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Dastin-van Rijn EM, Provenza NR, Calvert JS, Gilron R, Allawala AB, Darie R, Syed S, Matteson E, Vogt GS, Avendano-Ortega M, Vasquez AC, Ramakrishnan N, Oswalt DN, Bijanki KR, Wilt R, Starr PA, Sheth SA, Goodman WK, Harrison MT, Borton DA. Uncovering biomarkers during therapeutic neuromodulation with PARRM: Period-based Artifact Reconstruction and Removal Method. Cell Rep Methods 2021; 1:100010. [PMID: 34532716 PMCID: PMC8443190 DOI: 10.1016/j.crmeth.2021.100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/08/2021] [Accepted: 04/21/2021] [Indexed: 10/26/2022]
Abstract
Advances in therapeutic neuromodulation devices have enabled concurrent stimulation and electrophysiology in the central nervous system. However, stimulation artifacts often obscure the sensed underlying neural activity. Here, we develop a method, termed Period-based Artifact Reconstruction and Removal Method (PARRM), to remove stimulation artifacts from neural recordings by leveraging the exact period of stimulation to construct and subtract a high-fidelity template of the artifact. Benchtop saline experiments, computational simulations, five unique in vivo paradigms across animal and human studies, and an obscured movement biomarker are used for validation. Performance is found to exceed that of state-of-the-art filters in recovering complex signals without introducing contamination. PARRM has several advantages: (1) it is superior in signal recovery; (2) it is easily adaptable to several neurostimulation paradigms; and (3) it has low complexity for future on-device implementation. Real-time artifact removal via PARRM will enable unbiased exploration and detection of neural biomarkers to enhance efficacy of closed-loop therapies.
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Affiliation(s)
| | - Nicole R. Provenza
- Brown University School of Engineering, Providence, RI, USA
- Charles Stark Draper Laboratory, Cambridge, MA, USA
| | | | - Ro'ee Gilron
- Deparment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Radu Darie
- Brown University School of Engineering, Providence, RI, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, RI, USA
| | - Evan Matteson
- Brown University School of Engineering, Providence, RI, USA
| | - Gregory S. Vogt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ana C. Vasquez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nithya Ramakrishnan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Denise N. Oswalt
- Department of Neurosurgery, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kelly R. Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Robert Wilt
- Deparment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Philip A. Starr
- Deparment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - David A. Borton
- Brown University School of Engineering, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs, Providence, RI, USA
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Max JE, Wilde EA, Bigler ED, MacLeod M, Vasquez AC, Schmidt AT, Chapman SB, Hotz G, Yang TT, Levin HS. Psychiatric disorders after pediatric traumatic brain injury: a prospective, longitudinal, controlled study. J Neuropsychiatry Clin Neurosci 2013; 24:427-36. [PMID: 23224448 DOI: 10.1176/appi.neuropsych.12060149] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective was to examine the effects of traumatic brain injury (TBI), as compared with orthopedic injury (OI), relative to the risk for psychiatric disorder. There has only been one previous prospective study of this nature. Participants were age 7-17 years at the time of hospitalization for either TBI (complicated mild-to-severe) or OI. The study used a prospective, longitudinal, controlled design, with standardized psychiatric assessments conducted at baseline (reflecting pre-injury functioning) and 3 months post-injury. Assessments of pre-injury psychiatric, adaptive functioning, family adversity, and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales. The outcome measure was the presence of a psychiatric disorder not present before the injury ("novel"), during the first 3 months after TBI. Enrolled participants (N=141) included children with TBI (N=75) and with OI (N=66). The analyses focused on 118 children (84%) (TBI: N=65; OI: N=53) who returned for follow-up assessment at 3 months. Novel psychiatric disorder (NPD) occurred significantly more frequently in the TBI (32/65; 49%) than the OI (7/53; 13%) group. This difference was not accounted for by pre-injury lifetime psychiatric status; pre-injury adaptive functioning; pre-injury family adversity, family psychiatric history, socioeconomic status, injury severity, or age at injury. Furthermore, none of these variables significantly discriminated between children with TBI who developed, versus those who did not develop, NPD. These findings suggest that children with complicated mild-to-severe TBI are at significantly higher risk than OI-controls for the development of NPD in the first 3 months after injury.
