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Palacios EM, Owen JP, Yuh EL, Wang MB, Vassar MJ, Ferguson AR, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Robertson CS, Stein MB, Temkin N, Jain S, McCrea M, MacDonald CL, Levin HS, Manley GT, Mukherjee P. The evolution of white matter microstructural changes after mild traumatic brain injury: A longitudinal DTI and NODDI study. Sci Adv 2020; 6:eaaz6892. [PMID: 32821816 PMCID: PMC7413733 DOI: 10.1126/sciadv.aaz6892] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/26/2020] [Indexed: 05/11/2023]
Abstract
Neuroimaging biomarkers that can detect white matter (WM) pathology after mild traumatic brain injury (mTBI) and predict long-term outcome are needed to improve care and develop therapies. We used diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) to investigate WM microstructure cross-sectionally and longitudinally after mTBI and correlate these with neuropsychological performance. Cross-sectionally, early decreases of fractional anisotropy and increases of mean diffusivity corresponded to WM regions with elevated free water fraction on NODDI. This elevated free water was more extensive in the patient subgroup reporting more early postconcussive symptoms. The longer-term longitudinal WM changes consisted of declining neurite density on NODDI, suggesting axonal degeneration from diffuse axonal injury for which NODDI is more sensitive than DTI. Therefore, NODDI is a more sensitive and specific biomarker than DTI for WM microstructural changes due to mTBI that merits further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- E. M. Palacios
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - J. P. Owen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - E. L. Yuh
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - M. B. Wang
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - M. J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - A. R. Ferguson
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - R. Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J. T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - D. O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C. S. Robertson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M. B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - N. Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - S. Jain
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - M. McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - C. L. MacDonald
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - H. S. Levin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - G. T. Manley
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - P. Mukherjee
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
- Corresponding author.
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Faber J, Wilde EA, Hanten G, Ewing-Cobbs L, Aitken ME, Yallampalli R, MacLeod MC, Mullins SH, Chu ZD, Li X, Hunter JV, Noble-Haeusslein L, Levin HS. Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning. Brain Inj 2016; 30:1635-1641. [PMID: 27680309 DOI: 10.1080/02699052.2016.1199910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/20/2022]
Abstract
PRIMARY OBJECTIVE The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.
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Affiliation(s)
- J Faber
- a Rice University , Houston , TX , USA.,b Department of Physical Medicine and Rehabilitation
| | - E A Wilde
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - G Hanten
- b Department of Physical Medicine and Rehabilitation
| | - L Ewing-Cobbs
- f Children's Learning Institute and Department of Pediatrics , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - M E Aitken
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - R Yallampalli
- b Department of Physical Medicine and Rehabilitation.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - M C MacLeod
- b Department of Physical Medicine and Rehabilitation
| | - S H Mullins
- g Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Z D Chu
- d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - X Li
- b Department of Physical Medicine and Rehabilitation
| | - J V Hunter
- b Department of Physical Medicine and Rehabilitation.,d Department of Radiology , Baylor College of Medicine , Houston , TX , USA.,h Department of Pediatric Radiology , Texas Children's Hospital , Houston , TX , USA
| | - L Noble-Haeusslein
- i Departments of Neurosurgical Surgery and Physical Therapy and Rehabilitation Science , University of California , San Francisco , CA , USA
| | - H S Levin
- b Department of Physical Medicine and Rehabilitation.,c Department of Neurology.,e Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
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Chu Z, Wilde EA, Hunter JV, McCauley SR, Bigler ED, Troyanskaya M, Yallampalli R, Chia JM, Levin HS. Voxel-based analysis of diffusion tensor imaging in mild traumatic brain injury in adolescents. AJNR Am J Neuroradiol 2010; 31:340-6. [PMID: 19959772 DOI: 10.3174/ajnr.a1806] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI of normal-appearing WM as evaluated by conventional MR imaging in mTBI has the potential to identify important regional abnormalities that relate to PCS. VBA was used to examine WM changes in acute mTBI. MATERIALS AND METHODS WM was assessed between 1 and 6 days postinjury with voxel-based DTI analyses in 10 adolescent patients with mTBI and 10 age-matched control participants. In addition to the voxel-based group, analysis used to identify brain pathology across all patients with mTBI, 2 voxel-based linear regressions were performed. These analyses investigated the relation between 1) the ADC and PCS severity scores, and 2) ADC and scores on the BSI of emotional symptoms associated with mTBI. We hypothesized that frontotemporal WM changes would relate to symptoms associated with PCS and endorsed on the BSI. RESULTS Patients with mTBI demonstrated significant reductions in ADC in several WM regions and in the left thalamus. As expected, no increases in ADC were found in any region of interest. All injury-affected regions showed decreased radial diffusivity, unchanged AD, and increased FA, which is consistent with axonal cytotoxic edema, reflective of acute injury. CONCLUSIONS Whole-brain WM DTI measures can detect abnormalities in acute mTBI associated with PCS symptoms in adolescents.
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Affiliation(s)
- Z Chu
- E B Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX 77030, USA.
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Scheibel RS, Pearson DA, Faria LP, Kotrla KJ, Aylward E, Bachevalier J, Levin HS. An fMRI study of executive functioning after severe diffuse TBI. Brain Inj 2009. [DOI: 10.1080/ijf.18.2.219.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PRIMARY OBJECTIVE Preliminary study of whether severe diffuse traumatic brain injury (TBI) increases extent of frontal tissue recruited by cognitive control tasks. RESEARCH DESIGN Functional magnetic resonance imaging (fMRI) on N-back working memory (WM)and arrows inhibition tasks in a 46 year old man who had severe diffuse TBI 1 year earlier, a 44 year old man (inhibition task) and three women (working memory task), age 20-26 years. Images were acquired by 1.5 T magnet with BOLD method and PRESTO pulse sequence and analysed using SPM. MAIN OUTCOMES AND RESULTS Frontal activation increased under 2-back relative to 1-back condition of working memory in all participants with more extensive activation in the TBI patient relative to controls. Frontal activation increased with inhibition on the arrows task, but was greater in the TBI patient. CONCLUSION Severe diffuse TBI results in recruitment of additional neural resources for cognitive control.
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Affiliation(s)
- R S Scheibel
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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Dulay MF, Levin HS, York MK, Mizrahi EM, Verma A, Goldsmith I, Grossman RG, Yoshor D. Predictors of individual visual memory decline after unilateral anterior temporal lobe resection. Neurology 2009; 72:1837-42. [DOI: 10.1212/wnl.0b013e3181a71132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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York MK, Dulay M, Macias A, Levin HS, Grossman R, Simpson R, Jankovic J. Cognitive declines following bilateral subthalamic nucleus deep brain stimulation for the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry 2008; 79:789-95. [PMID: 17965146 DOI: 10.1136/jnnp.2007.118786] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the cognitive and psychiatric outcome 6 months after bilateral subthalamic nucleus deep brain stimulation (DBS) for the treatment of Parkinson's disease (PD) using a disease control group. METHODS 23 patients who underwent DBS were compared with 28 medically treated patients with PD at baseline and at 6 months for neuropsychological measures. In addition to the group outcomes, we report reliable change indices (RCI) and a dementia caseness analysis. RESULTS Patients who underwent DBS demonstrated a significant decline in verbal memory compared with the control group (p<0.003), and trends for decline on oral information processing, including verbal fluency, timed transcription and word naming. Patients who underwent DBS demonstrated declines in attention, set shifting and semantic fluency but these changes were similar to the rate of decline in the PD group. RCI indicated that patients who underwent DBS demonstrated clinically significant declines in verbal fluency (p<0.01) and inhibition of a dominant response (p<0.003), with trends for declines in set shifting (p<0.02) and verbal long term recall (p<0.08), indicative of frontostriatal dysfunction. Patients who underwent DBS did not demonstrate significant changes in depression, anxiety or psychological distress scores. The caseness analysis revealed that one of the patients who underwent DBS (4%) converted to dementia over 6 months compared with none of the PD controls. CONCLUSIONS Our findings demonstrated that patients who underwent DBS experienced declines in verbal recall and trends for declines in oral information processing 6 months following surgery, even when good motor outcome was achieved. Potential candidates should be counselled about the risk of mild frontostriatal cognitive declines following DBS to weigh the risks and benefits of surgery.
