1
|
Gilmore N, Tseng CEJ, Maffei C, Tromly SL, Deary KB, McKinney IR, Kelemen JN, Healy BC, Hu CG, Ramos-Llordén G, Masood M, Cali RJ, Guo J, Belanger HG, Yao EF, Baxter T, Fischl B, Foulkes AS, Polimeni JR, Rosen BR, Perl DP, Hooker JM, Zürcher NR, Huang SY, Kimberly WT, Greve DN, Mac Donald CL, Dams-O’Connor K, Bodien YG, Edlow BL. Impact of repeated blast exposure on active-duty United States Special Operations Forces. Proc Natl Acad Sci U S A 2024; 121:e2313568121. [PMID: 38648470 PMCID: PMC11087753 DOI: 10.1073/pnas.2313568121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [11C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [18F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.
Collapse
Affiliation(s)
- Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Chieh-En J. Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Samantha L. Tromly
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | | | - Isabella R. McKinney
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jessica N. Kelemen
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Brian C. Healy
- Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Collin G. Hu
- United States Army Special Operations Aviation Command, Fort Liberty, NC28307
- Department of Family Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Gabriel Ramos-Llordén
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Maryam Masood
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Ryan J. Cali
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jennifer Guo
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Heather G. Belanger
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL33613
| | - Eveline F. Yao
- Office of the Air Force Surgeon General, Falls Church, VA22042
| | - Timothy Baxter
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | - Bruce Fischl
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Jonathan R. Polimeni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Bruce R. Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Daniel P. Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Jacob M. Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Nicole R. Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Susie Y. Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - W. Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Douglas N. Greve
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY10029
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA02129
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| |
Collapse
|
2
|
Vande Vyvere T, Pisică D, Wilms G, Claes L, Van Dyck P, Snoeckx A, van den Hauwe L, Pullens P, Verheyden J, Wintermark M, Dekeyzer S, Mac Donald CL, Maas AIR, Parizel PM. Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2024. [PMID: 38482818 DOI: 10.1089/neu.2023.0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.
Collapse
Affiliation(s)
- Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Dana Pisică
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Guido Wilms
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lene Claes
- icometrix, Research and Development, Leuven, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Luc van den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Pim Pullens
- Department of Imaging, University Hospital Ghent; IBITech/MEDISIP, Engineering and Architecture, Ghent University; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Belgium
| | - Jan Verheyden
- icometrix, Research and Development, Leuven, Belgium
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Center, Houston, Texas, USA
| | - Sven Dekeyzer
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, University Hospital Ghent, Belgium
| | - Christine L Mac Donald
- Department of Neurological Surgery, School of Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, Royal Perth Hospital (RPH) and University of Western Australia (UWA), Perth, Australia; Western Australia National Imaging Facility (WA NIF) node, Australia
| |
Collapse
|
3
|
Mossa-Basha M, Andre JB, Yuh E, Hunt D, LaPiana N, Howlett B, Krakauer C, Crane P, Nelson J, DeZelar M, Meyers K, Larson E, Ralston J, Mac Donald CL. Comparison of brain imaging and physical health between research and clinical neuroimaging cohorts of ageing. Br J Radiol 2024; 97:614-621. [PMID: 38303547 PMCID: PMC11027291 DOI: 10.1093/bjr/tqae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES To compare brain MRI measures between Adult Changes in Thought (ACT) participants who underwent research, clinical, or both MRI scans, and clinical health measures across the groups and non-MRI subjects. METHODS Retrospective cohort study leveraging MRI, clinical, demographic, and medication data from ACT. Three neuroradiologists reviewed MRI scans using NIH Neuroimaging Common Data Elements (CDEs). Total brain and white matter hyperintensity (WMH) volumes, clinical characteristics, and outcome measures of brain and overall health were compared between groups. 1166 MRIs were included (77 research, 1043 clinical, and 46 both) and an additional 3146 participants with no MRI were compared. RESULTS Compared to the group with research MRI only, the clinical MRI group had higher prevalence of the following: acute infarcts, chronic haematoma, subarachnoid haemorrhage, subdural haemorrhage, haemorrhagic transformation, and hydrocephalus (each P < .001). Quantitative WMH burden was significantly lower (P < .001) and total brain volume significantly higher (P < .001) in research MRI participants compared to other MRI groups. Prevalence of hypertension, self-reported cerebrovascular disease, congestive heart failure, dementia, and recent hospitalization (all P < .001) and diabetes (P = .002) differed significantly across groups, with smaller proportions in the research MRI group. CONCLUSION In ageing populations, significant differences were observed in MRI metrics between research MRI and clinical MRI groups, and clinical health metric differences between research MRI, clinical MRI, and no-MRI groups. ADVANCES IN KNOWLEDGE This questions whether research cohorts can adequately represent the greater ageing population undergoing imaging. These findings may also be useful to radiologists when interpreting neuroimaging of ageing.
Collapse
Affiliation(s)
- Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, Washington, 98105 United States
| | - Jalal B Andre
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, Washington, 98105 United States
| | - Esther Yuh
- Department of Radiology, University of California San Francisco, 1001 Potrero Avenue, Building 5, San Francisco, California, 94110 United States
| | - David Hunt
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Nina LaPiana
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Bradley Howlett
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Chloe Krakauer
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Paul Crane
- Department of Internal Medicine, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Jennifer Nelson
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Margaret DeZelar
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Kelly Meyers
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Eric Larson
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - James Ralston
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| |
Collapse
|
4
|
Coppel D, Barber J, Temkin NR, Mac Donald CL. Combat Deployed Service Members by Blast TBI and Service Separation Status 5-years Post-deployment: Comparison of Cognitive, Neurobehavioral, and Psychological Profiles of Those Who Left vs. Those Still Serving. Mil Med 2024; 189:e795-e801. [PMID: 37756615 PMCID: PMC10898932 DOI: 10.1093/milmed/usad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Longitudinal research regarding the pre- and post-separation experience has been relatively limited, despite its potential as a major life transition. Separating from the military and re-integration to civilian life is noted to be a period of increased risk of significant adjustment challenges, which impacts a service member in a multitude of areas. Active duty service members with combat-related physical or mental health or pre-existing adjustment conditions may be more likely to separate from service and more at risk for post-military service adjustment problems. MATERIALS AND METHODS This is a secondary data analysis from a prospective, observational, longitudinal, multicohort study involving deployed service members originally enrolled between 2008 and 2013 in combat or following medical evacuation to Landstuhl, Germany. Two combat-deployed cohorts were examined: non-head-injured control without blast exposure (n = 109) and combat-related concussion arising from blast (n = 165). Comprehensive clinical evaluations performed at 1 year and 5 year follow-up included identical assessment batteries for neurobehavioral, psychiatric, and cognitive outcomes. In addition to demographics collected at each study visit, the current analysis leveraged the Glasgow Outcome Scale Extended (GOS-E), a measure of overall global disability. For neurobehavioral impairment, the Neurobehavioral Rating Scale-Revised (NRS) was used as well as the Headache Impact Test (HIT-6) to assess headache burden. To compare psychiatric symptom burden between those separated to those still serving, the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and Montgomery-Asberg Depression Rating Scale (MADRS) for depression were used as well as the Michigan Alcohol Screening Test (MAST) to be able to compare alcohol misuse across groups. Overall cognitive function/performance was defined for each service member by aggregating the 19 neuropsychological measures. RESULTS Overall comparisons following adjustment by linear regression and correction for multiple comparisons by separation status subgroup for non-blast control or blast traumatic brain injury (TBI) identified significant differences at 5 years post-enrollment in measures of global disability, neurobehavioral impairment, and psychiatric symptom burden. Those who separated had worse global disability, worse neurobehavioral symptoms, worse Post-Traumatic Stress Disorder symptoms, and worse depression symptoms than active duty service members. While service members who sustain a mild blast TBI during combat are more likely to separate from service within 5 years, there is a proportion of those non-injured who also leave during this time frame. Clinical profiles of both groups suggest service members who separated have elevated psychiatric and neurobehavioral symptoms but not cognitive dysfunction. Interestingly, the symptom load in these same domains is lower for those without blast TBI who separated during this time frame. CONCLUSIONS These results appear to support previous research depicting that, for some service members, transitioning out of the military and re-integrating into civilian life can be a challenging adjustment. Many factors, including personal and social circumstances, prior mental or emotional difficulties, availability of social or community support or resources, can influence the adjustment outcomes of veterans. Service members with prior adjustment difficulties and/or those with blast TBI history (and ongoing neurobehavioral symptoms) may find the transition from military to civilian life even more challenging, given the potential substantial changes in lifestyle, structure, identity, and support.
Collapse
Affiliation(s)
- David Coppel
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| |
Collapse
|
5
|
de Souza NL, Kumar RG, Pruyser A, Blunt EE, Sanders W, Meydan A, Lawrence P, Venkatesan UM, Mac Donald CL, Hoffman JM, Bodien YG, Edlow BL, Dams-O'Connor K. Intimate Partner Violence and Other Trauma Exposures in Females With Traumatic Brain Injury. J Neurotrauma 2024; 41:529-536. [PMID: 37974411 PMCID: PMC10837032 DOI: 10.1089/neu.2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
We examined whether females with a history of traumatic brain injury (TBI) and intimate partner violence (IPV) have greater exposure to lifetime trauma relative to females with TBI but no IPV history. Further, we assessed the effects of lifetime trauma on psychological outcomes after TBI. Female participants (n = 70; age M [standard deviation-SD] = 50.5 [15.2] years) with TBI (time since injury median [interquartile range -IQR] = 10.2 [5.3-17.8] years) completed a structured assessment of lifetime history of TBI, including an IPV module to query head injuries from physical violence by an intimate partner. We characterized lifetime trauma exposure with the Adverse Childhood Experiences (ACEs) questionnaire and Survey of Exposure to Community Violence (CV). We evaluated psychological functioning with self-report questionnaires of post-traumatic stress disorder (PTSD), depression, and anxiety symptoms. Compared with those with no IPV history (n = 51), participants reporting IPV-related head injuries (n = 19; 27.1%) reported more ACEs (M[SD] IPV: 4.5[2.9]; No IPV: 1.6[1.8], p < 0.001, d = 1.08) and greater CV (IPV: 17.5[8.4]; No IPV: 7.6[6.1], p < .0001, d = 1.26). Within the full sample, ACEs (β = 0.21, 95% confidence interval [CI] = 0.04-0.39) and CV (β = 0.07, 95% CI = 0.01-0.13) predicted worse PTSD symptoms, while IPV alone did not. Exposure to all three sources of trauma (ACEs, CV, and IPV) was associated with worse PTSD symptoms relative to fewer traumas. The results highlight the scope of traumatic exposures among TBI survivors and the importance of considering IPV and other lifetime trauma exposure in assessing and managing TBI. Trauma-informed interventions that are modified for TBI-related impairment may offer improved outcomes in managing psychological symptoms.
Collapse
Affiliation(s)
- Nicola L. de Souza
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ariel Pruyser
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily E. Blunt
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Sanders
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Anogue Meydan
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Phoebe Lawrence
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Umesh M. Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
| | - Christine L. Mac Donald
- Department of Neurological Surgery and University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance and Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
6
|
Gazula H, Tregidgo HFJ, Billot B, Balbastre Y, William-Ramirez J, Herisse R, Deden-Binder LJ, Casamitjana A, Melief EJ, Latimer CS, Kilgore MD, Montine M, Robinson E, Blackburn E, Marshall MS, Connors TR, Oakley DH, Frosch MP, Young SI, Van Leemput K, Dalca AV, FIschl B, Mac Donald CL, Keene CD, Hyman BT, Iglesias JE. Machine learning of dissection photographs and surface scanning for quantitative 3D neuropathology. bioRxiv 2024:2023.06.08.544050. [PMID: 37333251 PMCID: PMC10274889 DOI: 10.1101/2023.06.08.544050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
We present open-source tools for 3D analysis of photographs of dissected slices of human brains, which are routinely acquired in brain banks but seldom used for quantitative analysis. Our tools can: (i) 3D reconstruct a volume from the photographs and, optionally, a surface scan; and (ii) produce a high-resolution 3D segmentation into 11 brain regions per hemisphere (22 in total), independently of the slice thickness. Our tools can be used as a substitute for ex vivo magnetic resonance imaging (MRI), which requires access to an MRI scanner, ex vivo scanning expertise, and considerable financial resources. We tested our tools on synthetic and real data from two NIH Alzheimer's Disease Research Centers. The results show that our methodology yields accurate 3D reconstructions, segmentations, and volumetric measurements that are highly correlated to those from MRI. Our method also detects expected differences between post mortem confirmed Alzheimer's disease cases and controls. The tools are available in our widespread neuroimaging suite "FreeSurfer" ( https://surfer.nmr.mgh.harvard.edu/fswiki/PhotoTools ).
Collapse
|
7
|
Giza CC, Gioia G, Cook LJ, Asarnow R, Snyder A, Babikian T, Thompson P, Bazarian JJ, Whitlow CT, Miles CM, Otallah S, Kamins J, Didehbani N, Rosenbaum PE, Chrisman SP, Vaughan CG, Cullum M, Popoli DM, Choe M, Gill J, Dennis EL, Donald CLM, Rivara FP. CARE4Kids Study: Endophenotypes of Persistent Post-Concussive Symptoms in Adolescents: Study Rationale and Protocol. J Neurotrauma 2024; 41:171-185. [PMID: 37463061 PMCID: PMC11071085 DOI: 10.1089/neu.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implemented in response to the National Institute of Neurological Diseases and Stroke call for the development and initial clinical validation of objective biological measures to predict risk of PPCS in adolescents. We describe our plans for recruitment of a Development cohort of 11- to 17-year-old youth with concussion, and collection of autonomic, neurocognitive, biofluid, and imaging biomarkers. The most promising of these measures will then be validated in a separate Validation cohort of youth with concussion, and a final, clinically useful algorithm will be developed and disseminated. Upon completion of this study, we will have generated a battery of measures predictive of high risk for PPCS, which will allow for identification and testing of interventions to prevent PPCS in the most high-risk youth.