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Affiliation(s)
- Jeffrey E Max
- Dept. of Psychiatry, Univ. of California San Diego, Rady Children's Hospital, San Diego, CA 92123, USA.
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Max JE, Wilde EA, Bigler ED, Thompson WK, MacLeod M, Vasquez AC, Merkley TL, Hunter JV, Chu ZD, Yallampalli R, Hotz G, Chapman SB, Yang TT, Levin HS. Neuroimaging correlates of novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry 2012; 51:1208-17. [PMID: 23101746 PMCID: PMC3511860 DOI: 10.1016/j.jaac.2012.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/22/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study magnetic resonance imaging (MRI) correlates of novel (new-onset) psychiatric disorders (NPD) after traumatic brain injury (TBI) and orthopedic injury (OI). METHOD Participants were 7 to 17 years of age at the time of hospitalization for either TBI or OI. The study used a prospective, longitudinal, controlled design with standardized psychiatric assessments conducted at baseline (reflecting pre-injury function) and 3 months post-injury. MRI assessments including diffusion tensor imaging (DTI)-derived fractional anisotropy (FA), volumetric measures of gray and white matter regions, volumetric measures of lesions, and cortical thickness were conducted. Injury severity was assessed by standard clinical scales. The outcome measure was the presence of an NPD identified during the first 3 months after injury. RESULTS There were 88 participants (TBI, 44; OI, 44). NPD occurred more frequently in the TBI (21/44; 48%) versus the OI (6/44; 14%) group (Fisher's exact test, p = .001). NPD in TBI participants was not related to injury severity. Multivariate analysis of covariance of the relationship between FA in hypothesized regions of interest (bilateral frontal and temporal lobes, bilateral centrum semiovale, bilateral uncinate fasciculi) and NPD and group (TBI versus OI) was significant, and both variables (NPD, p < .05; group, p < .001) were jointly significantly related to FA. NPD was not significantly related to volumetric measures of white or gray matter structures, volumetric measures of lesions, or cortical thickness measures. CONCLUSIONS Lowered white matter integrity may be more important in the pathophysiology of NPD than indices of gray matter or white matter atrophic changes, macroscopic lesions, and injury severity.
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Affiliation(s)
- Jeffrey E Max
- University of California-San Diego, San Diego, CA 92123, USA.
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Schmidt AT, Hanten GR, Li X, Vasquez AC, Wilde EA, Chapman SB, Levin HS. Decision making after pediatric traumatic brain injury: trajectory of recovery and relationship to age and gender. Int J Dev Neurosci 2011; 30:225-30. [PMID: 22138008 DOI: 10.1016/j.ijdevneu.2011.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 10/15/2022] Open
Abstract
The aim of the study was to examine longitudinal patterns of decision making based on risk and reward using a modified version of the Iowa Gambling Task (IGT) in children who had sustained traumatic brain injury (TBI) and children with orthopedic injury (OI). Participants were 135 children and adolescents with TBI (n=71) or OI (n=64) who were 7-17 years at the time of injury were enrolled and assessed prospectively at baseline and at follow-up intervals of 3, 12, 18, and 24 months after injury. Groups were similar in age, socioeconomic status, and gender. Participants chose from four decks of cards with the aim of maximizing earnings across 100 trials. Two of the decks offered relatively small rewards and relatively small losses, but were advantageous over the course of the experiment. The other two decks offered large rewards, but also introduced occasional large losses, and were considered disadvantageous over the course of the experiment. The variable of interest was the proportion of advantageous decks chosen across trials. Longitudinal analysis of the pattern of change across 2 years revealed a three-way interaction among injury group, age, and the quadratic term of interval-since-injury. In this interaction, the effect of age weakened in the TBI group across time, as compared to the OI group, which showed stronger quadratic patterns across the recovery intervals that differed by age. The OI group generally outperformed the TBI group. In addition, analyses revealed a three-way interaction among group, gender and the cubic term of post-injury interval, such that overall, males improved a great deal with time, but females showed small gains, regardless of injury group.
