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Caeyenberghs K, Imms P, Irimia A, Monti MM, Esopenko C, de Souza NL, Dominguez D JF, Newsome MR, Dobryakova E, Cwiek A, Mullin HAC, Kim NJ, Mayer AR, Adamson MM, Bickart K, Breedlove KM, Dennis EL, Disner SG, Haswell C, Hodges CB, Hoskinson KR, Johnson PK, Königs M, Li LM, Liebel SW, Livny A, Morey RA, Muir AM, Olsen A, Razi A, Su M, Tate DF, Velez C, Wilde EA, Zielinski BA, Thompson PM, Hillary FG. ENIGMA's simple seven: Recommendations to enhance the reproducibility of resting-state fMRI in traumatic brain injury. Neuroimage Clin 2024; 42:103585. [PMID: 38531165 PMCID: PMC10982609 DOI: 10.1016/j.nicl.2024.103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Resting state functional magnetic resonance imaging (rsfMRI) provides researchers and clinicians with a powerful tool to examine functional connectivity across large-scale brain networks, with ever-increasing applications to the study of neurological disorders, such as traumatic brain injury (TBI). While rsfMRI holds unparalleled promise in systems neurosciences, its acquisition and analytical methodology across research groups is variable, resulting in a literature that is challenging to integrate and interpret. The focus of this narrative review is to address the primary methodological issues including investigator decision points in the application of rsfMRI to study the consequences of TBI. As part of the ENIGMA Brain Injury working group, we have collaborated to identify a minimum set of recommendations that are designed to produce results that are reliable, harmonizable, and reproducible for the TBI imaging research community. Part one of this review provides the results of a literature search of current rsfMRI studies of TBI, highlighting key design considerations and data processing pipelines. Part two outlines seven data acquisition, processing, and analysis recommendations with the goal of maximizing study reliability and between-site comparability, while preserving investigator autonomy. Part three summarizes new directions and opportunities for future rsfMRI studies in TBI patients. The goal is to galvanize the TBI community to gain consensus for a set of rigorous and reproducible methods, and to increase analytical transparency and data sharing to address the reproducibility crisis in the field.
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Affiliation(s)
- Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Alfred E. Mann Department of Biomedical Engineering, Andrew & Erna Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA; Department of Quantitative & Computational Biology, Dana and David Dornsife College of Arts & Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Martin M Monti
- Department of Psychology, UCLA, USA; Brain Injury Research Center (BIRC), Department of Neurosurgery, UCLA, USA.
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Nicola L de Souza
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Juan F Dominguez D
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia.
| | - Mary R Newsome
- Michael E. DeBakey VA Medical Center, Houston, TX, USA; H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA; Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Andrew Cwiek
- Department of Psychology, Penn State University, State College, PA, USA.
| | - Hollie A C Mullin
- Department of Psychology, Penn State University, State College, PA, USA.
| | - Nicholas J Kim
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Alfred E. Mann Department of Biomedical Engineering, Andrew & Erna Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, NM, USA; Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Maheen M Adamson
- Women's Operational Military Exposure Network (WOMEN) & Rehabilitation Department, VA Palo Alto, Palo Alto, CA, USA; Rehabilitation Service, VA Palo Alto, Palo Alto, CA, USA; Neurosurgery, Stanford School of Medicine, Stanford, CA, USA.
| | - Kevin Bickart
- UCLA Steve Tisch BrainSPORT Program, USA; Department of Neurology, David Geffen School of Medicine at UCLA, USA.
| | - Katherine M Breedlove
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | - Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Courtney Haswell
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
| | - Cooper B Hodges
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA; Department of Psychology, Brigham Young University, Provo, UT, USA.
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, OH, USA.
| | - Paula K Johnson
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; Neuroscience Center, Brigham Young University, Provo, UT, USA.
| | - Marsh Königs
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Lucia M Li
- C3NL, Imperial College London, United Kingdom; UK DRI Centre for Health Care and Technology, Imperial College London, United Kingdom.
| | - Spencer W Liebel
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Abigail Livny
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rajendra A Morey
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA.
| | - Alexandra M Muir
- Department of Psychology, Brigham Young University, Provo, UT, USA.
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; NorHEAD - Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Adeel Razi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; Wellcome Centre for Human Neuroimaging, University College London, WC1N 3AR London, United Kingdom; CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, ON, Canada.
| | - Matthew Su
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Carmen Velez
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Elisabeth A Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - Brandon A Zielinski
- Departments of Pediatrics, Neurology, and Neuroscience, University of Florida, Gainesville, FL, USA; Departments of Pediatrics, Neurology, and Radiology, University of Utah, Salt Lake City, UT, USA.
