were recruited. Both diffusion tensor imaging (DTI) and resting-state fMRI were used to create global connectivity matrices in the same individuals. Global and regional network analyses were applied to identify group differences and correlations with clinical assessments. RESULTS Most global network properties were conserved in both SCNs and FCNs in subacute mild TBI, whereas SCNs presented decreased global efficiency and characteristic path length at follow-up. Specifically, some hubs in healthy brain networks typically became non-hubs in patients and vice versa, such as the medial prefrontal cortex, superior temporal gyrus, middle frontal gyrus. The relationship between structural and functional connectivity (SC and FC) in patients also showed salient decoupling as a function of time, primarily located in the hubs. CONCLUSIONS These results suggested mild TBI influences the relationship between SCN and FCN, and the SC-FC coupling strength may be used as a potential biomarker to predict long-term outcomes after injury.
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Affiliation(s)
- Shan Wang
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xianning Road, Xi'an, China, 710049;
| | - Shuoqiu Gan
- Xi'an Jiaotong University Medical College First Affiliated Hospital, 162798, Department of Medical Imaging, Xi'an, Shaanxi, China;
| | - Xuefei Yang
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
| | - Tianhui Li
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
| | - Feng Xiong
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
| | - Xiaoyan Jia
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
| | - Yingxiang Sun
- Xi'an Jiaotong University Medical College First Affiliated Hospital, 162798, Department of Medical Imaging, Xi'an, Shaanxi, China;
| | - Jun Liu
- Xiangya Hospital Central South University, 159374, Department of Radiology, Changsha, Hunan, China;
| | - Ming Zhang
- Xi'an Jiaotong University Medical College First Affiliated Hospital, 162798, Department of Medical Imaging, Xi'an, Shaanxi, China;
| | - Lijun Bai
- Xi'an Jiaotong University, 12480, Department of Biomedical Engineering, Xi'an, Shaanxi, China;
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17
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Acabchuk RL, Brisson JM, Park CL, Babbott-Bryan N, Parmelee OA, Johnson BT. Therapeutic Effects of Meditation, Yoga, and Mindfulness-Based Interventions for Chronic Symptoms of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Appl Psychol Health Well Being 2020; 13:34-62. [PMID: 33136346 DOI: 10.1111/aphw.12244] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic symptoms of mild traumatic brain injury (mTBI) vary greatly and are difficult to treat; we investigate the impact of meditation, yoga, and mindfulness-based interventions on this treatment group. METHOD Search included four databases, allowing studies of any design containing pre/post outcomes for meditation, yoga, or mindfulness-based interventions in people suffering from brain injury acquired by mechanical force. Analyses used robust variance estimation to assess overall effects and random-effects models for selected outcomes; we evaluated both between- and within-group changes. RESULTS Twenty studies (N = 539) were included. Results revealed significant improvement of overall symptoms compared to controls (d = 0.41; 95% CI [0.04, 0.77]; τ2 = 0.06), with significant within-group improvements in mental health (d = 0.39), physical health (d = 0.39), cognitive performance (d = 0.24), quality of life (d = 0.39), and self-related processing (d = 0.38). Symptoms showing greatest improvement were fatigue (d = 0.96) and depression (d = 0.40). Findings were homogeneous across studies. Study quality concerns include lack of randomisation, blinding, and recording of adverse events. CONCLUSIONS This first-ever meta-analysis on meditation, yoga, and mindfulness-based interventions for chronic symptoms of mTBI offers hope but highlights the need for rigorous new trials to advance clinical applications and to explore mechanistic pathways.
