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Tuure J, Mohammadian M, Tenovuo O, Blennow K, Hossain I, Hutchinson P, Maanpää HR, Menon DK, Newcombe VF, Takala RSK, Tallus J, van Gils M, Zetterberg H, Posti JP. Late Blood Levels of Neurofilament Light Correlate With Outcome in Patients With Traumatic Brain Injury. J Neurotrauma 2024; 41:359-368. [PMID: 37698882 PMCID: PMC11071082 DOI: 10.1089/neu.2023.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Neurofilament light (NF-L) is an axonal protein that has shown promise as a traumatic brain injury (TBI) biomarker. Serum NF-L shows a rather slow rise after injury, peaking after 1-2 weeks, although some studies suggest that it may remain elevated for months after TBI. The aim of this study was to examine if plasma NF-L levels several months after the injury correlate with functional outcome in patients who have sustained TBIs of variable initial severity. In this prospective study of 178 patients with TBI and 40 orthopedic injury controls, we measured plasma NF-L levels in blood samples taken at the follow-up appointment on average 9 months after injury. Patients with TBI were divided into two groups (mild [mTBI] vs. moderate-to-severe [mo/sTBI]) according to the severity of injury assessed with the Glasgow Coma Scale upon admission. Recovery and functional outcome were assessed using the Extended Glasgow Outcome Scale (GOSE). Higher levels of NF-L at the follow-up correlated with worse outcome in patients with moderate-to-severe TBI (Spearman's rho = -0.18; p < 0.001). In addition, in computed tomography-positive mTBI group, the levels of NF-L were significantly lower in patients with GOSE 7-8 (median 18.14; interquartile range [IQR] 9.82, 32.15) when compared with patients with GOSE <7 (median 73.87; IQR 32.17, 110.54; p = 0.002). In patients with mTBI, late NF-L levels do not seem to provide clinical benefit for late-stage assessment, but in patients with initially mo/sTBI, persistently elevated NF-L levels are associated with worse outcome after TBI and may reflect ongoing brain injury.
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Affiliation(s)
- Juho Tuure
- Department of Clinical Neurosciences, University of Turku, Finland
| | - Mehrbod Mohammadian
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
| | - Olli Tenovuo
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
| | - Kaj Blennow
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom
| | - Iftakher Hossain
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Henna-Riikka Maanpää
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Finland
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Finland
| | - Jussi Tallus
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
- Department of Radiology, Turku University Hospital and University of Turku, Finland
| | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Jussi P Posti
- Department of Clinical Neurosciences, University of Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Finland
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Finland
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Korhonen O, Mononen M, Mohammadian M, Tenovuo O, Blennow K, Hossain I, Hutchinson P, Maanpää HR, Menon DK, Newcombe VF, Sanchez JC, Takala RSK, Tallus J, van Gils M, Zetterberg H, Posti JP. Outlier Analysis for Acute Blood Biomarkers of Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2024; 41:91-105. [PMID: 37725575 DOI: 10.1089/neu.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Blood biomarkers have been studied to improve the clinical assessment and prognostication of patients with moderate-severe traumatic brain injury (mo/sTBI). To assess their clinical usability, one needs to know of potential factors that might cause outlier values and affect clinical decision making. In a prospective study, we recruited patients with mo/sTBI (n = 85) and measured the blood levels of eight protein brain pathophysiology biomarkers, including glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), neurofilament light (Nf-L), heart-type fatty acid-binding protein (H-FABP), interleukin-10 (IL-10), total tau (T-tau), amyloid β40 (Aβ40) and amyloid β42 (Aβ42), within 24 h of admission. Similar analyses were conducted for controls (n = 40) with an acute orthopedic injury without any head trauma. The patients with TBI were divided into subgroups of normal versus abnormal (n = 9/76) head computed tomography (CT) and favorable (Glasgow Outcome Scale Extended [GOSE] 5-8) versus unfavorable (GOSE <5) (n = 38/42, 5 missing) outcome. Outliers were sought individually from all subgroups from and the whole TBI patient population. Biomarker levels outside Q1 - 1.5 interquartile range (IQR) or Q3 + 1.5 IQR were considered as outliers. The medical records of each outlier patient were reviewed in a team meeting to determine possible reasons for outlier values. A total of 29 patients (34%) combined from all subgroups and 12 patients (30%) among the controls showed outlier values for one or more of the eight biomarkers. Nine patients with TBI and five control patients had outlier values in more than one biomarker (up to 4). All outlier values were > Q3 + 1.5 IQR. A logical explanation was found for almost all cases, except the amyloid proteins. Explanations for outlier values included extremely severe injury, especially for GFAP and S100B. In the case of H-FABP and IL-10, the explanation was extracranial injuries (thoracic injuries for H-FABP and multi-trauma for IL-10), in some cases these also were associated with abnormally high S100B. Timing of sampling and demographic factors such as age and pre-existing neurological conditions (especially for T-tau), explained some of the abnormally high values especially for Nf-L. Similar explanations also emerged in controls, where the outlier values were caused especially by pre-existing neurological diseases. To utilize blood-based biomarkers in clinical assessment of mo/sTBI, very severe or fatal TBIs, various extracranial injuries, timing of sampling, and demographic factors such as age and pre-existing systemic or neurological conditions must be taken into consideration. Very high levels seem to be often associated with poor prognosis and mortality (GFAP and S100B).
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Affiliation(s)
- Otto Korhonen
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Malla Mononen
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Henna-Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Finland
| | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
- Department of Radiology, Turku University Hospital and University of Turku, Finland
| | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
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Hossain I, Mohammadian M, Maanpää HR, Takala RSK, Tenovuo O, van Gils M, Hutchinson P, Menon DK, Newcombe VF, Tallus J, Hirvonen J, Roine T, Kurki T, Blennow K, Zetterberg H, Posti JP. Plasma neurofilament light admission levels and development of axonal pathology in mild traumatic brain injury. BMC Neurol 2023; 23:304. [PMID: 37582732 PMCID: PMC10426141 DOI: 10.1186/s12883-023-03284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND It is known that blood levels of neurofilament light (NF-L) and diffusion-weighted magnetic resonance imaging (DW-MRI) are both associated with outcome of patients with mild traumatic brain injury (mTBI). Here, we sought to examine the association between admission levels of plasma NF-L and white matter (WM) integrity in post-acute stage DW-MRI in patients with mTBI. METHODS Ninety-three patients with mTBI (GCS ≥ 13), blood sample for NF-L within 24 h of admission, and DW-MRI ≥ 90 days post-injury (median = 229) were included. Mean fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated from the skeletonized WM tracts of the whole brain. Outcome was assessed using the Extended Glasgow Outcome Scale (GOSE) at the time of imaging. Patients were divided into CT-positive and -negative, and complete (GOSE = 8) and incomplete recovery (GOSE < 8) groups. RESULTS The levels of NF-L and FA correlated negatively in the whole cohort (p = 0.002), in CT-positive patients (p = 0.016), and in those with incomplete recovery (p = 0.005). The same groups showed a positive correlation with mean MD, AD, and RD (p < 0.001-p = 0.011). In CT-negative patients or in patients with full recovery, significant correlations were not found. CONCLUSION In patients with mTBI, the significant correlation between NF-L levels at admission and diffusion tensor imaging (DTI) measurements of diffuse axonal injury (DAI) over more than 3 months suggests that the early levels of plasma NF-L may associate with the presence of DAI at a later phase of TBI.
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Affiliation(s)
- Iftakher Hossain
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland.
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland.
- Department of Clinical Neurosciences, University of Turku, Turku, Finland.
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Intensive Care Medicine and Pain Management, Perioperative Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Tenovuo
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Timo Roine
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Turku, Finland
| | - Timo Kurki
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, University College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
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Niiranen TJU, Chiollaz AC, Takala RSK, Voutilainen M, Tenovuo O, Newcombe VFJ, Maanpää HR, Tallus J, Mohammadian M, Hossain I, van Gils M, Menon DK, Hutchinson PJ, Sanchez JC, Posti JP. Trajectories of interleukin 10 and heart fatty acid-binding protein levels in traumatic brain injury patients with or without extracranial injuries. Front Neurol 2023; 14:1133764. [PMID: 37082447 PMCID: PMC10111051 DOI: 10.3389/fneur.2023.1133764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundInterleukin 10 (IL-10) and heart fatty acid-binding protein (H-FABP) have gained interest as diagnostic biomarkers of traumatic brain injury (TBI), but factors affecting their blood levels in patients with moderate-to-severe TBI are largely unknown.ObjectiveTo investigate the trajectories of IL-10 and H-FABP between TBI patients with and without extracranial injuries (ECI); to investigate if there is a correlation between the levels of IL-10 and H-FABP with the levels of inflammation/infection markers C-reactive protein (CRP) and leukocytes; and to investigate if there is a correlation between the admission level of H-FABP with admission levels of cardiac injury markers, troponin (TnT), creatine kinase (CK), and creatine kinase MB isoenzyme mass (CK-MBm).Materials and methodsThe admission levels of IL-10, H-FABP, CRP, and leukocytes were measured within 24 h post-TBI and on days 1, 2, 3, and 7 after TBI. The admission levels of TnT, CK, and CK-MBm were measured within 24 h post-TBI.ResultsThere was a significant difference in the concentration of H-FABP between TBI patients with and without ECI on day 0 (48.2 ± 20.5 and 12.4 ± 14.7 ng/ml, p = 0.02, respectively). There was no significant difference in the levels of IL-10 between these groups at any timepoints. There was a statistically significant positive correlation between IL-10 and CRP on days 2 (R = 0.43, p < 0.01) and 7 (R = 0.46, p = 0.03) after injury, and a negative correlation between H-FABP and CRP on day 0 (R = -0.45, p = 0.01). The levels of IL-10 or H-FABP did not correlate with leukocyte counts at any timepoint. The admission levels of H-FABP correlated with CK (R = 0.70, p < 0.001) and CK-MBm (R = 0.61, p < 0.001), but not with TnT.ConclusionInflammatory reactions during the early days after a TBI do not significantly confound the use of IL-10 and H-FABP as TBI biomarkers. Extracranial injuries and cardiac sources may influence the levels of H-FABP in patients with moderate-to-severe TBI.