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA, USA.
| | - Frank G Hillary
- Department of Psychology, Penn State University, State College, PA, USA; Department of Neurology, Hershey Medical Center, PA, USA.
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Monti MM, Beekman R, Spivak NM, Thibaut A, Schnakers C, Whyte J, Molteni E. Common Data Element for Disorders of Consciousness: Recommendations from the Working Group on Therapeutic Interventions. Neurocrit Care 2024; 40:51-57. [PMID: 38030874 DOI: 10.1007/s12028-023-01873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Over the past 30 years, there have been significant advances in the understanding of the mechanisms associated with loss and recovery of consciousness following severe brain injury. This work has provided a strong grounding for the development of novel restorative therapeutic interventions. Although all interventions are aimed at modulating and thereby restoring brain function, the landscape of existing interventions encompasses a very wide scope of techniques and protocols. Despite vigorous research efforts, few approaches have been assessed with rigorous, high-quality randomized controlled trials. As a growing number of exploratory interventions emerge, it is paramount to develop standardized approaches to reporting results. The successful evaluation of novel interventions depends on implementation of shared nomenclature and infrastructure. To address this gap, the Neurocritical Care Society's Curing Coma Campaign convened nine working groups and charged them with developing common data elements (CDEs). Here, we report the work of the Therapeutic Interventions Working Group. METHODS The working group reviewed existing CDEs relevant to therapeutic interventions within the National Institutes of Health National Institute of Neurological Disorders and Stroke database and reviewed the literature for assessing key areas of research in the intervention space. CDEs were then proposed, iteratively discussed and reviewed, classified, and organized in a case report form (CRF). RESULTS We developed a unified CRF, including CDEs and key design elements (i.e., methodological or protocol parameters), divided into five sections: (1) patient information, (2) general study information, (3) behavioral interventions, (4) pharmacological interventions, and (5) device interventions. CONCLUSIONS The newly created CRF enhances systematization of future work by proposing a portfolio of measures that should be collected in the development and implementation of studies assessing novel interventions intended to increase the level of consciousness or rate of recovery of consciousness in patients with disorders of consciousness.
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Affiliation(s)
- Martin M Monti
- Department of Psychology, University of California Los Angeles, 6522 Pritzker Hall, Los Angeles, CA, USA.
| | - Rachel Beekman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Norman M Spivak
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
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Toker D, Müller E, Miyamoto H, Riga MS, Lladó-Pelfort L, Yamakawa K, Artigas F, Shine JM, Hudson AE, Pouratian N, Monti MM. Criticality supports cross-frequency cortical-thalamic information transfer during conscious states. eLife 2024; 13:e86547. [PMID: 38180472 PMCID: PMC10805384 DOI: 10.7554/elife.86547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Consciousness is thought to be regulated by bidirectional information transfer between the cortex and thalamus, but the nature of this bidirectional communication - and its possible disruption in unconsciousness - remains poorly understood. Here, we present two main findings elucidating mechanisms of corticothalamic information transfer during conscious states. First, we identify a highly preserved spectral channel of cortical-thalamic communication that is present during conscious states, but which is diminished during the loss of consciousness and enhanced during psychedelic states. Specifically, we show that in humans, mice, and rats, information sent from either the cortex or thalamus via δ/θ/α waves (∼1-13 Hz) is consistently encoded by the other brain region by high γ waves (52-104 Hz); moreover, unconsciousness induced by propofol anesthesia or generalized spike-and-wave seizures diminishes this cross-frequency communication, whereas the psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) enhances this low-to-high frequency interregional communication. Second, we leverage numerical simulations and neural electrophysiology recordings from the thalamus and cortex of human patients, rats, and mice to show that these changes in cross-frequency cortical-thalamic information transfer may be mediated by excursions of low-frequency thalamocortical electrodynamics toward/away from edge-of-chaos criticality, or the phase transition from stability to chaos. Overall, our findings link thalamic-cortical communication to consciousness, and further offer a novel, mathematically well-defined framework to explain the disruption to thalamic-cortical information transfer during unconscious states.
