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Rowland JA, Stapleton-Kotloski JR, Godwin DW, Hamilton CA, Martindale SL. The Functional Connectome and Long-Term Symptom Presentation Associated With Mild Traumatic Brain Injury and Blast Exposure in Combat Veterans. J Neurotrauma 2024. [PMID: 39150013 DOI: 10.1089/neu.2023.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Mild traumatic brain injury (TBI) sustained in a deployment environment (deployment TBI) can be associated with increased severity of long-term symptom presentation, despite the general expectation of full recovery from a single mild TBI. The heterogeneity in the effects of deployment TBI on the brain can be difficult for a case-control design to capture. The functional connectome of the brain is an approach robust to heterogeneity that allows global measurement of effects using a common set of outcomes. The present study evaluates how differences in the functional connectome relate to remote symptom presentation following combat deployment and determines if deployment TBI, blast exposure, or post-traumatic stress disorder (PTSD) are associated with these neurological differences. Participants included 181 Iraq and Afghanistan combat-exposed Veterans, approximately 9.4 years since deployment. Structured clinical interviews provided diagnoses and characterizations of TBI, blast exposure, and PTSD. Self-report measures provided characterization of long-term symptoms (psychiatric, behavioral health, and quality of life). Resting-state magnetoencephalography was used to characterize the functional connectome of the brain individually for each participant. Linear regression identified factors contributing to symptom presentation including relevant covariates, connectome metrics, deployment TBI, blast exposure PTSD, and conditional relationships. Results identified unique contributions of aspects of the connectome to symptom presentation. Furthermore, several conditional relationships were identified, demonstrating that the connectome was related to outcomes in the presence of only deployment-related TBI (including blast-related TBI, primary blast TBI, and blast exposure). No conditional relationships were identified for PTSD; however, the main effect of PTSD on symptom presentation was significant for all models. These results demonstrate that the connectome captures aspects of brain function relevant to long-term symptom presentation, highlighting that deployment-related TBI influences symptom outcomes through a neurological pathway. These findings demonstrate that changes in the functional connectome associated with deployment-related TBI are relevant to symptom presentation over a decade past the injury event, providing a clear demonstration of a brain-based mechanism of influence.
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Affiliation(s)
- Jared A Rowland
- Research and Academic Affairs, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer R Stapleton-Kotloski
- Research and Academic Affairs, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dwayne W Godwin
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Craig A Hamilton
- Research and Academic Affairs, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah L Martindale
- Research and Academic Affairs, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Paulo DL, Wills KE, Johnson GW, Gonzalez HFJ, Rolston JD, Naftel RP, Reddy SB, Morgan VL, Kang H, Williams Roberson S, Narasimhan S, Englot DJ. SEEG Functional Connectivity Measures to Identify Epileptogenic Zones: Stability, Medication Influence, and Recording Condition. Neurology 2022; 98:e2060-e2072. [PMID: 35338075 PMCID: PMC9162047 DOI: 10.1212/wnl.0000000000200386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Functional connectivity (FC) measures can be used to differentiate epileptogenic zones (EZs) from non-EZs in patients with medically refractory epilepsy. Little work has been done to evaluate the stability of stereo-EEG (SEEG) FC measures over time and their relationship with antiseizure medication (ASM) use, a critical confounder in epilepsy FC studies. We aimed to answer the following questions: Are SEEG FC measures stable over time? Are they influenced by ASMs? Are they affected by patient data collection state? METHODS In 32 patients with medically refractory focal epilepsy, we collected a single 2-minute prospective SEEG resting-state (awake, eyes closed) data set and consecutive 2-minute retrospective pseudo-rest (awake, eyes open) data sets for days 1-7 postimplantation. ASM dosages were recorded for days 1-7 postimplantation and drug load score (DLS) per day was calculated to standardize and compare across patients. FC was evaluated using directed and nondirected measures. Standard clinical interpretation of ictal SEEG was used to classify brain regions as EZs and non-EZs. RESULTS Over 7 days, presumed EZs consistently had higher FC than non-EZs when using between imaginary coherence (ImCoh) and partial directed coherence (PDC) inward strength, without accounting for DLS. These measures were demonstrated to be stable over a short-term period of 3 consecutive days with the same DLS. Between ImCoh FC differences between EZs and non-EZs were reduced with DLS decreases, whereas other measures were not affected by DLS. FC differences between EZs and non-EZs were seen during both resting-state and pseudo-rest conditions; ImCoh values were strongly correlated between the 2 conditions, whereas PDC values were not. DISCUSSION Inward and nondirected SEEG FC is higher in presumed EZs vs non-EZs and measures are stable over time. However, certain measures may be affected by ASM dose, as between ImCoh differences between EZs and non-EZs are less pronounced with lower doses, and other measures such as PDC are poorly correlated across recording conditions. These findings allow novel insight into how SEEG FC measures may aid surgical localization and how they are influenced by ASMs and other factors.