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Affiliation(s)
- M K York
- Baylor College of Medicine, Department of Neurology, 6501 Fannin, NB302, Houston, Texas 77030, USA.
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Wilde EA, McCauley SR, Hunter JV, Bigler ED, Chu Z, Wang ZJ, Hanten GR, Troyanskaya M, Yallampalli R, Li X, Chia J, Levin HS. Diffusion tensor imaging of acute mild traumatic brain injury in adolescents. Neurology 2008; 70:948-55. [PMID: 18347317 DOI: 10.1212/01.wnl.0000305961.68029.54] [Citation(s) in RCA: 410] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators. METHODS Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms. RESULTS The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group. CONCLUSIONS In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.
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Affiliation(s)
- E A Wilde
- Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine, Houston, TX 77025, USA.
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York MK, Lai EC, Jankovic J, Macias A, Atassi F, Levin HS, Grossman RG. Short and long-term motor and cognitive outcome of staged bilateral pallidotomy: a retrospective analysis. Acta Neurochir (Wien) 2007; 149:857-66; discussion 866. [PMID: 17624489 DOI: 10.1007/s00701-007-1242-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 06/11/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND We investigated retrospectively the short and long-term motor and cognitive functioning of staged bilateral pallidotomy using motor testing and a comprehensive neuropsychological battery before and after each procedure. METHODS Fifteen patients with idiopathic Parkinson's disease were assessed at baseline and at least 3 months after each of their two staged surgeries. Motor and neuropsychological results were compared to 15 non-surgical Parkinson's disease patients matched for disease stage and mental status. In addition, nine bilateral pallidotomy patients were evaluated for long-term cognitive changes (>2 years). FINDINGS Bilateral pallidotomy patients demonstrated significant improvements in motor functioning in the "on" and "off" states and with dyskinesias after the first surgery, with an additional improvement reported for dyskinesias after the second procedure. On long-term follow-up, dyskinesia improvements were maintained. Bilateral pallidotomy patients did not show significant cognitive declines following both procedures on the short-term follow-up and when compared to the Parkinson's disease group. However, significant cognitive declines were found on the long-term follow-up evaluation. CONCLUSIONS Parkinson's disease patients received significant short- and long-term motor benefits, particularly reduced dyskinesias, following staged bilateral pallidotomy without significant short-term cognitive consequences. Two years following the second procedure, bilateral pallidotomy patients tended to show an increase in both motor and non-motor symptoms of Parkinson's disease, particularly cognitive decline.
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Affiliation(s)
- M K York
- Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Spanos GK, Wilde EA, Bigler ED, Cleavinger HB, Fearing MA, Levin HS, Li X, Hunter JV. cerebellar atrophy after moderate-to-severe pediatric traumatic brain injury. AJNR Am J Neuroradiol 2007; 28:537-42. [PMID: 17353332 PMCID: PMC7977845] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE Although the cerebellum has not attracted the same degree of attention as cortical areas and the hippocampus in traumatic brain injury (TBI) literature, there is limited structural and functional imaging evidence that the cerebellum is also vulnerable to insult. The cerebellum is emerging as part of a frontocerebellar system that, when disrupted, results in significant cognitive and behavioral consequences. We hypothesized that cerebellar volume would be reduced in children following TBI and wished to examine the relation between the cerebellum and known sites of projection, including the prefrontal cortex, thalamus, and pons. MATERIALS AND METHODS Quantitative MR imaging was used to measure cerebellar white and gray matter and lesion volumes 1-10 years following TBI in 16 children 9-16 years of age and 16 demographically matched typically developing children 9-16 years of age. Cerebellar volumes were also compared with volumetric data from other brain regions to which the cerebellum projects. RESULTS A significant group difference was found in cerebellar white and gray matter volume, with children in the TBI group consistently exhibiting smaller volumes. Repeating the analysis after excluding children with focal cerebellar lesions revealed that significant group differences still remained for cerebellar white matter (WM). We also found a relation between the cerebellum and projection areas, including the dorsolateral prefrontal cortex, thalamus, and pons in 1 or both groups. CONCLUSION Our finding of reduced cerebellar WM volume in children with TBI is consistent with evidence from experimental studies suggesting that the cerebellum and its related projection areas are highly vulnerable to fiber degeneration following traumatic insult.
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Affiliation(s)
- G K Spanos
- Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX, USA
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Soury S, Mazaux JM, Lambert J, De Seze M, Joseph PA, Lozes-Boudillon S, McCauley S, Vanier M, Levin HS. [The neurobehavioral rating scale-revised: assessment of concurrent validity]. ACTA ACUST UNITED AC 2005; 48:61-70. [PMID: 15748770 DOI: 10.1016/j.annrmp.2004.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 08/26/2004] [Indexed: 11/29/2022]
Abstract
UNLABELLED Cognitive and behavioral impairment are a major source of disability in daily living of patients with traumatic brain injury (TBI). The Neurobehavioral Rating Scale-Revised (NRS-R) is a short, easy-to administer interview tool developed to improve assessment by clinicians. Data are available on its criterion validity and reliability, but the concurrent validity of the French NRS-R was not yet documented. OBJECTIVE To assess the concurrent validity of the NRS-R with current psychometric tests. METHOD One hundred and four patients with TBI enrolled in a community adjustment program underwent concurrent examination with the NRS-R, cognitive tests assessing memory, attention, and executive functions, and scales of anxiety (STAI) and depressive mood (CES-D). Intercorrelations were undertaken between these variables and the five factors of the NRS-R: F1, intentional behavior; F2, lowered emotional state; F3, survival-oriented behaviour/hightened emotional state; F4, arousal state; and F5, language. Patients were 82 men and 22 women, the mean age was 28.5 years, and 70% had severe TBI (Glasgow coma score [GCS] below 8 on admission). They were assessed 52 months on average after their injury. RESULTS Factor F1 was correlated with results on the GCS (P<0.05), the Tower of London test (TL, P<0.01), the Trail Making Test (TMT, P<0.01), divided attention (DA) and inhibition (IN) subscales of the Zimmermann and Fimm's Attention battery (TEA) (P<0.01) and reverse digit span (DS, P<0.05). Factor F2 was positively related to age at injury, time since injury (TSI) (P<0.05) and CESD and STAI scores (P<0.001). Factor F3 was related to DA (P<0.01) TL scores and TSI (P<0.05). Factor F4 was related to TL, TMT, DA, flexibility, DS (P<0.05), TSI, duration of post-traumatic amnesia, CES-D score (P<0.05) and STAI scores (P<0.01). Factor F5 was related to GCS, DA (P<0.05), and reaction time on the subscales IN and Go/nogo (GO) of the TEA battery (P<0.01). The NRS-R total score was related to CESD, STAI scores, TMT score, DA (P<0.01) and TL score, IN and GO scores and TSI (P<0.05). DISCUSSION As McCauley et al found with the English version of the NRS-R, significant relationships were found between NRS-R factor scores, cognitive tests and emotional scales. Relationships were also found between factor scores and indicators of injury severity and time since injury. These data suggest fair concurrent validity of the NRS-R.
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Affiliation(s)
- S Soury
- Unité UEROS, service MP réadaptation, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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Abstract
To investigate planning in traumatically brain injured children, the authors gave the Porteus Maze Test (PMT; S. D. Porteus, 1959) to 276 pediatric patients who had sustained a traumatic brain injury (TBI) at least 3 years previously. Sensitivity of the PMT to TBI severity, age at test, and volume of focal brain lesions detected by magnetic resonance imaging was also studied. The Peabody Picture Vocabulary Test-Revised (L. M. Dunn & L. M. Dunn, 1981) was also administered as a control measure. Results indicated that the PMT was highly sensitive to TBI severity and to volume of circumscribed prefrontal lesions. In contrast to the PMT data, receptive vocabulary was related to injury severity but not to discrete prefrontal lesions. Implications for mechanisms of cognitive deficit after TBI in children are discussed.
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Affiliation(s)
- H S Levin
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas 77030, USA.
