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Lima Santos JP, Jia-Richards M, Kontos AP, Collins MW, Versace A. Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6274. [PMID: 37444121 PMCID: PMC10341732 DOI: 10.3390/ijerph20136274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Meilin Jia-Richards
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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Kang W, Kang Y, Kim A, Tae WS, Kim KJ, Kim SG, Ham BJ, Han KM. Shape analysis of the subcortical structures in North Korean refugees with post-traumatic stress disorder and major depressive disorder. Psychiatry Res Neuroimaging 2022; 326:111527. [PMID: 36049318 DOI: 10.1016/j.pscychresns.2022.111527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/30/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the growing number of refugees and their mental health issues, neurobiological mechanisms to explain clinical symptoms resulting from traumatic events, such as post-traumatic stress disorder (PTSD) or major depressive disorder (MDD), have not been extensively investigated. Research on the mental health of North Korean refugees (NKRs) who defected to South Korea for resettlement is still at an early stage but commonly reports structural and functional abnormalities in brain regions related to reward and motivational processing. The nucleus accumbens (NAc) and ventral pallidum (VP) are the major sites in subcortical structures that play key roles in reward and motivation. METHODS The present study examined subcortical structural abnormalities of 28 NKRs and age-, sex- matched South Korean Controls (SKCs) using shape analysis at the vertex level. RESULTS Among the 28 NKRs, 18 had psychiatric disorders, including PTSD and MDD. The NKRs showed significantly reduced volumes in the right NAc and bilateral VP compared to the SKRs. The volume of the right VP showed a significant negative correlation with current PTSD severity in the NKR group. CONCLUSIONS Our findings demonstrated that structural alterations of the NAc and VP may explain PTSD and MDD observed in the refugees and further suggest that the aftereffect of trauma, manifested as anhedonia and anxiety, may show chronically.
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Affiliation(s)
- Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Younbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Sundaresh SN, Finan JD, Elkin BS, Basilio AV, McKhann GM, Morrison B. Region-Dependent Viscoelastic Properties of Human Brain Tissue Under Large Deformations. Ann Biomed Eng 2022; 50:1452-1460. [PMID: 35034227 DOI: 10.1007/s10439-022-02910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/01/2022] [Indexed: 11/01/2022]
Abstract
This study characterizes the mechanical properties of human brain tissue resected during the course of surgery under multistep indentation loading up to 30% strain. The experimental characterization using fresh, post-operative, human brain tissue is highly advantageous since postmortem times can affect its biomechanical behavior. Although the quasilinear theory of viscoelasticity (QLV) approach has been widely used to model brain tissue mechanical properties, our analysis concluded that the linear viscoelastic approach provided a better fit to the experimental data overall. The only statistically significant regional difference in observed stiffness was between the cortex gray and dentate gyrus. There were no statistically significant age or sex dependent differences, although the data suggested that the cortex white matter in males was stiffer than that in females. Our results can help improve the accuracy of finite element models of brain tissue deformation to predict its response to traumatic brain injury.
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Affiliation(s)
- Sowmya N Sundaresh
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, United States
| | - John D Finan
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, United States
| | - Benjamin S Elkin
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, United States
| | - Andrew V Basilio
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, United States
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York Presbyterian Hospital, 710 West 168th St, New York, NY, 10032, United States
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, United States.
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Synergistic Role of Quantitative Diffusion Magnetic Resonance Imaging and Structural Magnetic Resonance Imaging in Predicting Outcomes After Traumatic Brain Injury. J Comput Assist Tomogr 2022; 46:236-243. [PMID: 35297580 PMCID: PMC8974470 DOI: 10.1097/rct.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to assess if quantitative diffusion magnetic resonance imaging analysis would improve prognostication of individual patients with severe traumatic brain injury. METHODS We analyzed images of 30 healthy controls to extract normal fractional anisotropy ranges along 18 white-matter tracts. Then, we analyzed images of 33 patients, compared their fractional anisotropy values with normal ranges extracted from controls, and computed severity of injury to white-matter tracts. We also asked 2 neuroradiologists to rate severity of injury to different brain regions on fluid-attenuated inversion recovery and susceptibility-weighted imaging. Finally, we built 3 models: (1) fed with neuroradiologists' ratings, (2) fed with white-matter injury measures, and (3) fed with both input types. RESULTS The 3 models respectively predicted survival at 1 year with accuracies of 70%, 73%, and 88%. The accuracy with both input types was significantly better (P < 0.05). CONCLUSIONS Quantifying severity of injury to white-matter tracts complements qualitative imaging findings and improves outcome prediction in severe traumatic brain injury.