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Affiliation(s)
- Toni J. U. Niiranen
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- *Correspondence: Toni J. U. Niiranen,
| | - Anne-Cécile Chiollaz
- Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Riikka S. K. Takala
- Perioperative Services, Intensive Care Medicine, and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
- Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Miko Voutilainen
- Department of Microbiology, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Olli Tenovuo
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
| | - Virginia F. J. Newcombe
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | | | - Jussi Tallus
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | | | - Iftakher Hossain
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - David K. Menon
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jean-Charles Sanchez
- Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jussi P. Posti
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital, Turku, Finland
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Jussi P. Posti,
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Tallus J, Mohammadian M, Kurki T, Roine T, Posti JP, Tenovuo O. A comparison of diffusion tensor imaging tractography and constrained spherical deconvolution with automatic segmentation in traumatic brain injury. Neuroimage Clin 2023; 37:103284. [PMID: 36502725 PMCID: PMC9758569 DOI: 10.1016/j.nicl.2022.103284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/20/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
Detection of microstructural white matter injury in traumatic brain injury (TBI) requires specialised imaging methods, of which diffusion tensor imaging (DTI) has been extensively studied. Newer fibre alignment estimation methods, such as constrained spherical deconvolution (CSD), are better than DTI in resolving crossing fibres that are ubiquitous in the brain and may improve the ability to detect microstructural injuries. Furthermore, automatic tract segmentation has the potential to improve tractography reliability and accelerate workflow compared to the manual segmentation commonly used. In this study, we compared the results of deterministic DTI based tractography and manual tract segmentation with CSD based probabilistic tractography and automatic tract segmentation using TractSeg. 37 participants with a history of TBI (with Glasgow Coma Scale 13-15) and persistent symptoms, and 41 healthy controls underwent deterministic DTI-based tractography with manual tract segmentation and probabilistic CSD-based tractography with TractSeg automatic segmentation.Fractional anisotropy (FA) and mean diffusivity of corpus callosum and three bilateral association tracts were measured. FA and MD values derived from both tractography methods were generally moderately to strongly correlated. CSD with TractSeg differentiated the groups based on FA, while DTI did not. CSD and TractSeg-based tractography may be more sensitive in detecting microstructural changes associated with TBI than deterministic DTI tractography. Additionally, CSD with TractSeg was found to be applicable at lower b-value and number of diffusion-encoding gradients data than previously reported.
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Affiliation(s)
- Jussi Tallus
- Turku Brain Injury Center, Department of Clinical Neurosciences, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland; Department of Radiology, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland.
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Department of Clinical Neurosciences, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland
| | - Timo Kurki
- Turku Brain Injury Center, Department of Clinical Neurosciences, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland; Department of Radiology, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland
| | - Timo Roine
- Turku Brain and Mind Center, University of Turku, Turku FI-20014, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Rakentajanaukio 2 C, Espoo 02150, Finland
| | - Jussi P Posti
- Turku Brain Injury Center, Department of Clinical Neurosciences, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland; Neurocenter, Department of Neurosurgery, Turku University Hospital, University of Turku, Hämeentie 11, Turku FI-20521, Finland
| | - Olli Tenovuo
- Turku Brain Injury Center, Department of Clinical Neurosciences, University of Turku and Turku University Hospital, Hämeentie 11, Turku FI-20521, Finland
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6
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Newcombe VFJ, Ashton NJ, Posti JP, Glocker B, Manktelow A, Chatfield DA, Winzeck S, Needham E, Correia MM, Williams GB, Simrén J, Takala RSK, Katila AJ, Maanpää HR, Tallus J, Frantzén J, Blennow K, Tenovuo O, Zetterberg H, Menon DK. Post-acute blood biomarkers and disease progression in traumatic brain injury. Brain 2022; 145:2064-2076. [PMID: 35377407 PMCID: PMC9326940 DOI: 10.1093/brain/awac126] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/09/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
There is substantial interest in the potential for traumatic brain injury to result in progressive neurological deterioration. While blood biomarkers such as glial fibrillary acid protein (GFAP) and neurofilament light have been widely explored in characterizing acute traumatic brain injury (TBI), their use in the chronic phase is limited. Given increasing evidence that these proteins may be markers of ongoing neurodegeneration in a range of diseases, we examined their relationship to imaging changes and functional outcome in the months to years following TBI. Two-hundred and three patients were recruited in two separate cohorts; 6 months post-injury (n = 165); and >5 years post-injury (n = 38; 12 of whom also provided data ∼8 months post-TBI). Subjects underwent blood biomarker sampling (n = 199) and MRI (n = 172; including diffusion tensor imaging). Data from patient cohorts were compared to 59 healthy volunteers and 21 non-brain injury trauma controls. Mean diffusivity and fractional anisotropy were calculated in cortical grey matter, deep grey matter and whole brain white matter. Accelerated brain ageing was calculated at a whole brain level as the predicted age difference defined using T1-weighted images, and at a voxel-based level as the annualized Jacobian determinants in white matter and grey matter, referenced to a population of 652 healthy control subjects. Serum neurofilament light concentrations were elevated in the early chronic phase. While GFAP values were within the normal range at ∼8 months, many patients showed a secondary and temporally distinct elevations up to >5 years after injury. Biomarker elevation at 6 months was significantly related to metrics of microstructural injury on diffusion tensor imaging. Biomarker levels at ∼8 months predicted white matter volume loss at >5 years, and annualized brain volume loss between ∼8 months and 5 years. Patients who worsened functionally between ∼8 months and >5 years showed higher than predicted brain age and elevated neurofilament light levels. GFAP and neurofilament light levels can remain elevated months to years after TBI, and show distinct temporal profiles. These elevations correlate closely with microstructural injury in both grey and white matter on contemporaneous quantitative diffusion tensor imaging. Neurofilament light elevations at ∼8 months may predict ongoing white matter and brain volume loss over >5 years of follow-up. If confirmed, these findings suggest that blood biomarker levels at late time points could be used to identify TBI survivors who are at high risk of progressive neurological damage.
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Affiliation(s)
| | - Nicholas J Ashton
- Wallenberg Centre for Molecular and Translational Medicine, University of
Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and
Physiology, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- King’s College London, Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute,
London, UK
- Mental Health and Biomedical Research Unit for Dementia, Maudsley NIHR
Biomedical Research Centre, London, UK
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Ben Glocker
- Biomedical Image Analysis Group, Department of Computing, Imperial College
London, London, UK
| | - Anne Manktelow
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Doris A Chatfield
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Stefan Winzeck
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
- Biomedical Image Analysis Group, Department of Computing, Imperial College
London, London, UK
| | - Edward Needham
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Marta M Correia
- MRC (Medical Research Council) Cognition and Brain Sciences Unit,
University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Wolfson Brain Imaging Centre, Department of Clinical
Neurosciences, Cambridge, UK
| | - Joel Simrén
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management,
Department of Anesthesiology and Intensive Care, Turku University Hospital, University
of Turku, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management,
Department of Anesthesiology and Intensive Care, Turku University Hospital, University
of Turku, Turku, Finland
| | - Henna Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Janek Frantzén
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of
Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, University College
London, London, UK
- Hong Kong Center for Neurodegenerative Disease,
Hong Kong, China
| | - David K Menon
- Correspondence to: David Menon University Division of Anaesthesia
University of Cambridge Box 93, Addenbrooke’s Hospital Hills Road, Cambridge CB2 0QQ, UK
E-mail:
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7
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Dahl J, Tenovuo O, Posti JP, Hirvonen J, Katila AJ, Frantzén J, Maanpää HR, Takala R, Löyttyniemi E, Tallus J, Newcombe V, Menon DK, Hutchinson PJ, Mohammadian M. Cerebral Microbleeds and Structural White Matter Integrity in Patients With Traumatic Brain Injury-A Diffusion Tensor Imaging Study. Front Neurol 2022; 13:888815. [PMID: 35711272 PMCID: PMC9194845 DOI: 10.3389/fneur.2022.888815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Diffuse axonal injury (DAI) is a common neuropathological manifestation of traumatic brain injury (TBI), presenting as traumatic alterations in the cerebral white matter (WM) microstructure and often leading to long-term neurocognitive impairment. These WM alterations can be assessed using diffusion tensor imaging (DTI). Cerebral microbleeds (CMBs) are a common finding on head imaging in TBI and are often considered a visible sign of DAI, although they represent diffuse vascular injury. It is poorly known how they associate with long-term white matter integrity. This study included 20 patients with TBI and CMBs, 34 patients with TBI without CMBs, and 11 controls with orthopedic injuries. DTI was used to assess microstructural WM alterations. CMBs were detected using susceptibility-weighted imaging (SWI) and graded according to their location in the WM and total lesion load was counted. Patients underwent SWI within 2 months after injury. DTI and clinical outcome assessment were performed at an average of eight months after injury. Outcome was assessed using the extended Glasgow Outcome Scale (GOSe). The Glasgow Coma Scale (GCS) and length of post-traumatic amnesia (PTA) were used to assess clinical severity of the injury. We found that CMB grading and total lesion load were negatively associated with fractional anisotropy (FA) and positively associated with mean diffusivity (MD). Patients with TBI and CMBs had decreased FA and increased MD compared with patients with TBI without CMBs. CMBs were also associated with worse clinical outcome. When adjusting for the clinical severity of the injury, none of the mentioned associations were found. Thus, the difference in FA and MD is explained by patients with TBI and CMBs having more severe injuries. Our results suggest that CMBs are not associated with greater WM alterations when adjusting for the clinical severity of TBI. Thus, CMBs and WM alterations may not be strongly associated pathologies in TBI.