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Skacel M, Ormsby AH, Pettay JD, Tsiftsakis EK, Liou LS, Klein EA, Levin HS, Zippe CD, Tubbs RR. Aneusomy of chromosomes 7, 8, and 17 and amplification of HER-2/neu and epidermal growth factor receptor in Gleason score 7 prostate carcinoma: a differential fluorescent in situ hybridization study of Gleason pattern 3 and 4 using tissue microarray. Hum Pathol 2001; 32:1392-7. [PMID: 11774175 DOI: 10.1053/hupa.2001.29676] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent evidence shows that the proportion of poorly differentiated prostate carcinoma (Gleason pattern [GP] 4/5) is a surrogate factor for biochemical failure after radical prostatectomy (RP). However, little is known about specific molecular and cytogenetic changes in this aggressive component of localized prostate cancer. We constructed a tissue microarray containing areas of GP 3 and 4 from formalin-fixed radical prostatectomy specimens of 39 patients with Gleason score 7 carcinoma (>or=50% GP 4), known pathologic staging parameters (stage < T3b), and biochemical failure data (mean follow-up, 30 months; range, 5 to 74 months). Interphase fluorescent in situ hybridization (FISH) was performed on 5-microm microarray sections using pericentromeric probes to chromosomes 7, 8, and 17 and probes for the HER-2/neu and epidermal growth factor receptor (EGFR) genes. Low-level amplification of HER-2/neu was found in 26% of cases (3 to 5 signals per nucleus, corrected for chromosome 17 aneusomy). Aneusomy of chromosomes 7, 8, and 17 was identified in 21%, 15%, and 5% of cases, respectively. All aberrations occurred almost exclusively in GP 4 carcinoma (8 of 8 aneusomies 7, 2 of 2 trisomies 17, 9 of 10 HER-2/neu amplifications, and 5 of 6 aneusomies 8; P < .001). The presence of HER-2/neu amplification was associated with high tumor volume (>2.0 cm(3), P = 0.004). Among patients with negative surgical margins, gain of chromosome 7 was associated with biochemical failure after RP (P =.004, log-rank). Amplification of the EGFR gene occurred in only 1 case (3%). Significant differences in HER-2/neu amplification and gain of chromosomes 7, 8, and 17 were detected between GP 4 prostate carcinoma and GP 3. The frequency of aberrations increased with tumor volume. Chromosome 7 abnormalities may play an important role in cancer progression in margin-negative patients. EGFR amplification was rare, suggesting that this oncogene is not altered at the gene copy number level.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Aged
- Aged, 80 and over
- Aneuploidy
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 7
- Chromosomes, Human, Pair 8
- DNA, Neoplasm/analysis
- ErbB Receptors/genetics
- Gene Amplification
- Genes, erbB-2/genetics
- Histocytological Preparation Techniques
- Humans
- Immunoenzyme Techniques
- In Situ Hybridization
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Prostate-Specific Antigen/analysis
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/mortality
- Prostatic Neoplasms/pathology
- Prostatic Neoplasms/surgery
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- M Skacel
- Department of Anatomic, The Urology Institute, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Levin HS, Brown SA, Song JX, McCauley SR, Boake C, Contant CF, Goodman H, Kotrla KJ. Depression and posttraumatic stress disorder at three months after mild to moderate traumatic brain injury. J Clin Exp Neuropsychol 2001; 23:754-69. [PMID: 11910542 DOI: 10.1076/jcen.23.6.754.1021] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [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: 11/03/2022]
Abstract
To investigate the frequency and risk factors of major depressive disorder (MDD) after mild to moderate traumatic brain injury (TBI), 69 TBI and 52 general trauma (GT) patients were prospectively recruited and studied at 3-months postinjury. There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups. Therefore, a composite MDD group (TBI and GT patients) was compared to patients who were nondepressed. Female gender was related to MDD, but no other risk factors were identified. MDD was associated with disability (Glasgow Outcome Scale, Community Integration Questionnaire) and cognitive impairment. MDD was comorbid with posttraumatic stress disorder. Implications for postacute management of mild to moderate TBI are discussed.
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Affiliation(s)
- H S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
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McCauley SR, Boake C, Levin HS, Contant CF, Song JX. Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. J Clin Exp Neuropsychol 2001; 23:792-808. [PMID: 11910545 DOI: 10.1076/jcen.23.6.792.1016] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.6] [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: 11/03/2022]
Abstract
Previous studies of postconcussional disorder (PCD) have utilized a dimensional approach (i.e., number and/or severity ratings of symptoms) to study postconcussional symptoms. This study used a syndromal approach (modified form of the DSM-IV criteria) for investigating risk factors for developing PCD, 3-months postinjury. The head trauma requirement was waived in order to determine specificity of symptoms to traumatic brain injury. Preliminary results from this ongoing study indicated significant risk factors including female gender, poor social support, and elevated self-reported depressive symptoms at 1-month postinjury. Comorbidities included concurrent diagnosis of major depressive disorder and/or posttraumatic stress disorder. Hispanics were significantly less likely to develop PCD than other racial/ethnic groups. PCD resulted more frequently from motor vehicle accidents and assaults. Screening tests for PCD risk factors/comorbidities performed shortly after injury (i.e., during routine follow-up clinic appointments) coupled with appropriate referrals for psychoeducational interventions and support groups may avoid prolonged loss of productivity and poor perceived quality of life in these patients.
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Affiliation(s)
- S R McCauley
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
This paper presents findings on the cognitive outcome of older adults sustaining mild traumatic brain injury (TBI). Results indicate that mild TBI patients who are 50 years or older, unlike those with moderate TBI, exhibit cognitive functioning that is comparable to noninjured controls by 1-2-months postinjury. However, these patients continue to report significant anxiety, depression, and somatic preoccupation despite their improvement on objective neuropsychological measures. The lowest postresuscitation Glasgow Coma Scale (GCS) score and the presence of intracranial pathology are more strongly associated with outcome than the durations of posttraumatic amnesia and impaired consciousness, possibly reflecting measurement issues in older persons who are likely to be injured in low velocity falls and to suffer delayed complications. A classification system that considers not only the GCS score but also the presence of intracranial pathology is sensitive to differences in the outcome of older adults, similar to the findings in young patients. The implications of these findings for older TBI patients and directions for research are discussed.
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Affiliation(s)
- F C Goldstein
- Department of Neurology, Emory University School of Medicine and Wesley Woods Center of Emory University, Atlanta, GA 30329, USA.
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McCauley SR, Levin HS, Vanier M, Mazaux JM, Boake C, Goldfader PR, Rockers D, Butters M, Kareken DA, Lambert J, Clifton GL. The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment. J Neurol Neurosurg Psychiatry 2001; 71:643-51. [PMID: 11606677 PMCID: PMC1737597 DOI: 10.1136/jnnp.71.5.643] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. METHODS A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. RESULTS Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/affect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/affect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. CONCLUSIONS The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures.
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Affiliation(s)
- S R McCauley
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560 Fannin, Ste 1144, Houston, TX 77030, USA
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Clifton GL, Choi SC, Miller ER, Levin HS, Smith KR, Muizelaar JP, Wagner FC, Marion DW, Luerssen TG. Intercenter variance in clinical trials of head trauma--experience of the National Acute Brain Injury Study: Hypothermia. J Neurosurg 2001; 95:751-5. [PMID: 11702863 DOI: 10.3171/jns.2001.95.5.0751] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [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: 11/06/2022]
Abstract
OBJECT In a recently conducted trial of hypothermia in patients with severe brain injury, differences were found in the effects of hypothermia treatment among various centers. This analysis explores the reasons for such differences. METHODS The authors reviewed data obtained in 392 patients treated for severe brain injury. Prerandomization variables, critical physiological variables, treatment variables, and accrual methodologies were investigated among various centers. Hypothermia was found to be detrimental in patients older than the age of 45 years, beneficial in patients younger than 45 years of age in whom hypothermia was present on admission, and without effect in those in whom normothermia was documented on admission. Marginally significant differences (p < 0.054) in the intercenter outcomes of hypothermia-treated patients were likely the result of wide differences in the percentage of patients older than 45 years of age and in the percentage of patients in whom hypothermia was present on admission among centers. The trial sensitivity was likely diminished by significant differences in the incidence of mean arterial blood pressure (MABP) less than 70 mm Hg (p < 0.001) and cerebral perfusion pressure (CPP) less than 50 mm Hg (p < 0.05) but not intracranial pressure (ICP) greater than 25 mm Hg (not significant) among patients in the various centers. Hours of vasopressor usage (p < 0.03) and morphine dose (p < 0.001) and the percentage of dehydrated patients varied significantly among centers (p < 0.001). The participation of small centers increased intercenter variance and diminished the quality of data. CONCLUSIONS For Phase III clinical trials we recommend: 1) a detailed protocol specifying fluid and MABP, ICP, and CPP management: 2) continuous monitoring of protocol compliance; 3) a run-in period for new centers to test accrual and protocol adherence; and 4) inclusion of only centers in which patients are regularly randomized.