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Richey LN, Bryant BR, Krieg A, Bray MJC, Esagoff AI, Pradeep T, Jahed S, Luna LP, Trapp NT, Adkins J, Jones MB, Bledsoe A, Stevens DA, Roper C, Goldwaser EL, Morris L, Berich-Anastasio E, Pletnikova A, Lobner K, Lee DJ, Lauterbach M, Ducharme S, Sair HI, Peters ME. Neuroimaging correlates of syndromal depression following traumatic brain injury: A systematic review of the literature. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221133183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To complete a systematic review of the literature examining neuroimaging findings unique to co-occurring syndromal depression in the setting of TBI. Methods A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases for articles published prior to April of 2022. The database query yielded 4447 unique articles. These articles were narrowed based on specific inclusion criteria (e.g., clear TBI definition, clear depression construct commenting on the syndrome of major depressive disorder, conducted empirical analyses comparing neuroimaging correlates in TBI subjects with depression versus TBI subjects without depression, controlled for the time interval between TBI occurrence and acquisition of neuroimaging). Results A final cohort of 10 articles resulted, comprising the findings from 423 civilians with brain injury, 129 of which developed post-TBI depression. Four articles studied mild TBI, three mild/moderate, one moderate/severe, and two all-comers, with nine articles focusing on single TBI and one including both single and recurrent injuries. Spatially convergent structural abnormalities in individuals with TBI and co-occurring syndromal depression were identified primarily in bilateral frontal regions, particularly in those with damage to the left frontal lobe and prefrontal cortices, as well as temporal regions including bilateral temporal lobes, the left superior temporal gyrus, and bilateral hippocampi. Various parietal regions and the nucleus accumbens were also implicated. EEG studies showed supporting evidence of functional changes in frontal regions. Conclusion Additional inquiry with attention to TBI without depression control groups, consistent TBI definitions, previous TBI, clinically diagnosed syndromal depression, imaging timing post-injury, acute prospective design, functional neuroimaging, and well-defined neuroanatomical regions of interest is crucial to extrapolating finer discrepancies between primary and TBI-related depression.
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Affiliation(s)
- Lisa N. Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barry R. Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J. C. Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron I. Esagoff
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tejus Pradeep
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sahar Jahed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Licia P. Luna
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas T. Trapp
- Department of Psychiatry, University of Iowa Carver College of Medicine
| | - Jaxon Adkins
- Louisiana State University, Baton Rouge, Louisiana, USA
| | - Melissa B. Jones
- Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, Texas, USA
| | - Andrew Bledsoe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel A. Stevens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carrie Roper
- VA Maryland Healthcare System, Baltimore, Maryland, USA
- Sheppard Pratt Health System, Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eric L. Goldwaser
- Department of Psychiatry, University of Iowa Carver College of Medicine
| | - LiAnn Morris
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Alexandra Pletnikova
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katie Lobner
- Johns Hopkins University, Welch Medical Library, Baltimore, Maryland, USA
| | - Daniel J. Lee
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease & Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Margo Lauterbach
- Sheppard Pratt Health System, Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Montreal Neurological Institute, McConnell Brain Imaging Centre, Montreal, Canada
| | - Haris I. Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jahed S, Daneshvari NO, Liang AL, Richey LN, Bryant BR, Krieg A, Bray MJC, Pradeep T, Luna LP, Trapp NT, Jones MB, Stevens DA, Roper C, Goldwaser EL, Berich-Anastasio E, Pletnikova A, Lobner K, Lee DJ, Lauterbach M, Sair HI, Peters ME. Neuroimaging Correlates of Syndromal Anxiety Following Traumatic Brain Injury: A Systematic Review of the Literature. J Acad Consult Liaison Psychiatry 2021; 63:119-132. [PMID: 34534701 DOI: 10.1016/j.jaclp.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) can precipitate new-onset psychiatric symptoms or worsen existing psychiatric conditions. To elucidate specific mechanisms for this interaction, neuroimaging is often used to study both psychiatric conditions and TBI. This systematic review aims to synthesize the existing literature of neuroimaging findings among patients with anxiety after TBI. METHODS We conducted a Preferred Reporting Items for Systematic Review and Meta-Analyses-compliant literature search via PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases before May, 2019. We included studies that clearly defined TBI, measured syndromic anxiety as a primary outcome, and statistically analyzed the relationship between neuroimaging findings and anxiety symptoms. RESULTS A total of 5982 articles were retrieved from the systematic search, of which 65 studied anxiety and 13 met eligibility criteria. These studies were published between 2004 and 2017, collectively analyzing 764 participants comprised of 470 patients with TBI and 294 non-TBI controls. Imaging modalities used included magnetic resonance imaging, functional magnetic resonance imaging, diffusion tensor imaging, electroencephalogram, magnetic resonance spectrometry, and magnetoencephalography. Eight of 13 studies presented at least one significant finding and together reflect a complex set of changes that lead to anxiety in the setting of TBI. The left cingulate gyrus in particular was found to be significant in 2 studies using different imaging modalities. Two studies also revealed perturbances in functional connectivity within the default mode network. CONCLUSIONS This is the first systemic review of neuroimaging changes associated with anxiety after TBI, which implicated multiple brain structures and circuits, such as the default mode network. Future research with consistent, rigorous measurements of TBI and syndromic anxiety, as well as attention to control groups, previous TBIs, and time interval between TBI and neuroimaging, are warranted. By understanding neuroimaging correlates of psychiatric symptoms, this work could inform future post-TBI screening and surveillance, preventative efforts, and early interventions to improve neuropsychiatric outcomes.
