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Churchill NW, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Ji X, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Effects of post-acute COVID-19 syndrome on the functional brain networks of non-hospitalized individuals. Front Neurol 2023; 14:1136408. [PMID: 37051059 PMCID: PMC10083436 DOI: 10.3389/fneur.2023.1136408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionThe long-term impact of COVID-19 on brain function remains poorly understood, despite growing concern surrounding post-acute COVID-19 syndrome (PACS). The goal of this cross-sectional, observational study was to determine whether there are significant alterations in resting brain function among non-hospitalized individuals with PACS, compared to symptomatic individuals with non-COVID infection.MethodsData were collected for 51 individuals who tested positive for COVID-19 (mean age 41±12 yrs., 34 female) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19 (mean age 41±14 yrs., 9 female), with both groups assessed an average of 4-5 months after COVID testing. None of the participants had prior neurologic, psychiatric, or cardiovascular illness. Resting brain function was assessed via functional magnetic resonance imaging (fMRI), and self-reported symptoms were recorded.ResultsIndividuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions.DiscussionThese results provide preliminary evidence that patterns of functional connectivity distinguish PACS from non-COVID infection and correlate with the severity of clinical outcome, providing novel insights into this highly prevalent disorder.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Physics Department, Toronto Metropolitan University, Toronto, ON, Canada
- *Correspondence: Nathan W. Churchill,
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
| | - J. Jean Chen
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Aravinthan Jegatheesan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mario Masellis
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maged Goubran
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Benjamin Lam
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Integrated Community Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Emergency and Critical Care Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Sandra E. Black
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology and Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Simon J. Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada
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Kim WSH, Ji X, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, Graham SJ, MacIntosh BJ. MRI Assessment of Cerebral Blood Flow in Nonhospitalized Adults Who Self-Isolated Due to COVID-19. J Magn Reson Imaging 2022. [PMID: 36472248 PMCID: PMC9877942 DOI: 10.1002/jmri.28555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological symptoms associated with coronavirus disease 2019 (COVID-19), such as fatigue and smell/taste changes, persist beyond infection. However, little is known of brain physiology in the post-COVID-19 timeframe. PURPOSE To determine whether adults who experienced flu-like symptoms due to COVID-19 would exhibit cerebral blood flow (CBF) alterations in the weeks/months beyond infection, relative to controls who experienced flu-like symptoms but tested negative for COVID-19. STUDY TYPE Prospective observational. POPULATION A total of 39 adults who previously self-isolated at home due to COVID-19 (41.9 ± 12.6 years of age, 59% female, 116.5 ± 62.2 days since positive diagnosis) and 11 controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (41.5 ± 13.4 years of age, 55% female, 112.1 ± 59.5 since negative diagnosis). FIELD STRENGTH AND SEQUENCES A 3.0 T; T1-weighted magnetization-prepared rapid gradient and echo-planar turbo gradient-spin echo arterial spin labeling sequences. ASSESSMENT Arterial spin labeling was used to estimate CBF. A self-reported questionnaire assessed symptoms, including ongoing fatigue. CBF was compared between COVID-19 and control groups and between those with (n = 11) and without self-reported ongoing fatigue (n = 28) within the COVID-19 group. STATISTICAL TESTS Between-group and within-group comparisons of CBF were performed in a voxel-wise manner, controlling for age and sex, at a family-wise error rate of 0.05. RESULTS Relative to controls, the COVID-19 group exhibited significantly decreased CBF in subcortical regions including the thalamus, orbitofrontal cortex, and basal ganglia (maximum cluster size = 6012 voxels and maximum t-statistic = 5.21). Within the COVID-19 group, significant CBF differences in occipital and parietal regions were observed between those with and without self-reported on-going fatigue. DATA CONCLUSION These cross-sectional data revealed regional CBF decreases in the COVID-19 group, suggesting the relevance of brain physiology in the post-COVID-19 timeframe. This research may help elucidate the heterogeneous symptoms of the post-COVID-19 condition. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- William S H Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada