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Affiliation(s)
- G L Clifton
- Department of Neurosurgery, Vivian L. Smith Center for Neurologic Research, University of Texas-Houston Health Science Center, 77030, USA.
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Abstract
Metacognition is one of the cognitive processes included under the general term executive functions. The executive functions are widely held to be under the control of the prefrontal cortex, an area often damaged after severe traumatic brain injury (TBI). We examined the metacognitive processing of a group of 9 children with TBI, and a group of 9 healthy, age-matched control children. Children with TBI showed significant impairments in their accuracy of prediction of the ease with which an item would be learned and their ability to predict recall of an item after a 2-hr delay. No significant differences in recall performance between the TBI and control groups were exhibited. The results are interpreted as suggesting an impairment in metacognitive processing resulting from frontal lobe damage after TBI in children. Additional research is necessary to confirm the relation of frontal lobe pathology and severity of injury to metacognitive impairments.
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Affiliation(s)
- G Hanten
- Cognitive Neuroscience Laboratory, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560 Fannin, Suite 1144, Houston, TX 77030, USA.
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Abstract
To investigate planning in traumatically brain injured children, the authors gave the Porteus Maze Test (PMT; S. D. Porteus, 1959) to 276 pediatric patients who had sustained a traumatic brain injury (TBI) at least 3 years previously. Sensitivity of the PMT to TBI severity, age at test, and volume of focal brain lesions detected by magnetic resonance imaging was also studied. The Peabody Picture Vocabulary Test-Revised (L. M. Dunn & L. M. Dunn, 1981) was also administered as a control measure. Results indicated that the PMT was highly sensitive to TBI severity and to volume of circumscribed prefrontal lesions. In contrast to the PMT data, receptive vocabulary was related to injury severity but not to discrete prefrontal lesions. Implications for mechanisms of cognitive deficit after TBI in children are discussed.
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Affiliation(s)
- H S Levin
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas 77030, USA.
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Chapman SB, McKinnon L, Levin HS, Song J, Meier MC, Chiu S. Longitudinal outcome of verbal discourse in children with traumatic brain injury: three-year follow-up. J Head Trauma Rehabil 2001; 16:441-55. [PMID: 11574040 DOI: 10.1097/00001199-200110000-00004] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [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: 11/26/2022]
Abstract
PURPOSE This study compared changes in discourse ability between two groups of children age 5 to 10 years after brain injury: those with severe traumatic brain injury (TBI) and those with mild/moderate injury over 3-year follow-up testing. MATERIALS AND METHODS Forty-three children with TBI were recruited from a larger research project examining cognitive and linguistic recovery after injury. Twenty-two of these patients had severe injuries and 21 sustained mild/moderate injuries. All children were presented an ordered sequence of pictures and asked to verbally produce a story/narrative discourse. Each child was then asked to produce a lesson relating to the story. RESULTS The severe group performed significantly worse than the mild/moderate group when performance across all four discourse domains was considered. Both groups improved across time on selected discourse measures. Qualitative analysis suggested that the severe group showed differential rates of improvement across the individual discourse variables over the 3-year interval. CONCLUSIONS Severe TBI can have a pernicious effect on discourse abilities in children years after injury compared with children with mild/moderate injuries. The major caveat is that the discourse measures must be sufficiently challenging when used to assess older children and children with milder forms of TBI.
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Affiliation(s)
- S B Chapman
- Center for BrainHealth, Department of Human Development, University of Texas at Dallas, Dallas, Texas 45235, USA.
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Levin HS, Boake C, Song J, Mccauley S, Contant C, Diaz-Marchan P, Brundage S, Goodman H, Kotrla KJ. Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury. J Neurotrauma 2001; 18:575-84. [PMID: 11437080 DOI: 10.1089/089771501750291819] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [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: 11/12/2022] Open
Abstract
Using a structured outcome interview, this study addressed the validity and sensitivity to change of the Glasgow Outcome Scale (GOS) and the Extended GOS (GOSE) in a prospective study of patients who sustained mild (n = 30) to moderate (n = 13) traumatic brain injury (TBI) or general trauma (n = 44). The patients were recruited from the emergency center or inpatient units of Ben Taub General Hospital and invited to participate in follow-up examinations at 3 and 6 months. Using a series of functional outcome measures, assessment of affective status, and neuropsychological tests as criteria, the validity of the GOSE generally exceeded the GOS. Analysis of the outcome data for the patients who completed both the 3-month and 6-month assessments disclosed that the GOSE was more sensitive to change than the GOS. Comparison of the 3-month outcome data disclosed that the GOSE and GOS scores did not differ for the TBI and general trauma groups. These findings lend further support for utilization of the GOSE in clinical trials when it is based on a structured interview.
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Affiliation(s)
- H S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas 77030, USA.
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York MK, Levin HS, Grossman RG. Pallidotomy and psychological outcomes. J Neurosurg 2001; 94:866-8. [PMID: 11354429 DOI: 10.3171/jns.2001.94.5.0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bloom DR, Levin HS, Ewing-Cobbs L, Saunders AE, Song J, Fletcher JM, Kowatch RA. Lifetime and novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry 2001; 40:572-9. [PMID: 11349702 DOI: 10.1097/00004583-200105000-00017] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess lifetime and current psychiatric disorders at least 1 year after traumatic brain injury (TBI) in children and adolescents. METHOD Forty-six youths who sustained a TBI between the ages of 6 through 15 years were evaluated at least 1 year post-TBI to identify the presence of lifetime and/or novel psychiatric disorders. Semistructured interviews of the parent and child and standardized parent self-report rating instruments were used. RESULTS Attention-deficit/hyperactivity disorder and depressive disorders were the most common lifetime and novel diagnoses. A wide variety and high rate of novel psychiatric disorders were identified; 74% of these disorders persisted in 48% of the injured children. Internalizing disorders were more likely to resolve than externalizing disorders. Both interviews and parent ratings were sensitive to current externalizing behaviors; interviews more often detected internalizing disorders, whereas parent ratings also identified cognitive difficulties. CONCLUSIONS Findings were generally consistent with previous research demonstrating the high rate of novel psychiatric disorders following pediatric TBI. Psychiatric interviews were sensitive in identifying both lifetime and novel disorders.
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Affiliation(s)
- D R Bloom
- Department of Pediatrics, University of Texas-Houston Health Sciences Center, USA
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Levin HS, Song J, Ewing-Cobbs L, Chapman SB, Mendelsohn D. Word fluency in relation to severity of closed head injury, associated frontal brain lesions, and age at injury in children. Neuropsychologia 2001; 39:122-31. [PMID: 11163370 DOI: 10.1016/s0028-3932(00)00111-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [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] [Indexed: 10/18/2022]
Abstract
Effects of closed head injury (CHI) severity, focal brain lesions, and age at injury on word fluency (WF) were studied longitudinally in 122 children (78 severe, 44 mild); 112 CHI patients (68 severe, 44 mild CHI) and 104 uninjured normal controls participated in a cross-sectional study. WF was measured by asking the child to generate as many words as possible beginning with a designated letter within 60 s, repeated for three letters. Intellectual ability, receptive vocabulary, narrative discourse, and word list recall were also measured. Results of the cross-sectional study showed a significant group effect with poorer WF in severe CHI than mild CHI and control groups. Growth curve analysis of longitudinal data revealed an interaction of age, follow-up interval, and CHI severity as WF recovery was slower after severe CHI in younger children as compared to severe CHI in older children or mild CHI in younger children. An interaction of left frontal lesion with age and interval indicated a more adverse effect on WF in older children. Right frontal lesion effect was nonsignificant and did not interact with age. Correlations of WF with receptive vocabulary, word list recall, and narrative discourse were moderate and weak with estimated intellectual ability. Differences in focal lesion effects after traumatic versus nontraumatic brain injury in children, the contribution of diffuse white matter injury, reduced opportunity for language development, and functional commitment of left frontal region at time of CHI were discussed.
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Affiliation(s)
- H S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, One Baylor Plaza, MSC, ST1144, Houston, TX 77030, USA.