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Affiliation(s)
- Sahar Jahed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas O Daneshvari
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angela L Liang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tejus Pradeep
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Licia P Luna
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Melissa B Jones
- Menninger Department of Psychiatry and Behavioral Sciences, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX
| | - Daniel A Stevens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Eric L Goldwaser
- Sheppard Pratt, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD
| | | | - Alexandra Pletnikova
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Daniel J Lee
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease & Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Margo Lauterbach
- Sheppard Pratt, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD
| | - Haris I Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
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Kuusinen V, Peräkylä J, Sun L, Ogawa KH, Hartikainen KM. Emotional Modulation of Frontal Alpha Asymmetry - a Novel Biomarker of Mild Traumatic Brain Injury. Front Hum Neurosci 2021; 15:699947. [PMID: 34354578 PMCID: PMC8329358 DOI: 10.3389/fnhum.2021.699947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022] Open
Abstract
Objective findings of brain injury or dysfunction are typically lacking in mild traumatic brain injury (MTBI) despite prolonged post-concussion symptoms in some patients. Thus, there is a need for objective biomarkers of MTBI that reflect altered brain physiology underlying subjective symptoms. We have previously reported increased attention to threat-related stimuli in subjects with MTBI, suggesting a physiological vulnerability to depression. Vulnerability to depression has been linked with relatively greater activity of the right than left frontal cortex reflected in inverse pattern in frontal alpha with greater power on the left than right. We investigated whether patients with previous MTBI show this pattern of frontal activity reflected in more negative frontal alpha asymmetry (FAA) scores. Furthermore, in search for potential biomarkers of MTBI, we created a novel index, emotional modulation of FAA (eFAA) and investigated whether it correlates with subjective symptoms. EEG was recorded while subjects with previous MTBI and controls performed a computer-based reaction time task integrating different cognitive executive functions and containing either threat-related or emotionally neutral visual stimuli. Post-concussion symptoms and depression were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Beck's depression inventory (BDI). Task-induced FAA was assessed and eFAA calculated by subtracting FAA in the context of neutral stimuli from FAA in the context of emotional stimuli. The MTBI group showed FAA scores reflecting relatively greater right-sided frontal activity compared to healthy controls. eFAA differentiated the symptomatic MTBI from non-symptomatic MTBI group and from healthy controls. eFAA also correlated with RPQ and BDI scores. In conclusion, FAA pattern previously linked with vulnerability to depression, was observed in patients with previous MTBI. Furthermore, eFAA has potential as a biomarker of altered affective brain functions in MTBI.
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Affiliation(s)
- Venla Kuusinen
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Peräkylä
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lihua Sun
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Keith H. Ogawa
- Department of Psychology, Saint Mary’s College of California, Moraga, CA, United States
| | - Kaisa M. Hartikainen
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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A 3-month-delayed treatment with anatabine improves chronic outcomes in two different models of repetitive mild traumatic brain injury in hTau mice. Sci Rep 2021; 11:7900. [PMID: 33846461 PMCID: PMC8041866 DOI: 10.1038/s41598-021-87161-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/24/2021] [Indexed: 02/01/2023] Open
Abstract
To date, an overwhelming number of preclinical studies have addressed acute treatment in mild TBI (mTBI) and repetitive mTBI (r-mTBI), whereas, in humans, there often exists a significant time gap between the injury and the first medical intervention. Our study focused on a delayed treatment with anatabine, an anti-inflammatory compound, in hTau mice using two different models of r-mTBI. The rationale for using two models of the same impact but different frequencies (5 hit mTBI over 9 days and 24 hit mTBI over 90 days) was chosen to address the heterogeneity of r-mTBI in clinical population. Following the last injury in each model, three months elapsed before the initiation of treatment. Anatabine was administered in drinking water for 3 months thereafter. Our data demonstrated that a 3-month delayed treatment with anatabine mitigated astrogliosis in both TBI paradigms but improved cognitive functions only in more-frequently-injured mice (24 hit mTBI). We also found that anatabine decreased the phosphorylation of tau protein and NFκB, which were increased after r-mTBI in both models. The ability of anatabine to suppress these mechanisms suggests that delayed treatment can be effective for clinical population of r-mTBI. The discrepancy between the two models with regard to changes in cognitive performance suggests that r-mTBI heterogeneity may influence treatment efficiency and should be considered in therapeutic development.