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Affiliation(s)
- Danika L Paulo
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Kristin E Wills
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Graham W Johnson
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Hernan F J Gonzalez
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - John D Rolston
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Robert P Naftel
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Shilpa B Reddy
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Victoria L Morgan
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Hakmook Kang
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Shawniqua Williams Roberson
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Saramati Narasimhan
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
| | - Dario J Englot
- From the Departments of Neurological Surgery (D.L.P., K.E.W., R.P.N., V.L.M., S.N., D.J.E.), Radiology and Radiological Sciences (V.L.M., D.J.E.), Biostatistics (V.L.M., S.W.R., D.J.E.), and Neurology (H.K.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Vanderbilt Institute for Surgery and Engineering (K.E.W., G.W.J., H.F.J.G., V.L.M., S.N., D.J.E.); Department of Biomedical Engineering (G.W.J., H.F.J.G., V.L.M., S.W.R., S.N., D.J.E.), Vanderbilt University, Nashville, TN; Departments of Neurosurgery and Biomedical Engineering (J.D.R.), University of Utah, Salt Lake City; and Department of Pediatrics (S.B.R.), Vanderbilt Children's Hospital, Nashville, TN
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Rowland JA, Stapleton-Kotloski JR, Martindale SL, Rogers EE, Ord AS, Godwin DW, Taber KH. Alterations in the Topology of Functional Connectomes Are Associated with Post-Traumatic Stress Disorder and Blast-Related Mild Traumatic Brain Injury in Combat Veterans. J Neurotrauma 2021; 38:3086-3096. [PMID: 34435885 DOI: 10.1089/neu.2020.7450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common condition in post-deployment service members (SM). SMs of the conflicts in Iraq and Afghanistan also frequently experience traumatic brain injury (TBI) and exposure to blasts during deployments. This study evaluated the effect of these conditions and experiences on functional brain connectomes in post-deployment, combat-exposed veterans. Functional brain connectomes were created using 5-min resting-state magnetoencephalography data. Well-established clinical interviews determined current PTSD diagnosis, as well as deployment-acquired mild TBI and history of exposure to blast. Linear regression examined the effect of these conditions on functional brain connectomes beyond covariates. There were significant interactions between blast-related mild TBI and PTSD after correction for multiple comparisons including number of nodes (non-standardized parameter estimate [PE] = -12.47), average degree (PE = 0.05), and connection strength (PE = 0.05). A main effect of blast-related mild TBI was observed on the threshold level. These results demonstrate a distinct functional connectome presentation associated with the presence of both blast-related mild TBI and PTSD. These findings suggest the possibility that blast-related mild TBI alterations in functional brain connectomes affect the presentation or progression of recovery from PTSD. The current results offer mixed support for hyper-connectivity in the chronic phase of deployment TBI.
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Affiliation(s)
- Jared A Rowland
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer R Stapleton-Kotloski
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah L Martindale
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily E Rogers
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna S Ord
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dwayne W Godwin
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine H Taber
- W. G. (Bill) Hefner VA Healthcare System, Research and Academic Affairs, Salisbury, North Carolina, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.,Division of Biomedical Sciences, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA
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