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18
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Prajapati R, Emerson IA. Construction and analysis of brain networks from different neuroimaging techniques. Int J Neurosci 2020; 132:745-766. [DOI: 10.1080/00207454.2020.1837802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Rutvi Prajapati
- Bioinformatics Programming Laboratory, Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Isaac Arnold Emerson
- Bioinformatics Programming Laboratory, Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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19
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The Fetal Functional Connectome Offers Clues for Early Maturing Networks and Implications for Neurodevelopmental Disorders. J Neurosci 2020; 40:4436-4438. [PMID: 32493796 DOI: 10.1523/jneurosci.0260-20.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
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20
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Li F, Lu L, Shang S, Hu L, Chen H, Wang P, Zhang H, Chen YC, Yin X. Disrupted functional network connectivity predicts cognitive impairment after acute mild traumatic brain injury. CNS Neurosci Ther 2020; 26:1083-1091. [PMID: 32588522 PMCID: PMC7539836 DOI: 10.1111/cns.13430] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022] Open
Abstract
Aims This study aimed to detect alterations of brain functional connectivity (FC) in acute mild traumatic brain injury (mTBI) and to estimate the extent to which these FC differences predicted the characteristics of posttraumatic cognitive impairment. Methods Resting‐state fMRI data were acquired from acute mTBI patients (n = 50) and healthy controls (HCs) (n = 43). Resting‐state networks (RSNs) were established based on independent component analysis (ICA), and functional network connectivity (FNC) analysis was performed. Subsequently, we analyzed the correlations between FNC abnormalities and cognitive impairment outcomes. Results Altered FC within the salience network (SN), sensorimotor network (SMN), default mode network (DMN), executive control network (ECN), visual network (VN), and cerebellum network (CN) was found in the mTBI group relative to the HC group. Moreover, different patterns of altered network interactions were found between the mTBI patients and HCs, including the SN‐CN, VN‐SMN, and ECN‐DMN connections. Correlations between functional disconnection and cognitive impairment measurements in acute mTBI patients were also found. Conclusion This study indicated that widespread FNC impairment and altered integration existed in mTBI patients at acute stage, suggesting that FNC disruption as a biomarker may be applied for the early diagnosis and prediction of cognitive impairment in mTBI.
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Affiliation(s)
- Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song'an Shang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lanyue Hu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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21
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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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22
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Monroe DC, Cecchi NJ, Gerges P, Phreaner J, Hicks JW, Small SL. A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players. Front Neurol 2020; 11:218. [PMID: 32300329 PMCID: PMC7145392 DOI: 10.3389/fneur.2020.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r(16) > 0.626, p < 0.03 corrected], global efficiency [r(16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r(16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r(16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F(4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Paul Gerges
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Jenna Phreaner
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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23
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A Look Ahead. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
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24
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Abstract
Traumatic brain injury (TBI) represents a major clinical and economic challenge for health systems worldwide, and it is considered one of the leading causes of disability in young adults. The recent development of brain-computer interface (BCI) tools to target cognitive and motor impairments has led to the exploration of these techniques as potential therapeutic tools in patients with TBI. However, little evidence has been gathered so far to support applicability and efficacy of BCIs for TBI in a clinical setting. In the present chapter, results from studies using BCI approaches in conscious patients with TBI or in animal models of TBI as well as an overview of future directions in the use of BCIs to treat cognitive symptoms in this patient population will be presented.
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Affiliation(s)
- Virginia Conde
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Neuroscience Laboratory, Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
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25
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Kuceyeski AF, Jamison KW, Owen JP, Raj A, Mukherjee P. Longitudinal increases in structural connectome segregation and functional connectome integration are associated with better recovery after mild TBI. Hum Brain Mapp 2019; 40:4441-4456. [PMID: 31294921 PMCID: PMC6865536 DOI: 10.1002/hbm.24713] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
Traumatic brain injury damages white matter pathways that connect brain regions, disrupting transmission of electrochemical signals and causing cognitive and emotional dysfunction. Connectome-level mechanisms for how the brain compensates for injury have not been fully characterized. Here, we collected serial MRI-based structural and functional connectome metrics and neuropsychological scores in 26 mild traumatic brain injury subjects (29.4 ± 8.0 years, 20 males) at 1 and 6 months postinjury. We quantified the relationship between functional and structural connectomes using network diffusion (ND) model propagation time, a measure that can be interpreted as how much of the structural connectome is being utilized for the spread of functional activation, as captured via the functional connectome. Overall cognition showed significant improvement from 1 to 6 months (t25 = -2.15, p = .04). None of the structural or functional global connectome metrics was significantly different between 1 and 6 months, or when compared to 34 age- and gender-matched controls (28.6 ± 8.8 years, 25 males). We predicted longitudinal changes in overall cognition from changes in global connectome measures using a partial least squares regression model (cross-validated R2 = .27). We observe that increased ND model propagation time, increased structural connectome segregation, and increased functional connectome integration were related to better cognitive recovery. We interpret these findings as suggesting two connectome-based postinjury recovery mechanisms: one of neuroplasticity that increases functional connectome integration and one of remote white matter degeneration that increases structural connectome segregation. We hypothesize that our inherently multimodal measure of ND model propagation time captures the interplay between these two mechanisms.