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Traumatic brain injury and methamphetamine: A double-hit neurological insult. J Neurol Sci 2020; 411:116711. [DOI: 10.1016/j.jns.2020.116711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022]
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Wangnoo T, Zavorsky GS, Owen-Smith A. Association between Concussions and Suicidal Behaviors in Adolescents. J Neurotrauma 2020; 37:1401-1407. [PMID: 30520366 DOI: 10.1089/neu.2018.5721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
While there is increasing evidence on the long-term risks associated with concussions, the association between hopelessness, suicidal ideation, suicidal planning, and suicidal attempts in high school aged adolescents has not yet been explored. The current study aims to estimate the association between concussions and suicidal behaviors in Utah high school students. We analyzed the 2013 Utah Youth Risk Behavior Survey (YRBS), a state, representative survey of 2,195 ninth through 12th grade high school students. Bivariate and multi-variate logistic regressions controlling for race/ethnicity, sex, grade, and alcohol use were conducted to evaluate the adjusted odds ratio (OR) and 95% confidence interval (CI) of suicidal behaviors comparing students exposed to one or more concussions with those unexposed. Students with self-reported concussion exposure had significantly greater odds of reporting feeling sad or hopeless (OR = 1.7; 95% CI 1.4, 2.2, suicidal ideations [adjusted odds ratio (AOR) = 2.0; 95% CI 1.4, 2.7], suicidal planning [AOR = 2.0; 95% CI 1.4, 2.8], and suicidal attempts [OR = 2.3; 95% CI 1.4, 3.7]) after controlling for grade, sex, race, and alcohol-use. Results from this study suggest that high school students who have had a concussion are more likely to report suicidal behaviors, compared with high school students who did not report a concussion. Given the results, concussion prevention education efforts in high schools are warranted. In addition, it is imperative to educate parents, teachers, and health professionals how to recognize a concussion and any possible mental health outcomes as a result. Future longitudinal research is needed to better understand temporality of this association.
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Mithani K, Davison B, Meng Y, Lipsman N. The anterior limb of the internal capsule: Anatomy, function, and dysfunction. Behav Brain Res 2020; 387:112588. [PMID: 32179062 DOI: 10.1016/j.bbr.2020.112588] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/22/2019] [Accepted: 02/28/2020] [Indexed: 12/22/2022]
Abstract
The last two decades have seen a re-emergence of neurosurgery for severe, refractory psychiatric diseases, largely due to the advent of more precise and safe operative techniques. Nevertheless, the optimal targets for these surgeries remain a matter of debate, and are often grandfathered from experiences in the late 20th century. To better explore the rationale for one target in particular - the anterior limb of the internal capsule (ALIC) - we comprehensively reviewed all available literature on its role in the pathophysiology and treatment of mental illness. We first provide an overview of its functional anatomy, followed by a discussion on its role in several prevalent psychiatric diseases. Given its structural integration into the limbic system and involvement in a number of cognitive and emotional processes, the ALIC is a robust target for surgical treatment of refractory psychiatric diseases. The advent of novel neuroimaging techniques, coupled with image-guided therapeutics and neuromodulatory treatments, will continue to enable study on the ALIC in mental illness.
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Affiliation(s)
- Karim Mithani
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Ying Meng
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Ontario, Canada.
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13
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Cheng H, Deaton LM, Qiu M, Ha S, Pacoma R, Lao J, Tolley V, Moran R, Keeton A, Lamb JR, Fathman J, Walker JR, Schumacher AM. Tau overexpression exacerbates neuropathology after repeated mild head impacts in male mice. Neurobiol Dis 2019; 134:104683. [PMID: 31765727 DOI: 10.1016/j.nbd.2019.104683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/22/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023] Open
Abstract
Repeated mild traumatic brain injury (rmTBI) can lead to development of chronic traumatic encephalopathy (CTE), which is characterized by progressive neurodegeneration with presence of white matter damage, gliosis and hyper-phosphorylated tau. While animal models of rmTBI have been documented, few characterize the molecular pathogenesis and expression profiles of relevant injured brain regions. Additionally, while the usage of transgenic tau mice in rmTBI is prevalent, the effects of tau on pathological outcomes has not been well studied. Here we characterized a 42-impact closed-head rmTBI paradigm on 3-4 month old male C57BL/6 (WT) and Tau-overexpressing mice (Tau58.4). This injury paradigm resulted in chronic gliosis, T-cell infiltration, and demyelination of the optic nerve and associated white matter tracts at 1-month post-injury. At 3-months post-injury, Tau58.4 mice showed progressive neuroinflammation and neurodegeneration in multiple brain regions compared to WT mice. Corresponding to histopathology, RNAseq of the optic nerve tract at 1-month post-injury showed significant upregulation of inflammatory pathways and downregulation of myelin synthetic pathways in both genotypes. However, Tau58.4 mice showed additional changes in neurite development, protein processing, and cell stress. Comparisons with published transcriptomes of human Alzheimer's Disease and CTE revealed common signatures including neuroinflammation and downregulation of protein phosphatases. We next investigated the demyelination and T-cell infiltration phenotypes to determine whether these offer potential avenues for therapeutic intervention. Tau58.4 mice were treated with the histamine H3 receptor antagonist GSK239512 for 1-month post-injury to promote remyelination of white matter lesions. This restored myelin gene expression to sham levels but failed to repair the histopathologic lesions. Likewise, injured T-cell-deficient Rag2/Il2rg (R2G2) mice also showed evidence for inflammation and loss of myelin. However, unlike immune-competent mice, R2G2 mice had altered myeloid cell gene expression and fewer demyelinated lesions. Together this data shows that rmTBI leads to chronic white matter inflammatory demyelination and axonal loss exacerbated by human tau overexpression but suggests that immune-suppression and remyelination alone are insufficient to reverse damage.