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Verger K, Junqué C, Levin HS, Jurado MA, Pérez-Gómez M, Bartrés-Faz D, Barrios M, Alvarez A, Bartumeus F, Mercader JM. Correlation of atrophy measures on MRI with neuropsychological sequelae in children and adolescents with traumatic brain injury. Brain Inj 2001; 15:211-21. [PMID: 11260770 DOI: 10.1080/02699050010004059] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
To examine the relationship between neuropsychological sequelae and atrophy parameters from magnetic resonance imaging (MRI) following paediatric moderate-to-severe traumatic brain injury (TBI), 19 head injured children and adolescents were studied at least 6 years after injury. Three-dimensional MRI scans were obtained. A semi-automatic computerized method was used to estimate ventricular volumes and the corpus callosum area. Tests of intellectual, memory, visuospatial, frontal lobe, and motor speed functioning were administered to all patients and to 19 matched normal control subjects. Patients' performance significantly differed from controls in general intellectual function, visual memory, visuospatial and frontal lobe tests. The corpus callosum area correlated strongly with several measures involving processing speed and visuospatial function. Ventricular enlargement was less related to neuropsychological outcome. In conclusion, quantitative measurement of the corpus callosum on MRI reflects neuropsychological outcome better than ventricular dilation in paediatric patients.
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Affiliation(s)
- K Verger
- Department of Psychiatry and Clinical Psychobiology , University of Barcelona, Spain
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Goldstein FC, Levin HS, Goldman WP, Clark AN, Altonen TK. Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults. J Int Neuropsychol Soc 2001; 7:373-83. [PMID: 11311038 DOI: 10.1017/s1355617701733115] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study evaluated the early cognitive and neurobehavioral outcomes of older adults with mild versus moderate traumatic brain injury (TBI). Thirty-five patients who were age 50 years and older and sustained mild or moderate TBI were prospectively recruited from acute care hospitals. Patients were administered cognitive and neurobehavioral measures up to 2 months post-injury. Demographically comparable control participants received the same measures. Patients and controls did not have previous histories of substance abuse, neuropsychiatric disturbance, dementia, or neurologic illness. Moderate TBI patients performed significantly poorer than mild TBI patients and controls on most cognitive measures, whereas the mild patients performed comparably to controls. In contrast, both mild and moderate patients exhibited significantly greater depression and anxiety/somatic concern than controls. The results indicate that the classification of TBI as mild versus moderate is prognostically meaningful as applied to older adults. The findings extend previous investigations in young adults by demonstrating a relatively good cognitive outcome on objective measures, but subjective complaints after a single, uncomplicated mild TBI in older persons.
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Affiliation(s)
- F C Goldstein
- Department of Neurology, Emory University School of Medicine and Wesley Woods Center of Emory University, Atlanta, Georgia 30329, USA.
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Brown SA, McCauley SR, Levin HS, Boake C, Goldfader PR, McCormick SD, Rockers D, Butters M, Kareken DA, Gostnell D, Clifton GL. Factor analysis of an outcome interview for use in clinical trials of traumatically brain-injured patients: a preliminary study. Am J Phys Med Rehabil 2001; 80:196-205. [PMID: 11237274 DOI: 10.1097/00002060-200103000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/27/2022]
Abstract
OBJECTIVE To study the factor structure, internal consistency, concurrent validity, and sensitivity to detect change in patient report of problems of a structured interview in relationship with accepted outcome measures. DESIGN Outcome status of patients with severe traumatic brain injury participating in a randomized, phase III, multicenter clinical trial was assessed at 6 mo postinjury using the Glasgow Outcome Scale, the Disability Rating Scale, and the Severe Traumatic Brain Injury Outcome Interview. RESULTS Exploratory factor analysis of the Severe Traumatic Brain Injury Outcome Interview produced a meaningful five-factor model: (1) activities of daily living; (2) cognitive; (3) affective; (4) behavioral; and (5) instrumental activities of daily living. The internal consistency of the factors ranged from moderate (0.61 instrumental activities of daily living) to high (0.94 activities of daily living); the interfactor correlations were moderate. The summed factor scores were significantly correlated with measures of global outcome: the Glasgow Outcome Scale (r = 0.66; P < 0.0001) and the Disability Rating Scale (r = 0.61; P < 0.0001). Patient report of cognitive problems correlated moderately with the neuropsychological tests. The summed factor scores were sensitive to change over time. CONCLUSIONS Overall, the interview assessed the major important features of outcome pertinent to traumatic brain injury and demonstrated greater sensitivity to subtle changes over time than the unidimensional approaches, such as the Glasgow Outcome Scale and Disability Rating Scale.
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Affiliation(s)
- S A Brown
- Department of Psychology, University of Houston, Texas, USA
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Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR, Muizelaar JP, Wagner FC, Marion DW, Luerssen TG, Chesnut RM, Schwartz M. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001; 344:556-63. [PMID: 11207351 DOI: 10.1056/nejm200102223440803] [Citation(s) in RCA: 857] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Induction of hypothermia in patients with brain injury was shown to improve outcomes in small clinical studies, but the results were not definitive. To study this issue, we conducted a multicenter trial comparing the effects of hypothermia with those of normothermia in patients with acute brain injury. METHODS The study subjects were 392 patients 16 to 65 years of age with coma after sustaining closed head injuries who were randomly assigned to be treated with hypothermia (body temperature, 33 degrees C), which was initiated within 6 hours after injury and maintained for 48 hours by means of surface cooling, or normothermia. All patients otherwise received standard treatment. The primary outcome measure was functional status six months after the injury. RESULTS The mean age of the patients and the type and severity of injury in the two treatment groups were similar. The mean (+/-SD) time from injury to randomization was 4.3+/-1.1 hours in the hypothermia group and 4.1+/-1.2 hours in the normothermia group, and the mean time from injury to the achievement of the target temperature of 33 degrees C in the hypothermia group was 8.4+/-3.0 hours. The outcome was poor (defined as severe disability, a vegetative state, or death) in 57 percent of the patients in both groups. Mortality was 28 percent in the hypothermia group and 27 percent in the normothermia group (P=0.79). The patients in the hypothermia group had more hospital days with complications than the patients in the normothermia group. Fewer patients in the hypothermia group had high intracranial pressure than in the normothermia group. CONCLUSIONS Treatment with hypothermia, with the body temperature reaching 33 degrees C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.
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Affiliation(s)
- G L Clifton
- Vivian L Smith Center for Neurologic Research, Department of Neurosurgery, University of Texas-Houston Medical School, 77030, USA.
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Clark PE, Peereboom DM, Dreicer R, Levin HS, Clark SB, Klein EA. Phase II trial of neoadjuvant estramustine and etoposide plus radical prostatectomy for locally advanced prostate cancer. Urology 2001; 57:281-5. [PMID: 11182337 DOI: 10.1016/s0090-4295(00)00914-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To report the results of a Phase II trial of neoadjuvant estramustine and etoposide before radical prostatectomy in patients with locally advanced disease. METHODS Treatment consisted of three cycles of estramustine (10 mg/kg/day) and etoposide (50 mg/m(2)/day) orally on days 1 through 21, repeated every 28 days, followed by radical prostatectomy. The eligibility criteria included locally advanced prostate cancer (clinical Stage T2b/c or T3, prostate-specific antigen [PSA] level of 15 ng/mL or greater, or Gleason score of 8 or higher) without evidence of metastatic disease. The median PSA level was 14 ng/mL (range 5.3 to 50), the median Gleason score was 7 (range 6 to 9), and 44% had Stage T2b/c or T3 disease. The primary endpoint was feasibility of neoadjuvant therapy and radical prostatectomy, including drug and surgery-related toxicities. Secondary endpoints included the pre-prostatectomy PSA level, local response, pathologic outcomes, and time to PSA failure. RESULTS Eighteen patients were entered and completed all three cycles of therapy, and 16 (89%) underwent radical prostatectomy. A local response occurred in 15 (94%) of 16 patients with palpable tumors, and the serum PSA reached undetectable levels after therapy and before radical prostatectomy in 9 patients (50%). Five patients (28%) experienced grade 3 toxicity (two with deep venous thrombosis, two with neutropenia, and one with diarrhea) and one (6%) experienced grade 4 toxicity (pulmonary embolus) before surgery. The median operative time was 125 minutes, the mean blood loss was 665 mL, and the mean length of stay was 2.5 nights. Five minor surgical complications occurred in 4 patients. The pathologic analysis demonstrated residual carcinoma with squamous metaplasia and androgen deprivation effect in all patients. Five patients (31%) had organ-confined disease and 9 patients (56%) had specimen-confined disease. All patients achieved an undetectable PSA level postoperatively and at a median follow-up of 14 months (range 5 to 20) and without additional therapy, all 14 patients with negative lymph nodes were disease free. CONCLUSIONS This trial confirms the feasibility of radical prostatectomy with acceptable surgical morbidity after neoadjuvant therapy with estramustine and etoposide in patients with locally advanced prostate cancer. However, this regimen is associated with estramustine-induced thromboembolic toxicity. The results of the pathologic analysis suggest a higher than expected rate of organ-confined and specimen-confined disease, but little histologic evidence of antitumor effect beyond that associated with androgen deprivation. Additional study of this paradigm with other drug regimens is warranted.