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Affiliation(s)
- Amy F. Kuceyeski
- Department of RadiologyWeill Cornell MedicineNew YorkNew York
- Brain and Mind Research InstituteWeill Cornell MedicineNew YorkNew York
| | | | - Julia P. Owen
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Ashish Raj
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Pratik Mukherjee
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
- Department of Bioengineering and Therapeutic SciencesUniversity of CaliforniaSan FranciscoCalifornia
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26
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Mishra VR, Sreenivasan KR, Zhuang X, Yang Z, Cordes D, Banks SJ, Bernick C. Understanding white matter structural connectivity differences between cognitively impaired and nonimpaired active professional fighters. Hum Brain Mapp 2019; 40:5108-5122. [PMID: 31403734 DOI: 10.1002/hbm.24761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022] Open
Abstract
Long-term traumatic brain injury due to repeated head impacts (RHI) has been shown to be a risk factor for neurodegenerative disorders, characterized by a loss in cognitive performance. Establishing the correlation between changes in the white matter (WM) structural connectivity measures and neuropsychological test scores might help to identify the neural correlates of the scores that are used in daily clinical setting to investigate deficits due to repeated head blows. Hence, in this study, we utilized high angular diffusion MRI (dMRI) of 69 cognitively impaired and 70 nonimpaired active professional fighters from the Professional Fighters Brain Health Study, and constructed structural connectomes to understand: (a) whether there is a difference in the topological WM organization between cognitively impaired and nonimpaired active professional fighters, and (b) whether graph-theoretical measures exhibit correlations with neuropsychological scores in these groups. A dMRI derived structural connectome was constructed for every participant using brain regions defined in AAL atlas as nodes, and the product of fiber number and average fractional anisotropy of the tracts connecting the nodes as edges. Our study identified a topological WM reorganization due to RHI in fighters prone to cognitive decline that was correlated with neuropsychological scores. Furthermore, graph-theoretical measures were correlated differentially with neuropsychological scores between groups. We also found differentiated WM connectivity involving regions of hippocampus, precuneus, and insula within our cohort of cognitively impaired fighters suggesting that there is a discernible WM topological reorganization in fighters prone to cognitive decline.
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Affiliation(s)
- Virendra R Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | | | - Xiaowei Zhuang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | - Zhengshi Yang
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
| | - Dietmar Cordes
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | - Sarah J Banks
- Department of Neurosciences, University of California at San Diego, San Diego, California
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, Las Vegas, Nevada
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27
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Song Y, Epalle TM, Lu H. Characterizing and Predicting Autism Spectrum Disorder by Performing Resting-State Functional Network Community Pattern Analysis. Front Hum Neurosci 2019; 13:203. [PMID: 31258470 PMCID: PMC6587437 DOI: 10.3389/fnhum.2019.00203] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/29/2019] [Indexed: 11/28/2022] Open
Abstract
Growing evidence indicates that autism spectrum disorder (ASD) is a neuropsychological disconnection syndrome that can be analyzed using various complex network metrics used as pathology biomarkers. Recently, community detection and analysis rooted in the complex network and graph theories have been introduced to investigate the changes in resting-state functional network community structure under neurological pathologies. However, the potential of hidden patterns in the modular organization of networks derived from resting-state functional magnetic resonance imaging to predict brain pathology has never been investigated. In this study, we present a novel analysis technique to identify alterations in community patterns in functional networks under ASD. In addition, we design machine learning classifiers to predict the clinical class of patients with ASD and controls by using only community pattern quality metrics as features. Analyses conducted on six publicly available datasets from 235 subjects, including patients with ASD and age-matched controls revealed that the modular structure is significantly disturbed in patients with ASD. Machine learning algorithms showed that the predictive power of our five metrics is relatively high (~85.16% peak accuracy for in-site data and ~75.00% peak accuracy for multisite data). These results lend further credence to the dysconnectivity theory of this pathology.