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Affiliation(s)
- Hank Cheng
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Lisa M Deaton
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Minhua Qiu
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Sukwon Ha
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Reynand Pacoma
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Jianmin Lao
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Valerie Tolley
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Rita Moran
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Amber Keeton
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - John R Lamb
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA
| | - John Fathman
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - John R Walker
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
| | - Andrew M Schumacher
- Department of General Medical Biology, Genomics Institute for the Novartis Research Foundation, San Diego, CA 92121, USA.
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14
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Huang GH, Chen K, Sun YY, Zhu L, Sun ZL, Feng DF. 4-Phenylbutyrate Ameliorates Anxiety Disorder by Inhibiting Endoplasmic Reticulum Stress after Diffuse Axonal Injury. J Neurotrauma 2019; 36:1856-1868. [PMID: 30582423 DOI: 10.1089/neu.2018.6048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diffuse axonal injury (DAI) is accompanied frequently by adverse sequelae and psychiatric disorders, such as anxiety, leading to a decreased quality of life, social isolation, and poor outcomes in patients. The mechanisms regulating psychiatric disorders post-DAI are not well elucidated, however. Previous studies showed that endoplasmic reticulum (ER) stress functions as a pivotal factor in neurodegeneration disease. In this study, we showed that DAI can trigger ER stress and unfolded protein response (UPR) activation in both the acute and chronic periods, leading to cell death and anxiety disorder. Treatment with 4-phenylbutyrate (4-PBA) is able to inhibit the UPR and cell apoptosis and relieve the anxiety disorder in our DAI model. Later (14 days post-DAI) 4-PBA treatment, however, can restore only the related gene expression of ER stress and UPR but not the psychiatric disorder. Therefore, the early (5 min after DAI) administration of 4-PBA might be a therapeutic approach for blocking the ER stress/UPR-induced cell death and anxiety disorder after DAI.
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Affiliation(s)
- Guo-Hui Huang
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2 Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kui Chen
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2 Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Yu Sun
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2 Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhu
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao-Liang Sun
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Fu Feng
- 1 Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,2 Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Merkel SF, Andrews AM, Lutton EM, Razmpour R, Cannella LA, Ramirez SH. Dexamethasone Attenuates the Enhanced Rewarding Effects of Cocaine Following Experimental Traumatic Brain Injury. Cell Transplant 2018; 26:1178-1192. [PMID: 28933216 PMCID: PMC5447499 DOI: 10.1177/0963689717714341] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Clinical studies have identified traumatic brain injury (TBI) as a risk factor for the development of cocaine dependence. This claim is supported by our recent preclinical studies showing enhancement of the rewarding effects of cocaine in mice sustaining moderate controlled cortical impact (CCI) injury during adolescence. Here we test the efficacy of dexamethasone, an anti-inflammatory corticosteroid, to attenuate augmentation of the behavioral response to cocaine observed in CCI-TBI animals using the conditioned place preference (CPP) assay. These studies were performed in order to determine whether proinflammatory activity in the nucleus accumbens (NAc), a key brain nucleus in the reward pathway, mediates enhanced cocaine-induced CPP in adolescent animals sustaining moderate CCI-TBI. Our data reveal robust glial activation in the NAc following CCI-TBI and a significant increase in the cocaine-induced CPP of untreated CCI-TBI mice. Furthermore, our results show that dexamethasone treatment following CCI-TBI can attenuate the cocaine place preference of injured animals without producing aversion in the CPP assay. Our studies also found that dexamethasone treatment significantly reduced the expression of select immune response genes including Monocyte chemoattractant protein-1 (MCP-1/CCL2) and intercellular adhesion molecule-1 ( ICAM-1), returning their expression to control levels, which prompted an investigation of peripheral blood monocytes in dexamethasone-treated animals. Experimental findings showed that no craniectomy/dexamethasone mice had a significant increase, while CCI-TBI/dexamethasone animals had a significant decrease in the percentage of circulating nonclassical patrolling monocytes. These results suggest that a portion of these monocytes may migrate to the brain in response to CCI-TBI, potentially sparing the development of chronic neuroinflammation in regions associated with the reward circuitry such as the NAc. Overall, our findings indicate that anti-inflammatory agents, such as dexamethasone, may be effective in normalizing the rewarding effects of cocaine following CCI-TBI.