| | - J Jean Chen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Aravinthan Jegatheesan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maged Goubran
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Integrated Community Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Emergency & Critical Care Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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4
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MacIntosh BJ, Ji X, Chen JJ, Gilboa A, Roudaia E, Sekuler AB, Gao F, Chad JA, Jegatheesan A, Masellis M, Goubran M, Rabin J, Lam B, Cheng I, Fowler R, Heyn C, Black SE, Graham SJ. Brain structure and function in people recovering from COVID-19 after hospital discharge or self-isolation: a longitudinal observational study protocol. CMAJ Open 2021; 9:E1114-E1119. [PMID: 34848552 PMCID: PMC8648350 DOI: 10.9778/cmajo.20210023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The detailed extent of neuroinvasion or deleterious brain changes resulting from COVID-19 and their time courses remain to be determined in relation to "long-haul" COVID-19 symptoms. Our objective is to determine whether there are alterations in functional brain imaging measures among people with COVID-19 after hospital discharge or self-isolation. METHODS This paper describes a protocol for NeuroCOVID-19, a longitudinal observational study of adults aged 20-75 years at Sunnybrook Health Sciences Centre in Toronto, Ontario, that began in April 2020. We aim to recruit 240 adults, 60 per group: people who contracted COVID-19 and were admitted to hospital (group 1), people who contracted COVID-19 and self-isolated (group 2), people who experienced influenza-like symptoms at acute presentation but tested negative for COVID-19 and self-isolated (group 3, control) and healthy people (group 4, control). Participants are excluded based on premorbid neurologic or severe psychiatric illness, unstable cardiovascular disease, and magnetic resonance imaging (MRI) contraindications. Initial and 3-month follow-up assessments include multiparametric brain MRI and electroencephalography. Sensation and cognition are assessed alongside neuropsychiatric assessments and symptom self-reports. We will test the data from the initial and follow-up assessments for group differences based on 3 outcome measures: MRI cerebral blood flow, MRI resting state fractional amplitude of low-frequency fluctuation and electroencephalography spectral power. INTERPRETATION If neurophysiologic alterations are detected in the COVID-19 groups in our NeuroCOVID-19 study, this information could inform future research regarding interventions for long-haul COVID-19. The study results will be disseminated to scientists, clinicians and COVID-19 survivors, as well as the public and private sectors to provide context on how brain measures relate to lingering symptoms.
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Affiliation(s)
- Bradley J MacIntosh
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont.
| | - Xiang Ji
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - J Jean Chen
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Asaf Gilboa
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Eugenie Roudaia
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Allison B Sekuler
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Jordan A Chad
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Aravinthan Jegatheesan
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Mario Masellis
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Maged Goubran
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Jennifer Rabin
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Benjamin Lam
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Ivy Cheng
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Robert Fowler
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Chris Heyn
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Sandra E Black
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
| | - Simon J Graham
- Hurvitz Brain Sciences Program (MacIntosh, Gao, Masellis, Goubran, Lam, Heyn, Black, Graham), Physical Sciences Platform (MacIntosh, Jegatheesan, Goubran, Graham), Evaluative Clinical Sciences, Integrated Community Program (Cheng), Harquail Centre for Neuromodulation (Rabin) and Evaluative Clinical Sciences, Trauma, Emergency & Critical Care Research Program (Fowler), Sunnybrook Research Institute; Department of Medical Biophysics (MacIntosh, Chen, Chad, Jegatheesan, Goubran, Graham), University of Toronto; LC Campbell Cognitive Neurology Research Group (Ji, Gao, Masellis, Lam, Black), Sunnybrook Hospital; Rotman Research Institute (Chen, Gilboa, Roudaia, Sekuler, Chad), Baycrest Health Sciences; Division of Neurology (Masellis, Rabin, Lam, Black), Department of Medicine, University of Toronto; Rehabilitation Sciences Institute (Rabin), Department of Medical Imaging (Heyn) and Department of Psychology (Gilboa, Sekuler), University of Toronto; Department of Medicine (Cheng, Fowler), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Sekuler), McMaster University, Hamilton, Ont
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