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Affiliation(s)
- Yuqing Song
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang, China
| | - Thomas Martial Epalle
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang, China
| | - Hu Lu
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang, China
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28
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Siddiqi SH, Trapp NT, Hacker CD, Laumann TO, Kandala S, Hong X, Trillo L, Shahim P, Leuthardt EC, Carter AR, Brody DL. Repetitive Transcranial Magnetic Stimulation with Resting-State Network Targeting for Treatment-Resistant Depression in Traumatic Brain Injury: A Randomized, Controlled, Double-Blinded Pilot Study. J Neurotrauma 2019; 36:1361-1374. [PMID: 30381997 PMCID: PMC6909726 DOI: 10.1089/neu.2018.5889] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has demonstrated antidepressant efficacy but has limited evidence in depression associated with traumatic brain injury (TBI). Here, we investigate the use of rTMS targeted with individualized resting-state network mapping (RSNM) of dorsal attention network (DAN) and default mode network (DMN) in subjects with treatment-resistant depression associated with concussive or moderate TBI. The planned sample size was 50 with first interim analysis planned at 20, but only 15 were enrolled before the study was terminated for logistical reasons. Subjects were randomized to 20 sessions of bilateral rTMS (4000 left-sided excitatory pulses, 1000 right-sided inhibitory pulses) or sham. Treatment was targeted to the dorsolateral prefrontal cluster with maximal difference between DAN and DMN correlations based on resting-state functional magnetic resonance imaging with individualized RSNM. Mean improvement in the primary outcome, Montgomery-Asberg Depression Rating Scale (MADRS), was 56% ± 14% (n = 9) with active treatment and 27% ± 25% (n = 5) with sham (Cohen's d = 1.43). One subject randomized to sham withdrew before starting treatment. There were no seizures or other significant adverse events. MADRS improvement was inversely correlated with functional connectivity between the right-sided stimulation site and the subgenual anterior cingulate cortex (sgACC; r = -0.68, 95% confidence interval 0.03-0.925). Active treatment led to increased sgACC-DMN connectivity (d = 1.55) and increased sgACC anti-correlation with the left- and right-sided stimulation sites (d = -1.26 and -0.69, respectively). This pilot study provides evidence that RSNM-targeted rTMS is feasible in TBI patients with depression. Given the dearth of existing evidence-based treatments for depression in this patient population, these preliminarily encouraging results indicate that larger controlled trials are warranted.