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Affiliation(s)
- P E Clark
- Urology Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract
The discourse of 91 children who had sustained severe (n = 68) or mild (n = 23) closed head injury (CHI) was examined at least three years postinjury. The groups' retellings of a narrative story were analyzed according to two domains, information and language. In comparison to the mild CHI group, the severe group produced stories characterized by reduced content and information, impaired organization, fewer words, and less complex sentences. The relationships between discourse production and the groups' performance on measures of language, executive function, memory, and processing speed were examined. Correlations were found between discourse production and general verbal ability including verbal fluency. Correlations were also found for discourse performance and executive function measures associated with problem solving and working memory. Site and extent of lesion were not useful in predicting discourse production. These findings indicate that children who sustain a severe closed head injury during early to middle childhood are at risk for persisting deficits in discourse processing and other cognitive abilities.
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Affiliation(s)
- B L Brookshire
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas 77030, USA
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Rettig GM, York MK, Lai EC, Jankovic J, Krauss JK, Grossman RG, Levin HS. Neuropsychological outcome after unilateral pallidotomy for the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry 2000; 69:326-36. [PMID: 10945807 PMCID: PMC1737102 DOI: 10.1136/jnnp.69.3.326] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the long term cognitive outcome of unilateral posteroventral pallidotomy (PVP) and the overall efficacy of the surgery. METHODS Forty two (29 left and 13 right PVP) patients with Parkinson's disease underwent neurological and neuropsychological testing before PVP and at 3 and 12 months after PVP. The neuropsychological testing battery emphasised measures of verbal learning and memory, visuospatial abilities, speed of information processing, executive functioning, and affective functioning. RESULTS All patients demonstrated motor improvements after surgery during their off state, and 86% of patients also showed improvements in motor functioning in their on state. Repeated measures ANOVA showed significant improvements in confrontational naming, visuospatial organisation, and affective functioning 3 months and 12 months after surgery, with inconsistent improvements in executive functioning 12 months post-PVP. Patients demonstrated a transient impairment in verbal memory, with verbal learning performance returning to baseline 12 months post-PVP after a significant decline 3 months after PVP. When three patients with lesions extending outside of the PVP were excluded from the analysis, a decline in verbal fluency performance after PVP was not found to be significant. Differences due to side of lesion placement were not found on any of the cognitive measures. CONCLUSIONS In the largest long term follow up study reported to date, the cognitive changes found up to a year after PVP are minimal compared with the robust improvements in motor function. The findings highlight the need to investigate the relation between the specific fibre tracts affected by the lesions and cognitive outcome.
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Affiliation(s)
- G M Rettig
- Department of Neurosurgery, Baylor College of Medicine and The Methodist Hospital, 6560 Fannin, Suite 944, Houston, Texas 77030, USA
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Abstract
Patients with intersex syndrome are rare in the general population. In these patients, cryptorchid gonads that have an Y chromosome or Y chromosomal material are at risk for development of germinal and non-germinal neoplasm and non-neoplastic masses. Diagnosis of individual patients should be accurate for optimal care and risk assessment.
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Affiliation(s)
- H S Levin
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio, USA.
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Di Stefano G, Bachevalier J, Levin HS, Song JX, Scheibel RS, Fletcher JM. Volume of focal brain lesions and hippocampal formation in relation to memory function after closed head injury in children. J Neurol Neurosurg Psychiatry 2000; 69:210-6. [PMID: 10896695 PMCID: PMC1737037 DOI: 10.1136/jnnp.69.2.210] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES (1) A study of verbal learning and memory in children who had sustained a closed head injury (CHI) at least 3 months earlier. (2) To relate memory function to focal brain lesion and hippocampal formation volumes using morphometric analysis of MRI. METHODS A group of 245 children who had been admitted to hospital for CHI graded by the Glasgow coma scale (GCS), including 161 patients with severe and 84 with mild CHI completed the California verbal learning test (CVLT) and underwent MRI which was analysed for focal brain lesion volume independently of memory test data. Brain MRI with 1.5 mm coronal slices obtained in subsets of 25 patients with severe and 25 patients with mild CHI were analysed for hippocampal formation volume. Interoperator reliability in morphometry was satisfactory. RESULTS Severity of CHI and age at study significantly affected memory performance. Regression analysis showed that bifrontal, left frontal, and right frontal lesion volumes incremented prediction of various learning and memory indices after entering the GCS score and age into the model. Extrafrontal lesion volume did not contribute to predicting memory performance. CONCLUSIONS Prefrontal lesions contribute to residual impairment of learning and memory after severe CHI in children. Although effects of CHI on hippocampal formation volume might be difficult to demonstrate in non-fatal paediatric CHI, further investigation using functional brain imaging could potentially demonstrate hippocampal dysfunction.
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Affiliation(s)
- G Di Stefano
- Cognitive Neuroscience Laboratory, Baylor College of Medicine, Houston, Texas, USA.
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Backman V, Wallace MB, Perelman LT, Arendt JT, Gurjar R, Müller MG, Zhang Q, Zonios G, Kline E, McGilligan JA, Shapshay S, Valdez T, Badizadegan K, Crawford JM, Fitzmaurice M, Kabani S, Levin HS, Seiler M, Dasari RR, Itzkan I, Van Dam J, Feld MS, McGillican T. Detection of preinvasive cancer cells. Nature 2000; 406:35-6. [PMID: 10894529 DOI: 10.1038/35017638] [Citation(s) in RCA: 280] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- V Backman
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge 02139, USA
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Fergany A, Kupelian PA, Levin HS, Zippe CD, Reddy C, Klein EA. No difference in biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients. Urology 2000; 56:92-5. [PMID: 10869632 DOI: 10.1016/s0090-4295(00)00550-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To detect the short-term differences in biochemical relapse-free rates between patients with and without pelvic lymph node dissection (PLND). Recently, a trend has begun to omit PLND in patients undergoing radical prostatectomy considered at low risk of pelvic lymph node metastases. METHODS The records of 1152 consecutive radical prostatectomy cases were reviewed. A total of 575 patients with favorable tumor characteristics (prostate-specific antigen [PSA] 10 ng/mL or less, Gleason score 6 or less, and clinical Stage T1 or T2) who were not receiving adjuvant or neoadjuvant therapy were divided into two groups according to whether PLND was performed (PLND group, n = 372) or omitted (no PLND group, n = 203). Proportional hazards were used to analyze the effect of age, race, family history, stage, biopsy Gleason score, initial PSA, PLND, and pathologic findings on the likelihood of biochemical failure. Biochemical failure-free survival for each group was estimated by Kaplan-Meier analysis. The mean follow-up was 38 months (range 1 to 141). RESULTS The actuarial 4-year biochemical relapse-free rate for the PLND versus no PLND groups was 91% and 97%, respectively (P = 0.16). On multivariate analysis, PLND was not an independent predictor of outcome (P = 0.24). CONCLUSIONS The results of our study indicate that the omission of PLND in patients with favorable tumor characteristics does not adversely affect biochemical relapse rates.
