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Aumann MA, Richerson W, Song AK, Davis LT, Pruthi S, Davis S, Patel NJ, Custer C, Kassim AA, DeBaun MR, Donahue MJ, Jordan LC. Cerebral hemodynamic changes after haploidentical hematopoietic stem cell transplant in adults with sickle cell disease. Blood Adv 2024; 8:608-619. [PMID: 37883803 PMCID: PMC10838697 DOI: 10.1182/bloodadvances.2023010717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
ABSTRACT Preliminary evidence from a series of 4 adults with sickle cell disease (SCD) suggests that hematopoietic stem cell transplant (HSCT) improves cerebral hemodynamics. HSCT largely normalizes cerebral hemodynamics in children with SCD. We tested the hypothesis in adults with SCD that cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) measured using magnetic resonance imaging, normalized to healthy values, comparing measurements from ∼1 month before to 12 to 24 months after HSCT (n = 11; age, 33.3 ± 8.9 years; 389 ± 150 days after HSCT) with age-, race- and sex-matched values from healthy adults without sickle trait (n = 28; age, 30.2 ± 5.6 years). Before transplant, 7 patients had neurological indications for transplant (eg, overt stroke) and 4 had nonneurological reasons for haploidentical bone marrow transplant (haplo-BMT). All received haplo-BMT from first-degree relatives (parent, sibling, or child donor) with reduced-intensity preparation and maintained engraftment. Before transplant, CBF was elevated (CBF, 69.11 ± 24.7 mL/100 g/min) compared with that of controls (P = .004). Mean CBF declined significantly after haplo-BMT (posttransplant CBF, 48.2 ± 13.9 mL/100 g/min; P = .003). OEF was not different from that of controls at baseline and did not change significantly after haplo-BMT (pretransplant, 43.1 ± 6.7%; posttransplant, 39.6 ± 7.0%; P = .34). After transplant, CBF and OEF were not significantly different from controls (CBF, 48.2 ± 13.4 mL/100 g/min; P = .78; and OEF, 39.6 ± 7.0%; P > .99). CMRO2 did not change significantly after haplo-BMT (pretransplant, 3.18 ± 0.87 mL O2/100 g/min; posttransplant, 2.95 ± 0.83; P = .56). Major complications of haplo-BMT included 1 infection-related death and 1 severe chronic graft-versus-host disease. Haplo-BMT in adults with SCD reduces CBF to that of control values and maintains OEF and CMRO2 on average at levels observed in healthy adult controls. The trial was registered at www.clinicaltrials.gov as #NCT01850108.
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Affiliation(s)
- Megan A. Aumann
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley Richerson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander K. Song
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - L. Taylor Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Sumit Pruthi
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Samantha Davis
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Niral J. Patel
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea Custer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Adetola A. Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J. Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Franco G, Trujillo P, Lopez AM, Aumann MA, Englot DJ, Hainline A, Kang H, Konrad PE, Dawant BM, Claassen DO, Bick SK. Structural brain differences in essential tremor and Parkinson's disease deep brain stimulation patients. J Clin Neurosci 2023; 115:121-128. [PMID: 37549435 PMCID: PMC10530137 DOI: 10.1016/j.jocn.2023.08.001] [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: 05/22/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Essential tremor (ET) and Parkinson's disease (PD) are the most common tremor disorders and are common indications for deep brain stimulation (DBS). In some patients, PD and ET symptoms overlap and diagnosis can be challenging based on clinical criteria alone. The objective of this study was to identify structural brain differences between PD and ET DBS patients to help differentiate these disorders and improve our understanding of the different brain regions involved in these pathologic processes. METHODS We included ET and PD patients scheduled to undergo DBS surgery in this observational study. Patients underwent 3T brain MRI while under general anesthesia as part of their procedure. Cortical thicknesses and subcortical volumes were quantified from T1-weighted images using automated multi-atlas segmentation. We used logistic regression analysis to identify brain regions associated with diagnosis of ET or PD. RESULTS 149 ET and 265 PD patients were included. Smaller volumes in the pallidum and thalamus and reduced thickness in the anterior orbital gyrus, lateral orbital gyrus, and medial precentral gyrus were associated with greater odds of ET diagnosis. Conversely, reduced volumes in the caudate, amygdala, putamen, and basal forebrain, and reduced thickness in the orbital part of the inferior frontal gyrus, supramarginal gyrus, and posterior cingulate were associated with greater odds of PD diagnosis. CONCLUSIONS These findings identify structural brain differences between PD and ET patients. These results expand our understanding of the different brain regions involved in these disorders and suggest that structural MRI may help to differentiate patients with these two disorders.
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Affiliation(s)
- Giulia Franco
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Alexander M Lopez
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Megan A Aumann
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA.
| | - Allison Hainline
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37203, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37203, USA.
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV 26505, USA.
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, PMB 351662, Nashville, TN 37235-1662, USA.
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA.
| | - Sarah K Bick
- Department of Neurosurgery, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA; Department of Psychiatry, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
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Chen TX, Lin CYR, Aumann MA, Yan Y, Amokrane N, Desai NA, Kang H, Claassen DO, Kuo SH. Impulsivity Trait Profiles in Patients With Cerebellar Ataxia and Parkinson Disease. Neurology 2022; 99:e176-e186. [PMID: 35428731 PMCID: PMC9280994 DOI: 10.1212/wnl.0000000000200349] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with cerebellar ataxia (CA) can develop impulsive behavioral symptoms, often resulting in negative interpersonal consequences, detrimentally affecting their quality of life. Limited evidence exists concerning impulsivity in CA and its associated behavioral changes. We assessed impulsive traits in CA using the Barratt Impulsivity Scale (BIS-11) and compared them with those of Parkinson disease (PD) to investigate the differences in the impulsive trait profiles between CA and PD. METHODS We conducted a dual-center cross-sectional study with individuals with CA and PD enrolled through consecutive sampling from movement disorders clinics at Columbia University Medical Center and Vanderbilt University Medical Center, respectively. Age-matched controls were recruited at the respective institutions. Participants were excluded if they had prior or comorbid neurologic and psychiatric diseases known to be associated with impulsivity. All participants completed the BIS-11 questionnaire as a measure of impulsive traits. We used a general linear model and a least absolute shrinkage and selection operation regression to compare the total, subscale, and individual items of the BIS-11 scores between groups. Subgroup analyses were performed to isolate cerebellar contributions to impulsivity from potential effects of extracerebellar pathology and dopaminergic dysfunction or medications. RESULTS A total of 190 participants-90 age-matched controls, 50 participants with CA, and 50 with PD-completed the assessments. Persons with CA reported 9.7% higher BIS-11 scores than controls (p < 0.001), while persons with PD reported 24.9% higher scores than controls (p < 0.001). In CA, the most affected domain of impulsivity was nonplanning. In contrast, persons with PD noted greater impulsivity across the nonplanning, attentional, and motor domains. DISCUSSION Impulsivity in CA is uniquely driven by the nonplanning trait, unlike in PD. This suggests that the cerebellum and basal ganglia may differentially govern impulsive behaviors with the cerebellum contributing to the brain circuitry of impulsivity in a domain-specific manner.
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Affiliation(s)
- Tiffany X Chen
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Chi-Ying R Lin
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Megan A Aumann
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Yan Yan
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Nadia Amokrane
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Natasha A Desai
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Daniel O Claassen
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Sheng-Han Kuo
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN.
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