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Affiliation(s)
- Juho Dahl
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Diagnostic Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Janek Frantzén
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Riikka Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Virginia Newcombe
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
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8
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Roine T, Mohammadian M, Hirvonen J, Kurki T, Posti JP, Takala RS, Newcombe V, Tallus J, Katila AJ, Maanpää HR, Frantzen J, Menon D, Tenovuo O. Structural brain connectivity correlates with outcome in mild traumatic brain injury. J Neurotrauma 2022; 39:336-347. [PMID: 35018829 DOI: 10.1089/neu.2021.0093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We investigated the topology of structural brain connectivity networks and its association to outcome following mild traumatic brain injury, a major cause of permanent disability. Eighty-five patients with mild traumatic brain injury underwent MRI twice, about three weeks and eight months after injury, and 30 age-matched orthopedic trauma control subjects were scanned. Outcome was assessed with Extended Glasgow Outcome Scale on average eight months after injury. We performed constrained spherical deconvolution based probabilistic streamlines tractography on diffusion MRI data and parcellated cortical and subcortical gray matter into 84 regions based on T1-weighted data to reconstruct structural brain connectivity networks weighted by the number of streamlines. Graph theoretical methods were employed to measure network properties in both patients and controls, and correlations between these properties and outcome were calculated. We found no global differences in the network properties between patients with mild traumatic brain injury and orthopedic control subjects at either stage. However, we found significantly increased betweenness centrality of the right pars opercularis in the chronic stage compared to control subjects. Furthermore, both global and local network properties correlated significantly with outcome. Higher normalized global efficiency, degree, and strength as well as lower small-worldness were associated with better outcome. Correlations between the outcome and the local network properties were the most prominent in the left putamen and the left postcentral gyrus. Our results indicate that both global and local network properties provide valuable information about the outcome already in the acute/subacute stage, and therefore, are promising biomarkers for prognostic purposes in mild traumatic brain injury.
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Affiliation(s)
- Timo Roine
- University of Turku, 8058, Turku Brain and Mind Center, Turku, Finland.,Aalto University School of Science, 313201, Department of Neuroscience and Biomedical Engineering, Espoo, Finland;
| | - Mehrbod Mohammadian
- University of Turku Faculty of Medicine, 60654, Department of Clinical Neurosciences, Turku, Finland.,Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Finland;
| | - Jussi Hirvonen
- TYKS Turku University Hospital, 60652, Department of Radiology, Turku, Varsinais-Suomi, Finland;
| | - Timo Kurki
- University of Turku Faculty of Medicine, 60654, Department of Clinical Neurosciences, Turku, Finland.,Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Finland.,TYKS Turku University Hospital, 60652, Department of Radiology, Turku, Varsinais-Suomi, Finland;
| | - Jussi P Posti
- University of Turku Faculty of Medicine, 60654, Department of Clinical Neurosciences, Turku, Finland.,Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Varsinais-Suomi, Finland.,TYKS Turku University Hospital, 60652, Department of Neurosurgery. Neurocenter, Turku, Varsinais-Suomi, Finland;
| | - Riikka Sk Takala
- Turku University Hospital, Perioperative Services, Intensive Care Medicine and Pain Management, Turku, Finland.,University of Turku, 8058, Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku, Varsinais-Suomi, Finland;
| | - Virginia Newcombe
- University of Cambridge, Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, United Kingdom of Great Britain and Northern Ireland;
| | - Jussi Tallus
- Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Varsinais-Suomi, Finland;
| | - Ari J Katila
- Turku University Hospital, Perioperative Services, Intensive Care Medicine and Pain Management, Turku, Varsinais-Suomi, Finland;
| | - Henna-Riikka Maanpää
- Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Varsinais-Suomi, Finland.,Turku University Hospital, Department of Neurosurgery, Neurocenter, Turku, Varsinais-Suomi, Finland;
| | - Janek Frantzen
- Turku University Hospital, Turku Brain Injury Center, Neurocenter, Turku, Finland.,Turku University Hospital, Department of Neurosurgery, Neurocenter, Turku, Varsinais-Suomi, Finland.,University of Turku Faculty of Medicine, 60654, Department of Clinical Neurosciences, Turku, Finland;
| | - David Menon
- University of Cambridge, Division of Anaesthesia, Addenbrooke's Hospital, Cambridge, United Kingdom of Great Britain and Northern Ireland;
| | - Olli Tenovuo
- University of Turku Faculty of Medicine, 60654, Department of Clinical Neurosciences, Turku, Finland.,Turku University Hospital, 60652, Turku Brain Injury Center, Neurocenter, Turku, Finland;
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9
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Koivikko P, Posti JP, Mohammadian M, Lagerstedt L, Azurmendi L, Hossain I, Katila AJ, Menon D, Newcombe VFJ, Hutchinson PJ, Maanpää HR, Tallus J, Zetterberg H, Blennow K, Tenovuo O, Sanchez JC, Takala RSK. Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury. Emerg Med J 2021; 39:206-212. [PMID: 34916280 DOI: 10.1136/emermed-2020-209471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting. METHODS Adult patients (≥18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011-2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13-15 was classified as mild (mTBI); GCS 9-12 as moderate (moTBI) and GCS 3-8 as severe (sTBI). Serum samples were collected within 24 hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed. RESULTS Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL-10 (0.26, IQR=0.21, 0.39 pg/mL), H-FABP (4.15, IQR=2.72, 5.83 ng/mL) and NF-L (8.6, IQR=6.35, 15.98 pg/mL) compared with those admitted to the neurosurgical ward, IL-10 (0.55, IQR=0.31, 1.42 pg/mL), H-FABP (6.022, IQR=4.19, 20.72 ng/mL) and NF-L (13.95, IQR=8.33, 19.93 pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls. CONCLUSIONS S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting.
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Affiliation(s)
- Pia Koivikko
- Perioperative Services, Intensive Care Medicine, and Pain Management, Turku University Hospital, Turku, Finland .,Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Mehrbod Mohammadian
- Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Neurocenter, Turku Brain Injury Center, Turku University Hospital, Turku, Finland
| | - Linnea Lagerstedt
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Leire Azurmendi
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Iftakher Hossain
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Cambridge, UK
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine, and Pain Management, Turku University Hospital, Turku, Finland.,Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - David Menon
- Department of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Peter John Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Cambridge, UK
| | - Henna-Riikka Maanpää
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jussi Tallus
- Neurocenter, Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,Department of Radiology, University of Turku, Turku, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Gothenburg Sahlgrenska Academy, Mölndal, Sweden.,UK Dementia Research Institute, UCL, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, University of Gothenburg Sahlgrenska Academy, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Olli Tenovuo
- Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Neurocenter, Turku Brain Injury Center, Turku University Hospital, Turku, Finland
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine, and Pain Management, Turku University Hospital, Turku, Finland.,Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
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10
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Mohammadian M, Roine T, Hirvonen J, Kurki T, Posti JP, Katila AJ, Takala RSK, Tallus J, Maanpää HR, Frantzén J, Hutchinson PJ, Newcombe VF, Menon DK, Tenovuo O. Alterations in Microstructure and Local Fiber Orientation of White Matter Are Associated with Outcome after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:2616-2623. [PMID: 32689872 DOI: 10.1089/neu.2020.7081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) can have long-lasting consequences. We investigated white matter (WM) alterations at 6-12 months following mTBI using diffusion tensor imaging (DTI) and assessed if the alterations associate with outcome. Eighty-five patients with mTBI underwent diffusion-weighted magnetic resonance imaging (MRI) on average 8 months post-injury and patients' outcome was assessed at the time of imaging using the Glasgow Outcome Scale-Extended (GOS-E). Additionally, 30 age-matched patients with extracranial orthopedic injuries were used as control subjects. Voxel-wise analysis of the data was performed using a tract-based spatial statistics (TBSS) approach and differences in microstructural metrics between groups were investigated. Further, the susceptibility of the abnormalities to specific fiber orientations was investigated by analyzing the first eigenvector of the diffusion tensor in the voxels with significant differences. We found significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD) and radial diffusivity (RD) in patients with mTBI compared with control subjects, whereas no significant differences were observed in axial diffusivity (AD) between the groups. The differences were present bilaterally in several WM regions and correlated with outcome. Moreover, multiple clusters were found in the principal fiber orientations of the significant voxels in anisotropy, and similar orientation patterns were found for the diffusivity metrics. These directional clusters correlated with patients' functional outcome. Our study showed that mTBI is associated with WM changes at the chronic stage and these alterations occur in several WM regions. In addition, several significant clusters of WM alterations in specific fiber orientations were found and these clusters were associated with outcome.