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Affiliation(s)
- A Fergany
- Department of Urology (Section of Urologic Oncology), Cleveland Clinic Foundation, OH 44195, USA
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Vanier M, Mazaux JM, Lambert J, Dassa C, Levin HS. Assessment of neuropsychologic impairments after head injury: interrater reliability and factorial and criterion validity of the Neurobehavioral Rating Scale-Revised. Arch Phys Med Rehabil 2000; 81:796-806. [PMID: 10857527 DOI: 10.1016/s0003-9993(00)90114-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study interrater reliability and factorial and criterion validity of the Neurobehavioral Rating Scale-Revised (NRS-R). DESIGN Validity study on persons with traumatic brain injury (TBI) and test-retest reliability study on a randomly selected subset of patients. Factor analyses, kappa statistics, intraclass correlation coefficients, and Cronbach's alphas were used. SETTING Inpatients from 15 French hospitals, mainly rehabilitation units. Other recruitment sites included a neurology hospital unit and a psychiatry hospital specifically devoted to TBI rehabilitation. PATIENTS Two hundred eighty-six TBI patients ages 16 to 70 years (convenience sample). RESULTS For the reliability study, the average of percentages of agreement among the items was 74.3% and the average of kappa statistics was .40. Factor analyses disclosed a maximum likelihood extraction of 5 correlated factors (F), explaining 42.2% of total variance: (F1) deficits in intentional behavior and in memory, (F2) lowering of emotional state, (F3) emotional and behavioral hyperactivation, (F4) lowering of arousal state and of attention, and (F5) language and speech problems. Results support the criterion validity of the factors. Reliability of the factor scores and internal consistencies of factors were very good. CONCLUSIONS Results describe some important properties of the NRS-R and, through an understanding of its underlying structure and relationships with the patients' clinical characteristics, contribute to the conceptual framework of neuropsychologic impairments after TBI.
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Affiliation(s)
- M Vanier
- Ecole de Réadaptation, Université de Montréal, Québec, Canada
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Abstract
OBJECTIVES To measure the radial extent of extracapsular penetration by tumor cells, thereby providing estimates of the margins needed around target volumes. New radiotherapeutic techniques, like brachytherapy and conformal radiotherapy, irradiate small volumes and reduce the dose to periprostatic tissues. Even in the early stages of localized prostate cancer, extracapsular extension (ECE) is commonly seen. METHODS Two hundred sixty-five consecutive radical prostatectomy specimens were analyzed for the presence of ECE. ECE was found in 92 of all cases (35%); measurements were performed in 79 of the 92 cases. A total of 98 ECE sites were evaluated in the 79 cases. The distance of tumor outside the capsule was measured in millimeters. Extension less than 0.1 mm was considered as "focal". RESULTS The site of ECE was posterolateral in 53% of cases, lateral in 24%, posterior in 13%, and at the base in 10%. The median amount of ECE at all sites was 1. 1 mm (mean 1.7). However, the range was wide; the minimum measurable extent was 0.1 mm and the maximum 10.0 mm. The extent was within 3.8 mm for 90% of all cases. By stratifying cases with favorable and unfavorable tumors, the 90th percentiles of ECE were as follows: 3.3 mm for favorable tumors (clinical Stage T1-2, initial prostate-specific antigen 10 ng/mL or less, and biopsy Gleason score 6 or less) and 3.9 mm for unfavorable tumors (clinical Stage T3, initial prostate-specific antigen greater than 10 ng/mL, or biopsy Gleason score 7 or greater). CONCLUSIONS Most of the ECE was at posterolateral sites. The extent of disease outside the prostate was within 4 mm in 90% of cases. Since ECE was observed in 30% to 60% of all patients with clinical Stage T1-2 prostate cancer, only 3% to 7% of all such cases would have disease extent exceeding 4 mm. The present study provides useful estimates of the amount of ECE. These estimates could be potentially used in planning the target volumes for treatment of prostate cancer with either conformal radiotherapy or brachytherapy.
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Affiliation(s)
- C Sohayda
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Levin HS, Benavidez DA, Verger-Maestre K, Perachio N, Song J, Mendelsohn DB, Fletcher JM. Reduction of corpus callosum growth after severe traumatic brain injury in children. Neurology 2000; 54:647-53. [PMID: 10680798 DOI: 10.1212/wnl.54.3.647] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [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: 11/15/2022] Open
Abstract
OBJECTIVE To study effects of closed head injury (CHI) severity on development of corpus callosum (CC) in children, using MRI. BACKGROUND Vulnerability of CC to diffuse axonal injury has been shown in adults and children by neuropathologic and MRI studies. Given continued development of CC through the second decade, serial MRI could characterize effects of CHI on CC growth in children. METHOD MRI performed at 3 and 36 months after severe (mean age = 10.3 years, n = 25) and mild to moderate (mean age = 9.7 years, n = 28) CHI. Mild to moderate and severe CHI groups did not differ in demographic features. Morphometry of T1-weighted midsagittal CC by two operators with satisfactory interrater reliability yielded uncorrected and corrected CC volume. RESULTS An interaction of occasion with CHI severity was present as CC area decreased from 3 to 36 months in severely injured children and increased in the mild to moderate CHI group. Uncorrected CC area was correlated with acute CHI severity and functional outcome at 36 months postinjury. CONCLUSIONS Morphometric measurement of CC area provides a useful index of diffuse injury, which is related to functional outcome of CHI in children.
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Affiliation(s)
- H S Levin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Normative data for 267 neurologically normal adults (age range 18-91) are provided for a six-trial administration of Form I of the Verbal Selective Reminding Test (VSRT; Hannay & Levin, 1985). Gender corrections were generated by age- and education-matched pair analyses of the VSRT performance of 82 males and 82 females. Normative data are grouped by seven age cohorts: 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-91. A regression-based procedure is provided, so that existing delayed recall norms, based on a 12-trial administration, can be utilized, following a 6-trial administration.
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Abstract
This study describes a left handed woman with prosopagnosia following traumatic brain injury with a focal lesion confined to the left-posterior hemisphere. Few cases of prosopagnosia following unilateral left hemisphere lesions have previously been reported in the literature. Corrected visual acuity was 20/70 (binocular), color vision was intact on screening, and shape detection was borderline. Impairments in higher order visual perception were evident to varying degrees on nonfacial tasks. Matching of unfamiliar faces was very slow but accurate. A marked impairment in the ability to recognize familiar faces and learn new face-name associations was evident on experimental tasks relative to the performance of healthy control subjects. In contrast, identification of characteristics of faces (gender, age) and identification and matching of facial expressions were relatively preserved. We discuss the cognitive processing stages that appear to be disrupted using Bruce and Young's (1986) model of facial recognition and perception as a framework.
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Affiliation(s)
- A J Mattson
- Neuropsychology Service, Western State Hospital, Steilacoom, Washington, USA
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Levin HS, Song J, Scheibel RS, Fletcher JM, Harward HN, Chapman SB. Dissociation of frequency and recency processing from list recall after severe closed head injury in children and adolescents. J Clin Exp Neuropsychol 2000; 22:1-15. [PMID: 10649541 DOI: 10.1076/1380-3395(200002)22:1;1-8;ft001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/03/2022]
Abstract
To investigate judgment of the frequency and recency of events relative to word list recall in children following closed head injury (CHI), 124 children and adolescents, including 79 severe CHI patients (mean age at test = 13.2 years), 27 mild CHI cases (mean age at test = 12.1 years), and 18 uninjured comparison subjects (mean age = 12.8 years) were studied. The mean postinjury interval was 63.6 months for the severe and 46.7 months for the mild CHI groups. The experimental tasks included estimation of the frequency of presentation of words and designs and recency judgment to select the most recently presented of two stimuli on verbal (words) and nonverbal (faces) tasks. To compare frequency and recency judgments to performance on a task which has been shown to be sensitive to CHI severity and age at test, verbal recall was tested using the California Verbal Learning Test-Children's Version. Severity of CHI (group) affected verbal recall across trials and after delays, but had no effect on estimating frequency and isolated effects on judgment of recency. Age was also primarily related to verbal recall. A subgroup of severe CHI patients with frontal lesions was impaired on delayed recall. The results are discussed in relation to previous research on the effects of CHI on processing the frequency and recency of events.
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Affiliation(s)
- H S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, TX, USA.