Collapse
Affiliation(s)
- Christopher C. Giza
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
| | - Lawrence J. Cook
- Department of Pediatric Critical Care, University of Utah, Salt Lake City, Utah, USA
| | - Robert Asarnow
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Aliyah Snyder
- UCLA BrainSPORT Program, Los Angeles, California, USA
- Departent of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Fixel Institute, University of Florida, Gainesville, Florida, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Paul Thompson
- Departments of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, and Radiology and Engineering, University of Southern California, Los Angeles, California, USA
| | - Jeffery J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christopher T. Whitlow
- Department of Radiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Scott Otallah
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Joshua Kamins
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philip E. Rosenbaum
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Sara P.D. Chrisman
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher G. Vaughan
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David M. Popoli
- Department of Orthopedics and Rehabilitation, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Meeryo Choe
- Department of Pediatric Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily L. Dennis
- TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Christine L. Mac Donald
- Department of Neurological Surgery, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| |
Collapse
|
8
|
Edlow BL, Gilmore N, Tromly SL, Deary KB, McKinney IR, Hu CG, Kelemen JN, Maffei C, Tseng CEJ, Llorden GR, Healy BC, Masood M, Cali RJ, Baxter T, Yao EF, Belanger HG, Benjamini D, Basser PJ, Priemer DS, Kimberly WT, Polimeni JR, Rosen BR, Fischl B, Zurcher NR, Greve DN, Hooker JM, Huang SY, Caruso A, Smith GA, Szymanski TG, Perl DP, Dams-O'Connor K, Mac Donald CL, Bodien YG. Optimizing Brain Health of United States Special Operations Forces. J Spec Oper Med 2023; 23:47-56. [PMID: 37851859 DOI: 10.55460/99qw-k0hg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 10/20/2023]
Abstract
United States Special Operations Forces (SOF) personnel are frequently exposed to explosive blasts in training and combat. However, the effects of repeated blast exposure on the human brain are incompletely understood. Moreover, there is currently no diagnostic test to detect repeated blast brain injury (rBBI). In this "Human Performance Optimization" article, we discuss how the development and implementation of a reliable diagnostic test for rBBI has the potential to promote SOF brain health, combat readiness, and quality of life.
Collapse
|
9
|
Parsey CM, Kang HJ, Eaton JC, McGrath ME, Barber J, Temkin NR, Donald CLM. Chronic frontal neurobehavioural symptoms in combat-deployed military personnel with and without a history of blast-related mild traumatic brain injury. Brain Inj 2023; 37:1127-1134. [PMID: 37165638 PMCID: PMC10524397 DOI: 10.1080/02699052.2023.2209740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/02/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study evaluated frontal behavioural symptoms, via the FrSBe self-report, in military personnel with and without a history of blast-related mild traumatic brain injury (mild TBI). METHODS Prospective observational cohort study of combat-deployed service members leveraging 1-year and 5-year demographic and follow up clinical outcome data. RESULTS The blast mild TBI group (n = 164) showed greater frontal behavioural symptoms, including clinically elevated apathy, disinhibition, and executive dysfunction, during a 5-year follow-up, compared to a group of combat-deployed controls (n = 107) without mild TBI history or history of blast exposure. We also explored changes inbehaviourall symptoms over a 4-year span, which showed clinically significant increases in disinhibition in the blast mild TBI group, whereas the control group did not show significant increases in symptoms over time. CONCLUSION Our findings add to the growing evidence that a proportion of individuals who sustain mild TBI experience persistent behavioural symptoms. We also offer a demonstration of a novel use of the FrSBe as a tool for longitudinal symptom monitoring in a military mild TBI population.
Collapse
Affiliation(s)
- Carolyn M. Parsey
- Department of Neurology, University of Washington, School of Medicine, Seattle, WA USA
| | | | - Jessica C. Eaton
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Margaret E. McGrath
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
- Department of Biostatistics, University of Washington, School of Public Health, Seattle, WA USA
| | - Christine L. Mac Donald
- Harborview Medical Center, Seattle WA USA
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| |
Collapse
|
10
|
Igbinigie S, Rice M, Ciol MA, Pickard C, Webb L, Lin C, Mac Donald CL. The Effect of a Group Physical Activity Program on Behavior of Incarcerated Youth. J Correct Health Care 2023; 29:268-274. [PMID: 37130303 DOI: 10.1089/jchc.22.05.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Behavioral health challenges are more prevalent in incarcerated youth than in the general youth population. Questions remain regarding whether physical activity programs can reduce behavioral health challenges in incarcerated youth. Data were available for 1,285 youths incarcerated between January 2017 and December 2018. The structured exercise program was implemented in January 2018. Primary outcomes were numbers of use of force (UoF) and of program modifications (PMs) indicative of delinquent behavior in pre- and post-exercise implementation periods. Rates per 1,000 person-days for UoF (10.0 in 2017 vs. 7.4 in 2018) and for PMs (36.7 vs. 22.9) were statistically different. For youths incarcerated both years, rates per 1,000 person-days for UoF (12.3 vs. 7.9), and for PMs (43.3 vs. 23.5) were statistically different. There was a reduction in behavior modifications in incarcerated youths after implementing the exercise program, but further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Sherry Igbinigie
- University of Washington School of Medicine, Sports Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Seattle, Washington, USA
| | - Melanie Rice
- University of Washington School of Medicine, Sports Institute, Seattle, Washington, USA
| | - Marcia A Ciol
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Seattle, Washington, USA
| | | | | | - Cindy Lin
- University of Washington School of Medicine, Sports Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Seattle, Washington, USA
| | - Christine L Mac Donald
- University of Washington School of Medicine, Sports Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Neurological Surgery, Seattle, Washington, USA
| |
Collapse
|
11
|
Figuracion KCF, Thompson H, Mac Donald CL. Integrating Neuroimaging Measures in Nursing Research. Biol Res Nurs 2023; 25:341-352. [PMID: 36398659 PMCID: PMC10404904 DOI: 10.1177/10998004221140608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Medical and scientific advancement worldwide has led to a longer lifespan. With the population aging comes the risk of developing cognitive decline. The incorporation of neuroimaging measures in evaluating cognitive changes is limited in nursing research. The aim of this review is to introduce nurse scientists to neuroimaging measures employed to assess the association between brain and cognitive changes. METHODS Relevant literature was identified by searching CINAHL, Web of Science, and PubMed databases using the following keywords: "neuroimaging measures," "aging," "cognition," "qualitative scoring," "cognitive ability," "molecular," "structural," and "functional." RESULTS Neuroimaging measures can be categorized into structural, functional, and molecular imaging approaches. The structural imaging technique visualizes the anatomical regions of the brain. Visual examination and volumetric segmentation of select structural sequences extract information such as white matter hyperintensities and cerebral atrophy. Functional imaging techniques evaluate brain regions and underlying processes using blood-oxygen-dependent signals. Molecular imaging technique is the real-time visualization of biological processes at the cellular and molecular levels in a given region. Examples of biological measures associated with neurodegeneration include decreased glutamine level, elevated total choline, and elevated Myo-inositol. DISCUSSION Nursing is at the forefront of addressing upstream factors impacting health outcomes across a lifespan of a population at increased risk of progressive cognitive decline. Nurse researchers can become more facile in using these measures both in qualitative and quantitative methodology by leveraging previously gathered neuroimaging clinical data for research purposes to better characterize the associations between symptom progression, disease risk, and health outcomes.
Collapse
Affiliation(s)
- Karl Cristie F. Figuracion
- Department of School of Nursing, University of Washington, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Hilaire Thompson
- Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
12
|
Gabitto MI, Travaglini KJ, Rachleff VM, Kaplan ES, Long B, Ariza J, Ding Y, Mahoney JT, Dee N, Goldy J, Melief EJ, Brouner K, Campos J, Carr AJ, Casper T, Chakrabarty R, Clark M, Compos J, Cool J, Valera Cuevas NJ, Dalley R, Darvas M, Ding SL, Dolbeare T, Mac Donald CL, Egdorf T, Esposito L, Ferrer R, Gala R, Gary A, Gloe J, Guilford N, Guzman J, Ho W, Jarksy T, Johansen N, Kalmbach BE, Keene LM, Khawand S, Kilgore M, Kirkland A, Kunst M, Lee BR, Malone J, Maltzer Z, Martin N, McCue R, McMillen D, Meyerdierks E, Meyers KP, Mollenkopf T, Montine M, Nolan AL, Nyhus J, Olsen PA, Pacleb M, Pham T, Pom CA, Postupna N, Ruiz A, Schantz AM, Sorensen SA, Staats B, Sullivan M, Sunkin SM, Thompson C, Tieu M, Ting J, Torkelson A, Tran T, Wang MQ, Waters J, Wilson AM, Haynor D, Gatto N, Jayadev S, Mufti S, Ng L, Mukherjee S, Crane PK, Latimer CS, Levi BP, Smith K, Close JL, Miller JA, Hodge RD, Larson EB, Grabowski TJ, Hawrylycz M, Keene CD, Lein ES. Integrated multimodal cell atlas of Alzheimer's disease. Res Sq 2023:rs.3.rs-2921860. [PMID: 37292694 PMCID: PMC10246227 DOI: 10.21203/rs.3.rs-2921860/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia in older adults. Neuropathological and imaging studies have demonstrated a progressive and stereotyped accumulation of protein aggregates, but the underlying molecular and cellular mechanisms driving AD progression and vulnerable cell populations affected by disease remain coarsely understood. The current study harnesses single cell and spatial genomics tools and knowledge from the BRAIN Initiative Cell Census Network to understand the impact of disease progression on middle temporal gyrus cell types. We used image-based quantitative neuropathology to place 84 donors spanning the spectrum of AD pathology along a continuous disease pseudoprogression score and multiomic technologies to profile single nuclei from each donor, mapping their transcriptomes, epigenomes, and spatial coordinates to a common cell type reference with unprecedented resolution. Temporal analysis of cell-type proportions indicated an early reduction of Somatostatin-expressing neuronal subtypes and a late decrease of supragranular intratelencephalic-projecting excitatory and Parvalbumin-expressing neurons, with increases in disease-associated microglial and astrocytic states. We found complex gene expression differences, ranging from global to cell type-specific effects. These effects showed different temporal patterns indicating diverse cellular perturbations as a function of disease progression. A subset of donors showed a particularly severe cellular and molecular phenotype, which correlated with steeper cognitive decline. We have created a freely available public resource to explore these data and to accelerate progress in AD research at SEA-AD.org.
Collapse
Affiliation(s)
| | | | - Victoria M. Rachleff
- Allen Institute for Brain Science, Seattle, WA, 98109
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Brian Long
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jeanelle Ariza
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Yi Ding
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Nick Dee
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jeff Goldy
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Erica J. Melief
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - John Campos
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Tamara Casper
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Michael Clark
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jazmin Compos
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jonah Cool
- Chan Zuckerberg Initiative, Redwood City, CA 94063
| | | | - Rachel Dalley
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Martin Darvas
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Song-Lin Ding
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tim Dolbeare
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Tom Egdorf
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Luke Esposito
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Rohan Gala
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Amanda Gary
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jessica Gloe
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Windy Ho
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tim Jarksy
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Lisa M. Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Sarah Khawand
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Mitch Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Amanda Kirkland
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Michael Kunst
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Brian R. Lee
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Zoe Maltzer
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Naomi Martin
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Rachel McCue
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Kelly P. Meyers
- Kaiser Permanente Washington Research Institute, Seattle, WA, 98101
| | | | - Mark Montine
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Amber L. Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Julie Nyhus
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Paul A. Olsen
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Maiya Pacleb
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Thanh Pham
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Nadia Postupna
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Augustin Ruiz
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Aimee M. Schantz
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Brian Staats
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Matt Sullivan
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Michael Tieu
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jonathan Ting
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Amy Torkelson
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tracy Tran
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Jack Waters
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Angela M. Wilson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - David Haynor
- Department of Radiology, University of Washington, Seattle, WA 98014
| | - Nicole Gatto
- Kaiser Permanente Washington Research Institute, Seattle, WA, 98101
| | - Suman Jayadev
- Department of Neurology, University of Washington, Seattle, WA 98104
| | - Shoaib Mufti
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Lydia Ng
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA 98104
| | - Caitlin S. Latimer
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Boaz P. Levi
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | | | | | - Eric B. Larson
- Department of Medicine, University of Washington, Seattle, WA 98104
| | | | | | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Ed S. Lein
- Allen Institute for Brain Science, Seattle, WA, 98109
| |
Collapse
|
13
|
Latimer CS, Melief EJ, Ariza-Torres J, Howard K, Keen AR, Keene LM, Schantz AM, Sytsma TM, Wilson AM, Grabowski TJ, Darvas M, O'Connor KD, Nolan AL, Edlow BL, Mac Donald CL, Keene CD. Protocol for the Systematic Fixation, Circuit-Based Sampling, and Qualitative and Quantitative Neuropathological Analysis of Human Brain Tissue. Methods Mol Biol 2023; 2561:3-30. [PMID: 36399262 DOI: 10.1007/978-1-0716-2655-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Human brain tissue has long been a critical resource for neuroanatomy and neuropathology, but with the advent of advanced imaging and molecular sequencing techniques, it has become possible to use human brain tissue to study, in great detail, the structural, molecular, and even functional underpinnings of human brain disease. In the century following the first description of Alzheimer's disease (AD), numerous technological advances applied to human tissue have enabled novel diagnostic approaches using diverse physical and molecular biomarkers, and many drug therapies have been tested in clinical trials (Schachter and Davis, Dialogues Clin Neurosci 2:91-100, 2000). The methods for brain procurement and tissue stabilization have remained somewhat consistently focused on formalin fixation and freezing. Although these methods have enabled research protocols of multiple modalities, new, more advanced technologies demand improved methodologies for the procurement, characterization, stabilization, and preparation of both normal and diseased human brain tissues. Here, we describe our current protocols for the procurement and characterization of fixed brain tissue, to enable systematic and precisely targeted diagnoses, and describe the novel, quantitative molecular, and neuroanatomical studies that broadly expand the use of formalin-fixed, paraffin-embedded (FFPE) tissue that will further our understanding of the mechanisms underlying human neuropathologies.