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Affiliation(s)
- Mehrbod Mohammadian
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Timo Roine
- Turku Brain and Mind Center, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Jussi Hirvonen
- Department of Radiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Timo Kurki
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Radiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Jussi P Posti
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Jussi Tallus
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Henna-Riikka Maanpää
- Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Janek Frantzén
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Division of Clinical Neurosciences, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - David K Menon
- Division of Anesthesia, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olli Tenovuo
- Department of Clinical Neurosciences, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.,Turku Brain Injury Center, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
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11
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Posti JP, Takala RSK, Raj R, Luoto TM, Azurmendi L, Lagerstedt L, Mohammadian M, Hossain I, Gill J, Frantzén J, van Gils M, Hutchinson PJ, Katila AJ, Koivikko P, Maanpää HR, Menon DK, Newcombe VF, Tallus J, Blennow K, Tenovuo O, Zetterberg H, Sanchez JC. Admission Levels of Interleukin 10 and Amyloid β 1-40 Improve the Outcome Prediction Performance of the Helsinki Computed Tomography Score in Traumatic Brain Injury. Front Neurol 2020; 11:549527. [PMID: 33192979 PMCID: PMC7661930 DOI: 10.3389/fneur.2020.549527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/28/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Blood biomarkers may enhance outcome prediction performance of head computed tomography scores in traumatic brain injury (TBI). Objective: To investigate whether admission levels of eight different protein biomarkers can improve the outcome prediction performance of the Helsinki computed tomography score (HCTS) without clinical covariates in TBI. Materials and methods: Eighty-two patients with computed tomography positive TBIs were included in this study. Plasma levels of β-amyloid isoforms 1–40 (Aβ40) and 1–42 (Aβ42), glial fibrillary acidic protein, heart fatty acid-binding protein, interleukin 10 (IL-10), neurofilament light, S100 calcium-binding protein B, and total tau were measured within 24 h from admission. The patients were divided into favorable (Glasgow Outcome Scale—Extended 5–8, n = 49) and unfavorable (Glasgow Outcome Scale—Extended 1–4, n = 33) groups. The outcome was assessed 6–12 months after injury. An optimal predictive panel was investigated with the sensitivity set at 90–100%. Results: The HCTS alone yielded a sensitivity of 97.0% (95% CI: 90.9–100) and specificity of 22.4% (95% CI: 10.2–32.7) and partial area under the curve of the receiver operating characteristic of 2.5% (95% CI: 1.1–4.7), in discriminating patients with favorable and unfavorable outcomes. The threshold to detect a patient with unfavorable outcome was an HCTS > 1. The three best individually performing biomarkers in outcome prediction were Aβ40, Aβ42, and neurofilament light. The optimal panel included IL-10, Aβ40, and the HCTS reaching a partial area under the curve of the receiver operating characteristic of 3.4% (95% CI: 1.7–6.2) with a sensitivity of 90.9% (95% CI: 81.8–100) and specificity of 59.2% (95% CI: 40.8–69.4). Conclusion: Admission plasma levels of IL-10 and Aβ40 significantly improve the prognostication ability of the HCTS after TBI.
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Affiliation(s)
- Jussi P Posti
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Leire Azurmendi
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Linnéa Lagerstedt
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mehrbod Mohammadian
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Iftakher Hossain
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland.,Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Janek Frantzén
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Peter J Hutchinson
- Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Pia Koivikko
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jussi Tallus
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olli Tenovuo
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom.,The United Kingdom Dementia Research Institute at University College London, University College London, London, United Kingdom
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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12
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Östberg A, Ledig C, Katila A, Maanpää HR, Posti JP, Takala R, Tallus J, Glocker B, Rueckert D, Tenovuo O. Volume Change in Frontal Cholinergic Structures After Traumatic Brain Injury and Cognitive Outcome. Front Neurol 2020; 11:832. [PMID: 32903569 PMCID: PMC7438550 DOI: 10.3389/fneur.2020.00832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023] Open
Abstract
The cholinergic nuclei in the basal forebrain innervate frontal cortical structures regulating attention. Our aim was to investigate if cognitive test results measuring attention relate to the longitudinal volume change of cholinergically innervated structures following traumatic brain injury (TBI). During the prospective, observational TBIcare project patients with all severities of TBI (n = 114) and controls with acute orthopedic injuries (n = 17) were recruited. Head MRI was obtained in both acute (mean 2 weeks post-injury) and late (mean 8 months) time points. T1-weighted 3D MR images were analyzed with an automatic segmentation method to evaluate longitudinal, structural brain volume change. The cognitive outcome was assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB). Analyses included 16 frontal cortical structures, of which four showed a significant correlation between post-traumatic volume change and the CANTAB test results. The strongest correlation was found between the volume loss of the supplementary motor cortex and motor screening task results (R-sq 0.16, p < 0.0001), where poorer test results correlated with greater atrophy. Of the measured sum structures, greater cortical gray matter atrophy rate showed a significant correlation with the poorer CANTAB test results. TBI caused volume loss of frontal cortical structures that are heavily innervated by cholinergic neurons is associated with neuropsychological test results measuring attention.
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Affiliation(s)
- Anna Östberg
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Christian Ledig
- Department of Computing, Imperial College London, London, United Kingdom
| | - Ari Katila
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Henna-Riikka Maanpää
- Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jussi P Posti
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Riikka Takala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Jussi Tallus
- Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Ben Glocker
- Department of Computing, Imperial College London, London, United Kingdom
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, United Kingdom
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Turku, Turku, Finland
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13
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Hossain I, Mohammadian M, Takala RSK, Tenovuo O, Azurmendi Gil L, Frantzén J, van Gils M, Hutchinson PJ, Katila AJ, Maanpää HR, Menon DK, Newcombe VF, Tallus J, Hrusovsky K, Wilson DH, Gill J, Blennow K, Sanchez JC, Zetterberg H, Posti JP. Admission Levels of Total Tau and β-Amyloid Isoforms 1-40 and 1-42 in Predicting the Outcome of Mild Traumatic Brain Injury. Front Neurol 2020; 11:325. [PMID: 32477238 PMCID: PMC7237639 DOI: 10.3389/fneur.2020.00325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The purpose of this study was to investigate if admission levels of total tau (T-tau) and β-amyloid isoforms 1-40 (Aβ40) and 1-42 (Aβ42) could predict clinical outcome in patients with mild traumatic brain injury (mTBI). Methods: A total of 105 patients with mTBI [Glasgow Coma Scale (GCS) ≥ 13] recruited in Turku University Hospital, Turku, Finland were included in this study. Blood samples were drawn within 24 h of admission for analysis of plasma T-tau, Aβ40, and Aβ42. Patients were divided into computed tomography (CT)-positive and CT-negative groups. The outcome was assessed 6–12 months after the injury using the Extended Glasgow Outcome Scale (GOSE). Outcomes were defined as complete (GOSE 8) or incomplete (GOSE < 8) recovery. The Rivermead Post Concussion Symptoms Questionnaire (RPCSQ) was also used to assess mTBI-related symptoms. Predictive values of the biomarkers were analyzed independently, in panels and together with clinical parameters. Results: The admission levels of plasma T-tau, Aβ40, and Aβ42 were not significantly different between patients with complete and incomplete recovery. The levels of T-tau, Aβ40, and Aβ42 could poorly predict complete recovery, with areas under the receiver operating characteristic curve 0.56, 0.52, and 0.54, respectively. For the whole cohort, there was a significant negative correlation between the levels of T-tau and ordinal GOSE score (Spearman ρ = −0.231, p = 0.018). In a multivariate logistic regression model including age, GCS, duration of posttraumatic amnesia, Injury Severity Score (ISS), time from injury to sampling, and CT findings, none of the biomarkers could predict complete recovery independently or together with the other two biomarkers. Plasma levels of T-tau, Aβ40, and Aβ42 did not significantly differ between the outcome groups either within the CT-positive or CT-negative subgroups. Levels of Aβ40 and Aβ42 did not significantly correlate with outcome, but in the CT-positive subgroup, the levels of T-tau significantly correlated with ordinal GOSE score (Spearman ρ = −0.288, p = 0.035). The levels of T-tau, Aβ40, and Aβ42 were not correlated with the RPCSQ scores. Conclusions: The early levels of T-tau are correlated with the outcome in patients with mTBI, but none of the biomarkers either alone or in any combinations could predict complete recovery in patients with mTBI.
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Affiliation(s)
- Iftakher Hossain
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mehrbod Mohammadian
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Leire Azurmendi Gil
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Janek Frantzén
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jussi Tallus
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Radiology, Turku University Hospital, Turku, Finland
| | | | | | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom.,UK Dementia Research Institute at UCL, University College London, London, United Kingdom
| | - Jussi P Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
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14
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Lagerstedt L, Azurmendi L, Tenovuo O, Katila AJ, Takala RSK, Blennow K, Newcombe VFJ, Maanpää HR, Tallus J, Hossain I, van Gils M, Menon DK, Hutchinson PJ, Zetterberg H, Posti JP, Sanchez JC. Interleukin 10 and Heart Fatty Acid-Binding Protein as Early Outcome Predictors in Patients With Traumatic Brain Injury. Front Neurol 2020; 11:376. [PMID: 32581990 PMCID: PMC7280446 DOI: 10.3389/fneur.2020.00376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Patients with traumatic brain injury (TBI) exhibit a variable and unpredictable outcome. The proteins interleukin 10 (IL-10) and heart fatty acid-binding protein (H-FABP) have shown predictive values for the presence of intracranial lesions. Aim: To evaluate the individual and combined outcome prediction ability of IL-10 and H-FABP, and to compare them to the more studied proteins S100β, glial fibrillary acidic protein (GFAP), and neurofilament light (NF-L), both with and without clinical predictors. Methods: Blood samples from patients with acute TBI (all severities) were collected <24 h post trauma. The outcome was measured >6 months post injury using the Glasgow Outcome Scale Extended (GOSE) score, dichotomizing patients into: (i) those with favorable (GOSE≥5)/unfavorable outcome (GOSE ≤ 4) and complete (GOSE = 8)/incomplete (GOSE ≤ 7) recovery, and (ii) patients with mild TBI (mTBI) and patients with TBIs of all severities. Results: When sensitivity was set at 95-100%, the proteins' individual specificities remained low. H-FABP showed the best specificity (%) and sensitivity (100%) in predicting complete recovery in patients with mTBI. IL-10 had the best specificity (50%) and sensitivity (96%) in identifying patients with favorable outcome in patients with TBIs of all severities. When individual proteins were combined with clinical parameters, a model including H-FABP, NF-L, and ISS yielded a specificity of 56% and a sensitivity of 96% in predicting complete recovery in patients with mTBI. In predicting favorable outcome, a model consisting IL-10, age, and TBI severity reached a specificity of 80% and a sensitivity of 96% in patients with TBIs of all severities. Conclusion: Combining novel TBI biomarkers H-FABP and IL-10 with GFAP, NF-L and S100β and clinical parameters improves outcome prediction models in TBI.