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Affiliation(s)
- Steven F Merkel
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,2 Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Allison M Andrews
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,2 Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Evan M Lutton
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Roshanak Razmpour
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lee Anne Cannella
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,2 Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Servio H Ramirez
- 1 Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,2 Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,3 Shriners Hospitals Pediatric Research Center, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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16
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Chen YH, Huang EYK, Kuo TT, Miller J, Chiang YH, Hoffer BJ. Impact of Traumatic Brain Injury on Dopaminergic Transmission. Cell Transplant 2018; 26:1156-1168. [PMID: 28933212 PMCID: PMC5657731 DOI: 10.1177/0963689717714105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Brain trauma is often associated with severe morbidity and is a major public health concern. Even when injury is mild and no obvious anatomic disruption is seen, many individuals suffer disabling neuropsychological impairments such as memory loss, mood dysfunction, substance abuse, and adjustment disorder. These changes may be related to subtle disruption of neural circuits as well as functional changes at the neurotransmitter level. In particular, there is considerable evidence that dopamine (DA) physiology in the nigrostriatal and mesocorticolimbic pathways might be impaired after traumatic brain injury (TBI). Alterations in DA levels can lead to oxidative stress and cellular dysfunction, and DA plays an important role in central nervous system inflammation. Therapeutic targeting of DA pathways may offer benefits for both neuronal survival and functional outcome after TBI. The purpose of this review is to discuss the role of DA pathology in acute TBI and the potential impact of therapies that target these systems for the treatment of TBI.
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Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Yuan-Hao Chen, Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 4F, No. 325, 2nd Sec., Cheng-Kung Road, Nei-Hu District, Taipei City, 114 Taiwan, Republic of China.
| | - Eagle Yi-Kung Huang
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan, Republic of China
| | - Jonathan Miller
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yung-Hsiao Chiang
- Section of Neurosurgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Barry J. Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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17
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Braun M, Vaibhav K, Saad NM, Fatima S, Vender JR, Baban B, Hoda MN, Dhandapani KM. White matter damage after traumatic brain injury: A role for damage associated molecular patterns. Biochim Biophys Acta Mol Basis Dis 2017; 1863:2614-2626. [PMID: 28533056 DOI: 10.1016/j.bbadis.2017.05.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and long-term morbidity worldwide. Despite decades of pre-clinical investigation, therapeutic strategies focused on acute neuroprotection failed to improve TBI outcomes. This lack of translational success has necessitated a reassessment of the optimal targets for intervention, including a heightened focus on secondary injury mechanisms. Chronic immune activation correlates with progressive neurodegeneration for decades after TBI; however, significant challenges remain in functionally and mechanistically defining immune activation after TBI. In this review, we explore the burgeoning evidence implicating the acute release of damage associated molecular patterns (DAMPs), such as adenosine 5'-triphosphate (ATP), high mobility group box protein 1 (HMGB1), S100 proteins, and hyaluronic acid in the initiation of progressive neurological injury, including white matter loss after TBI. The role that pattern recognition receptors, including toll-like receptor and purinergic receptors, play in progressive neurological injury after TBI is detailed. Finally, we provide support for the notion that resident and infiltrating macrophages are critical cellular targets linking acute DAMP release with adaptive immune responses and chronic injury after TBI. The therapeutic potential of targeting DAMPs and barriers to clinical translational, in the context of TBI patient management, are discussed.
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Affiliation(s)
- Molly Braun
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Kumar Vaibhav
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, United States; Department of Medical Laboratory, Imaging & Radiologic Sciences, College of Allied Health Science, Augusta University, Augusta, GA, United States
| | - Nancy M Saad
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, United States
| | - Sumbul Fatima
- Department of Medical Laboratory, Imaging & Radiologic Sciences, College of Allied Health Science, Augusta University, Augusta, GA, United States
| | - John R Vender
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Babak Baban
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, United States; Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Md Nasrul Hoda
- Department of Medical Laboratory, Imaging & Radiologic Sciences, College of Allied Health Science, Augusta University, Augusta, GA, United States; Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Krishnan M Dhandapani
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, United States.
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18
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Merkel SF, Cannella LA, Razmpour R, Lutton E, Raghupathi R, Rawls SM, Ramirez SH. Factors affecting increased risk for substance use disorders following traumatic brain injury: What we can learn from animal models. Neurosci Biobehav Rev 2017; 77:209-218. [PMID: 28359860 DOI: 10.1016/j.neubiorev.2017.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/06/2017] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
Recent studies have helped identify multiple factors affecting increased risk for substance use disorders (SUDs) following traumatic brain injury (TBI). These factors include age at the time of injury, repetitive injury and TBI severity, neurocircuits, neurotransmitter systems, neuroinflammation, and sex differences. This review will address each of these factors by discussing 1) the clinical and preclinical data identifying patient populations at greatest risk for SUDs post-TBI, 2) TBI-related neuropathology in discrete brain regions heavily implicated in SUDs, and 3) the effects of TBI on molecular mechanisms that may drive substance abuse behavior, like dopaminergic and glutamatergic transmission or neuroimmune signaling in mesolimbic regions of the brain. Although these studies have laid the groundwork for identifying factors that affect risk of SUDs post-TBI, additional studies are required. Notably, preclinical models have been shown to recapitulate many of the behavioral, cellular, and neurochemical features of SUDs and TBI. Therefore, these models are well suited for answering important questions that remain in future investigations.