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Affiliation(s)
- Adam T Schmidt
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, United States
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Newsome MR, Scheibel RS, Chu Z, Hunter JV, Li X, Wilde EA, Lu H, Wang ZJ, Lin X, Steinberg JL, Vasquez AC, Cook L, Levin HS. The relationship of resting cerebral blood flow and brain activation during a social cognition task in adolescents with chronic moderate to severe traumatic brain injury: a preliminary investigation. Int J Dev Neurosci 2011; 30:255-66. [PMID: 22120754 DOI: 10.1016/j.ijdevneu.2011.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 10/21/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022] Open
Abstract
Alterations in cerebrovascular function are evident acutely in moderate to severe traumatic brain injury (TBI), although less is known about their chronic effects. Adolescent and adult patients with moderate to severe TBI have been reported to demonstrate diffuse activation throughout the brain during functional magnetic resonance imaging (fMRI). Because fMRI is a measure related to blood flow, it is possible that any deficits in blood flow may alter activation. An arterial spin labeling (ASL) perfusion sequence was performed on seven adolescents with chronic moderate to severe TBI and seven typically developing (TD) adolescents during the same session in which they had performed a social cognition task during fMRI. In the TD group, prefrontal CBF was positively related to prefrontal activation and negatively related to non-prefrontal, posterior, brain activation. This relationship was not seen in the TBI group, who demonstrated a greater positive relationship between prefrontal CBF and non-prefrontal activation than the TD group. An analysis of CBF data independent of fMRI showed reduced CBF in the right non-prefrontal region (p<.055) in the TBI group. To understand any role reduced CBF may play in diffuse extra-activation, we then related the right non-prefrontal CBF to activation. CBF in the right non-prefrontal region in the TD group was positively associated with prefrontal activation, suggesting an interactive role of non-prefrontal and prefrontal blood flow throughout the right hemisphere in healthy brains. However, the TBI group demonstrated a positive association with activation constrained to the right non-prefrontal region. These data suggest a relationship between impaired non-prefrontal CBF and the presence of non-prefrontal extra-activation, where the region with more limited blood flow is associated with activation limited to that region. In a secondary analysis, pathology associated with hyperintensities on T2-weighted FLAIR imaging over the whole brain was related to whole brain activation, revealing a negative relationship between lesion volume and frontal activation, and a positive relationship between lesion volume and posterior activation. These preliminary data, albeit collected with small sample sizes, suggest that reduced non-prefrontal CBF, and possibly pathological tissue associated with T2-hyperintensities, may provide contributions to the diffuse, primarily posterior extra-activation observed in adolescents following moderate to severe TBI.
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Affiliation(s)
- Mary R Newsome
- Traumatic Brain Injury Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
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Wu TC, Wilde EA, Bigler ED, Li X, Merkley TL, Yallampalli R, McCauley SR, Schnelle KP, Vasquez AC, Chu Z, Hanten G, Hunter JV, Levin HS. Longitudinal changes in the corpus callosum following pediatric traumatic brain injury. Dev Neurosci 2010; 32:361-73. [PMID: 20948181 DOI: 10.1159/000317058] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/11/2010] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Atrophy of the corpus callosum (CC) is a documented consequence of moderate-to-severe traumatic brain injury (TBI), which has been expressed as volume loss using quantitative magnetic resonance imaging (MRI). Other advanced imaging modalities such as diffusion tensor imaging (DTI) have also detected white matter microstructural alteration following TBI in the CC. The manner and degree to which macrostructural changes such as volume and microstructural changes develop over time following pediatric TBI, and their relation to a measure of processing speed is the focus of this longitudinal investigation. As such, DTI and volumetric changes in the CC in participants with TBI and a comparison group at approximately 3 and 18 months after injury as well as their relation to processing speed were determined. METHODS Forty-eight children and adolescents aged 7-17 years who sustained either complicated mild