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Affiliation(s)
- Linnéa Lagerstedt
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Leire Azurmendi
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olli Tenovuo
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Virginia F J Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Henna-Riikka Maanpää
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital Turku, Turku, Finland
| | - Jussi Tallus
- Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Iftakher Hossain
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital Turku, Turku, Finland
| | - Mark van Gils
- Knowledge Intensive Products and Services, VTT Technical Research Centre of Finland Ltd, Tampere, Finland
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.,National Institute for Health Research, Cambridge BRC, Cambridge, United Kingdom.,Royal College of Surgeons of England, London, United Kingdom
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Jussi P Posti
- Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Clinical Neurosciences, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital Turku, Turku, Finland
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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15
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Posti JP, Takala RSK, Lagerstedt L, Dickens AM, Hossain I, Mohammadian M, Ala-Seppälä H, Frantzén J, van Gils M, Hutchinson PJ, Katila AJ, Maanpää HR, Menon DK, Newcombe VF, Tallus J, Hrusovsky K, Wilson DH, Gill J, Sanchez JC, Tenovuo O, Zetterberg H, Blennow K. Correlation of Blood Biomarkers and Biomarker Panels with Traumatic Findings on Computed Tomography after Traumatic Brain Injury. J Neurotrauma 2019; 36:2178-2189. [PMID: 30760178 DOI: 10.1089/neu.2018.6254] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of the study was to examine the ability of eight protein biomarkers and their combinations in discriminating computed tomography (CT)-negative and CT-positive patients with traumatic brain injury (TBI), utilizing highly sensitive immunoassays in a well-characterized cohort. Blood samples were obtained from 160 patients with acute TBI within 24 h of admission. Levels of β-amyloid isoforms 1-40 (Aβ40) and 1-42 (Aβ42), glial fibrillary acidic protein (GFAP), heart fatty-acid binding protein (H-FABP), interleukin 10 (IL-10), neurofilament light (NF-L), S100 calcium-binding protein B (S100B), and tau were measured. Patients were divided into CT-negative (n = 65) and CT-positive (n = 95), and analyses were conducted separately for TBIs of all severities (Glasgow Coma Scale [GCS] score 3-15) and mild TBIs (mTBIs; GCS 13-15). NF-L, GFAP, and tau were the best in discriminating CT-negative and CT-positive patients, both in patients with mTBI and with all severities. In patients with all severities, area under the curve of the receiver operating characteristic (AUC) was 0.822, 0.817, and 0.781 for GFAP, NF-L, and tau, respectively. In patients with mTBI, AUC was 0.720, 0.689, and 0.676, for GFAP, tau, and NF-L, respectively. The best panel of three biomarkers for discriminating CT-negative and CT-positive patients in the group of all severities was a combination of GFAP+H-FABP+IL-10, with a sensitivity of 100% and specificity of 38.5%. In patients with mTBI, the best panel of three biomarkers was H-FABP+S100B+tau, with a sensitivity of 100% and specificity of 46.4%. Panels of biomarkers outperform individual biomarkers in separating CT-negative and CT-positive patients. Panels consisted mainly of different biomarkers than those that performed best as an individual biomarker.
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Affiliation(s)
- Jussi P Posti
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Riikka S K Takala
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Finland
| | - Linnéa Lagerstedt
- 5 Department of Specialities of Internal Medicine, University of Geneva, Geneva, Switzerland
| | - Alex M Dickens
- 6 Turku Center for Biotechnology, University of Turku, Turku, Finland
| | - Iftakher Hossain
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Mehrbod Mohammadian
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Henna Ala-Seppälä
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Janek Frantzén
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Mark van Gils
- 7 VTT Technical Research Center of Finland Ltd., Tampere, Finland
| | - Peter J Hutchinson
- 8 Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,5 Department of Specialities of Internal Medicine, University of Geneva, Geneva, Switzerland
| | - Henna-Riikka Maanpää
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - David K Menon
- 9 Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- 9 Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jussi Tallus
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland.,10 Department of Radiology, Turku University Hospital, Turku, Finland
| | | | | | - Jessica Gill
- 12 National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Jean-Charles Sanchez
- 5 Department of Specialities of Internal Medicine, University of Geneva, Geneva, Switzerland
| | - Olli Tenovuo
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Henrik Zetterberg
- 13 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,14 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,15 Department of Neurodegenerative Disease, University College London, London, United Kingdom.,16 UK Dementia Research Institute at UCL, University College London, London, United Kingdom
| | - Kaj Blennow
- 13 Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,14 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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16
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Hossain I, Mohammadian M, Takala RSK, Tenovuo O, Lagerstedt L, Ala-Seppälä H, Frantzén J, van Gils M, Hutchinson P, Katila AJ, Maanpää HR, Menon DK, Newcombe VF, Tallus J, Hrusovsky K, Wilson DH, Blennow K, Sanchez JC, Zetterberg H, Posti JP. Early Levels of Glial Fibrillary Acidic Protein and Neurofilament Light Protein in Predicting the Outcome of Mild Traumatic Brain Injury. J Neurotrauma 2019; 36:1551-1560. [PMID: 30489229 DOI: 10.1089/neu.2018.5952] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to correlate the early levels of glial fibrillary acidic protein (GFAP) and neurofilament light protein (NF-L) with outcome in patients with mild traumatic brain injury (mTBI). A total of 107 patients with mTBI (Glasgow Coma Scale ≥13) who had blood samples for GFAP and NF-L available within 24 h of arrival were included. Patients with mTBI were divided into computed tomography (CT)-positive and CT-negative groups. Glasgow Outcome Scale-Extended (GOSE) was used to assess the outcome. Outcomes were defined as complete (GOSE 8) versus incomplete (GOSE <8), and favorable (GOSE 5-8) versus unfavorable (GOSE 1-4). GFAP and NF-L concentrations in blood were measured using ultrasensitive single molecule array technology. Patients with incomplete recovery had significantly higher levels of NF-L compared with those with complete recovery (p = 0.005). The levels of GFAP and NF-L were significantly higher in patients with unfavorable outcome than in patients with favorable outcome (p = 0.002 for GFAP and p < 0.001 for NF-L). For predicting favorable outcome, the area under the receiver operating characteristic curve for GFAP and NF-L was 0.755 and 0.826, respectively. In a multi-variate logistic regression model, the level of NF-L was still a significant predictor for complete recovery (odds ratio [OR] = 1.008; 95% confidence interval [CI], 1.000-1.016). Moreover, the level of NF-L was a significant predictor for complete recovery in CT-positive patients (OR = 1.009; 95% CI, 1.001-1.016). The early levels of GFAP and NF-L are significantly correlated with the outcome in patients with mTBI. The level of NF-L within 24 h from arrival has a significant predictive value in mTBI also in a multi-variate model.
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Affiliation(s)
- Iftakher Hossain
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Mehrbod Mohammadian
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Riikka S K Takala
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Tenovuo
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Linnéa Lagerstedt
- 5 Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Henna Ala-Seppälä
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Janek Frantzén
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - Mark van Gils
- 6 VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Peter Hutchinson
- 7 Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
| | - David K Menon
- 8 Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- 8 Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jussi Tallus
- 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland.,9 Department of Radiology, Turku University Hospital, Turku, Finland
| | | | | | - Kaj Blennow
- 11 Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,12 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jean-Charles Sanchez
- 5 Department of Human Protein Sciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Henrik Zetterberg
- 11 Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,12 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,13 Department of Molecular Neuroscience, Institute of Neurology, Queen Square, University College London, London, United Kingdom.,14 U.K. Dementia Research Institute, Queen Square, University College London, London, United Kingdom
| | - Jussi P Posti
- 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.,2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland.,3 Department of Neurology, University of Turku, Turku, Finland
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17
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Dickens AM, Posti JP, Takala RSK, Ala-Seppälä H, Mattila I, Coles JP, Frantzén J, Hutchinson PJ, Katila AJ, Kyllönen A, Maanpää HR, Newcombe V, Outtrim J, Tallus J, Carpenter KLH, Menon DK, Hyötyläinen T, Tenovuo O, Orešic M. Serum Metabolites Associated with Computed Tomography Findings after Traumatic Brain Injury. J Neurotrauma 2018; 35:2673-2683. [PMID: 29947291 DOI: 10.1089/neu.2017.5272] [Citation(s) in RCA: 12] [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: 12/28/2022] Open
Abstract
There is a need to rapidly detect patients with traumatic brain injury (TBI) who require head computed tomography (CT). Given the energy crisis in the brain following TBI, we hypothesized that serum metabolomics would be a useful tool for developing a set of biomarkers to determine the need for CT and to distinguish among different types of injuries observed. Logistical regression models using metabolite data from the discovery cohort (n = 144, Turku, Finland) were used to distinguish between patients with traumatic intracranial findings and those with negative findings on head CT. The resultant models were then tested in the validation cohort (n = 66, Cambridge, United Kingdom). The levels of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 were also quantified in the serum from the same patients. Despite there being significant differences in the protein biomarkers in patients with TBI, the model that determined the need for a CT scan validated poorly (area under the curve [AUC] = 0.64: Cambridge patients). However, using a combination of six metabolites (two amino acids, three sugar derivatives, and one ketoacid) it was possible to discriminate patients with intracranial abnormalities on CT and patients with a normal CT (AUC = 0.77 in Turku patients and AUC = 0.73 in Cambridge patients). Further, a combination of three metabolites could distinguish between diffuse brain injuries and mass lesions (AUC = 0.87 in Turku patients and AUC = 0.68 in Cambridge patients). This study identifies a set of validated serum polar metabolites, which associate with the need for a CT scan. Additionally, serum metabolites can also predict the nature of the brain injury. These metabolite markers may prevent unnecessary CT scans, thus reducing the cost of diagnostics and radiation load.