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Affiliation(s)
- Steven F Merkel
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Lee Anne Cannella
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Roshanak Razmpour
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Evan Lutton
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Scott M Rawls
- Department of Pharmacology, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Servio H Ramirez
- Department of Pathology and Laboratory Medicine, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Shriners Hospitals Pediatric Research Center, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; Center for Substance Abuse Research, The Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
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19
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Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
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Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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20
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Dona O, Noseworthy MD, DeMatteo C, Connolly JF. Fractal Analysis of Brain Blood Oxygenation Level Dependent (BOLD) Signals from Children with Mild Traumatic Brain Injury (mTBI). PLoS One 2017; 12:e0169647. [PMID: 28072842 PMCID: PMC5224975 DOI: 10.1371/journal.pone.0169647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conventional imaging techniques are unable to detect abnormalities in the brain following mild traumatic brain injury (mTBI). Yet patients with mTBI typically show delayed response on neuropsychological evaluation. Because fractal geometry represents complexity, we explored its utility in measuring temporal fluctuations of brain resting state blood oxygen level dependent (rs-BOLD) signal. We hypothesized that there could be a detectable difference in rs-BOLD signal complexity between healthy subjects and mTBI patients based on previous studies that associated reduction in signal complexity with disease. METHODS Fifteen subjects (13.4 ± 2.3 y/o) and 56 age-matched (13.5 ± 2.34 y/o) healthy controls were scanned using a GE Discovery MR750 3T MRI and 32-channel RF-coil. Axial FSPGR-3D images were used to prescribe rs-BOLD (TE/TR = 35/2000ms), acquired over 6 minutes. Motion correction was performed and anatomical and functional images were aligned and spatially warped to the N27 standard atlas. Fractal analysis, performed on grey matter, was done by estimating the Hurst exponent using de-trended fluctuation analysis and signal summation conversion methods. RESULTS AND CONCLUSIONS Voxel-wise fractal dimension (FD) was calculated for every subject in the control group to generate mean and standard deviation maps for regional Z-score analysis. Voxel-wise validation of FD normality across controls was confirmed, and non-Gaussian voxels (3.05% over the brain) were eliminated from subsequent analysis. For each mTBI patient, regions where Z-score values were at least 2 standard deviations away from the mean (i.e. where |Z| > 2.0) were identified. In individual patients the frequently affected regions were amygdala (p = 0.02), vermis(p = 0.03), caudate head (p = 0.04), hippocampus(p = 0.03), and hypothalamus(p = 0.04), all previously reported as dysfunctional after mTBI, but based on group analysis. It is well known that the brain is best modeled as a complex system. Therefore a measure of complexity using rs-BOLD signal FD could provide an additional method to grade and monitor mTBI. Furthermore, this approach can be personalized thus providing unique patient specific assessment.
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Affiliation(s)
- Olga Dona
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Michael D. Noseworthy
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Carol DeMatteo
- School of Rehabilitation Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John F. Connolly
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Linguistics, McMaster University, Hamilton, Ontario, Canada
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21
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Raji CA, Merrill DA, Barrio JR, Omalu B, Small GW. Progressive Focal Gray Matter Volume Loss in a Former High School Football Player: A Possible Magnetic Resonance Imaging Volumetric Signature for Chronic Traumatic Encephalopathy. Am J Geriatr Psychiatry 2016; 24:784-90. [PMID: 27567184 DOI: 10.1016/j.jagp.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/15/2016] [Indexed: 01/01/2023]
Abstract
Here a case is presented of a 51-year-old former high school football player with multiple concussions, including one episode with loss of consciousness. The patient experienced 6 years of cognitive and mood decline, and his wife corroborated increasing memory loss, attentional difficulties, and depressed mood without suicidal ideation. He had been unable to maintain full-time employment because of progressive decline. Based on his presentation, he had been previously diagnosed with attention deficit hyperactivity disorder and bipolar disorder, type II. Neuropsychological tests indicated domain-specific cognitive impairment, and longitudinal volumetric magnetic resonance imaging (MRI) of the brain showed progressive brainstem, diencephalic, and frontal lobe atrophy. This regional volume loss correlated with the increased signal seen on tau and amyloid imaging (FDDNP-PET scan) of a separate case of suspected chronic traumatic encephalopathy (CTE). Visual assessment of the MRI also showed evidence of old petechial hemorrhages in the frontal and temporal-parietal lobe white matter. This case raises the possibility of distinct quantitative and visual brain MRI findings in suspected CTE.
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Affiliation(s)
- Cyrus A Raji
- Departments of Radiology, David Geffen School of Medicine at University of California, Los Angeles, CLA, Los Angeles, CA.