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Affiliation(s)
- Daniel Toker
- Department of Neurology, University of California, Los AngelesLos AngelesUnited States
- Department of Psychology, University of California, Los AngelesLos AngelesUnited States
| | - Eli Müller
- Brain and Mind Centre, University of SydneySydneyAustralia
| | - Hiroyuki Miyamoto
- Laboratory for Neurogenetics, RIKEN Center for Brain ScienceSaitamaJapan
- PRESTO, Japan Science and Technology AgencySaitamaJapan
- International Research Center for Neurointelligence, University of TokyoNagoyaJapan
| | - Maurizio S Riga
- Andalusian Center for Molecular Biology and Regenerative MedicineSevilleSpain
| | - Laia Lladó-Pelfort
- Departament de Ciències Bàsiques, Universitat de Vic-Universitat Central de CatalunyaBarcelonaSpain
| | - Kazuhiro Yamakawa
- Laboratory for Neurogenetics, RIKEN Center for Brain ScienceSaitamaJapan
- Department of Neurodevelopmental Disorder Genetics, Institute of Brain Science, Nagoya City University Graduate School of Medical ScienceNagoyaJapan
| | - Francesc Artigas
- Departament de Neurociències i Terapèutica Experimental, CSIC-Institut d’Investigacions Biomèdiques de BarcelonaBarcelonaSpain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos IIIMadridSpain
| | - James M Shine
- Brain and Mind Centre, University of SydneySydneyAustralia
| | - Andrew E Hudson
- Department of Anesthesiology, Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesUnited States
- Department of Anesthesiology and Perioperative Medicine, University of California, Los AngelesLos AngelesUnited States
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical CenterDallasUnited States
| | - Martin M Monti
- Department of Psychology, University of California, Los AngelesLos AngelesUnited States
- Department of Neurosurgery, University of California, Los AngelesLos AngelesUnited States
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Monti MM, Spivak NM, Edlow BL, Bodien YG. What is a minimal clinically important difference for clinical trials in patients with disorders of consciousness? a novel probabilistic approach. PLoS One 2023; 18:e0290290. [PMID: 37616196 PMCID: PMC10449161 DOI: 10.1371/journal.pone.0290290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Over the last 30 years, there has been a growing trend in clinical trials towards assessing novel interventions not only against the benchmark of statistical significance, but also with respect to whether they lead to clinically meaningful changes for patients. In the context of Disorders of Consciousness (DOC), despite a growing landscape of experimental interventions, there is no agreed standard as to what counts as a minimal clinically important difference (MCID). In part, this issue springs from the fact that, by definition, DOC patients are either unresponsive (i.e., in a Vegetative State; VS) or non-communicative (i.e., in a Minimally Conscious State; MCS), which renders it impossible to assess any subjective perception of benefit, one of the two core aspects of MCIDs. Here, we develop a novel approach that leverages published, international diagnostic guidelines to establish a probability-based minimal clinically important difference (pMCID), and we apply it to the most validated and frequently used scale in DOC: the Coma Recovery Scale-Revised (CRS-R). This novel method is objective (i.e., based on published criteria for patient diagnosis) and easy to recalculate as the field refines its agreed-upon criteria for diagnosis. We believe this new approach can help clinicians determine whether observed changes in patients' behavior are clinically important, even when patients cannot communicate their experiences, and can align the landscape of clinical trials in DOC with the practices in other medical fields.
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Affiliation(s)
- Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Neurosurgery, Brain Injury Research Center, University of California Los Angeles, Los Angeles, California, United States of America
| | - Norman M. Spivak
- Department of Neurosurgery, Brain Injury Research Center, University of California Los Angeles, Los Angeles, California, United States of America
- UCLA-Caltech Medical Scientist Training Program, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Brian L. Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Yelena G. Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School Charlestown, Massachusetts, United States of America
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Kuhn T, Spivak NM, Dang BH, Becerra S, Halavi SE, Rotstein N, Rosenberg BM, Hiller S, Swenson A, Cvijanovic L, Dang N, Sun M, Kronemyer D, Berlow R, Revett MR, Suthana N, Monti MM, Bookheimer S. Transcranial focused ultrasound selectively increases perfusion and modulates functional connectivity of deep brain regions in humans. Front Neural Circuits 2023; 17:1120410. [PMID: 37091318 PMCID: PMC10114286 DOI: 10.3389/fncir.2023.1120410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundLow intensity, transcranial focused ultrasound (tFUS) is a re-emerging brain stimulation technique with the unique capability of reaching deep brain structures non-invasively.Objective/HypothesisWe sought to demonstrate that tFUS can selectively and accurately target and modulate deep brain structures in humans important for emotional functioning as well as learning and memory. We hypothesized that tFUS would result in significant longitudinal changes in perfusion in the targeted brain region as well as selective modulation of BOLD activity and BOLD-based functional connectivity of the target region.MethodsIn this study, we collected MRI before, simultaneously during, and after tFUS of two deep brain structures on different days in sixteen healthy adults each serving as their own control. Using longitudinal arterial spin labeling (ASL) MRI and simultaneous blood oxygen level dependent (BOLD) functional MRI, we found changes in cerebral perfusion, regional brain activity and functional connectivity specific to the targeted regions of the amygdala and entorhinal cortex (ErC).ResultstFUS selectively increased perfusion in the targeted brain region and not in the contralateral homolog or either bilateral control region. Additionally, tFUS directly affected BOLD activity in a target specific fashion without engaging auditory cortex in any analysis. Finally, tFUS resulted in selective modulation of the targeted functional network connectivity.ConclusionWe demonstrate that tFUS can selectively modulate perfusion, neural activity and connectivity in deep brain structures and connected networks. Lack of auditory cortex findings suggests that the mechanism of tFUS action is not due to auditory or acoustic startle response but rather a direct neuromodulatory process. Our findings suggest that tFUS has the potential for future application as a novel therapy in a wide range of neurological and psychiatric disorders associated with subcortical pathology.