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Affiliation(s)
- Shan H. Siddiqi
- Department of Neurology, McLean Hospital, Belmont, Massachusetts
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health/Uniformed Services University of Health Sciences Traumatic Brain Injury Research Group, Bethesda, Maryland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Nicholas T. Trapp
- Department of Psychiatry, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Carl D. Hacker
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy O. Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Sridhar Kandala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Xin Hong
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Ludwig Trillo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Pashtun Shahim
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health/Uniformed Services University of Health Sciences Traumatic Brain Injury Research Group, Bethesda, Maryland
| | - Eric C. Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alexandre R. Carter
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - David L. Brody
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health/Uniformed Services University of Health Sciences Traumatic Brain Injury Research Group, Bethesda, Maryland
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
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29
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van Montfort SJT, van Dellen E, Stam CJ, Ahmad AH, Mentink LJ, Kraan CW, Zalesky A, Slooter AJC. Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis. NEUROIMAGE-CLINICAL 2019; 23:101809. [PMID: 30981940 PMCID: PMC6461601 DOI: 10.1016/j.nicl.2019.101809] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 01/05/2023]
Abstract
Delirium is an acute neuropsychiatric syndrome characterized by altered levels of attention and awareness with cognitive deficits. It is most prevalent in elderly hospitalized patients and related to poor outcomes. Predisposing risk factors, such as older age, determine the baseline vulnerability for delirium, while precipitating factors, such as use of sedatives, trigger the syndrome. Risk factors are heterogeneous and the underlying biological mechanisms leading to vulnerability for delirium are poorly understood. We tested the hypothesis that delirium and its risk factors are associated with consistent brain network changes. We performed a systematic review and qualitative meta-analysis and included 126 brain network publications on delirium and its risk factors. Findings were evaluated after an assessment of methodological quality, providing N=99 studies of good or excellent quality on predisposing risk factors, N=10 on precipitation risk factors and N=7 on delirium. Delirium was consistently associated with functional network disruptions, including lower EEG connectivity strength and decreased fMRI network integration. Risk factors for delirium were associated with lower structural connectivity strength and less efficient structural network organization. Decreased connectivity strength and efficiency appear to characterize structural brain networks of patients at risk for delirium, possibly impairing the functional network, while functional network disintegration seems to be a final common pathway for the syndrome. Delirium is consistently associated with functional network impairments. Risk factors are associated with lower structural connectivity strength. Risk factors are associated with a less efficient structural network organization. Structural impairments make the functional network more vulnerable to deterioration. Functional network disintegration seems to be a final common pathway for delirium.
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Affiliation(s)
- S J T van Montfort
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - E van Dellen
- Department of Psychiatry and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Melbourne Neuropsychiatry Center, Department of Psychiatry, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton South, 3053 Victoria, University of Melbourne and Melbourne Health, Australia
| | - C J Stam
- Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - A H Ahmad
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Faculty of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - L J Mentink
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - C W Kraan
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - A Zalesky
- Melbourne Neuropsychiatry Center, Department of Psychiatry, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton South, 3053 Victoria, University of Melbourne and Melbourne Health, Australia
| | - A J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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30
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Lawrence TP, Steel A, Ezra M, Speirs M, Pretorius PM, Douaud G, Sotiropoulos S, Cadoux-Hudson T, Emir UE, Voets NL. MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury. Brain Inj 2019; 33:854-868. [PMID: 30848964 PMCID: PMC6619394 DOI: 10.1080/02699052.2019.1584332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The posterior cingulate cortex (PCC) and corpus callosum (CC) are susceptible to trauma, but injury often evades detection. PCC Metabolic disruption may predict CC white matter tract injury and the secondary cascade responsible for progression. While the time frame for the secondary cascade remains unclear in humans, the first 24 h (hyper-acute phase) are crucial for life-saving interventions. Objectives: To test whether Magnetic Resonance Imaging (MRI) markers are detectable in the hyper-acute phase and progress after traumatic brain injury (TBI) and whether alterations in these parameters reflect injury severity. Methods: Spectroscopic and diffusion-weighted MRI data were collected in 18 patients with TBI (within 24 h and repeated 7–15 days following injury) and 18 healthy controls (scanned once). Results: Within 24 h of TBI N-acetylaspartate was reduced (F = 11.43, p = 0.002) and choline increased (F = 10.67, p = 0.003), the latter driven by moderate-severe injury (F = 5.54, p = 0.03). Alterations in fractional anisotropy (FA) and axial diffusivity (AD) progressed between the two time-points in the splenium of the CC (p = 0.029 and p = 0.013). Gradual reductions in FA correlated with progressive increases in choline (p = 0.029). Conclusions: Metabolic disruption and structural injury can be detected within hours of trauma. Metabolic and diffusion parameters allow identification of severity and provide evidence of injury progression.