| | - David A Merrill
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CLA, Los Angeles, CA
| | - Jorge R Barrio
- Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles, CLA, Los Angeles, CA
| | - Bennet Omalu
- Department of Pathology, University of California Davis Medical Center, Davis, CA
| | - Gary W Small
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CLA, Los Angeles, CA
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22
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Merkel SF, Razmpour R, Lutton EM, Tallarida CS, Heldt NA, Cannella LA, Persidsky Y, Rawls SM, Ramirez SH. Adolescent Traumatic Brain Injury Induces Chronic Mesolimbic Neuroinflammation with Concurrent Enhancement in the Rewarding Effects of Cocaine in Mice during Adulthood. J Neurotrauma 2016; 34:165-181. [PMID: 27026056 DOI: 10.1089/neu.2015.4275] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Clinical psychiatric disorders of depression, anxiety, and substance abuse are most prevalent after traumatic brain injury (TBI). Pre-clinical research has focused on depression and anxiety post-injury; however, virtually no data exist examining whether the preference for illicit drugs is affected by traumatic injury in the developing adolescent brain. Using the controlled cortical impact (CCI) model of TBI and the conditioned place preference (CPP) assay, we tested the underlying hypothesis that brain injury during adolescence exacerbates the rewarding properties of cocaine in adulthood possibly through an active inflammatory status in the mesolimbic pathway. Six-week old, C57BL/6 mice sustained a single CCI-TBI to the right somatosensory cortex. CPP experiments with cocaine began 2 weeks post-TBI. Animals receiving cocaine displayed significant place preference shifts compared to saline controls. Further, within the cocaine-experienced cohort, moderate CCI-TBI during adolescence significantly increased the preference shift in adulthood when compared to naïve controls. Additionally, persistent neuroinflammatory responses were observed in the cortex, nucleus accumbens (NAc), and ventral tegmental area post-CCI-TBI. Significant increases in both astrocytic, glial fibrillary acidic protein, and microglial, ionization basic acid 1, markers were observed in the NAc at the end of CPP testing. Moreover, analysis using focused array gene expression panels identified the upregulation of numerous inflammatory genes in moderate CCI-TBI animals, compared to naïve controls, both in the cortex and NAc at 2 weeks post-TBI, before onset of cocaine administration. These results suggest that sustaining moderate TBI during adolescence may augment the rewarding effects of psychostimulants in adulthood, possibly by induction of chronic mesolimbic neuroinflammation.
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Affiliation(s)
- Steven F Merkel
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania.,2 The Center for Substance Abuse Research, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Roshanak Razmpour
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Evan M Lutton
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Christopher S Tallarida
- 2 The Center for Substance Abuse Research, Temple University School of Medicine , Philadelphia, Pennsylvania.,4 Department of Pharmacology, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Nathan A Heldt
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Lee Anne Cannella
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Yuri Persidsky
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania.,2 The Center for Substance Abuse Research, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Scott M Rawls
- 2 The Center for Substance Abuse Research, Temple University School of Medicine , Philadelphia, Pennsylvania.,4 Department of Pharmacology, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Servio H Ramirez
- 1 Department of Pathology and Laboratory Medicine, Temple University School of Medicine , Philadelphia, Pennsylvania.,2 The Center for Substance Abuse Research, Temple University School of Medicine , Philadelphia, Pennsylvania.,3 The Shriners Hospitals Pediatric Research Center, Temple University School of Medicine , Philadelphia, Pennsylvania
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Amen DG, Willeumier K, Omalu B, Newberg A, Raghavendra C, Raji CA. Perfusion Neuroimaging Abnormalities Alone Distinguish National Football League Players from a Healthy Population. J Alzheimers Dis 2016; 53:237-41. [PMID: 27128374 PMCID: PMC4942725 DOI: 10.3233/jad-160207] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND National Football League (NFL) players are exposed to multiple head collisions during their careers. Increasing awareness of the adverse long-term effects of repetitive head trauma has raised substantial concern among players, medical professionals, and the general public. OBJECTIVE To determine whether low perfusion in specific brain regions on neuroimaging can accurately separate professional football players from healthy controls. METHOD A cohort of retired and current NFL players (n = 161) were recruited in a longitudinal study starting in 2009 with ongoing interval follow up. A healthy control group (n = 124) was separately recruited for comparison. Assessments included medical examinations, neuropsychological tests, and perfusion neuroimaging with single photon emission computed tomography (SPECT). Perfusion estimates of each scan were quantified using a standard atlas. We hypothesized that hypoperfusion particularly in the orbital frontal, anterior cingulate, anterior temporal, hippocampal, amygdala, insular, caudate, superior/mid occipital, and cerebellar sub-regions alone would reliably separate controls from NFL players. Cerebral perfusion differences were calculated using a one-way ANOVA and diagnostic separation was determined with discriminant and automatic linear regression predictive models. RESULTS NFL players showed lower cerebral perfusion on average (p < 0.01) in 36 brain regions. The discriminant analysis subsequently distinguished NFL players from controls with 90% sensitivity, 86% specificity, and 94% accuracy (95% CI 95-99). Automatic linear modeling achieved similar results. Inclusion of age and clinical co-morbidities did not improve diagnostic classification. CONCLUSION Specific brain regions commonly damaged in traumatic brain injury show abnormally low perfusion on SPECT in professional NFL players. These same regions alone can distinguish this group from healthy subjects with high diagnostic accuracy. This study carries implications for the neurological safety of NFL players.
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Affiliation(s)
| | | | - Bennet Omalu
- Department of Pathology, University of California, Davis, CA, USA
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cauligi Raghavendra
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Cyrus A. Raji
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
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24
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Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion. Brain Imaging Behav 2015; 10:1108-1116. [DOI: 10.1007/s11682-015-9473-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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