or moderate-to-severe TBI (n = 23) or orthopedic injury (OI; n = 25) were studied. The participants underwent brain MRI and were administered the Eriksen flanker task at both time points. RESULTS At 3 months after injury, there were significant group differences in DTI metrics in the total CC and its subregions (genu/anterior, body/central and splenium/posterior), with the TBI group demonstrating significantly lower fractional anisotropy (FA) and a higher apparent diffusion coefficient (ADC) in comparison to the OI group. These group differences were also present at 18 months after injury in all CC subregions, with lower FA and a higher ADC in the TBI group. In terms of longitudinal changes in DTI, despite the group difference in mean FA, both groups generally demonstrated a modest increase in FA over time though this increase was only significant in the splenium/posterior subregion. Interestingly, the TBI group also generally demonstrated ADC increases from 3 to 18 months though the OI group demonstrated ADC decreases over time. Volumetrically, the group differences at 3 months were marginal for the midanterior and body/central subregions and total CC. However, by 18 months, the TBI group demonstrated a significantly decreased volume in all subregions except the splenium/posterior area relative to the OI group. Unlike the OI group, which showed a significant volume increase in subregions of the CC over time, the TBI group demonstrated a significant and consistent volume decrease. Performance on a measure of processing speed did not differentiate the groups at either visit, and only the OI group showed significantly improved performance over time. Processing speed was related to FA in the splenium/posterior and total CC only in the TBI group on both occasions, with a stronger relation at 18 months. CONCLUSION In response to TBI, macrostructural volume loss in the CC occurred over time; yet, at the microstructural level, DTI demonstrated both indicators of continued maturation and development even in the damaged CC, as well as evidence of potential degenerative change. Unlike volumetrics, which likely reflects the degree of overall neuronal loss and axonal damage, DTI may reflect some aspects of postinjury maturation and adaptation in white matter following TBI. Multimodality imaging studies may be important to further understand the long-term consequences of pediatric TBI.
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Affiliation(s)
- Trevor C Wu
- Department of Psychology, Brigham Young University, Provo, Utah, USA
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Krawczyk DC, Hanten G, Wilde EA, Li X, Schnelle KP, Merkley TL, Vasquez AC, Cook LG, McClelland M, Chapman SB, Levin HS. Deficits in analogical reasoning in adolescents with traumatic brain injury. Front Hum Neurosci 2010; 4. [PMID: 20844604 PMCID: PMC2938978 DOI: 10.3389/fnhum.2010.00062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/15/2010] [Indexed: 11/13/2022] Open
Abstract
Individuals with traumatic brain injury (TBI) exhibit deficits in executive control, which may impact their reasoning abilities. Analogical reasoning requires working memory and inhibitory abilities. In this study, we tested adolescents with moderate to severe TBI and typically developing (TD) controls on a set of picture analogy problems. Three factors were varied: complexity (number of relations in the problems), distraction (distractor item present or absent), and animacy (living or non-living items in the problems). We found that TD adolescents performed significantly better overall than TBI adolescents. There was also an age effect present in the TBI group where older participants performed better than younger ones. This age effect was not observed in the TD group. Performance was affected by complexity and distraction. Further, TBI participants exhibited lower performance with distractors present than TD participants. The reasoning deficits exhibited by the TBI participants were correlated with measures of executive function that required working memory updating, attention, and attentional screening. Using MRI-derived measures of cortical thickness, correlations were carried out between task accuracy and cortical thickness. The TD adolescents showed negative correlations between thickness and task accuracy in frontal and temporal regions consistent with cortical maturation in these regions. This study demonstrates that adolescent TBI results in impairments in analogical reasoning ability. Further, TBI youth have difficulty effectively screening out distraction, which may lead to failures in comprehension of the relations among items in visual scenes. Lastly, TBI youth fail to show robust cortical–behavior correlations as observed in TD individuals.