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Affiliation(s)
- Alex M Dickens
- 1 Turku Centre for Biotechnology, University of Turku , Turku, Finland
| | - Jussi P Posti
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland .,4 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
| | - Riikka S K Takala
- 5 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | | | - Ismo Mattila
- 6 Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Jonathan P Coles
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Janek Frantzén
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland .,4 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
| | - Peter J Hutchinson
- 8 Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 5 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Anna Kyllönen
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Virginia Newcombe
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joanne Outtrim
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jussi Tallus
- 3 Department of Neurology, University of Turku , Turku, Finland
| | - Keri L H Carpenter
- 8 Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David K Menon
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - Olli Tenovuo
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland
| | - Matej Orešic
- 1 Turku Centre for Biotechnology, University of Turku , Turku, Finland .,10 Schools of Medical Science, Örebro University , Örebro, Sweden
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18
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Ledig C, Kamnitsas K, Koikkalainen J, Posti JP, Takala RSK, Katila A, Frantzén J, Ala-Seppälä H, Kyllönen A, Maanpää HR, Tallus J, Lötjönen J, Glocker B, Tenovuo O, Rueckert D. Regional brain morphometry in patients with traumatic brain injury based on acute- and chronic-phase magnetic resonance imaging. PLoS One 2017; 12:e0188152. [PMID: 29182625 PMCID: PMC5705131 DOI: 10.1371/journal.pone.0188152] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/01/2017] [Indexed: 02/02/2023] Open
Abstract
Traumatic brain injury (TBI) is caused by a sudden external force and can be very heterogeneous in its manifestation. In this work, we analyse T1-weighted magnetic resonance (MR) brain images that were prospectively acquired from patients who sustained mild to severe TBI. We investigate the potential of a recently proposed automatic segmentation method to support the outcome prediction of TBI. Specifically, we extract meaningful cross-sectional and longitudinal measurements from acute- and chronic-phase MR images. We calculate regional volume and asymmetry features at the acute/subacute stage of the injury (median: 19 days after injury), to predict the disability outcome of 67 patients at the chronic disease stage (median: 229 days after injury). Our results indicate that small structural volumes in the acute stage (e.g. of the hippocampus, accumbens, amygdala) can be strong predictors for unfavourable disease outcome. Further, group differences in atrophy are investigated. We find that patients with unfavourable outcome show increased atrophy. Among patients with severe disability outcome we observed a significantly higher mean reduction of cerebral white matter (3.1%) as compared to patients with low disability outcome (0.7%).
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Affiliation(s)
- Christian Ledig
- Imperial College London, Department of Computing, London, United Kingdom
- * E-mail:
| | | | - Juha Koikkalainen
- Combinostics, Tampere, Finland
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Jussi P. Posti
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Riikka S. K. Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Ari Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Janek Frantzén
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Henna Ala-Seppälä
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Anna Kyllönen
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Jussi Tallus
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jyrki Lötjönen
- Combinostics, Tampere, Finland
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Ben Glocker
- Imperial College London, Department of Computing, London, United Kingdom
| | - Olli Tenovuo
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland
| | - Daniel Rueckert
- Imperial College London, Department of Computing, London, United Kingdom
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Koivisto M, Grassini S, Hurme M, Salminen-Vaparanta N, Railo H, Vorobyev V, Tallus J, Paavilainen T, Revonsuo A. TMS-EEG reveals hemispheric asymmetries in top-down influences of posterior intraparietal cortex on behavior and visual event-related potentials. Neuropsychologia 2017; 107:94-101. [PMID: 29137988 DOI: 10.1016/j.neuropsychologia.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022]
Abstract
Clinical data and behavioral studies using transcranial magnetic stimulation (TMS) suggest right-hemisphere dominance for top-down modulation of visual processing in humans. We used concurrent TMS-EEG to directly test for hemispheric differences in causal influences of the right and left intraparietal cortex on visual event-related potentials (ERPs). We stimulated the left and right posterior part of intraparietal sulcus (IPS1) while the participants were viewing and rating the visibility of bilaterally presented Gabor patches. Subjective visibility ratings showed that TMS of right IPS shifted the visibility toward the right hemifield, while TMS of left IPS did not have any behavioral effect. TMS of right IPS, but not left one, reduced the amplitude of posterior N1 potential, 180-220ms after stimulus-onset. The attenuation of N1 occurred bilaterally over the posterior areas of both hemispheres. Consistent with previous TMS-fMRI studies, this finding suggests that the right IPS has top-down control on the neural processing in visual cortex. As N1 most probably reflects reactivation of early visual areas, the current findings support the view that the posterior parietal cortex in the right hemisphere amplifies recurrent interactions in ventral visual areas during the time-window that is critical for conscious perception.
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Affiliation(s)
- Mika Koivisto
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland.
| | - Simone Grassini
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
| | - Mikko Hurme
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
| | - Niina Salminen-Vaparanta
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
| | - Henry Railo
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
| | - Victor Vorobyev
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
| | - Jussi Tallus
- Department of Radiology, Turku University Hospital, 20014 Turun yliopisto, Finland
| | - Teemu Paavilainen
- Department of Radiology, Turku University Hospital, 20014 Turun yliopisto, Finland
| | - Antti Revonsuo
- Department of Psychology, University of Turku, 20014 Turun yliopisto, Finland; School of Bioscience, Department of Cognitive Neuroscience and Philosophy, University of Skövde, Sweden; Centre for Cognitive Neuroscience, University of Turku, 20014 Turun yliopisto, Finland
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20
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Posti JP, Takala RSK, Runtti H, Newcombe VF, Outtrim J, Katila AJ, Frantzén J, Ala-Seppälä H, Coles JP, Hossain MI, Kyllönen A, Maanpää HR, Tallus J, Hutchinson PJ, van Gils M, Menon DK, Tenovuo O. The Levels of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 During the First Week After a Traumatic Brain Injury: Correlations With Clinical and Imaging Findings. Neurosurgery 2017; 79:456-64. [PMID: 26963330 DOI: 10.1227/neu.0000000000001226] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are promising biomarkers of traumatic brain injury (TBI). OBJECTIVE We investigated the relation of the GFAP and UCH-L1 levels to the severity of TBI during the first week after injury. METHODS Plasma UCH-L1 and GFAP were measured from 324 consecutive patients with acute TBI and 81 control subject enrolled in a 2-center prospective study. The baseline measures included initial Glasgow Coma Scale (GCS), head computed tomographic (CT) scan at admission, and blood samples for protein biomarkers that were collected at admission and on days 1, 2, 3, and 7 after injury. RESULTS Plasma levels of GFAP and UCH-L1 during the first 2 days after the injury strongly correlated with the initial severity of TBI as assessed with GCS. Additionally, levels of UCH-L1 on the seventh day after the injury were significantly related to the admission GCS scores. At admission, both biomarkers were capable of distinguishing mass lesions from diffuse injuries in CT, and the area under the curve of the receiver-operating characteristic curve for prediction of any pathological finding in CT was 0.739 (95% confidence interval, 0.636-0.815) and 0.621 (95% confidence interval, 0.517-0.713) for GFAP and UCH-L1, respectively. CONCLUSION These results support the prior findings of the potential role of GFAP and UCH-L1 in acute-phase diagnostics of TBI. The novel finding is that levels of GFAP and UCH-L1 correlated with the initial severity of TBI during the first 2 days after the injury, thus enabling a window for TBI diagnostics with latency. ABBREVIATIONS AUC, area under the curveCI, confidence intervalED, emergency departmentGCS, Glasgow Coma ScaleGRAP, glial fibrillary acidic proteinIMPACT, International Mission for Prognosis and Clinical TrialROC, receiver-operating characteristicTBI, traumatic brain injuryTRACK-TBI, Transforming Research and Clinical Knowledge in Traumatic Brain InjuryUCH-L1, ubiquitin C-terminal hydrolase-L1.
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Affiliation(s)
- Jussi P Posti
- *Division of Clinical Neurosciences, Department of Neurosurgery and ‡Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland; §Department of Neurology, University of Turku, Turku, Finland; ¶Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland; ‖Systems Medicine, VTT Technical Research Centre of Finland, Tampere, Finland; #Division of Anaesthesia, Department of Medicine and **Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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21
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Posti JP, Hossain I, Takala RSK, Liedes H, Newcombe V, Outtrim J, Katila AJ, Frantzén J, Ala-Seppälä H, Coles JP, Kyllönen A, Maanpää HR, Tallus J, Hutchinson PJ, van Gils M, Menon DK, Tenovuo O. Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 Are Not Specific Biomarkers for Mild CT-Negative Traumatic Brain Injury. J Neurotrauma 2017; 34:1427-1438. [PMID: 27841729 DOI: 10.1089/neu.2016.4442] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) have been studied as potential biomarkers of mild traumatic brain injury (mTBI). We report the levels of GFAP and UCH-L1 in patients with acute orthopedic injuries without central nervous system involvement, and relate them to the type of extracranial injury, head magnetic resonance imaging (MRI) findings, and levels of GFAP and UCH-L1 in patients with CT-negative mTBI. Serum UCH-L1 and GFAP were longitudinally measured from 73 patients with acute orthopedic injury on arrival and on days 1, 2, 3, 7 after admission, and on the follow-up visit 3-10 months after the injury. The injury types were recorded, and 71% patients underwent also head MRI. The results were compared with those found in patients with CT-negative mTBI (n = 93). The levels of GFAP were higher in patients with acute orthopedic trauma than in patients with CT-negative mTBI (p = 0.026) on arrival; however, no differences were found on the following days. The levels of UCH-L1 were not significantly different between these two groups at any measured point of time. Levels of GFAP and UCH-L1 were not able to distinguish patients with CT-negative mTBI from patients with orthopedic trauma. Patients with orthopedic trauma and high levels of UCH-L1 or GFAP values may be falsely diagnosed as having a concomitant mTBI, predisposing them to unwarranted diagnostics and unnecessary brain imaging. This casts a significant doubt on the diagnostic value of GFAP and UCH-L1 in cases with mTBI.
