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Dill LK, Teymornejad S, Sharma R, Bozkurt S, Christensen J, Chu E, Rewell SS, Shad A, Mychasiuk R, Semple BD. Modulating chronic outcomes after pediatric traumatic brain injury: Distinct effects of social and environmental enrichment. Exp Neurol 2023; 364:114407. [PMID: 37059414 DOI: 10.1016/j.expneurol.2023.114407] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
Impairments in social and cognitive function are a common consequence of pediatric traumatic brain injury (TBI). Rehabilitation has the potential to promote optimal behavioral recovery. Here, we evaluated whether an enhanced social and/or cognitive environment could improve long-term outcomes in a preclinical model of pediatric TBI. Male C57Bl/6 J mice received a moderately-severe TBI or sham procedure at postnatal day 21. After one week, mice were randomized to different social conditions (minimal socialization, n = 2/cage; or social grouping, n = 6/cage), and housing conditions (standard cage, or environmental enrichment (EE), incorporating sensory, motor, and cognitive stimuli). After 8 weeks, neurobehavioral outcomes were assessed, followed by post-mortem neuropathology. We found that TBI mice exhibited hyperactivity, spatial memory deficits, reduced anxiety-like behavior, and reduced sensorimotor performance compared to age-matched sham controls. Pro-social and sociosexual behaviors were also reduced in TBI mice. EE increased sensorimotor performance, and the duration of sociosexual interactions. Conversely, social housing reduced hyperactivity and altered anxiety-like behavior in TBI mice, and reduced same-sex social investigation. TBI mice showed impaired spatial memory retention, except for TBI mice exposed to both EE and group housing. In the brain, while TBI led to significant regional tissue atrophy, social housing had modest neuroprotective effects on hippocampal volumes, neurogenesis, and oligodendrocyte progenitor numbers. In conclusion, manipulation of the post-injury environment has benefit for chronic behavioral outcomes, but the benefits are specific to the type of enrichment available. This study improves understanding of modifiable factors that may be harnessed to optimize long-term outcomes for survivors of early-life TBI.
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Affiliation(s)
- Larissa K Dill
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia; The Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
| | - Sadaf Teymornejad
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Rishabh Sharma
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Salome Bozkurt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Jennaya Christensen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Erskine Chu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Sarah S Rewell
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Ali Shad
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3050, Australia.
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Mariajoseph FP, Chen Z, Sekhar P, Rewell SS, O'Brien TJ, Antonic‐Baker A, Semple BD. Incidence and risk factors of posttraumatic epilepsy following pediatric traumatic brain injury: A systematic review and meta-analysis. Epilepsia 2022; 63:2802-2812. [PMID: 35996866 PMCID: PMC9826023 DOI: 10.1111/epi.17398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 06/20/2022] [Revised: 07/31/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
Posttraumatic epilepsy (PTE) is a well-known chronic complication following traumatic brain injury (TBI). Despite some evidence that age at the time of injury may influence the likelihood of PTE, the incidence of PTE in pediatric populations remains unclear. We therefore conducted a systematic review to determine the overall reported incidence of PTE, and explore potential risk factors associated with PTE after pediatric TBI. A comprehensive literature search of the PubMed, Embase, and Web of Science databases was conducted, including randomized controlled trials and cohort studies assessing the incidence of PTE in TBI pediatric patients. We excluded studies with a sample size of <10 patients and those in which a pediatric cohort was not clearly discernable. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We found that the overall incidence of PTE following pediatric TBI was 10% (95% confidence interval [CI] = 5.9%-15%). Subgroup analysis of a small number of studies demonstrated that the occurrence of early seizures (cumulative incidence ratio [CIR] = 7.28, 95% CI = 1.09-48.4, p = .040), severe TBI (CIR = 1.81, 95% CI = 1.23-2.67, p < .001), and intracranial hemorrhage (CIR = 1.60, 95% CI = 1.06-2.40, p = .024) increased the risk of PTE in this population. Other factors, including male sex and neurosurgical intervention, were nonsignificantly associated with a higher incidence of PTE. In conclusion, PTE is a significant chronic complication following childhood TBI, similar to in the adult population. Further standardized investigation into clinical risk factors and management guidelines is warranted. PROSPERO ID# CRD42021245802.