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Affiliation(s)
- Daniel C Krawczyk
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas TX, USA
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Oni MB, Wilde EA, Bigler ED, McCauley SR, Wu TC, Yallampalli R, Chu Z, Li X, Hunter JV, Vasquez AC, Levin HS. Diffusion tensor imaging analysis of frontal lobes in pediatric traumatic brain injury. J Child Neurol 2010; 25:976-84. [PMID: 20332386 PMCID: PMC3227397 DOI: 10.1177/0883073809356034] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined the use of diffusion tensor imaging in detecting white matter changes in the frontal lobes following pediatric traumatic brain injury. A total of 46 children (ages 8-16 years) with moderate to severe traumatic brain injury and 47 children with orthopedic injury underwent 1.5 Tesla magnetic resonance imaging (MRI) at 3 months postinjury. Conventional MRI studies were obtained along with diffusion tensor imaging. Diffusion tensor imaging metrics, including fractional anisotropy, apparent diffusion coefficient, and radial diffusivity, were compared between the groups. Significant group differences were identified, implicating frontal white matter alterations in the injury group that were predictive of later Glasgow Outcome Scale ratings; however, focal lesions were not related to the Glasgow Outcome Scale ratings. Injury severity was also significantly associated with diffusion tensor imaging metrics. Diffusion tensor imaging holds great promise as an index of white matter integrity in traumatic brain injury and as a potential biomarker reflective of outcome.
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Affiliation(s)
| | - Elisabeth A. Wilde
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Radiology, Baylor College of Medicine, Houston, Texas,Department of Neurology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Erin D. Bigler
- Department of Psychology, Brigham Young University, Provo, Utah,Department of Neuroscience, Brigham Young University, Provo, Utah,The Brain Institute, University of Utah, Salt Lake City, Utah
| | - Stephen R. McCauley
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Pediatrics-Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Trevor C. Wu
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Ragini Yallampalli
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili Chu
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Xiaoqi Li
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Ana C. Vasquez
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
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Newsome MR, Scheibel RS, Hanten G, Chu Z, Steinberg JL, Hunter JV, Lu H, Vasquez AC, Li X, Lin X, Cook L, Levin HS. Brain activation while thinking about the self from another person's perspective after traumatic brain injury in adolescents. Neuropsychology 2010; 24:139-47. [PMID: 20230107 DOI: 10.1037/a0017432] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Deficits in self awareness and taking the perspective of others are often observed following traumatic brain injury (TBI). Nine adolescents (ages 12-19 years) who had sustained moderate to severe TBI after an average interval of 2.6 years and nine typically developing (TD) adolescents underwent functional MRI (fMRI) while performing a perspective taking task (D'Argembeau et al., 2007). Participants made trait attributions either from their own perspective or from that of the significant other. The groups did not differ in reaction time or on a consistency criterion. When thinking of the self from a third-person perspective, adolescents with TBI demonstrated greater activation in posterior brain regions implicated in social cognition, the left lingual gyrus (BA 18) and posterior cingulate (BA 31), extending into neighboring regions not generally associated with social cognition, that is, cuneus (BA 31) and parahippocampal gyrus, relative to TD adolescents. We postulate that adolescents with moderate to severe TBI recruited alternative neural pathways during perspective-taking because traumatic axonal injury disrupted their fronto-parietal networks mediating social cognition.
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Affiliation(s)
- Mary R Newsome
- Newsome, Baylor College of Medicine, Cognitive Neuroscience Laboratory, 1709 Dryden Road, Suite 725, Houston, TX 77030, USA.
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Ghosh A, Wilde EA, Hunter JV, Bigler ED, Chu Z, Li X, Vasquez AC, Menefee D, Yallampalli R, Levin HS. The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury. Brain Inj 2009; 23:228-33. [PMID: 19205959 DOI: 10.1080/02699050802672789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE To examine initial Glasgow Coma Scale (GCS) score and its relationship with later cerebral atrophy in children with traumatic brain injury (TBI) using Quantitative Magnetic Resonance Imaging (QMRI) at 4 months post-injury. It was hypothesized that a lower GCS score would predict later generalized atrophy. As a guide in assessing paediatric TBI patients, the probability of developing chronic cerebral atrophy was determined based on the initial GCS score. METHODS AND PROCEDURES The probability model used data from 45 paediatric patients (mean age = 13.6) with mild-to-severe TBI and 41 paediatric (mean age = 12.4) orthopaedically-injured children. RESULTS This study found a 24% increase in the odds of developing an abnormal ventricle-to-brain ratio (VBR) and a 27% increase in the odds of developing reduced white matter percentage on neuroimaging with each numerical drop in GCS score. Logistic regression models with cut-offs determined by normative QMRI data confirmed that a lower initial GCS score predicts later atrophy. CONCLUSION GCS is a commonly used measure of injury severity. It has proven to be a prognostic indicator of cognitive recovery and functional outcome and is also predictive of later parenchymal change.