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Abstract
Despite the findings of significantly improved motor functioning following pallidotomy for the treatment of Parkinson's disease, the cognitive sequelae following surgery have yet to be clearly defined. With increasing knowledge of the surgery's effect on frontostriatal circuits, the cognitive processes potentially affected by the procedure require further exploration to evaluate fully the efficacy of the treatment. We reviewed 10 studies on the neuropsychological outcome after pallidotomy that were published in peer-reviewed journals. A general agreement exists that pallidotomy is a relatively safe and effective treatment for ameliorating the motor symptoms of Parkinson's disease, with relatively few cognitive changes reported following surgery. However, a number of conceptual and methodological concerns, including diverse selection criteria, small sample sizes and short follow-up periods, limit the interpretation and generalizability of these findings. These concerns are discussed in detail, along with a summary of the current neuropsychological literature, suggested guidelines for the conduct of research and future research directions. The neuropsychological findings are critically reviewed and tabulated by study, cognitive domain and follow-up period, with particular emphasis on hemisphere-specific cognitive changes.
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Affiliation(s)
- M K York
- Baylor College of Medicine, Department of Neurosurgery, Houston, Texas 77030, USA.
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Jhaveri FM, Klein EA, Kupelian PA, Zippe C, Levin HS. Declining rates of extracapsular extension after radical prostatectomy: evidence for continued stage migration. J Clin Oncol 1999; 17:3167-72. [PMID: 10506614 DOI: 10.1200/jco.1999.17.10.3167] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prostate-specific antigen (PSA)-based screening is responsible for a profound clinical stage migration in newly detected prostate cancers. Extracapsular extension (ECE) is an important predictor of outcome after radical prostatectomy (RP). We examined trends in the rate of ECE for cancers detected by PSA screening in 731 RP specimens between 1987 and 1997, when screening became routine urologic practice in the United States. METHODS The rates of ECE were examined in 311 prostates with nonpalpable (stage T1c) disease and 420 with palpable but clinically localized (stage T2) disease. Specimens were step-sectioned and examined by a senior pathologist. Rates of ECE were compared with respect to time, and logistic regression was used to identify predictors of ECE. RESULTS The rate of ECE decreased from 81% to 36% during the 10-year observation period. Multivariateanalysis involving clinical tumor stage, preoperative serum PSA level, and Gleason score demonstrated that year of treatment was an independent predictor of ECE, with a two-fold reduction of risk occurring during the study period (P <. 001; odds ratio, 1.96; 95% confidence interval, 1.37 to 2.78). CONCLUSION PSA screening has resulted in a downward trend in pathologic stage in clinically localized prostate cancer, independent of preoperative PSA level, tumor stage, and Gleason score. This time-dependent downward stage migration suggests the need for continuous updating of predictive nomograms and caution in interpreting differences in contemporarily treated patients compared with historical controls. Further study is needed to determine whether this trend will translate into improved disease-free survival.
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Affiliation(s)
- F M Jhaveri
- Section of Urologic Oncology, Department of Urology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Benavidez DA, Fletcher JM, Hannay HJ, Bland ST, Caudle SE, Mendelsohn DB, Yeakley J, Brunder DG, Harward H, Song J, Perachio NA, Bruce D, Scheibel RS, Lilly MA, Verger-Maestre K, Levin HS. Corpus callosum damage and interhemispheric transfer of information following closed head injury in children. Cortex 1999; 35:315-36. [PMID: 10440072 DOI: 10.1016/s0010-9452(08)70803-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 11/30/2022]
Abstract
We evaluated the relationship of corpus callosum atrophy and/or lesions on magnetic resonance imaging (MRI) to functional hemispheric disconnection following closed head injury (CHI) in 51 pediatric patients, including mild CHI, moderate to severe CHI with extracallosal lesions, and moderate to severe CHI with callosal atrophy and/or lesions. Interhemispheric transfer of information was assessed using auditory, motor, tactile, and visual tests in patients and in 16 uninjured children. Total and regional callosal areas were measured from the midsagittal MRI slice by morphometry. The corpus callosum lesion group demonstrated a greater right ear advantage on verbal dichotic listening than all other groups. Areas of the posterior corpus callosum were negatively correlated with laterality indices of verbal dichotic listening performance and tachistoscopic identification of verbal material. The relationship of corpus callosum atrophy and/or lesions to asymmetry in dichotic listening is consistent with previous investigation of posttraumatic hemispheric disconnection effects in adults.
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Affiliation(s)
- D A Benavidez
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Hendin BN, Streem SB, Levin HS, Klein EA, Novick AC. Impact of diagnostic ureteroscopy on long-term survival in patients with upper tract transitional cell carcinoma. J Urol 1999; 161:783-5. [PMID: 10022684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE We determine whether diagnostic retrograde ureteroscopy for evaluation of upper tract transitional cell carcinoma adversely affects survival outcomes in terms of urothelial and metastatic tumor recurrence, and tumor-free and overall survival. MATERIALS AND METHODS A total of 96 patients underwent total nephroureterectomy or resection of the distal ureter with a bladder cuff for upper tract transitional cell carcinoma. Of the patients 48 (study group) had undergone preoperative diagnostic ureteroscopy while 48 (control group) had not. Grade and stage of disease were compared, and time to recurrence, and disease-free and overall survival were analyzed. RESULTS Grade and stage of disease were equivalent in both groups. There were no significant differences in recurrence rates, time to recurrence or mortality between the groups. Metastases developed in 9 patients (18.8%) in the control group and 6 (12.5%) in the study group (p = 0.58), while 5 (10.4%) in each group died of metastases of upper tract carcinoma (p = 1.00). Kaplan-Meier estimates were 0.67 and 0.71 for metastasis-free survival at 5 years (p = 0.25, not significant) and 0.87 and 0.76 for overall 5-year survival (p = 0.75, not significant) for the study and control groups, respectively. CONCLUSIONS Diagnostic ureteroscopy has no clinically apparent adverse effect on long-term or disease specific survival of patients with upper tract transitional cell carcinoma who subsequently undergo standard definitive surgical management.
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Affiliation(s)
- B N Hendin
- Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA
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Goldstein FC, Levin HS, Goldman WP, Kalechstein AD, Clark AN, Kenehan-Altonen T. Cognitive and behavioral sequelae of closed head injury in older adults according to their significant others. J Neuropsychiatry Clin Neurosci 1999; 11:38-44. [PMID: 9990554 DOI: 10.1176/jnp.11.1.38] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined the neurobehavioral effects of closed head injury (CHI) in older adults according to their significant others. Informants of 17 mild and moderate CHI patients > or = 50 years old when injured completed the Geriatric Evaluation of Relative's Rating Instrument, a questionnaire inquiring about the patient's cognition, affect, interpersonal relations, and daily activities. The significant others provided retrospective ratings of preinjury functioning and completed the same instrument an average of 4 and 13 months post-injury. The significant others of 10 community-residing, normal control subjects completed the questionnaire at comparable intervals between each rating. Compared with their preinjury functioning, and unlike the control subjects, patients showed declines in cognition and mood. The possible impact of these changes, including their effect on subjective burden in caregivers, is discussed.
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Affiliation(s)
- F C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Ewing-Cobbs L, Fletcher JM, Levin HS, Iovino I, Miner ME. Academic achievement and academic placement following traumatic brain injury in children and adolescents: a two-year longitudinal study. J Clin Exp Neuropsychol 1998; 20:769-81. [PMID: 10484689 DOI: 10.1076/jcen.20.6.769.1109] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.0] [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] [Indexed: 11/03/2022]
Abstract
Prospective, longitudinal follow-up of academic status following pediatric traumatic brain injury (TBI) identified that patients with severe TBI (n = 33) obtained significantly lower reading recognition, spelling, and arithmetic scores than those with mild to moderate TBI (n = 28). Independent of injury severity, adolescents scored lower than children on computational arithmetic and reading comprehension subtests. Although all achievement scores increased significantly from the baseline evaluation to 6 months after the injury, no further change was noted from 6 months to 2 years. Despite average achievement test scores by 2 years after TBI, 79% of the severely injured patients had either failed a grade or received special educational assistance. Traditional achievement tests may be insensitive to posttraumatic academic deficits.
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Affiliation(s)
- L Ewing-Cobbs
- Department of Pediatrics, University of Texas Houston Health Science Center, 77030, USA.
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50
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Abstract
Investigations of cognitive recovery from traumatic brain injury have utilized experimental cognitive tasks, including measures of executive function and discourse processing, to elucidate specific sequelae. The scope of research, which includes brain imaging and pharmacologic intervention, could potentially enhance rehabilitation of patients with brain injury.
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Affiliation(s)
- H S Levin
- Physical Medicine and Rehabilitation Research Office, Baylor College of Medicine, Houston, TX 77030, USA.
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