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Affiliation(s)
| | - Zhibin Chen
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Praba Sekhar
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Sarah S. Rewell
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia
| | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
| | - Ana Antonic‐Baker
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Bridgette D. Semple
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
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Mariajoseph FP, Rewell SS, O'Brien TJ, Semple BD, Antonic-Baker A. Incidence of post-traumatic epilepsy following paediatric traumatic brain injury: protocol for systematic review and meta-analysis. BMJ Open 2021; 11:e054034. [PMID: 34728458 PMCID: PMC8565535 DOI: 10.1136/bmjopen-2021-054034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Post-traumatic epilepsy (PTE) is a recognised complication of traumatic brain injury (TBI), and is associated with higher rates of mortality and morbidity when compared with patients with TBI who do not develop PTE. The majority of the literature on PTE has focused on adult populations, and consequently there is a paucity of information regarding paediatric cohorts. Additionally, there is considerable heterogeneity surrounding the reported incidence of PTE following childhood TBI in the current literature. The primary aim of our study is to summarise reported PTE incidences in paediatric populations to derive an accurate estimate of the global incidence of PTE following childhood TBI. Our secondary aim is to explore risk factors that increase the likelihood of developing PTE. METHODS AND ANALYSIS A systematic literature search of Embase (1947-2021), PubMed (1996-2021) and Web of Science (1900-2021) will be conducted. Publications in English that report the incidence of PTE in populations under 18 years of age will be included. Publications that evaluate fewer than 10 patients, report an alternative cause of epilepsy, or in which a paediatric cohort is not discernable, will be excluded. Independent investigators will identify the relevant publications, and discrepancies will be adjudicated by a third independent investigator. Data extracted will include incidence of PTE, time intervals between TBI and PTE, seizure characteristics, injury characteristics, patient demographics and clinical data. Data extraction will be performed by two independent investigators and cross-checked by a third investigator. A descriptive analysis of PTE incidence will be conducted and a weighted mean will be calculated. If sufficient data are available, stratified meta-analysis of subgroups will also be conducted. ETHICS AND DISSEMINATION Ethics approval was not required for this study. We intend to publish our findings in a high-quality peer-reviewed journal on completion. PROSPERO REGISTRATION NUMBER CRD42021245802.
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Affiliation(s)
| | - Sarah S Rewell
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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Borschmann KN, Rewell SS, Iuliano S, Ghasem-Zadeh A, Davey RA, Ho H, Skeers PN, Bernhardt J, Howells DW. Reduced bone formation markers, and altered trabecular and cortical bone mineral densities of non-paretic femurs observed in rats with ischemic stroke: A randomized controlled pilot study. PLoS One 2017; 12:e0172889. [PMID: 28278253 PMCID: PMC5344372 DOI: 10.1371/journal.pone.0172889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Immobility and neural damage likely contribute to accelerated bone loss after stroke, and subsequent heightened fracture risk in humans. Objective To investigate the skeletal effect of middle cerebral artery occlusion (MCAo) stroke in rats and examine its utility as a model of human post-stroke bone loss. Methods Twenty 15-week old spontaneously hypertensive male rats were randomized to MCAo or sham surgery controls. Primary outcome: group differences in trabecular bone volume fraction (BV/TV) measured by Micro-CT (10.5 micron istropic voxel size) at the ultra-distal femur of stroke affected left legs at day 28. Neurological impairments (stroke behavior and foot-faults) and physical activity (cage monitoring) were assessed at baseline, and days 1 and 27. Serum bone turnover markers (formation: N-terminal propeptide of type 1 procollagen, PINP; resorption: C-terminal telopeptide of type 1 collagen, CTX) were assessed at baseline, and days 7 and 27. Results No effect of stroke was observed on BV/TV or physical activity, but PINP decreased by -24.5% (IQR -34.1, -10.5, p = 0.046) at day 27. In controls, cortical bone volume (5.2%, IQR 3.2, 6.9) and total volume (6.4%, IQR 1.2, 7.6) were higher in right legs compared to left legs, but these side-to-side differences were not evident in stroke animals. Conclusion MCAo may negatively affect bone formation. Further investigation of limb use and physical activity patterns after MCAo is required to determine the utility of this current model as a representation of human post-stroke bone loss.