Collapse
Affiliation(s)
- Caitlin S Latimer
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Erica J Melief
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Jeanelle Ariza-Torres
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Kim Howard
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Amanda R Keen
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Lisa M Keene
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Aimee M Schantz
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Trevor M Sytsma
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Angela M Wilson
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | | | - Martin Darvas
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | | | - Amber L Nolan
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Brian L Edlow
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | | | - C Dirk Keene
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA.
| |
Collapse
|
14
|
Kulbe JR, Jain S, Nelson LD, Korley FK, Mukherjee P, Sun X, Okonkwo DO, Giacino JT, Vassar MJ, Robertson CS, McCrea MA, Wang KKW, Temkin N, Mac Donald CL, Taylor SR, Ferguson AR, Markowitz AJ, Diaz-Arrastia R, Manley GT, Stein MB. Association of day-of-injury plasma glial fibrillary acidic protein concentration and six-month posttraumatic stress disorder in patients with mild traumatic brain injury. Neuropsychopharmacology 2022; 47:2300-2308. [PMID: 35717463 PMCID: PMC9630517 DOI: 10.1038/s41386-022-01359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
Several proteins have proven useful as blood-based biomarkers to assist in evaluation and management of traumatic brain injury (TBI). The objective of this study was to determine whether two day-of-injury blood-based biomarkers are predictive of posttraumatic stress disorder (PTSD). We used data from 1143 individuals with mild TBI (mTBI; defined as admission Glasgow Coma Scale [GCS] score 13-15) enrolled in TRACK-TBI, a prospective longitudinal study of level 1 trauma center patients. Plasma glial fibrillary acidic protein (GFAP) and serum high sensitivity C-reactive protein (hsCRP) were measured from blood collected within 24 h of injury. Two hundred and twenty-seven (19.9% of) patients had probable PTSD (PCL-5 score ≥ 33) at 6 months post-injury. GFAP levels were positively associated (Spearman's rho = 0.35, p < 0.001) with duration of posttraumatic amnesia (PTA). There was an inverse association between PTSD and (log)GFAP (adjusted OR = 0.85, 95% CI 0.77-0.95 per log unit increase) levels, but no significant association with (log)hsCRP (adjusted OR = 1.11, 95% CI 0.98-1.25 per log unit increase) levels. Elevated day-of-injury plasma GFAP, a biomarker of glial reactivity, is associated with reduced risk of PTSD after mTBI. This finding merits replication and additional studies to determine a possible neurocognitive basis for this relationship.
Collapse
Affiliation(s)
- Jacqueline R. Kulbe
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
| | - Sonia Jain
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Lindsay D. Nelson
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Frederick K. Korley
- grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA
| | - Pratik Mukherjee
- grid.266102.10000 0001 2297 6811Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Bioengineering & Therapeutic Sciences, UCSF, San Francisco, CA USA
| | - Xiaoying Sun
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - David O. Okonkwo
- grid.412689.00000 0001 0650 7433Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Joseph T. Giacino
- grid.38142.3c000000041936754XDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA ,grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Mary J. Vassar
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Claudia S. Robertson
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Michael A. McCrea
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Kevin K. W. Wang
- grid.15276.370000 0004 1936 8091Department of Emergency Medicine, University of Florida, Gainesville, FL USA
| | - Nancy Temkin
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Christine L. Mac Donald
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Sabrina R. Taylor
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Adam R. Ferguson
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Amy J. Markowitz
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Ramon Diaz-Arrastia
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Geoffrey T. Manley
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Murray B. Stein
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242School of Public Health, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VA San Diego Healthcare System, San Diego, CA USA
| | | |
Collapse
|
15
|
Palacios EM, Yuh EL, Mac Donald CL, Bourla I, Wren-Jarvis J, Sun X, Vassar MJ, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Robertson CS, Stein MB, Temkin N, McCrea MA, Levin HS, Markowitz AJ, Jain S, Manley GT, Mukherjee P. Diffusion Tensor Imaging Reveals Elevated Diffusivity of White Matter Microstructure that Is Independently Associated with Long-Term Outcome after Mild Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2022; 39:1318-1328. [PMID: 35579949 PMCID: PMC9529303 DOI: 10.1089/neu.2021.0408] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Diffusion tensor imaging (DTI) literature on single-center studies contains conflicting results regarding acute effects of mild traumatic brain injury (mTBI) on white matter (WM) microstructure and the prognostic significance. This larger-scale multi-center DTI study aimed to determine how acute mTBI affects WM microstructure over time and how early WM changes affect long-term outcome. From Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI), a cohort study at 11 United States level 1 trauma centers, a total of 391 patients with acute mTBI ages 17 to 60 years were included and studied at two weeks and six months post-injury. Demographically matched friends or family of the participants were the control group (n = 148). Axial diffusivity (AD), fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) were the measures of WM microstructure. The primary outcome was the Glasgow Outcome Scale Extended (GOSE) score of injury-related functional limitations across broad life domains at six months post-injury. The AD, MD, and RD were higher and FA was lower in mTBI versus friend control (FC) at both two weeks and six months post-injury throughout most major WM tracts of the cerebral hemispheres. In the mTBI group, AD and, to a lesser extent, MD decreased in WM from two weeks to six months post-injury. At two weeks post-injury, global WM AD and MD were both independently associated with six-month incomplete recovery (GOSE <8 vs = 8) even after accounting for demographic, clinical, and other imaging factors. DTI provides reliable imaging biomarkers of dynamic WM microstructural changes after mTBI that have utility for patient selection and treatment response in clinical trials. Continued technological advances in the sensitivity, specificity, and precision of diffusion magnetic resonance imaging hold promise for routine clinical application in mTBI.
Collapse
Affiliation(s)
- Eva M. Palacios
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | | | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Mary J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Murray B. Stein
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael A. McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harvey S. Levin
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, California, USA
| |
Collapse
|
16
|
Robinson EM, Sivakanthan S, Durfy S, Rivara FP, Chrisman S, Mac Donald CL. A Comparative Analysis of Depressive Symptoms Following Sports-Related Concussion in Youth Athletes Versus Their Age-Matched Non-concussed Counterparts. Cureus 2022; 14:e28549. [PMID: 36185860 PMCID: PMC9519058 DOI: 10.7759/cureus.28549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Athletics is the leading cause of pediatric concussion, and depression is a major comorbidity associated with concussion in the pediatric population. Prior studies have described the risk of depression after concussion in high school-, collegiate-, and elite-level athletes, but there is scarce data on younger athletes. Interpretation of existing research on the association of depression with concussions in youth athletes is complicated by diverse study designs, varying measures of depression, differing timelines for symptom development, and a lack of control groups. Furthermore, limited research exists on sex-related differences in the development of depressive symptoms following sports-related concussions (SRC) in younger athletes. This study used the Seattle Pediatric Concussion Research Collaborative (SPCRC) Data Repository to compare depressive symptoms between youth athletes at one month post-SRC and non-concussed age-matched controls by using a standardized measure of depressive symptoms: the Patient Health Questionnaire-9 (PHQ-9). The secondary goal was to compare PHQ-9 scores between males and females for both concussed and non-concussed groups. Methods This study entailed a secondary analysis of data collected as part of the SPCRC Data Repository. We conducted a retrospective subgroup analysis of PHQ-9 scores at one month post-concussion for concussed youth athletes. We compared the PHQ9 scores of concussed youth athletes with PHQ-9 scores collected at the time of enrollment for non-concussed youth athletes. Results After random age-matching, a cohort of 266 patients (133 in the concussed group and 133 in the non-concussed control group) was included in the final analysis. The mean age was 13.8 years (range: 5-18 years). For the concussed group, a history of SRC was associated with a higher mean total PHQ-9 score at one month post-concussion compared with the control group at the time of enrollment (6.14 ±5.46 versus 1.53 ±1.81, respectively, p<0.0001). All nine subdomains of the PHQ-9 showed significantly higher scores in the concussion group compared with the control group (p<0.0001). Significantly higher scores were observed when comparing mean total PHQ-9 scores for male athletes in the concussion group with male athletes in the control group (7.03 ±5.72 versus 1.59 ±1.66, p<0.0001) and for female athletes in the concussion group compared with female controls (5.28 ±5.10 versus 1.49 ±1.92, p<0.0001). No significant differences were observed between sexes for total PHQ-9 scores or PHQ-9 subscores. Conclusion At one month post concussion, youth with SRC demonstrated higher levels of depressive symptoms as measured by PHQ-9 compared with age-matched typically developing controls. No significant differences were identified in total PHQ-9 scores and subscores between male and female participants for either the concussion or control group. This study suggests that clinicians need to be vigilant and monitor for symptoms of depression in young athletes for at least one month post-concussion.
Collapse
|
17
|
Edlow BL, Bodien YG, Baxter T, Belanger H, Cali R, Deary K, Fischl B, Foulkes AS, Gilmore N, Greve DN, Hooker JM, Huang SY, Kelemen JN, Kimberly WT, Maffei C, Masood M, Perl D, Polimeni JR, Rosen BR, Tromly S, Tseng CEJ, Yao EF, Zurcher NR, Mac Donald CL, Dams-O'Connor K. Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol. J Neurotrauma 2022; 39:1391-1407. [PMID: 35620901 PMCID: PMC9529318 DOI: 10.1089/neu.2022.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/30/2022] Open
Abstract
Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.
Collapse
Affiliation(s)
- Brian L Edlow
- Harvard Medical School, 1811, 175 Cambridge Street - Suite 300, Boston, Massachusetts, United States, 02115.,Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Yelena G Bodien
- Massachusetts General Hospital, 2348, Department of Neurology, 101 Merrimac, Boston, Massachusetts, United States, 02114;
| | - Timothy Baxter
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Heather Belanger
- University of South Florida, 7831, Department of Psychiatry and Behavioral Neurosciences, Tampa, Florida, United States;
| | - Ryan Cali
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Katryna Deary
- Navy SEAL Foundation, Virginia Beach, Virginia, United States;
| | - Bruce Fischl
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Room 2301, 149 13th Street, Charlestown, Massachusetts, United States, 02129-2020.,Massachusetts General Hospital;
| | - Andrea S Foulkes
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Natalie Gilmore
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Douglas N Greve
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jacob M Hooker
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Susie Y Huang
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jessica N Kelemen
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - W Taylor Kimberly
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Chiara Maffei
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Maryam Masood
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Daniel Perl
- Uniformed Services University of the Health Sciences, 1685, Pathology, 4301 Jones Bridge Road, Room B3138, Bethesda, Maryland, United States, 20814;
| | - Jonathan R Polimeni
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Bruce R Rosen
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States;
| | - Samantha Tromly
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Chieh-En J Tseng
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Eveline F Yao
- United States Special Operations Command, Office of the Surgeon General, MacDill Air Force Base, United States;
| | - Nicole R Zurcher
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Christine L Mac Donald
- University of Washington, 7284, Department of Neurological Surgery, Seattle, Washington, United States;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
| |
Collapse
|
18
|
Barkley AS, Sullivan LT, Gibson AW, Zalewski K, Mac Donald CL, Barber JK, Hakimian S, Ko AL, Ojemann JG, Hauptman JS. Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy. Neurosurgery 2022; 91:347-354. [PMID: 35506941 DOI: 10.1227/neu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables. OBJECTIVE To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year. METHODS A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively. RESULTS Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class (P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors. CONCLUSION APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
Collapse
Affiliation(s)
- Ariana S Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Liam T Sullivan
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| |
Collapse
|
19
|
Abstract
OBJECTIVE To examine global disability trajectories in US military with and without traumatic brain injury (TBI) over the first decade following deployment to identify risk profiles for better intervention stratification, hopefully reducing long-term cost. SETTING Patients and participants were enrolled in combat or directly following medical evacuation at the time of injury and followed up every 6 months for 10 years. PARTICIPANTS There are 4 main groups (n = 475), 2 primary and 2 exploratory: (1) combat-deployed controls without a history of blast exposure "non-blast- control" (n = 143), (2) concussive blast TBI "'blast-TBI" (n = 236) (primary), (3) combat-deployed controls with a history of blast exposure "blast-control" (n = 54), and (4) patients sustaining a combat concussion not from blast "non-blast-TBI" (n = 42) (exploratory). DESIGN Prospective, observational, longitudinal study. MAIN MEASURES Combat concussion, blast exposure, and subsequent head injury exposure over the first decade post-deployment. Global disability measured by the Glasgow Outcome Scale Extended (GOSE). RESULTS Latent class growth analysis identified 4 main trajectories of global outcome, with service members sustaining combat concussion 37 to 49 times more likely to be in the worse disability trajectories than non-blast-controls (blast-TBI: odds ratio [OR] = 49.33; CI, 19.77-123.11; P < .001; non-blast-TBI: OR = 37.50; CI, 10.01-140.50; P < .001). Even blast-exposed-controls were 5 times more likely to be in these worse disability categories compared with non-blast-controls (OR = 5.00; CI, 1.59-15.99; P = .007). Adjustment for demographic factors and subsequent head injury exposure did not substantially alter these odds ratios. CONCLUSIONS Very high odds of poor long-term outcome trajectory were identified for those who sustained a concussion in combat, were younger at the time of injury, had lower education, and enlisted in the Army above the risk of deployment alone. These findings help identify a risk profile that could be used to target early intervention and screen for poor long-term outcome to aid in reducing the high public health cost and enhance the long-term quality of life for these service members following deployment.