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Affiliation(s)
- Jussi P Posti
- 1 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Riikka S K Takala
- 4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Hilkka Liedes
- 5 Systems Medicine, VTT Technical Research Centre of Finland Ltd , Tampere, Finland
| | - Virginia Newcombe
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joanne Outtrim
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Janek Frantzén
- 1 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
| | | | - Jonathan P Coles
- 7 Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Anna Kyllönen
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Jussi Tallus
- 3 Department of Neurology, University of Turku , Turku, Finland
| | - Peter J Hutchinson
- 7 Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mark van Gils
- 5 Systems Medicine, VTT Technical Research Centre of Finland Ltd , Tampere, Finland
| | - David K Menon
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olli Tenovuo
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
- 3 Department of Neurology, University of Turku , Turku, Finland
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22
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Mohammadian M, Roine T, Hirvonen J, Kurki T, Ala-Seppälä H, Frantzén J, Katila A, Kyllönen A, Maanpää HR, Posti J, Takala R, Tallus J, Tenovuo O. High angular resolution diffusion-weighted imaging in mild traumatic brain injury. Neuroimage Clin 2016; 13:174-180. [PMID: 27981032 PMCID: PMC5144744 DOI: 10.1016/j.nicl.2016.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 01/19/2023]
Abstract
We sought to investigate white matter abnormalities in mild traumatic brain injury (mTBI) using diffusion-weighted magnetic resonance imaging (DW-MRI). We applied a global approach based on tract-based spatial statistics skeleton as well as constrained spherical deconvolution tractography. DW-MRI was performed on 102 patients with mTBI within two months post-injury and 30 control subjects. A robust global approach considering only the voxels with a single-fiber configuration was used in addition to global analysis of the tract skeleton and probabilistic whole-brain tractography. In addition, we assessed whether the microstructural parameters correlated with age, time from injury, patient's outcome and white matter MRI hyperintensities. We found that whole-brain global approach restricted to single-fiber voxels showed significantly decreased fractional anisotropy (FA) (p = 0.002) and increased radial diffusivity (p = 0.011) in patients with mTBI compared with controls. The results restricted to single-fiber voxels were more significant and reproducible than those with the complete tract skeleton or the whole-brain tractography. FA correlated with patient outcomes, white matter hyperintensities and age. No correlation was observed between FA and time of scan post-injury. In conclusion, the global approach could be a promising imaging biomarker to detect white matter abnormalities following traumatic brain injury.
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Key Words
- AD, axial diffusivity
- CSD, constrained-spherical deconvolution
- DAI, diffuse axonal injury
- DTI, diffusion tensor imaging
- DW-MRI, diffusion-weighted magnetic resonance imaging
- Diffusion-weighted magnetic resonance imaging
- FA, fractional anisotropy
- GCS, Glasgow Coma Scale
- GOSe, Glasgow Outcome Scale extended
- Global approach
- HARDI, high angular resolution diffusion imaging
- MD, mean diffusivity
- Magnetic resonance imaging
- PTA, post-traumatic amnesia
- Probabilistic tractography
- RD, radial diffusivity
- TBI, traumatic brain injury
- TBSS, tract-based spatial statistics
- Traumatic brain injury
- mTBI, mild traumatic brain injury
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Affiliation(s)
- Mehrbod Mohammadian
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland
| | - Timo Roine
- iMinds-Vision lab, Department of Physics, University of Antwerp, Antwerp, Belgium
| | - Jussi Hirvonen
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Timo Kurki
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | | | - Janek Frantzén
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Ari Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Anna Kyllönen
- Department of Neurology, University of Turku, Turku, Finland
| | | | - Jussi Posti
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Riikka Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Tallus
- Department of Neurology, University of Turku, Turku, Finland
| | - Olli Tenovuo
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, Turku, Finland
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23
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Orešič M, Posti JP, Kamstrup-Nielsen MH, Takala RSK, Lingsma HF, Mattila I, Jäntti S, Katila AJ, Carpenter KLH, Ala-Seppälä H, Kyllönen A, Maanpää HR, Tallus J, Coles JP, Heino I, Frantzén J, Hutchinson PJ, Menon DK, Tenovuo O, Hyötyläinen T. Human Serum Metabolites Associate With Severity and Patient Outcomes in Traumatic Brain Injury. EBioMedicine 2016; 12:118-126. [PMID: 27665050 PMCID: PMC5078571 DOI: 10.1016/j.ebiom.2016.07.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability worldwide, especially in children and young adults. TBI is an example of a medical condition where there are still major lacks in diagnostics and outcome prediction. Here we apply comprehensive metabolic profiling of serum samples from TBI patients and controls in two independent cohorts. The discovery study included 144 TBI patients, with the samples taken at the time of hospitalization. The patients were diagnosed as severe (sTBI; n = 22), moderate (moTBI; n = 14) or mild TBI (mTBI; n = 108) according to Glasgow Coma Scale. The control group (n = 28) comprised of acute orthopedic non-brain injuries. The validation study included sTBI (n = 23), moTBI (n = 7), mTBI (n = 37) patients and controls (n = 27). We show that two medium-chain fatty acids (decanoic and octanoic acids) and sugar derivatives including 2,3-bisphosphoglyceric acid are strongly associated with severity of TBI, and most of them are also detected at high concentrations in brain microdialysates of TBI patients. Based on metabolite concentrations from TBI patients at the time of hospitalization, an algorithm was developed that accurately predicted the patient outcomes (AUC = 0.84 in validation cohort). Addition of the metabolites to the established clinical model (CRASH), comprising clinical and computed tomography data, significantly improved prediction of patient outcomes. The identified ‘TBI metabotype’ in serum, that may be indicative of disrupted blood-brain barrier, of protective physiological response and altered metabolism due to head trauma, offers a new avenue for the development of diagnostic and prognostic markers of broad spectrum of TBIs. The study reports that serum metabolites are sensitive to severity of TBI as well as predict the patient outcomes. The findings are indicative of disruption in blood brain barrier and of protective response and altered TBI metabolism. Metabolites significantly improved the prediction of patient outcomes when added to the established clinical model.
Traumatic brain injury (TBI) is an example of a medical condition where there are still major lacks in diagnostics, outcome prediction, and the therapy development. Since the blood-brain barrier prevents diffusion of most water-soluble molecules with molecular mass over 500 Da, here we hypothesized that circulating small molecules (metabolites) are a potential source of TBI markers. Based on serum metabolomic studies in two independent cohorts, we found that metabolites are sensitive to severity of TBI as well as predict the patient outcomes. The findings of this study may pave the way for new diagnostic tools for TBI.
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Affiliation(s)
- Matej Orešič
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, FI-20520 Turku, Finland; Steno Diabetes Center A/S, DK-2820 Gentofte, Denmark; VTT Technical Research Centre of Finland, FI-02044, VTT, Espoo, Finland.
| | - Jussi P Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, FI-20521 Turku, Finland; Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | | | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, FI-20521 Turku, Finland
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands
| | - Ismo Mattila
- Steno Diabetes Center A/S, DK-2820 Gentofte, Denmark; VTT Technical Research Centre of Finland, FI-02044, VTT, Espoo, Finland
| | - Sirkku Jäntti
- VTT Technical Research Centre of Finland, FI-02044, VTT, Espoo, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, FI-20521 Turku, Finland
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Henna Ala-Seppälä
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Anna Kyllönen
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Henna-Riikka Maanpää
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Jussi Tallus
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Jonathan P Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Box 93, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Iiro Heino
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Janek Frantzén
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, FI-20521 Turku, Finland; Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Box 93, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital, FI-20521 Turku, Finland; Department of Neurology, University of Turku, FI-20014 Turku, Finland.
| | - Tuulia Hyötyläinen
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, FI-20520 Turku, Finland; Steno Diabetes Center A/S, DK-2820 Gentofte, Denmark; VTT Technical Research Centre of Finland, FI-02044, VTT, Espoo, Finland; Clinical Research Institute, Helsinki University Central Hospital, FI-00290 Helsinki, Finland; Department of Chemistry, Örebro University, 702 81 Örebro, Sweden.
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Ala-Seppälä H, Heino I, Frantzén J, Takala RSK, Katila AJ, Kyllönen A, Maanpää HR, Posti JP, Tallus J, Tenovuo O. Injury profiles, demography and representativeness of patients with TBI attending a regional emergency department. Brain Inj 2016; 30:1062-7. [DOI: 10.3109/02699052.2016.1170880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Takala RSK, Posti JP, Runtti H, Newcombe VF, Outtrim J, Katila AJ, Frantzén J, Ala-Seppälä H, Kyllönen A, Maanpää HR, Tallus J, Hossain MI, Coles JP, Hutchinson P, van Gils M, Menon DK, Tenovuo O. Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 as Outcome Predictors in Traumatic Brain Injury. World Neurosurg 2015; 87:8-20. [PMID: 26547005 DOI: 10.1016/j.wneu.2015.10.066] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. METHODS Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). RESULTS Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score ≤ 3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. CONCLUSIONS GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.