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Affiliation(s)
- Alokananda Ghosh
- E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX, USA
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Wilde EA, McCauley SR, Chu Z, Hunter JV, Bigler ED, Yallampalli R, Wang ZJ, Hanten G, Li X, Ramos MA, Sabir SH, Vasquez AC, Menefee D, Levin HS. Diffusion tensor imaging of hemispheric asymmetries in the developing brain. J Clin Exp Neuropsychol 2008; 31:205-18. [PMID: 19052951 DOI: 10.1080/13803390802098118] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diffusion tensor imaging (DTI) was performed in 39 right-handed children to examine structural hemispheric differences and the impact of age, socioeconomic status, and sex on these differences. Apparent diffusion coefficient (ADC) values were smaller in the left than in the right temporal, prefrontal, anterior internal capsular and the thalamic regions, and fractional anisotropy (FA) values were larger in the left than in the right internal capsule, thalamus, and cingulate. Significant region-by-sex interactions disclosed that the relation of DTI asymmetries to performance depended on sex including the relation of temporal lobes to reading comprehension and the relation of frontal lobes to solving applied mathematical problems.
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Affiliation(s)
- Elisabeth A Wilde
- Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, TX 77030, USA.
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Abstract
The phenotype and function of splenic DC populations from diabetes-prone NOD mice were characterized and compared to DC from diabetes-resistant strains in the presence or absence of Flt3 ligand (FL) treatment. NOD mice were found to have significantly fewer CD8alpha+ DC than both B10.BR and C57BL/6 mice, and this defect was reversed by FL treatment. Freshly isolated CD8alpha+ and CD8alpha- DC from all three strains were found to express similar levels of costimulatory molecules and this was similar in both FL-treated and untreated animals. IL-12 p40 production was significantly lower in purified CD11c+ DC from NOD mice compared to DC from C57BL/6 or B10.BR mice. CD8alpha+ DC isolated from NOD mice produced lower levels of IL-12p40 than CD8alpha+ DC from C57CBL/6 and this was dependent on the nature of the stimulus given. In contrast both CD8alpha+ and CD8alpha- DC from FL-treated mice produced high levels of IL-12p40 following activation, but only the CD8alpha- DC produced IL-12p70. Functionally, freshly isolated CD8alpha- DC were more stimulatory than CD8alpha+ DC in a primary allogeneic mixed lymphocyte reaction. However, DC maturation resulted in increased T cell stimulatory capacity for both DC subsets, and this pattern was seen in all strains. These results demonstrate significant differences in phenotype and function of splenic NOD CD8alpha+ DC, and further suggest that FL treatment may reverse some of these abnormalities.
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Affiliation(s)
- A C Vasquez
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
NOD mice spontaneously develop diabetes between 15 and 20 weeks of age, which is preceded by insulitis characterized by the infiltration of lymphocytes. Dendritic cells (DC) are among the first cells to infiltrate the islet and they have been implicated in the pathogenesis of the disease. Our work has been concerned with the detailed characterization of four distinct DC populations in NOD mice: two derived from bone marrow (BM) cells cultured in either granulocyte-macrophage colony-stimulating factor (GM-CSF) plus interleukin-4 (IL-4) or GM-CSF alone and two from the spleen of Flt3 ligand (Flt3L) -treated mice, isolated on the basis of CD8alpha expression. Phenotypic and functional differences between these DC subsets in NOD mice have been identified. In addition, we obtained a lower yield of NOD BM-derived DC and they expressed higher levels of cell-surface CD40 and IL-12 p40 mRNA than BM-derived DC from the diabetes-resistant strain, B10.BR. We have also investigated the ability of these DC populations to modulate the development and progression of diabetes in NOD mice.
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Affiliation(s)
- P A Morel
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA. morel+@pitt.edu
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