Collapse
Affiliation(s)
- Christine L Mac Donald
- University of Washington School of Medicine, Seattle (Drs Donald and Temkin, Mr Barber, and Ms Patterson); and Washington University, Saint Louis, Missouri (Ms Johnson)
| | | | | | | | | |
Collapse
|
20
|
Rincon SP, Mukherjee P, Levin HS, Temkin NR, Mac Donald CL, Krainak DM, Sun X, Jain S, Taylor SR, Markowitz AJ, Kumar A, Manley GT, Yuh EL. Interrater Reliability of National Institutes of Health Traumatic Brain Injury Imaging Common Data Elements for Brain Magnetic Resonance Imaging in Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2831-2840. [PMID: 34275326 PMCID: PMC9836673 DOI: 10.1089/neu.2021.0138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH-NINDS) Traumatic Brain Injury (TBI) Imaging Common Data Elements (CDEs) are standardized definitions for pathological intracranial lesions based on their appearance on neuroimaging studies. The NIH-NINDS TBI Imaging CDEs were designed to be as consistent as possible with the U.S. Food and Drug Administration (FDA) definition of biomarkers as "an indicator of normal biological processes, pathogenic processes, or biological responses to an exposure or intervention." However, the FDA qualification process for biomarkers requires proof of reliable biomarker test measurements. We determined the interrater reliability of TBI Imaging CDEs on subacute brain magnetic resonance imaging (MRI) performed on 517 mild TBI patients presenting to 11 U.S. level 1 trauma centers. Three U.S. board-certified neuroradiologists independently evaluated brain MRI performed 2 weeks post-injury for the following CDEs: traumatic axonal injury (TAI), diffuse axonal injury (DAI), and brain contusion. We found very high interrater agreement for brain contusion, with prevalence- and bias-adjusted kappa (PABAK) values for pairs of readers from 0.92 [95% confidence interval, 0.88-0.95] to 0.94 [0.90-0.96]. We found intermediate agreement for TAI and DAI, with PABAK values of 0.74-0.78 [0.70-0.82]. The near-perfect agreement for subacute brain contusion is likely attributable to the high conspicuity and distinctive appearance of these lesions on T1-weighted images. Interrater agreement for TAI and DAI was lower, because signal void in small vascular structures, and artifactual foci of signal void, can be difficult to distinguish from the punctate round or linear areas of slight hemorrhage that are a common hallmark of TAI/DAI on MRI.
Collapse
Affiliation(s)
- Sandra P. Rincon
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Daniel M. Krainak
- U.S. Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Sabrina R. Taylor
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Amy J. Markowitz
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Geoffrey T. Manley
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| |
Collapse
|
21
|
Williams JR, Nieblas-Bedolla E, Feroze A, Young C, Temkin NR, Giacino JT, Okonkwo DO, Manley GT, Barber J, Durfy S, Markowitz AJ, Yuh EL, Mukherjee P, Mac Donald CL. Correction to: Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study. Neurocrit Care 2021; 35:927. [PMID: 34591257 DOI: 10.1007/s12028-021-01356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John R Williams
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | | | - Abdullah Feroze
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christopher Young
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Bldg. 1 Rm 101, Box 0899, San Francisco, CA, 94143, USA
| | - Jason Barber
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Sharon Durfy
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Amy J Markowitz
- Department of Neurological Surgery, Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Bldg. 1 Rm 101, Box 0899, San Francisco, CA, 94143, USA.
| | - Esther L Yuh
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA.
| | | |
Collapse
|
22
|
Williams JR, Nieblas-Bedolla E, Feroze A, Young C, Temkin NR, Giacino JT, Okonkwo DO, Manley GT, Barber J, Durfy S, Markowitz AJ, Yu EL, Mukherjee P, Mac Donald CL. Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study. Neurocrit Care 2021; 35:335-346. [PMID: 34309784 DOI: 10.1007/s12028-021-01263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied. METHODS Patients with brainstem and cerebrum injury (BSI+) were matched by age, sex, and admission Glasgow Coma Scale (GCS) score to patients with cerebrum injuries only. All patients had an interpretable head computed tomography (CT) scan from the first 48 hours after injury and a 6-month Glasgow Outcome Scale Extended (GOSE) score. CT scans were reviewed for brainstem lesions and, when present, characterized by location, size, and type (traumatic axonal injury, contusion, or Duret hemorrhage). Clinical, demographic, and outcome data were then compared between the two groups. RESULTS Mann-Whitney U-tests showed no significant difference in 6-month GOSE scores in patients with BSI+ (mean 2.7) compared with patients with similar but only cerebrum injuries (mean 3.9), although there is a trend (p = 0.10). However, subclassification by brainstem lesion type, traumatic axonal injury (mean 4.0) versus Duret hemorrhage or contusion (mean 1.4), did identify a proportion of BSI+ with significantly less favorable outcome (p = 0.002). The incorporation of brainstem lesion type (traumatic axonal injury vs. contusion/Duret), along with GCS into a multivariate logistic regression model of favorable outcome (GOSE score 4-8) did show a significant contribution to the prognostication of this brainstem injury subgroup (odds ratio 0.08, 95% confidence interval 0.00-0.67, p = 0.01). CONCLUSIONS These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.
Collapse
Affiliation(s)
- John R Williams
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | | | - Abdullah Feroze
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christopher Young
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Bldg. 1 Rm 101, Box 0899, San Francisco, CA, 94143, USA
| | - Jason Barber
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Sharon Durfy
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA
| | - Amy J Markowitz
- Department of Neurological Surgery, Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Avenue, Bldg. 1 Rm 101, Box 0899, San Francisco, CA, 94143, USA.
| | - Esther L Yu
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359924, Seattle, WA, 98104, USA.
| | | |
Collapse
|
23
|
Nolan AL, Petersen C, Iacono D, Mac Donald CL, Mukherjee P, van der Kouwe A, Jain S, Stevens A, Diamond BR, Wang R, Markowitz AJ, Fischl B, Perl DP, Manley GT, Keene CD, Diaz-Arrastia R, Edlow BL. Tractography-Pathology Correlations in Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2021; 38:1620-1631. [PMID: 33412995 PMCID: PMC8165468 DOI: 10.1089/neu.2020.7373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Diffusion tractography magnetic resonance imaging (MRI) can infer changes in network connectivity in patients with traumatic brain injury (TBI), but the pathological substrates of disconnected tracts have not been well defined because of a lack of high-resolution imaging with histopathological validation. We developed an ex vivo MRI protocol to analyze tract terminations at 750-μm isotropic resolution, followed by histopathological evaluation of white matter pathology, and applied these methods to a 60-year-old man who died 26 days after TBI. Analysis of 74 cerebral hemispheric white matter regions revealed a heterogeneous distribution of tract disruptions. Associated histopathology identified variable white matter injury with patchy deposition of amyloid precursor protein (APP), loss of neurofilament-positive axonal processes, myelin dissolution, astrogliosis, microgliosis, and perivascular hemosiderin-laden macrophages. Multiple linear regression revealed that tract disruption strongly correlated with the density of APP-positive axonal swellings and neurofilament loss. Ex vivo diffusion MRI can detect tract disruptions in the human brain that reflect axonal injury.
Collapse
Affiliation(s)
- Amber L. Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Cathrine Petersen
- Neuroscience Graduate Program, University of California San Francisco, San Francisco, California, USA
| | - Diego Iacono
- Department of Pathology, Uniformed Services University (USU), Bethesda, Maryland, USA
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland, USA
- DoD/USU Brain Tissue Repository (BTR) & Neuropathology Core, Uniformed Services University (USU), Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland, USA
- Complex Neurodegenerative Disorders, Motor Neuron Disorders Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | | | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | - Allison Stevens
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bram R. Diamond
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruopeng Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Health Sciences and Technology, Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Daniel P. Perl
- Department of Pathology, Uniformed Services University (USU), Bethesda, Maryland, USA
- DoD/USU Brain Tissue Repository (BTR) & Neuropathology Core, Uniformed Services University (USU), Bethesda, Maryland, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian L. Edlow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Groot C, Risacher SL, Chen JQA, Dicks E, Saykin AJ, Mac Donald CL, Mez J, Trittschuh EH, Mukherjee S, Barkhof F, Scheltens P, van der Flier WM, Ossenkoppele R, Crane PK. Differential trajectories of hypometabolism across cognitively-defined Alzheimer's disease subgroups. Neuroimage Clin 2021; 31:102725. [PMID: 34153688 PMCID: PMC8238088 DOI: 10.1016/j.nicl.2021.102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Cognitive-subgroups can be identified among individuals
with AD dementia. Subgroup-specific patterns and longitudinal trajectories of
hypometabolism observed. Regional hypometabolism matched respective cognitive
profiles of subgroups. Cognitive-classification yields biologically distinct
subgroups.
Disentangling biologically distinct subgroups of Alzheimer’s
disease (AD) may facilitate a deeper understanding of the neurobiology underlying
clinical heterogeneity. We employed longitudinal [18F]FDG-PET
standardized uptake value ratios (SUVRs) to map hypometabolism across
cognitively-defined AD subgroups. Participants were 384 amyloid-positive individuals
with an AD dementia diagnosis from ADNI who had a total of 1028 FDG-scans (mean time
between first and last scan: 1.6 ± 1.8 years). These participants were categorized
into subgroups on the basis of substantial impairment at time of dementia diagnosis
in a specific cognitive domain relative to the average across domains. This approach
resulted in groups of AD-Memory (n = 135), AD-Executive (n = 8), AD-Language
(n = 22), AD-Visuospatial (n = 44), AD-Multiple Domains (n = 15) and AD-No Domains
(for whom no domain showed substantial relative impairment; n = 160). Voxelwise
contrasts against controls revealed that all AD-subgroups showed progressive
hypometabolism compared to controls across temporoparietal regions at time of AD
diagnosis. Voxelwise and regions-of-interest (ROI)-based linear mixed model analyses
revealed there were also subgroup-specific hypometabolism patterns and trajectories.
The AD-Memory group had more pronounced hypometabolism compared to all other groups
in the medial temporal lobe and posterior cingulate, and faster decline in metabolism
in the medial temporal lobe compared to AD-Visuospatial. The AD-Language group had
pronounced lateral temporal hypometabolism compared to all other groups, and the
pattern of metabolism was also more asymmetrical (left < right) than all other
groups. The AD-Visuospatial group had faster decline in metabolism in parietal
regions compared to all other groups, as well as faster decline in the precuneus
compared to AD-Memory and AD-No Domains. Taken together, in addition to a common
pattern, cognitively-defined subgroups of people with AD dementia show
subgroup-specific hypometabolism patterns, as well as differences in trajectories of
metabolism over time. These findings provide support to the notion that
cognitively-defined subgroups are biologically distinct.
Collapse
Affiliation(s)
- Colin Groot
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | | | - J Q Alida Chen
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Ellen Dicks
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Andrew J Saykin
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease Center, Boston University School of Medicine, MA, USA.
| | - Emily H Trittschuh
- Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Geriatric Research, Education, & Clinical Center, Seattle, WA, USA
| | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; University College London, Institutes of Neurology & Healthcare Engineering, London, United Kingdom.
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Lund University, Clinical Memory Research Unit, Lund, Sweden.
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
25
|
Groot C, Grothe MJ, Mukherjee S, Jelistratova I, Jansen I, van Loenhoud AC, Risacher SL, Saykin AJ, Mac Donald CL, Mez J, Trittschuh EH, Gryglewski G, Lanzenberger R, Pijnenburg YAL, Barkhof F, Scheltens P, van der Flier WM, Crane PK, Ossenkoppele R. Differential patterns of gray matter volumes and associated gene expression profiles in cognitively-defined Alzheimer's disease subgroups. Neuroimage Clin 2021; 30:102660. [PMID: 33895633 PMCID: PMC8186562 DOI: 10.1016/j.nicl.2021.102660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
The clinical presentation of Alzheimer's disease (AD) varies widely across individuals but the neurobiological mechanisms underlying this heterogeneity are largely unknown. Here, we compared regional gray matter (GM) volumes and associated gene expression profiles between cognitively-defined subgroups of amyloid-β positive individuals clinically diagnosed with AD dementia (age: 66 ± 7, 47% male, MMSE: 21 ± 5). All participants underwent neuropsychological assessment with tests covering memory, executive-functioning, language and visuospatial-functioning domains. Subgroup classification was achieved using a psychometric framework that assesses which cognitive domain shows substantial relative impairment compared to the intra-individual average across domains, which yielded the following subgroups in our sample; AD-Memory (n = 41), AD-Executive (n = 117), AD-Language (n = 33), AD-Visuospatial (n = 171). We performed voxel-wise contrasts of GM volumes derived from 3Tesla structural MRI between subgroups and controls (n = 127, age 58 ± 9, 42% male, MMSE 29 ± 1), and observed that differences in regional GM volumes compared to controls closely matched the respective cognitive profiles. Specifically, we detected lower medial temporal lobe GM volumes in AD-Memory, lower fronto-parietal GM volumes in AD-Executive, asymmetric GM volumes in the temporal lobe (left < right) in AD-Language, and lower GM volumes in posterior areas in AD-Visuospatial. In order to examine possible biological drivers of these differences in regional GM volumes, we correlated subgroup-specific regional GM volumes to brain-wide gene expression profiles based on a stereotactic characterization of the transcriptional architecture of the human brain as provided by the Allen human brain atlas. Gene-set enrichment analyses revealed that variations in regional expression of genes involved in processes like mitochondrial respiration and metabolism of proteins were associated with patterns of regional GM volume across multiple subgroups. Other gene expression vs GM volume-associations were only detected in particular subgroups, e.g., genes involved in the cell cycle for AD-Memory, specific sets of genes related to protein metabolism in AD-Language, and genes associated with modification of gene expression in AD-Visuospatial. We conclude that cognitively-defined AD subgroups show neurobiological differences, and distinct biological pathways may be involved in the emergence of these differences.
Collapse
Affiliation(s)
- Colin Groot
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain; German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.
| | | | | | - Iris Jansen
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
| | - Anna Catharina van Loenhoud
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Andrew J Saykin
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease Center, Boston University School of Medicine, MA, USA.
| | - Emily H Trittschuh
- Psychiatry & Behavioral Science, University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Health Care System, Geriatric Research, Education, & Clinical Center, Seattle, WA, USA.
| | - Gregor Gryglewski
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Yolande A L Pijnenburg
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; University College London, Institutes of Neurology & Healthcare Engineering, London, United Kingdom.