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Affiliation(s)
- Karen N. Borschmann
- School of Allied Health, La Trobe University, Bundoora, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Melbourne, Australia
- * E-mail:
| | - Sarah S. Rewell
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Sandra Iuliano
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Ali Ghasem-Zadeh
- Department of Endocrinology, Austin Health, University of Melbourne, Heidelberg, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Rachel A. Davey
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Heidi Ho
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Peta N. Skeers
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Julie Bernhardt
- School of Allied Health, La Trobe University, Bundoora, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Melbourne, Australia
| | - David W. Howells
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- University of Tasmania, School of Medicine, Faculty of Health, Hobart, Australia
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Pascoe MC, Howells DW, Crewther DP, Constantinou N, Carey LM, Rewell SS, Turchini GM, Kaur G, Crewther SG. Fish oil diet associated with acute reperfusion related hemorrhage, and with reduced stroke-related sickness behaviors and motor impairment. Front Neurol 2014; 5:14. [PMID: 24567728 PMCID: PMC3915239 DOI: 10.3389/fneur.2014.00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 10/22/2013] [Accepted: 01/20/2014] [Indexed: 01/25/2023] Open
Abstract
Ischemic stroke is associated with motor impairment and increased incidence of affective disorders such as anxiety/clinical depression. In non-stroke populations, successful management of such disorders and symptoms has been reported following diet supplementation with long chain omega-3-polyunsaturated-fatty-acids (PUFAs). However, the potential protective effects of PUFA supplementation on affective behaviors after experimentally induced stroke and sham surgery have not been examined previously. This study investigated the behavioral effects of PUFA supplementation over a 6-week period following either middle cerebral artery occlusion or sham surgery in the hooded-Wistar rat. The PUFA diet supplied during the acclimation period prior to surgery was found to be associated with an increased risk of acute hemorrhage following the reperfusion component of the surgery. In surviving animals, PUFA supplementation did not influence infarct size as determined 6 weeks after surgery, but did decrease omega-6-fatty-acid levels, moderate sickness behaviors, acute motor impairment, and longer-term locomotor hyperactivity and depression/anxiety-like behavior.
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Affiliation(s)
- Michaela C Pascoe
- Brain Sciences Institute, Swinburne University , Melbourne, VIC , Australia
| | | | - David P Crewther
- Brain Sciences Institute, Swinburne University , Melbourne, VIC , Australia
| | | | | | - Sarah S Rewell
- Florey Neuroscience Institutes , Melbourne, VIC , Australia
| | - Giovanni M Turchini
- School of Life and Environmental Sciences, Deakin University , Warrnambool, VIC , Australia
| | - Gunveen Kaur
- Institute of Sport Exercise and Active Living, Victoria University , Melbourne, VIC , Australia
| | - Sheila G Crewther
- School of Psychological Science, La Trobe University , Melbourne, VIC , Australia
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Sharma V, Ling TW, Rewell SS, Hare DL, Howells DW, Kourakis A, Wookey PJ. A novel population of α-smooth muscle actin-positive cells activated in a rat model of stroke: an analysis of the spatio-temporal distribution in response to ischemia. J Cereb Blood Flow Metab 2012; 32:2055-65. [PMID: 22805872 PMCID: PMC3493995 DOI: 10.1038/jcbfm.2012.107] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a rat model of stroke, the spatio-temporal distribution of α-smooth muscle actin-positive, (αSMA+) cells was investigated in the infarcted hemisphere (ipsilateral) and compared with the contralateral hemisphere. At day 3 postischemia, αSMA+ cells were concentrated in two main loci within the ipsilateral hemisphere (Area A) in the medial corpus callosum and (Area B) midway through the striatum adjacent to the lateral ventricle. By day 7 and further by day 14, fewer αSMA+ cells remained in Areas A and B but a steady increase in the peri-infarct was observed. αSMA+ cells also expressed glial acidic fibrillary protein [GFAP: αSMA+/GFAP+ (29%); αSMA+/GFAP- (71%) phenotypes] and feline leukemia virus C receptor 2 (FLVCR2), but not ED1(microglia) and established markers of pericytes normally located in vascular wall. αSMA+ cells were also located close to the subventricular zones (SVZ) adjacent to Areas A and B. In conclusion, αSMA+ cells have been identified in a spatial and temporal sequence from the SVZ, at intermediate loci and in the vicinity of the peri-infarct. It is hypothesized that novel populations of αSMA+ precursors of pericytes are born on the SVZ, migrate into the peri-infarct region and are incorporated into new vessels of the peri-infarct regions.
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Affiliation(s)
- Varun Sharma
- Cardiology Department, Austin Health, Melbourne, Victoria, Australia
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