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Affiliation(s)
- Tim P Lawrence
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Adam Steel
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,c Laboratory of Brain and Cognition , National Institute of Mental Health, National Institutes of Health , Bethesda , MD , USA
| | - Martyn Ezra
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom
| | - Mhairi Speirs
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Pieter M Pretorius
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Gwenaelle Douaud
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom
| | - Stamatios Sotiropoulos
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,d Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham , Nottingham , UK.,e National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre , Nottingham , UK
| | - Tom Cadoux-Hudson
- b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Uzay E Emir
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,f School of Health Sciences , Purdue University , West Lafayette , IN , USA
| | - Natalie L Voets
- a FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , United Kingdom.,b Department of Neuroscience , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
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31
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Kaushal M, España LY, Nencka AS, Wang Y, Nelson LD, McCrea MA, Meier TB. Resting-state functional connectivity after concussion is associated with clinical recovery. Hum Brain Mapp 2018; 40:1211-1220. [PMID: 30451340 DOI: 10.1002/hbm.24440] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/05/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
There has been a recent call for longitudinal imaging studies to better characterize the time course of physiological recovery following sport-related concussion (SRC) and its relationship with clinical recovery. To address this, we evaluated changes to resting-state functional connectivity (rs-FC) of the whole-brain network following SRC and explored associations between rs-FC and measures of clinical outcome. High school and collegiate football athletes were enrolled during preseason. Athletes that suffered SRC (N = 62) were assessed across the acute (within 48 hr) and sub-acute (days 8, 15, and 45) phases. Matched football athletes without concussion served as controls (N = 60) and participated in similar visits. Multi-band resting-state fMRI was used to assess whole-brain rs-FC at each visit using network-based statistic and average nodal strength from regions of interest defined using a common whole-brain parcellation. Concussed athletes had elevated symptoms, psychological distress, and oculomotor, balance, and memory deficits at 48 hr postconcussion relative to controls, with diminished yet significant elevations in symptoms and psychological distress at 8 days. Both rs-FC analyses showed that concussed athletes had a global increase in connectivity at 8 days postconcussion relative to controls, with no differences at the 48-hr, 15-day, or 45-day visits. Further analysis revealed the group effect at the 8-day visit was driven by the large minority of concussed athletes still symptomatic at their visit; asymptomatic concussed athletes did not differ from controls. Findings from this large-scale, prospective study suggest whole-brain rs-FC alterations following SRC are delayed in onset but associated with the presence of self-reported symptoms.
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Affiliation(s)
- Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lezlie Y España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - 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
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32
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Bigler ED. Structural neuroimaging in sport-related concussion. Int J Psychophysiol 2018; 132:105-123. [DOI: 10.1016/j.ijpsycho.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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33
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Nelson DV, Esty ML. Minute Pulsed Electromagnetic Neurostimulation for Mixed Trauma Syndromes. J Evid Based Integr Med 2018; 23:2515690X18770136. [PMID: 29692181 PMCID: PMC5987890 DOI: 10.1177/2515690x18770136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research regarding noninvasive brain stimulation technologies for the treatment of mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), and mixed (mTBI/PTSD) trauma syndromes has been increasing exponentially. Technologies with the greatest potential thus far include repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and cranial electrotherapy stimulation (CES). The nature and some of the controversies distinguishing mTBI, PTSD, and mTBI/PTSD are reviewed along with evidence for shared underlying mechanisms. An overview of treatment applications for rTMS, tDCS, and CES are also reviewed. A novel variant of a minute pulsed electromagnetic stimulation technology linked to ongoing electroencephalograph monitoring known as the Flexyx Neurotherapy System is introduced with an overview of the technology and technique, as well as a summary of supportive data to date that explores potential applications for amelioration of these syndromes.
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Affiliation(s)
| | - Mary Lee Esty
- 2 Brain Wellness and Biofeedback Center of Washington, Bethesda, MD, USA
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