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; Epidemiology and Biostatistics, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center, Amsterdam University Medical Center - Location VU University Medical Center, Amsterdam, The Netherlands; Lund University, Clinical Memory Research Unit, Lund, Sweden.
| |
Collapse
|
26
|
Edlow BL, Boly M, Chou SHY, Fischer D, Kondziella D, Li LM, Mac Donald CL, McNett M, Newcombe VFJ, Stevens RD, Menon DK. Common Data Elements for COVID-19 Neuroimaging: A GCS-NeuroCOVID Proposal. Neurocrit Care 2021; 34:365-370. [PMID: 33575956 PMCID: PMC7878171 DOI: 10.1007/s12028-021-01192-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge Street - Suite 300, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Melanie Boly
- Departments of Neurology, University of Wisconsin, Madison, WI, USA
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Sherry H-Y Chou
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Safar Center for Resuscitation Research, Pittsburgh, PA, USA
| | - David Fischer
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge Street - Suite 300, Boston, MA, 02114, USA
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lucia M Li
- UK Dementia Research Institute - Centre for Health Care and Technology, Imperial College London, London, UK
| | | | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Virginia F J Newcombe
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital Cambridge, Cambridge, UK
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David K Menon
- University Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital Cambridge, Cambridge, UK
| |
Collapse
|
27
|
Williams JR, Meyer MR, Ricard JA, Sen R, Young CC, Feroze AH, Greil ME, Barros G, Durfy S, Hanak B, Morton RP, Temkin NR, Barber JK, Mac Donald CL, Chesnut RM. Re-examining decompressive craniectomy medial margin distance from midline as a metric for calculating the risk of post-traumatic hydrocephalus. J Clin Neurosci 2021; 87:125-131. [PMID: 33863519 DOI: 10.1016/j.jocn.2021.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Decompressive craniectomy (DC) is a life-saving procedure in severe traumatic brain injury, but is associated with higher rates of post-traumatic hydrocephalus (PTH). The relationship between the medial craniectomy margin's proximity to midline and frequency of developing PTH is controversial. The primary study objective was to determine whether average medial craniectomy margin distance from midline was closer to midline in patients who developed PTH after DC for severe TBI compared to patients that did not. The secondary objective was to determine if a threshold distance from midline could be identified, at which the risk of developing PTH increased if the DC was performed closer to midline than this threshold. A retrospective review was performed of 380 patients undergoing DC at a single institution between March 2004 and November 2014. Clinical, operative and demographic variables were collected, including age, sex, DC parameters and occurrence of PTH. Statistical analysis compared mean axial craniectomy margin distance from midline in patients with versus without PTH. Distances from midline were tested as potential thresholds. No significant difference was identified in mean axial craniectomy margin distance from midline in patients developing PTH compared with patients with no PTH (n = 24, 12.8 mm versus n = 356, 16.6 mm respectively, p = 0.086). No significant cutoff distance from midline was identified (n = 212, p = 0.201). This study, the largest to date, was unable to identify a threshold with sufficient discrimination to support clinical recommendations in terms of DC margins with regard to midline, including thresholds reportedly significant in previously published research.
Collapse
Affiliation(s)
- John R Williams
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA.
| | - Michael R Meyer
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jocelyn A Ricard
- University of Minnesota, 3 Morrill Hall, 100 Church St. S.E, Minneapolis, MN 55455, USA
| | - Rajeev Sen
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christopher C Young
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Loma Linda University Health, 11234 Anderson St., Suite 2562B, Loma Linda, CA 92354, USA
| | - Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Guilherme Barros
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Brian Hanak
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Ryan P Morton
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Randall M Chesnut
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| |
Collapse
|
28
|
Stein MB, Yuh E, Jain S, Okonkwo DO, Mac Donald CL, Levin H, Giacino JT, Dikmen S, Vassar MJ, Diaz-Arrastia R, Robertson CS, Nelson LD, McCrea M, Sun X, Temkin N, Taylor SR, Markowitz AJ, Manley GT, Mukherjee P. Smaller Regional Brain Volumes Predict Posttraumatic Stress Disorder at 3 Months After Mild Traumatic Brain Injury. Biol Psychiatry Cogn Neurosci Neuroimaging 2021; 6:352-359. [PMID: 33386283 PMCID: PMC7946719 DOI: 10.1016/j.bpsc.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Brain volumes in regions such as the hippocampus and amygdala have been associated with risk for the development of posttraumatic stress disorder (PTSD). The objective of this study was to determine whether a set of regional brain volumes, measured by magnetic resonance imaging at 2 weeks following mild traumatic brain injury, were predictive of PTSD at 3 and 6 months after injury. METHODS Using data from TRACK-TBI (Transforming Research and Clinical Knowledge in TBI), we included patients (N = 421) with Glasgow Coma Scale scores 13-15 assessed after evaluation in the emergency department and at 2 weeks, 3 months, and 6 months after injury. Probable PTSD diagnosis (PTSD Checklist for DSM-5 score, ≥33) was the outcome. FreeSurfer 6.0 was used to perform volumetric analysis of three-dimensional T1-weighted magnetic resonance images at 3T obtained 2 weeks post injury. Brain regions selected a priori for volumetric analyses were insula, hippocampus, amygdala, superior frontal cortex, rostral and caudal anterior cingulate, and lateral and medial orbitofrontal cortices. RESULTS Overall, 77 (18.3%) and 70 (16.6%) patients had probable PTSD at 3 and 6 months. A composite volume derived as the first principal component incorporating 73.8% of the variance in insula, superior frontal cortex, and rostral and caudal cingulate contributed to the prediction of 3-month (but not 6-month) PTSD in multivariable models incorporating other established risk factors. CONCLUSIONS Results, while needing replication, provide support for a brain reserve hypothesis of PTSD and proof of principle for how prediction of at-risk individuals might be accomplished to enhance prognostic accuracy and enrich clinical prevention trials for individuals at the highest risk of PTSD following mild traumatic brain injury.
Collapse
Affiliation(s)
- Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California.
| | - Esther Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Harvey Levin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Sureyya Dikmen
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Mary J Vassar
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California; Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California; Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Amy J Markowitz
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California; Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| |
Collapse
|
29
|
Mac Donald CL, Barber J, Patterson J, Johnson AM, Parsey C, Scott B, Fann JR, Temkin NR. Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion. Neurology 2020; 96:e387-e398. [PMID: 33177226 PMCID: PMC7884983 DOI: 10.1212/wnl.0000000000011089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. METHODS This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups: controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. A total of 347 participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey p values calculated for the pairwise comparisons. RESULTS Significant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in neurobehavioral (Neurobehavioral Rating Scale-Revised [NRS]; Cohen d, -1.10 to -1.40, confidence intervals [CIs] [-0.82, -1.32] to [-0.97, -1.83] by group) and psychiatric domains (Clinician-Administered PTSD Scale for DSM-IV [CAPS]; Cohen d, -0.91 to -1.19, CIs [-0.63, -1.19] to [-0.76, -1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1- to 5-year evaluation (66%-76% neurobehavioral NRS; 41%-54% psychiatric CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%-50% neurobehavioral NRS; 9%-25% psychiatric CAPS by group). CONCLUSIONS There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members.
Collapse
Affiliation(s)
- Christine L Mac Donald
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO.
| | - Jason Barber
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Jana Patterson
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Ann M Johnson
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Carolyn Parsey
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Beverly Scott
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Jesse R Fann
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Nancy R Temkin
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
30
|
Diamond BR, Donald CLM, Frau-Pascual A, Snider SB, Fischl B, Dams-O'Connor K, Edlow BL. Optimizing the accuracy of cortical volumetric analysis in traumatic brain injury. MethodsX 2020; 7:100994. [PMID: 32760659 PMCID: PMC7393399 DOI: 10.1016/j.mex.2020.100994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/06/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
Cortical volumetric analysis is widely used to study the anatomic basis of neurological deficits in patients with traumatic brain injury (TBI). However, patients with TBI-related lesions are often excluded from MRI analyses because cortical lesions may compromise the accuracy of reconstructed surfaces upon which volumetric measurements are based. We developed a FreeSurfer-based lesion correction method and tested its impact on cortical volume measures in 87 patients with chronic moderate-to-severe TBI. We reconstructed cortical surfaces from T1-weighted MRI scans, then manually labeled and removed vertices on the cortical surfaces where lesions caused inaccuracies. Next, we measured the surface area of lesion overlap with seven canonical brain networks and the percent volume of each network affected by lesions.The lesion correction method revealed that cortical lesions in patients with TBI are preferentially located in the limbic and default mode networks (95.7% each), with the limbic network also having the largest average surface area (4.4+/−3.7%) and percent volume affected by lesions (12.7+/−9.7%). The method has the potential to improve the accuracy of cortical volumetric measurements and permit inclusion of patients with lesioned brains in MRI analyses. The method also provides new opportunities to elucidate network-based mechanisms of neurological deficits in patients with TBI.
Collapse
Affiliation(s)
- Bram R Diamond
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | | | - Aina Frau-Pascual
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Samuel B Snider
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Harvard-MIT Health Sciences and Technology, Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| |
Collapse
|
31
|
Mac Donald CL, Barber J, Andre J, Panks C, Zalewski K, Temkin N. Longitudinal neuroimaging following combat concussion: sub-acute, 1 year and 5 years post-injury. Brain Commun 2019; 1:fcz031. [PMID: 31915753 PMCID: PMC6935683 DOI: 10.1093/braincomms/fcz031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/03/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 12/25/2022] Open
Abstract
Questions remain regarding the long-term impact of combat concussive blast exposure. While efforts have begun to highlight the clinical impact, less is known about neuroimaging trajectories that may inform underlying pathophysiological changes post-injury. Through collaborative efforts in combat, following medical evacuation, and at universities in the USA, this study followed service members both with and without blast concussion from the sub-acute to 1-year and 5-year outcomes with quantitative neuroimaging. The following two primary and two exploratory groups were examined: combat-deployed controls without blast exposure history ‘non-blast control’ and concussive blast patients (primary) and combat concussion arising not from blast ‘non-blast concussion’ and combat-deployed controls with blast exposure history ‘blast control’ (exploratory). A total of 575 subjects were prospectively enrolled and imaged; 347 subjects completed further neuroimaging examination at 1 year and 342 subjects completed further neuroimaging examination at 5 years post-injury. At each time point, MRI scans were completed that included high-resolution structural as well as diffusion tensor imaging acquisitions processed for quantitative volumetric and diffusion tensor imaging changes. Longitudinal evaluation of the number of abnormal diffusion tensor imaging and volumetric regions in patients with blast concussion revealed distinct trends by imaging modality. While the presence of abnormal volumetric regions remained quite stable comparing our two primary groups of non-blast control to blast concussion, the diffusion tensor imaging abnormalities were observed to have varying trajectories. Most striking was the fractional anisotropy ‘U-shaped’ curve observed for a proportion of those that, if we had only followed them to 1 year, would look like trajectories of recovery. However, by continuing the follow-up to 5 years in these very same patients, a secondary increase in the number of reduced fractional anisotropy regions was identified. Comparing non-blast controls to blast concussion at each time point revealed significant differences in the number of regions with reduced fractional anisotropy at both the sub-acute and 5-year time points, which held after adjustment for age, education, gender, scanner and subsequent head injury exposure followed by correction for multiple comparisons. The secondary increase identified in patients with blast concussion may be the earliest indications of microstructural changes underlying the ‘accelerated brain aging’ theory recently reported from chronic, cross-sectional studies of veterans following brain injury. These varying trajectories also inform potential prognostic neuroimaging biomarkers of progression and recovery.
Collapse
Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Jalal Andre
- Department of Radiology, University of Washington, Seattle, WA 98104, USA
| | - Chris Panks
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA.,Department of Biostatistics, University of Washington, Seattle, WA 98104, USA
| |
Collapse
|
32
|
Stein MB, Jain S, Giacino JT, Levin H, Dikmen S, Nelson LD, Vassar MJ, Okonkwo DO, Diaz-Arrastia R, Robertson CS, Mukherjee P, McCrea M, Mac Donald CL, Yue JK, Yuh E, Sun X, Campbell-Sills L, Temkin N, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Diaz-Arrastia R, Dikmen S, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson A, Foreman B, Gardner R, Gaudette E, Giacino JT, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Korley F, Kramer J, Kreitzer N, Levin H, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, McCrea M, Merchant R, Mukherjee P, Nelson LD, Noel F, Okonkwo DO, Palacios E, Perl D, Puccio A, Rabinowitz M, Robertson CS, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Stein MB, Taylor S, Toga A, Temkin N, Valadka A, Vassar MJ, Vespa P, Wang K, Yue JK, Yuh E, Zafonte R. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry 2019; 76:249-258. [PMID: 30698636 PMCID: PMC6439818 DOI: 10.1001/jamapsychiatry.2018.4288] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [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: 01/09/2023]
Abstract
IMPORTANCE Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. OBJECTIVE To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. MAIN OUTCOMES AND MEASURES Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. RESULTS Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. CONCLUSIONS AND RELEVANCE After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.