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Affiliation(s)
- Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi P Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital and University of Turku, Turku, Finland; Department of Neurology, University of Turku, Turku, Finland
| | - Hilkka Runtti
- Systems Medicine, VTT Technical Research Centre of Finland, Tampere, Finland
| | - Virginia F Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joanne Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Janek Frantzén
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland; Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Anna Kyllönen
- Department of Neurology, University of Turku, Turku, Finland
| | | | - Jussi Tallus
- Department of Neurology, University of Turku, Turku, Finland
| | | | - Jonathan P Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mark van Gils
- Systems Medicine, VTT Technical Research Centre of Finland, Tampere, Finland
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital and University of Turku, Turku, Finland; Department of Neurology, University of Turku, Turku, Finland
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Tallus J, Soveri A, Hämäläinen H, Tuomainen J, Laine M. Effects of Auditory Attention Training with the Dichotic Listening Task: Behavioural and Neurophysiological Evidence. PLoS One 2015; 10:e0139318. [PMID: 26439112 PMCID: PMC4595478 DOI: 10.1371/journal.pone.0139318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/11/2015] [Indexed: 11/18/2022] Open
Abstract
Facilitation of general cognitive capacities such as executive functions through training has stirred considerable research interest during the last decade. Recently we demonstrated that training of auditory attention with forced attention dichotic listening not only facilitated that performance but also generalized to an untrained attentional task. In the present study, 13 participants underwent a 4-week dichotic listening training programme with instructions to report syllables presented to the left ear (FL training group). Another group (n = 13) was trained using the non-forced instruction, asked to report whichever syllable they heard the best (NF training group). The study aimed to replicate our previous behavioural results, and to explore the neurophysiological correlates of training through event-related brain potentials (ERPs). We partially replicated our previous behavioural training effects, as the FL training group tended to show more allocation of auditory spatial attention to the left ear in a standard dichotic listening task. ERP measures showed diminished N1 and enhanced P2 responses to dichotic stimuli after training in both groups, interpreted as improvement in early perceptual processing of the stimuli. Additionally, enhanced anterior N2 amplitudes were found after training, with relatively larger changes in the FL training group in the forced-left condition, suggesting improved top-down control on the trained task. These results show that top-down cognitive training can modulate the left-right allocation of auditory spatial attention, accompanied by a change in an evoked brain potential related to cognitive control.
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Affiliation(s)
- Jussi Tallus
- Department of Psychology, Centre for Cognitive Neuroscience, and Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Anna Soveri
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Heikki Hämäläinen
- Department of Psychology, Centre for Cognitive Neuroscience, and Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Jyrki Tuomainen
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
- * E-mail:
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Turku, Finland
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Posti J, Takala R, Runtti H, Newcombe V, Outtrim J, Katila A, Frantzén J, Ala-Seppälä H, Coles J, Hossain I, Kyllönen A, Maanpää HR, Tallus J, Hutchinson PJ, Menon DK, van Gils M, Tenovuo O. 176 The Levels of GFAP and UCH-L1 During the First Week After a Traumatic Brain Injury—Correlations With Clinical and Imaging Findings and Outcome. Neurosurgery 2015. [DOI: 10.1227/01.neu.0000467140.81385.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Posti J, Hyötyläinen T, Jäntti S, Ala-Seppälä H, Coles J, Katila A, Kyllönen A, Maanpää HR, Menon DK, Outrim J, Hutchinson PJ, Carpenter K, Tallus J, Sysi-Aho M, Takala R, Orea M, Tenovuo O. Depuy-Synthes Award for Resident Research on Brain and Craniofacial Injury 155 Blood Metabolic Patterns Correlate With the Severity of Traumatic Brain Injury. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452430.52541.db] [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: 11/19/2022] Open
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Soveri A, Tallus J, Laine M, Nyberg L, Bäckman L, Hugdahl K, Tuomainen J, Westerhausen R, Hämäläinen H. Modulation of Auditory Attention by Training. Exp Psychol 2013; 60:44-52. [PMID: 22935330 DOI: 10.1027/1618-3169/a000172] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We studied the effects of training on auditory attention in healthy adults with a speech perception task involving dichotically presented syllables. Training involved bottom-up manipulation (facilitating responses from the harder-to-report left ear through a decrease of right-ear stimulus intensity), top-down manipulation (focusing attention on the left-ear stimuli through instruction), or their combination. The results showed significant training-related effects for top-down training. These effects were evident as higher overall accuracy rates in the forced-left dichotic listening (DL) condition that sets demands on attentional control, as well as a response shift toward left-sided reports in the standard DL task. Moreover, a transfer effect was observed in an untrained auditory-spatial attention task involving bilateral stimulation where top-down training led to a relatively stronger focus on left-sided stimuli. Our results indicate that training of attentional control can modulate the allocation of attention in the auditory space in adults. Malleability of auditory attention in healthy adults raises the issue of potential training gains in individuals with attentional deficits.
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Affiliation(s)
- Anna Soveri
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Jussi Tallus
- Department of Psychology, Centre for Cognitive Neuroscience, University of Turku, Finland
| | - Matti Laine
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Lars Nyberg
- Department of Radiation Sciences, Umeå University, Sweden
- Department of Integrative Medical Biology, Umeå University, Sweden
- Umeå Centre for Functional Brain Imaging, Sweden
| | - Lars Bäckman
- Aging Research Center, Karolinska Institutet, Sweden
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Norway
- Department of Radiology, Haukeland University Hospital, Norway
| | - Jyrki Tuomainen
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
- Speech, Hearing and Phonetics Sciences, University College London, UK
| | - René Westerhausen
- Department of Biological and Medical Psychology, University of Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Norway
| | - Heikki Hämäläinen
- Department of Psychology, Centre for Cognitive Neuroscience, University of Turku, Finland
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Tallus J, Lioumis P, Hämäläinen H, Kähkönen S, Tenovuo O. Transcranial magnetic stimulation-electroencephalography responses in recovered and symptomatic mild traumatic brain injury. J Neurotrauma 2013; 30:1270-7. [PMID: 23384582 DOI: 10.1089/neu.2012.2760] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mild traumatic brain injury (mTBI) may cause diffuse damage to the brain, especially to the frontal areas, that may lead to persistent symptoms. We studied participants with past mTBI by means of navigated transcranial magnetic stimulation (nTMS) combined with electroencephalography (EEG). Eleven symptomatic and 8 recovered participants with a history of single mTBI and 9 healthy controls participated. Average time from injury to testing was 5 years. The participants did not have abnormalities or signs of injury on brain magnetic resonance imaging, and they did not use any centrally acting medication. Left primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) were stimulated with nTMS and evoked potentials measured from the corresponding areas of both hemispheres. Delayed ipsilateral P30 and contralateral N45 peak latencies to left DLPFC nTMS were found in the symptomatic group, along with higher DLPFC N100 amplitudes compared with the control or recovered group. The recovered group had shorter P200 latencies in left DLPFC nTMS compared with the other groups. Both mTBI groups had higher motor thresholds compared with the control group. In left M1 nTMS, the mTBI groups showed less P30 amplitude increase, and the symptomatic group showed longer P60 interhemispheric latency difference with higher stimulation intensities. The results suggest altered brain reactivity and connectivity in mTBI. Some of the observed differences may be related to compensatory mechanisms of recovery. nTMS-EEG is a potentially useful tool for studying the effects of mTBI.
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Affiliation(s)
- Jussi Tallus
- Department of Psychology, Centre for Cognitive Neuroscience, University of Turku, Turku, Finland.
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Abstract
OBJECTIVES Mild traumatic brain injury (mTBI) is very common, and part of the patients experience persistent symptoms. These may be caused by diffuse neuronal damage and could therefore affect cortical excitability. The motor threshold (MT), measured by transcranial magnetic stimulation (TMS), is a measure of cortical excitability and cortico-spinal tract integrity. MATERIALS AND METHODS We used navigated TMS (nTMS) and electromyography to determine subjects' left hemisphere MTs. Nineteen subjects with mTBI (11 with persistent symptoms and eight fully recovered) and nine healthy controls were tested. The injuries had occurred on average 5 years earlier. All participants had normal brain MRIs, that is, no signs of injury. None used centrally acting medication. RESULTS The mean MT in controls was 43.0% (SD 2.5) of maximum stimulator output. The mTBI subjects mean MT was 53.4% (SD 9.7), being higher than the controls' threshold. Subjective recovery did not correlate with MT. CONCLUSIONS The results show chronic MT elevation in a sample of subjects with symptomatic or recovered mTBI. This suggests that mTBI may be compensated, although not fully recovered, years after the injury. While the cause for MT elevation cannot be concluded from these preliminary observations, possible explanations include decreased cortical excitability and impaired subcortical conduction.
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Affiliation(s)
- J Tallus
- Centre for Cognitive Neuroscience, Department of Psychology, University of Turku, Finland.
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Railo H, Tallus J, Hämäläinen H. Right visual field advantage for perceived contrast: Correlation with an auditory bias and handedness. Brain Cogn 2011; 77:391-400. [DOI: 10.1016/j.bandc.2011.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/17/2011] [Accepted: 08/29/2011] [Indexed: 11/27/2022]
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Hämäläinen H, Soveri A, Tallus J, Laine M, Tuomainen J, Nyberg L, Bäckman L, Hugdahl K. Training of executive functions: A dichotic listening (DL) study. Int J Psychophysiol 2010. [DOI: 10.1016/j.ijpsycho.2010.06.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tallus J, Mattila J, Lioumis P, Hämäläinen H, Kähkönen S, Tenovuo O. Cortical responsivity in traumatic brain injury patients with chronic symptoms. Brain Stimul 2008. [DOI: 10.1016/j.brs.2008.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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