Collapse
Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla,Department of Family Medicine & Public Health, University of California San Diego, La Jolla,VA San Diego Healthcare System, San Diego, California
| | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Lindsay D. Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Mary J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Claudia S. Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | | | - John K. Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Radiology & Biomedical Imaging, University of California, San Francisco,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Xiaoying Sun
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | | | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle,Department of Biostatistics, University of Washington, Seattle
| | - Geoffrey T. Manley
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California,Department of Neurological Surgery, University of California, San Francisco
| | | | | | | | - Kim Boase
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | | | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | | | - V Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond
| | - Adam Ferguson
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Raquel Gardner
- Department of Neurology, University of California, San Francisco
| | | | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Sonia Jain
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | - Joel Kramer
- Department of Neurology, University of California, San Francisco
| | | | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Chris Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Alastair Martin
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Randall Merchant
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond
| | - Pratik Mukherjee
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee
| | - Florence Noel
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eva Palacios
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miri Rabinowitz
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Claudia S Robertson
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - Angelle Sander
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gabriela Satris
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - David Schnyer
- Department of Psychology, University of Texas at Austin, Austin
| | | | | | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla.,Department of Family Medicine & Public Health, University of California San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
| | - Sabrina Taylor
- Department of Neurological Surgery, University of California, San Francisco
| | - Arthur Toga
- University of Southern California, Los Angeles
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle.,Department of Biostatistics, University of Washington, Seattle
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Mary J Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Paul Vespa
- Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles
| | - Kevin Wang
- Department of Psychiatry, University of Florida, Gainesville
| | - John K Yue
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther Yuh
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.,Department of Radiology & Biomedical Imaging, University of California, San Francisco.,Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
33
|
Mac Donald CL, Fann JR, Temkin NR. Mild Traumatic Brain Injury and Mental Health-Reply. JAMA Neurol 2019; 74:1378. [PMID: 29049812 DOI: 10.1001/jamaneurol.2017.2771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jesse R Fann
- University of Washington School of Medicine, Seattle
| | | |
Collapse
|
34
|
Mac Donald CL, Barber J, Wright J, Coppel D, De Lacy N, Ottinger S, Peck S, Panks C, Sun S, Zalewski K, Temkin N. Longitudinal Clinical and Neuroimaging Evaluation of Symptomatic Concussion in 10- to 14-Year-Old Youth Athletes. J Neurotrauma 2019; 36:264-274. [DOI: 10.1089/neu.2018.5629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Christine L. Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, Washington
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Jason Wright
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - David Coppel
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Nina De Lacy
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Steve Ottinger
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Suzanne Peck
- Seattle Children's Research Institute, Seattle, Washington
| | - Chris Panks
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Samantha Sun
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| |
Collapse
|
35
|
Mac Donald CL, Barber J, Patterson J, Johnson AM, Dikmen S, Fann JR, Temkin N. Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat. JAMA Netw Open 2019; 2:e186676. [PMID: 30646193 PMCID: PMC6324322 DOI: 10.1001/jamanetworkopen.2018.6676] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although previous work has examined clinical outcomes in combat-deployed veterans, questions remain regarding how symptoms evolve or resolve following mild blast traumatic brain injury (TBI) treated in theater and their association with long-term outcomes. OBJECTIVE To characterize 5-year outcome in patients with nonmedically evacuated blast concussion compared with combat-deployed controls and understand what clinical measures collected acutely in theater are associated with 5-year outcome. DESIGN, SETTING, AND PARTICIPANTS A prospective, longitudinal cohort study including 45 service members with mild blast TBI within 7 days of injury (mean 4 days) and 45 combat deployed nonconcussed controls was carried out. Enrollment occurred in Afghanistan at the point of injury with evaluation of 5-year outcome in the United States. The enrollment occurred from March to September 2012 with 5-year follow up completed from April 2017 to May 2018. Data analysis was completed from June to July 2018. EXPOSURES Concussive blast TBI. All patients were treated in theater, and none required medical evacuation. MAIN OUTCOMES AND MEASURES Clinical measures collected in theater included measures for concussion symptoms, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, balance performance, combat exposure intensity, cognitive performance, and demographics. Five-year outcome evaluation included measures for global disability, neurobehavioral impairment, PTSD symptoms, depression symptoms, and 10 domains of cognitive function. Forward selection multivariate regression was used to determine predictors of 5-year outcome for global disability, neurobehavior impairment, PTSD, and cognitive function. RESULTS Nonmedically evacuated patients with concussive blast injury (n = 45; 44 men, mean [SD] age, 31 [5] years) fared poorly at 5-year follow-up compared with combat-deployed controls (n = 45; 35 men; mean [SD] age, 34 [7] years) on global disability, neurobehavioral impairment, and psychiatric symptoms, whereas cognitive changes were unremarkable. Acute predictors of 5-year outcome consistently identified TBI diagnosis with contribution from acute concussion and mental health symptoms and select measures of cognitive performance depending on the model for 5-year global disability (area under the curve following bootstrap validation [AUCBV] = 0.79), neurobehavioral impairment (correlation following bootstrap validation [RBV] = 0.60), PTSD severity (RBV = 0.36), or cognitive performance (RBV = 0.34). CONCLUSIONS AND RELEVANCE Service members with concussive blast injuries fared poorly at 5-year outcome. The results support a more focused acute screening of mental health following TBI diagnosis as strong indicators of poor long-term outcome. This extends prior work examining outcome in patients with concussive blast injury to the larger nonmedically evacuated population.
Collapse
Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Jana Patterson
- Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University, Saint Louis Missouri
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R. Fann
- Department of Psychiatry, University of Washington, Seattle
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| |
Collapse
|
36
|
Edlow BL, Keene CD, Perl DP, Iacono D, Folkerth RD, Stewart W, Mac Donald CL, Augustinack J, Diaz-Arrastia R, Estrada C, Flannery E, Gordon WA, Grabowski TJ, Hansen K, Hoffman J, Kroenke C, Larson EB, Lee P, Mareyam A, McNab JA, McPhee J, Moreau AL, Renz A, Richmire K, Stevens A, Tang CY, Tirrell LS, Trittschuh EH, van der Kouwe A, Varjabedian A, Wald LL, Wu O, Yendiki A, Young L, Zöllei L, Fischl B, Crane PK, Dams-O'Connor K. Multimodal Characterization of the Late Effects of Traumatic Brain Injury: A Methodological Overview of the Late Effects of Traumatic Brain Injury Project. J Neurotrauma 2018; 35:1604-1619. [PMID: 29421973 DOI: 10.1089/neu.2017.5457] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Epidemiological studies suggest that a single moderate-to-severe traumatic brain injury (TBI) is associated with an increased risk of neurodegenerative disease, including Alzheimer's disease (AD) and Parkinson's disease (PD). Histopathological studies describe complex neurodegenerative pathologies in individuals exposed to single moderate-to-severe TBI or repetitive mild TBI, including chronic traumatic encephalopathy (CTE). However, the clinicopathological links between TBI and post-traumatic neurodegenerative diseases such as AD, PD, and CTE remain poorly understood. Here, we describe the methodology of the Late Effects of TBI (LETBI) study, whose goals are to characterize chronic post-traumatic neuropathology and to identify in vivo biomarkers of post-traumatic neurodegeneration. LETBI participants undergo extensive clinical evaluation using National Institutes of Health TBI Common Data Elements, proteomic and genomic analysis, structural and functional magnetic resonance imaging (MRI), and prospective consent for brain donation. Selected brain specimens undergo ultra-high resolution ex vivo MRI and histopathological evaluation including whole-mount analysis. Co-registration of ex vivo and in vivo MRI data enables identification of ex vivo lesions that were present during life. In vivo signatures of postmortem pathology are then correlated with cognitive and behavioral data to characterize the clinical phenotype(s) associated with pathological brain lesions. We illustrate the study methods and demonstrate proof of concept for this approach by reporting results from the first LETBI participant, who despite the presence of multiple in vivo and ex vivo pathoanatomic lesions had normal cognition and was functionally independent until her mid-80s. The LETBI project represents a multidisciplinary effort to characterize post-traumatic neuropathology and identify in vivo signatures of postmortem pathology in a prospective study.
Collapse
Affiliation(s)
- Brian L Edlow
- 1 Department of Neurology, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.,2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - C Dirk Keene
- 3 Department of Pathology, University of Washington , Seattle, Washington
| | - Daniel P Perl
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Department of Pathology, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Diego Iacono
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Department of Pathology, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,6 Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,7 The Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland
| | - Rebecca D Folkerth
- 8 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.,9 City of New York Office of the Chief Medical Examiner and New York University School of Medicine , New York, New York
| | - William Stewart
- 10 Department of Neuropathology, Queen Elizabeth University Hospital and Institute of Neuroscience and Psychology, University of Glasgow , United Kingdom
| | | | - Jean Augustinack
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ramon Diaz-Arrastia
- 12 Department of Neurology and Center for Brain Injury and Repair, Hospital of the University of Pennsylvania , Philadelphia
| | - Camilo Estrada
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Elissa Flannery
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Wayne A Gordon
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Thomas J Grabowski
- 15 Department of Neurology, University of Washington , Seattle, Washington.,16 Department of Radiology, University of Washington , Seattle, Washington
| | - Kelly Hansen
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Jeanne Hoffman
- 17 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Christopher Kroenke
- 18 Advanced Imaging Research Center, Oregon Health and Science University , Portland, Oregon
| | - Eric B Larson
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Patricia Lee
- 4 Brain Tissue Repository and Neuropathology Core, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,7 The Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, Maryland
| | - Azma Mareyam
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Jennifer A McNab
- 19 Department of Radiology, Stanford University , Stanford, California
| | - Jeanne McPhee
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Allison L Moreau
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Anne Renz
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - KatieRose Richmire
- 13 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Allison Stevens
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Cheuk Y Tang
- 20 Department of Radiology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Lee S Tirrell
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Emily H Trittschuh
- 21 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,22 Geriatric Research Education and Clinical Center , VA Puget Sound Health Care System, Seattle, Washington
| | - Andre van der Kouwe
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ani Varjabedian
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Lawrence L Wald
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Ona Wu
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Anastasia Yendiki
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Liza Young
- 16 Department of Radiology, University of Washington , Seattle, Washington
| | - Lilla Zöllei
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Bruce Fischl
- 2 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School , Charlestown, Massachusetts
| | - Paul K Crane
- 23 Department of Medicine, University of Washington , Seattle, Washington
| | - Kristen Dams-O'Connor
- 14 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,24 Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, New York
| |
Collapse
|
37
|
Keene CD, Latimer CS, Steele LM, Mac Donald CL. First confirmed case of chronic traumatic encephalopathy in a professional bull rider. Acta Neuropathol 2018; 135:303-305. [PMID: 29285625 PMCID: PMC5773642 DOI: 10.1007/s00401-017-1801-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 11/09/2022]
|
38
|
Bonow RH, Friedman SD, Perez FA, Ellenbogen RG, Browd SR, Mac Donald CL, Vavilala MS, Rivara FP. Prevalence of Abnormal Magnetic Resonance Imaging Findings in Children with Persistent Symptoms after Pediatric Sports-Related Concussion. J Neurotrauma 2017; 34:2706-2712. [PMID: 28490224 DOI: 10.1089/neu.2017.4970] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographical studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal computed tomographies or MRI scans ordered for reasons other than concussion were excluded. Among 3338 children identified with concussion, 427 underwent MRI. Only 2 (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The 2 patients with microhemorrhage each had three previous concussions, significantly more than patients whose scans were normal (median, 1) or abnormal without injury (median, 1.5; p = 0.048). MRI rarely revealed intracranial injuries in children post-concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.
Collapse
Affiliation(s)
- Robert H Bonow
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Seth D Friedman
- 3 Radiology Clinical Research Imaging Core, Center for Clinical and Translational Research , Seattle Children's Hospital, Seattle, Washington
| | - Francisco A Perez
- 4 Department of Radiology, Seattle Children's Hospital, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Richard G Ellenbogen
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Samuel R Browd
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Christine L Mac Donald
- 2 Department of Neurological Surgery, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| | - Monica S Vavilala
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,5 Department of Anesthesia & Pain Medicine, Harborview Medical Center, University of Washington , Seattle, Washington
| | - Frederick P Rivara
- 1 Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington , Seattle, Washington.,6 Department of Pediatrics, Seattle Children's Hospital, University of Washington , and Seattle Children's Hospital, Seattle, Washington
| |
Collapse
|
39
|
Mac Donald CL, Barber J, Jordan M, Johnson AM, Dikmen S, Fann JR, Temkin N. Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury. JAMA Neurol 2017; 74:821-829. [PMID: 28459953 PMCID: PMC5732492 DOI: 10.1001/jamaneurol.2017.0143] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden. Objectives To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. Design, Setting, and Participants This prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One- and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. Main Outcomes and Measures Changes in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1- to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. Results Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34 [8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended Glasgow Outcome Scale (GOS-E) at 5 years as a measure of overall disability identified brain injury diagnosis, preinjury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity at 1 year as risk factors for a poor outcome at 5 years, with an area under the curve of 0.92 indicating excellent prediction strength. Thirty-six of 50 patients with concussive blast TBI (72%) had a decline in the GOS-E from the 1- to 5-year evaluations, in contrast with only 5 of 44 combat-deployed controls (11%). Worsening of symptoms in concussive blast TBI was also observed on measures of posttraumatic stress disorder and depression. Service members with concussive blast TBI experienced evolution, not resolution, of symptoms from the 1- to 5-year outcomes. Conclusions and Relevance Considerable decline was observed in military service members with concussive blast TBI when comparing 1- and 5-year clinical outcomes. These results advocate for new treatment strategies to combat the long-term and extremely costly effect of these wartime injuries.
Collapse
Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Mary Jordan
- Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M Johnson
- Center for Clinical Studies, Washington University, St Louis, Missouri
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R Fann
- Department of Psychiatry, University of Washington, Seattle
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle
| |
Collapse
|
40
|
Manley GT, Mac Donald CL, Markowitz AJ, Stephenson D, Robbins A, Gardner RC, Winkler E, Bodien YG, Taylor SR, Yue JK, Kannan L, Kumar A, McCrea MA, Wang KK. The Traumatic Brain Injury Endpoints Development (TED) Initiative: Progress on a Public-Private Regulatory Collaboration To Accelerate Diagnosis and Treatment of Traumatic Brain Injury. J Neurotrauma 2017; 34:2721-2730. [PMID: 28363253 DOI: 10.1089/neu.2016.4729] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Traumatic Brain Injury Endpoints Development (TED) Initiative is a 5-year, Department of Defense-funded project that is working toward the ultimate goal of developing better designed clinical trials, leading to more precise diagnosis, and effective treatments for traumatic brain injury (TBI). TED is comprised of leading academic clinician-scientists, along with innovative industry leaders in biotechnology and imaging technology, patient advocacy organizations, and philanthropists, working collaboratively with regulatory authorities, specifically the U.S. Food and Drug Administration (FDA). The goals of the TED Initiative are to gain consensus and validation of TBI clinical outcome assessment measures and biomarkers for endorsement by global regulatory agencies for use in drug and device development processes. This article summarizes the Initiative's Stage I progress over the first 18 months, including intensive engagement with a number of FDA divisions responsible for review and validation of biomarkers and clinical outcome assessments, progression into the prequalification phase of the FDA's Medical Device Development Tool program for a candidate set of neuroimaging biomarkers, and receipt of the FDA's Recognition of Research Importance Letter and a Letter of Support regarding TBI. Other signal achievements relate to the creation of the TED Metadataset, harmonizing study measures across eight major TBI studies, and the leadership role played by TED investigators in the conversion of the NINDS TBI Common Data Elements to Clinical Data Interchange Standards Consortium standards. This article frames both the near-term expectations and the Initiative's long-term vision to accelerate approval of treatments for patients affected by TBI in urgent need of effective therapies.
Collapse
Affiliation(s)
- Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California
| | | | - Amy J Markowitz
- Department of Neurological Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California
| | | | | | - Raquel C Gardner
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Ethan Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California
| | - Lakshmi Kannan
- Emergency Preparedness/Operations and Medical Countermeasures Program, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin K Wang
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Department of Psychiatry, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | | |
Collapse
|
41
|
Mac Donald CL, Barber J, Andre J, Evans N, Panks C, Sun S, Zalewski K, Elizabeth Sanders R, Temkin N. 5-Year imaging sequelae of concussive blast injury and relation to early clinical outcome. Neuroimage Clin 2017; 14:371-378. [PMID: 28243574 PMCID: PMC5320067 DOI: 10.1016/j.nicl.2017.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/27/2022]
Abstract
Current imaging diagnostic techniques are often insensitive to the underlying pathological changes following mild traumatic brain injury (TBI) or concussion so much so that the explicit definition of these uncomplicated mild brain injuries includes the absence of radiological findings. In the US military, this is complicated by the natural tendency of service members to down play symptoms for fear of removal from their unit particularly in combat making it challenging for clinicians to definitively diagnose and determine course of treatment. Questions remain regarding the long-term impact of these war-time brain injuries. The objective of the current study was to evaluate the long-term imaging sequelae of blast concussion in active-duty US military and leverage previous longitudinal data collected in these same patients to identify predictors of sustained DTI signal change indicative of chronic neurodegeneration. In total, 50 blast TBI and 44 combat-deployed controls were evaluated at this 5-year follow up by advanced neuroimaging techniques including diffusion tensor imaging and quantitative volumetry. While cross-sectional analysis of regions of white matter on DTI images did not reveal significant differences across groups after statistical correction, an approach flexible to the heterogeneity of brain injury at the single-subject level identified 74% of the concussive blast TBI cohort to have reductions in fractional anisotropy indicative of chronic brain injury. Logistic regression leveraging clinical and demographic data collected in the acute/sub-acute and 1-year follow up to determine predictors of these long-term imaging changes determined that brain injury diagnosis, older age, verbal memory and verbal fluency best predicted the presence of DTI abnormalities 5 years post injury with an AUC of 0.78 indicating good prediction strength. These results provide supporting evidence for the evolution not resolution of this brain injury pathology, adding to the growing body of literature describing imaging signatures of chronic neurodegeneration even after mild TBI and concussion. Design: prospective, observational, longitudinal research study Patients: concussive blast (n = 50), combat-deployed control (n = 44) Diffusion tensor imaging analyzed 5 yr post-injury, highly predicted by 1 yr outcomes. Imaging abnormalities appear to evolve from sub-acute, to 1-year, to 5-year scan. Findings indicate chronic neurodegeneration in majority of blast concussion patients.
Collapse
Key Words
- A-P, anterior–posterior
- Concussion
- DR-BUDDI, Diffeomorphic Registration for Blip-Up blip-Down Diffusion Imaging
- DTI, Diffusion Tensor Imaging
- Diffusion tensor imaging
- EPI, Echo Planar Imaging
- EPV, events-per-variable
- FA, Fractional Anisotropy
- FLAIR, Fluid attenuation inversion recovery
- MPRAGE, Magnetization prepared rapid gradient-echo
- Neurodegeneration
- TBI, Traumatic Brain Injury
- TORTOISE, Tolerably Obsessive Registration and Tensor Optimization Indolent Software Ensemble
- Traumatic brain injury
- US, United States
Collapse
Affiliation(s)
| | - Jason Barber
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Jalal Andre
- University of Washington, Department of Radiology, Seattle, WA, USA
| | - Nicole Evans
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Chris Panks
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Samantha Sun
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | - Kody Zalewski
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA
| | | | - Nancy Temkin
- University of Washington, Department of Neurological Surgery, Seattle, WA, USA; University of Washington, Department of Biostatistics, Seattle, WA, USA
| |
Collapse
|
42
|
McEvoy SD, Lee A, Poliakov A, Friedman S, Shaw D, Browd SR, Ellenbogen RG, Ojemann JG, Mac Donald CL. Longitudinal cerebellar diffusion tensor imaging changes in posterior fossa syndrome. Neuroimage Clin 2016; 12:582-590. [PMID: 27689022 PMCID: PMC5031477 DOI: 10.1016/j.nicl.2016.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 11/30/2022]
Abstract
Posterior fossa syndrome is a severe transient loss of language that frequently complicates resection of tumors of the cerebellum. The associated pathophysiology and relevant anatomy to this language deficit remains controversial. We performed a retrospective analysis of all cerebellar tumor resections at Seattle Children's Hospital from 2010 to 2015. Diffusion tensor imaging was performed on each of the patients as part of their clinical scan. Patients included in the study were divided into groups based on language functioning following resection: intact (N = 19), mild deficit (N = 19), and posterior fossa syndrome (N = 9). Patients with posterior fossa syndrome showed white matter changes evidenced by reductions in fractional anisotropy in the left and right superior cerebellar peduncle following resection, and these changes were still evident 1-year after surgery. These changes were greater in the superior cerebellar peduncle than elsewhere in the cerebellum. Prior to surgery, posterior fossa patients did not show changes in fractional anisotropy however differences were observed in mean and radial diffusivity measures in comparison to other groups which may provide a radiographic marker of those at greatest risk of developing post-operative language loss.
Collapse
Key Words
- AD, axial diffusivity
- AP, anterior-posterior
- CBW, cerebellar white matter
- CTC, cerebellar-thalamic-cortical
- Cerebellar mutism syndrome (CMS)
- Diffusion tensor imaging
- FA, fractional anisotropy
- KW, kruskal-wallis
- MCP, middle cerebellar peduncle
- MD, mean diffusivity
- MPRAGE, Magnetization Prepared Rapid Acquisition Gradient Echo
- PFS, posterior fossa syndrome
- Posterior fossa syndrome (PFS)
- RD, radial diffusivity
- RESTORE, Robust Estimation of Tensors by Outlier Rejection
- SCP, superior cerebellar peduncle
- SWI, Susceptibility weighted imaging
- TE, echo time
- TORTOISE, Tolerably Obsessive Registration and Tensor Optimization Indolent Software Ensemble
- TR, relaxation time
- Tumor
Collapse
Affiliation(s)
- Sean D McEvoy
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Amy Lee
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Andrew Poliakov
- Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Seth Friedman
- Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Dennis Shaw
- Seattle Children's Hospital, Division of Radiology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Samuel R Browd
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Richard G Ellenbogen
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Jeffrey G Ojemann
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Children's Hospital, Division of Neurosurgery, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Christine L Mac Donald
- University of Washington, Department of Neurological Surgery, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| |
Collapse
|
43
|
Brody DL, Mac Donald CL, Shimony JS. Current and future diagnostic tools for traumatic brain injury: CT, conventional MRI, and diffusion tensor imaging. Handb Clin Neurol 2016; 127:267-75. [PMID: 25702222 DOI: 10.1016/b978-0-444-52892-6.00017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brain imaging plays a key role in the assessment of traumatic brain injury. In this review, we present our perspectives on the use of computed tomography (CT), conventional magnetic resonance imaging (MRI), and newer advanced modalities such as diffusion tensor imaging. Specifically, we address assessment for immediately life-threatening intracranial lesions (noncontrast head CT), assessment of progression of intracranial lesions (noncontrast head CT), documenting intracranial abnormalities for medicolegal reasons (conventional MRI with blood-sensitive sequences), presurgical planning for post-traumatic epilepsy (high spatial resolution conventional MRI), early prognostic decision making (conventional MRI with diffusion-weighted imaging), prognostic assessment for rehabilitative planning (conventional MRI and possibly diffusion tensor imaging in the future), stratification of subjects and pharmacodynamic tracking of targeted therapies in clinical trials (specific MRI sequences or positron emission tomography (PET) ligands, e.g., diffusion tensor imaging for traumatic axonal injury). We would like to emphasize that all of these methods, especially the newer research approaches, require careful radiologic-pathologic validation for optimal interpretation. We have taken this approach in a mouse model of pericontusional traumatic axonal injury. We found that the extent of reduction in the diffusion tensor imaging parameter relative anisotropy directly correlated with the number of amyloid precursor protein (APP)-stained axonal varicosities (r(2)=0.81, p<0.0001, n=20 injured mice). Interestingly, however, the least severe contusional injuries did not result in APP-stained axonal varicosities, but did cause reduction in relative anisotropy. Clearly, both the imaging assessments and the pathologic assessments will require iterative refinement.
Collapse
Affiliation(s)
- David L Brody
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | | | - Joshua S Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
44
|
Chrisman SPD, Mac Donald CL, Friedman S, Andre J, Rowhani-Rahbar A, Drescher S, Stein E, Holm M, Evans N, Poliakov AV, Ching RP, Schwien CC, Vavilala MS, Rivara FP. Head Impact Exposure During a Weekend Youth Soccer Tournament. J Child Neurol 2016; 31:971-8. [PMID: 26951540 DOI: 10.1177/0883073816634857] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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] [Received: 08/21/2015] [Accepted: 01/18/2016] [Indexed: 12/26/2022]
Abstract
Concussion is a known risk in youth soccer, but little is known about subconcussive head impacts. The authors provided a prospective cohort study measuring frequency and magnitude of subconcussive head impacts using accelerometry in a middle school-age soccer tournament, and association between head impacts and changes in (1) symptoms, (2) cognitive testing, and (3) advanced neuroimaging. A total of 17 youth completed the study (41% female, mean 12.6 years). There were 73 head impacts >15g measured (45% headers) and only 2 had a maximum peak linear acceleration >50g No youth reported symptoms consistent with concussion. After correction for multiple comparisons and a sensitivity analysis excluding clear outliers, no significant associations were found between head impact exposure and neuropsychological testing or advanced neuroimaging. The authors conclude that head impacts were relatively uncommon and low in acceleration in youth playing a weekend soccer tournament. This study adds to the limited data regarding head impacts in youth soccer.
Collapse
Affiliation(s)
- Sara P D Chrisman
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Christine L Mac Donald
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Neurosurgery, University of Washington, Seattle, WA, USA
| | - Seth Friedman
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Radiology, Seattle Children's Hospital, Seattle, WA, USA Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jalal Andre
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Neuroradiology, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Epidemiology, University of Washington, Seattle, WA, USA
| | - Sara Drescher
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Elizabeth Stein
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Matthew Holm
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Nicole Evans
- Neurosurgery, University of Washington, Seattle, WA, USA
| | | | - Randal P Ching
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Applied Biomechanics Laboratory, University of Washington, Seattle, WA, USA
| | - Christina C Schwien
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| |
Collapse
|
45
|
Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, Werner NJ, Adam OR, Rivet DJ, Flaherty SF, Oh JS, Zonies D, Fang R, Brody DL. Outcome Trends after US Military Concussive Traumatic Brain Injury. J Neurotrauma 2016; 34:2206-2219. [PMID: 27198861 DOI: 10.1089/neu.2016.4434] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Care for US military personnel with combat-related concussive traumatic brain injury (TBI) has substantially changed in recent years, yet trends in clinical outcomes remain largely unknown. Our prospective longitudinal studies of US military personnel with concussive TBI from 2008-2013 at Landstuhl Regional Medical Center in Germany and twp sites in Afghanistan provided an opportunity to assess for changes in outcomes over time and analyze correlates of overall disability. We enrolled 321 active-duty US military personnel who sustained concussive TBI in theater and 254 military controls. We prospectively assessed clinical outcomes 6-12 months later in 199 with concussive TBI and 148 controls. Global disability, neurobehavioral impairment, depression severity, and post-traumatic stress disorder (PTSD) severity were worse in concussive TBI groups in comparison with controls in all cohorts. Global disability primarily reflected a combination of work-related and nonwork-related disability. There was a modest but statistically significant trend toward less PTSD in later cohorts. Specifically, there was a decrease of 5.9 points of 136 possible on the Clinician Administered PTSD Scale (-4.3%) per year (95% confidence interval, 2.8-9.0 points, p = 0.0037 linear regression, p = 0.03 including covariates in generalized linear model). No other significant trends in outcomes were found. Global disability was more common in those with TBI, those evacuated from theater, and those with more severe depression and PTSD. Disability was not significantly related to neuropsychological performance, age, education, self-reported sleep deprivation, injury mechanism, or date of enrollment. Thus, across multiple cohorts of US military personnel with combat-related concussion, 6-12 month outcomes have improved only modestly and are often poor. Future focus on early depression and PTSD after concussive TBI appears warranted. Adverse outcomes are incompletely explained, however, and additional studies with prospective collection of data on acute injury severity and polytrauma, as well as reduced attrition before follow-up will be required to fully address the root causes of persistent disability after wartime injury.
Collapse
Affiliation(s)
- Christine L Mac Donald
- 1 Washington University School of Medicine , St. Louis, Missouri.,2 Department of Neurological Surgery, University of Washington , Seattle, Washington
| | - Ann M Johnson
- 1 Washington University School of Medicine , St. Louis, Missouri
| | | | | | | | - Elliot C Nelson
- 1 Washington University School of Medicine , St. Louis, Missouri
| | - Nicole J Werner
- 1 Washington University School of Medicine , St. Louis, Missouri
| | - Octavian R Adam
- 4 Naval Medical Center Portsmouth , Portsmouth, Virginia.,5 Department of Neurology, Berkshire Medical Center , Pittsfield, Massachusetts
| | - Dennis J Rivet
- 4 Naval Medical Center Portsmouth , Portsmouth, Virginia.,6 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
| | - Stephen F Flaherty
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,7 Acute Surgical Care Specialists , El Paso, Texas
| | - John S Oh
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,8 Trauma, Critical Care, and Acute Care Surgery, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David Zonies
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,9 Trauma and Critical Care, Oregon Health and Sciences University , Portland, Oregon
| | - Raymond Fang
- 3 Landstuhl Regional Medical Center , Landstuhl, Germany .,10 US Air Force Center for Sustainment of Trauma & Readiness Skills, R. Adams Cowley Shock Trauma Center, University of Maryland , Baltimore, Maryland
| | - David L Brody
- 1 Washington University School of Medicine , St. Louis, Missouri
| |
Collapse
|
46
|
Adam O, Mac Donald CL, Rivet D, Ritter J, May T, Barefield M, Duckworth J, LaBarge D, Asher D, Drinkwine B, Woods Y, Connor M, Brody DL. Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan. Neurology 2015; 85:219-27. [PMID: 26109715 DOI: 10.1212/wnl.0000000000001758] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 03/05/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery. METHODS Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI. RESULTS Significantly greater impairment was observed in participants with mTBI vs controls: RPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control -11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005). CONCLUSIONS Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.
Collapse
Affiliation(s)
- Octavian Adam
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI.
| | - Christine L Mac Donald
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Dennis Rivet
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - John Ritter
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Todd May
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Maria Barefield
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Josh Duckworth
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Donald LaBarge
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Dean Asher
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Benjamin Drinkwine
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Yvette Woods
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - Michael Connor
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| | - David L Brody
- From the Division of Neurology (O.A.) and Departments of Neurological Surgery (D.R.) and Radiology (D.L.), Naval Medical Center Portsmouth, VA; Department of Neurology (C.L.M., D.L.B.), Washington University, St. Louis, MO; Department of Neurosurgery (D.R.), Virginia Commonwealth University, Richmond; Department of Radiology (J.R.) and Department of Orthopedics and Rehabilitation, Occupational Therapy Service (Y.W.), San Antonio Military Medical Center, TX; Department of Sports Medicine (T.M.), Naval Hospital, Camp Pendleton, CA; Department of Occupational Therapy (M.B.), Naval Hospital Jacksonville, FL; Departments of Neurology (J.D.) and Radiology (D.A., B.D.), San Diego Naval Medical Center, CA; and Branch Health Clinic (M.C.), Naval Air Station Jacksonville, FL. O.A. is currently affiliated with the Department of Neurology, Berkshire Medical Center, Pittsfield, MA; C.L.M. is currently affiliated with the Department of Neurological Surgery, University of Washington, Seattle; and D.L. is currently affiliated with Midland Radiology Associates, MI
| |
Collapse
|
47
|
Magnoni S, Mac Donald CL, Esparza TJ, Conte V, Sorrell J, Macrì M, Bertani G, Biffi R, Costa A, Sammons B, Snyder AZ, Shimony JS, Triulzi F, Stocchetti N, Brody DL. Quantitative assessments of traumatic axonal injury in human brain: concordance of microdialysis and advanced MRI. Brain 2015; 138:2263-77. [PMID: 26084657 DOI: 10.1093/brain/awv152] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/09/2015] [Indexed: 11/14/2022] Open
Abstract
Axonal injury is a major contributor to adverse outcomes following brain trauma. However, the extent of axonal injury cannot currently be assessed reliably in living humans. Here, we used two experimental methods with distinct noise sources and limitations in the same cohort of 15 patients with severe traumatic brain injury to assess axonal injury. One hundred kilodalton cut-off microdialysis catheters were implanted at a median time of 17 h (13-29 h) after injury in normal appearing (on computed tomography scan) frontal white matter in all patients, and samples were collected for at least 72 h. Multiple analytes, such as the metabolic markers glucose, lactate, pyruvate, glutamate and tau and amyloid-β proteins, were measured every 1-2 h in the microdialysis samples. Diffusion tensor magnetic resonance imaging scans at 3 T were performed 2-9 weeks after injury in 11 patients. Stability of diffusion tensor imaging findings was verified by repeat scans 1-3 years later in seven patients. An additional four patients were scanned only at 1-3 years after injury. Imaging abnormalities were assessed based on comparisons with five healthy control subjects for each patient, matched by age and sex (32 controls in total). No safety concerns arose during either microdialysis or scanning. We found that acute microdialysis measurements of the axonal cytoskeletal protein tau in the brain extracellular space correlated well with diffusion tensor magnetic resonance imaging-based measurements of reduced brain white matter integrity in the 1-cm radius white matter-masked region near the microdialysis catheter insertion sites. Specifically, we found a significant inverse correlation between microdialysis measured levels of tau 13-36 h after injury and anisotropy reductions in comparison with healthy controls (Spearman's r = -0.64, P = 0.006). Anisotropy reductions near microdialysis catheter insertion sites were highly correlated with reductions in multiple additional white matter regions. We interpret this result to mean that both microdialysis and diffusion tensor magnetic resonance imaging accurately reflect the same pathophysiological process: traumatic axonal injury. This cross-validation increases confidence in both methods for the clinical assessment of axonal injury. However, neither microdialysis nor diffusion tensor magnetic resonance imaging have been validated versus post-mortem histology in humans. Furthermore, future work will be required to determine the prognostic significance of these assessments of traumatic axonal injury when combined with other clinical and radiological measures.
Collapse
Affiliation(s)
- Sandra Magnoni
- 1 Department of Anaesthesiology and Intensive Care, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Christine L Mac Donald
- 2 Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas J Esparza
- 3 Department of Neurology, Washington University, St Louis, MO, USA
| | - Valeria Conte
- 1 Department of Anaesthesiology and Intensive Care, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - James Sorrell
- 3 Department of Neurology, Washington University, St Louis, MO, USA
| | | | - Giulio Bertani
- 5 Department of Neurosurgery, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Riccardo Biffi
- 6 Department of Neuroradiology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Antonella Costa
- 6 Department of Neuroradiology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Brian Sammons
- 3 Department of Neurology, Washington University, St Louis, MO, USA
| | - Abraham Z Snyder
- 7 Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
| | - Joshua S Shimony
- 7 Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
| | - Fabio Triulzi
- 6 Department of Neuroradiology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Nino Stocchetti
- 1 Department of Anaesthesiology and Intensive Care, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milano, Italy 4 Milan University, Milano, Italy
| | - David L Brody
- 3 Department of Neurology, Washington University, St Louis, MO, USA 8 Hope Centre for Neurological Disorders, Washington University, St Louis, MO, USA
| |
Collapse
|
48
|
Mac Donald CL, Adam OR, Johnson AM, Nelson EC, Werner NJ, Rivet DJ, Brody DL. Acute post-traumatic stress symptoms and age predict outcome in military blast concussion. Brain 2015; 138:1314-26. [PMID: 25740219 DOI: 10.1093/brain/awv038] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/16/2014] [Indexed: 11/13/2022] Open
Abstract
High rates of adverse outcomes have been reported following blast-related concussive traumatic brain injury in US military personnel, but the extent to which such adverse outcomes can be predicted acutely after injury is unknown. We performed a prospective, observational study of US military personnel with blast-related concussive traumatic brain injury (n = 38) and controls (n = 34) enrolled between March and September 2012. Importantly all subjects returned to duty and did not require evacuation. Subjects were evaluated acutely 0-7 days after injury at two sites in Afghanistan and again 6-12 months later in the United States. Acute assessments revealed heightened post-concussive, post-traumatic stress, and depressive symptoms along with worse cognitive performance in subjects with traumatic brain injury. At 6-12 months follow-up, 63% of subjects with traumatic brain injury and 20% of controls had moderate overall disability. Subjects with traumatic brain injury showed more severe neurobehavioural, post-traumatic stress and depression symptoms along with more frequent cognitive performance deficits and more substantial headache impairment than control subjects. Logistic regression modelling using only acute measures identified that a diagnosis of traumatic brain injury, older age, and more severe post-traumatic stress symptoms provided a good prediction of later adverse global outcomes (area under the receiver-operating characteristic curve = 0.84). Thus, US military personnel with concussive blast-related traumatic brain injury in Afghanistan who returned to duty still fared quite poorly on many clinical outcome measures 6-12 months after injury. Poor global outcome seems to be largely driven by psychological health measures, age, and traumatic brain injury status. The effects of early interventions and longer term implications of these findings are unknown.
Collapse
Affiliation(s)
- Christine L Mac Donald
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Octavian R Adam
- 2 Naval Medical Centre Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708 USA
| | - Ann M Johnson
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Elliot C Nelson
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Nicole J Werner
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| | - Dennis J Rivet
- 2 Naval Medical Centre Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708 USA
| | - David L Brody
- 1 Washington University School of Medicine, Department of Neurology and Psychiatry, 660 S Euclid Ave, Saint Louis, MO 63110 USA
| |
Collapse
|
49
|
Brody DL, Benetatos J, Bennett RE, Klemenhagen KC, Mac Donald CL. The pathophysiology of repetitive concussive traumatic brain injury in experimental models; new developments and open questions. Mol Cell Neurosci 2015; 66:91-8. [PMID: 25684677 DOI: 10.1016/j.mcn.2015.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/03/2015] [Accepted: 02/06/2015] [Indexed: 12/14/2022] Open
Abstract
In recent years, there has been an increasing interest in the pathophysiology of repetitive concussive traumatic brain injury (rcTBI) in large part due to the association with dramatic cases of progressive neurological deterioration in professional athletes, military personnel, and others. However, our understanding of the pathophysiology of rcTBI is less advanced than for more severe brain injuries. Most prominently, the mechanisms underlying traumatic axonal injury, microglial activation, amyloid-beta accumulation, and progressive tau pathology are not yet known. In addition, the role of injury to dendritic spine cytoskeletal structures, vascular reactivity impairments, and microthrombi are intriguing and subjects of ongoing inquiry. Methods for quantitative analysis of axonal injury, dendritic injury, and synaptic loss need to be refined for the field to move forward in a rigorous fashion. We and others are attempting to develop translational approaches to assess these specific pathophysiological events in both animals and humans to facilitate clinically relevant pharmacodynamic assessments of candidate therapeutics. In this article, we review and discuss several of the recent experimental results from our lab and others. We include new initial data describing the difficulty in modeling progressive tau pathology in experimental rcTBI, and results demonstrating that sertraline can alleviate social interaction deficits and depressive-like behaviors following experimental rcTBI plus foot shock stress. Furthermore, we propose a discrete set of open, experimentally tractable questions that may serve as a framework for future investigations. In addition, we also raise several important questions that are less experimentally tractable at this time, in hopes that they may stimulate future methodological developments to address them. This article is part of a Special Issue entitled "Traumatic Brain Injury".
Collapse
Affiliation(s)
- David L Brody
- Department of Neurology, Washington University School of Medicine and Hope Center for Neurological Disorders, St Louis, MO, USA.
| | - Joseph Benetatos
- Department of Neurology, Washington University School of Medicine and Hope Center for Neurological Disorders, St Louis, MO, USA
| | - Rachel E Bennett
- Department of Neurology, Washington University School of Medicine and Hope Center for Neurological Disorders, St Louis, MO, USA
| | - Kristen C Klemenhagen
- Department of Neurology, Washington University School of Medicine and Hope Center for Neurological Disorders, St Louis, MO, USA
| | - Christine L Mac Donald
- Department of Neurology, Washington University School of Medicine and Hope Center for Neurological Disorders, St Louis, MO, USA
| |
Collapse
|
50
|
Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, Werner NJ, Zonies D, Oh J, Fang R, Brody DL. Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA Neurol 2014; 71:994-1002. [PMID: 24934200 DOI: 10.1001/jamaneurol.2014.1114] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Blast injury has been identified as the signature injury in the conflicts in Iraq and Afghanistan. However it remains to be determined whether fundamental differences may exist between blast-related traumatic brain injury (TBI) and TBI due to other mechanisms. OBJECTIVES To determine similarities and differences between clinical outcomes in US military personnel with blast-related vs. non-blast-related concussive TBI and to identify the specific domains of impairment that best correlate with overall disability. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study involving active duty US Military personnel evacuated from Iraq or Afghanistan to Landstuhl Regional Medical Center, in Landstuhl, Germany. Four groups of participants were enrolled from 2010 to 2013: (1) blast plus impact complex TBI (n=53), (2) non-blast related TBI with injury due to other mechanisms (n=29), (3) blast-exposed controls evacuated for other medical reasons (n=27) (4) non-blast-exposed controls evacuated for other medical reasons (n=69). All patients with TBI met Department of Defense criteria for concussive (mild) TBI. The study participants were evaluated 6-12 months after injury at Washington University in St Louis. In total, 255 subjects were enrolled in the study, and 183 participated in follow-up evaluations, 5 of whom were disqualified. MAIN OUTCOMES AND MEASURES In-person clinical examinations included evaluation for overall disability, a standardized neurological exam, headache questionnaires, neuropsychological test battery, combat exposure and alcohol use surveys, and structured interview evaluations for post-traumatic stress disorder (PTSD) and depression. RESULTS Global outcomes, headache severity, neuropsychological performance, and surprisingly even PTSD severity and depression were indistinguishable between the two TBI groups, independent of mechanism of injury. Both TBI groups had higher rates of moderate to severe overall disability than the respective control groups: 41/53 (77%) of blast plus impact TBI and 23/29 (79%) of nonblast TBI vs. 16/27 (59%) of blast-exposed controls and 28/69 (41%) of non-blast-exposed controls. In addition, blast-exposed controls had worse headaches and more severe PTSD than non-blast-exposed controls. Self-reported combat exposure intensity was higher in the blast plus impact TBI group than in nonblast TBI group and was higher in blast-exposed controls than in non-blast-exposed controls. However, combat exposure intensity did not correlate with PTSD severity in the TBI groups, but a modest positive correlation was observed in the controls. Overall outcomes were most strongly correlated with depression, headache severity, and number of abnormalities on neuropsychological testing. However a substantial fraction of the variance in overall outcome was not explained by any of the assessed measures. CONCLUSIONS AND RELEVANCE One potential interpretation of these results is that TBI itself, independent of injury mechanism and combat exposure intensity, is a primary driver of adverse outcomes. Many other important factors may be as yet unmeasured, and adverse outcomes following war-time injuries are difficult to fully explain. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01313130.
Collapse
Affiliation(s)
- Christine L Mac Donald
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri2Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M Johnson
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | | | | | - Elliot C Nelson
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Nicole J Werner
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - David Zonies
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - John Oh
- Landstuhl Regional Medical Center, Landstuhl, Germany5Department of Trauma, Critical Care, and Acute Care Surgery, Walter Reed National Military Medical Center, Baltimore, Maryland
| | - Raymond Fang
- Landstuhl Regional Medical Center, Landstuhl, Germany6US Air Force Center for Sustainment of Trauma and Readiness Skills, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore
| | - David L Brody
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|