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Affiliation(s)
- Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Taylor Kuhn,
| | - Norman M. Spivak
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
- UCLA-Caltech Medical Scientist Training Program, Los Angeles, CA, United States
| | - Bianca H. Dang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sergio Becerra
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sabrina E. Halavi
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Natalie Rotstein
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Benjamin M. Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andrew Swenson
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Luka Cvijanovic
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nolan Dang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Sun
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - David Kronemyer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rustin Berlow
- American Brain Stimulation Clinic, Del Mar, CA, United States
| | - Malina R. Revett
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin M. Monti
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Zheng ZS, Reggente N, Monti MM. Arousal Regulation by the External Globus Pallidus: A New Node for the Mesocircuit Hypothesis. Brain Sci 2023; 13:brainsci13010146. [PMID: 36672127 PMCID: PMC9856495 DOI: 10.3390/brainsci13010146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
In the decade since its debut, the Mesocircuit Hypothesis (MH) has provided researchers a scaffolding for interpreting their findings by associating subcortical-cortical dysfunction with the loss and recovery of consciousness following severe brain injury. Here, we leverage new findings from human and rodent lesions, as well as chemo/optogenetic, tractography, and stimulation studies to propose the external segment of the globus pallidus (GPe) as an additional node in the MH, in hopes of increasing its explanatory power. Specifically, we discuss the anatomical and molecular mechanisms involving the GPe in sleep-wake control and propose a plausible mechanistic model explaining how the GPe can modulate cortical activity through its direct connections with the prefrontal cortex and thalamic reticular nucleus to initiate and maintain sleep. The inclusion of the GPe in the arousal circuitry has implications for understanding a range of phenomena, such as the effects of the adenosine (A2A) and dopamine (D2) receptors on sleep-wake cycles, the paradoxical effects of zolpidem in disorders of consciousness, and sleep disturbances in conditions such as Parkinson's Disease.
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Affiliation(s)
- Zhong Sheng Zheng
- Research Institute, Casa Colina Hospitals and Centers for Healthcare, Pomona, CA 91767, USA
- Correspondence: ; Tel.: +1-909-596-7733 (ext. 2279)
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA 90403, USA
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
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7
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Frohlich J, Chiang JN, Mediano PAM, Nespeca M, Saravanapandian V, Toker D, Dell’Italia J, Hipp JF, Jeste SS, Chu CJ, Bird LM, Monti MM. Author Correction: Neural complexity is a common denominator of human consciousness across diverse regimes of cortical dynamics. Commun Biol 2023; 6:41. [PMID: 36639573 PMCID: PMC9839733 DOI: 10.1038/s42003-023-04460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Joel Frohlich
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA ,grid.10392.390000 0001 2190 1447Present Address: Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Jeffrey N. Chiang
- grid.19006.3e0000 0000 9632 6718Department of Computational Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Pedro A. M. Mediano
- grid.7445.20000 0001 2113 8111Department of Computing, Imperial College London, London, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Mark Nespeca
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA ,grid.286440.c0000 0004 0383 2910Department of Neurology, Rady Children’s Hospital San Diego, San Diego, CA USA
| | - Vidya Saravanapandian
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA USA
| | - Daniel Toker
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA
| | - John Dell’Italia
- Institute for Advanced Consciousness Studies, Santa Monica, CA USA
| | - Joerg F. Hipp
- grid.417570.00000 0004 0374 1269Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Shafali S. Jeste
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA USA ,grid.239546.f0000 0001 2153 6013Present Address: Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Catherine J. Chu
- grid.38142.3c000000041936754XDepartment of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Lynne M. Bird
- grid.266100.30000 0001 2107 4242Department of Pediatrics, University of California San Diego, San Diego, CA USA ,grid.286440.c0000 0004 0383 2910Division of Genetics/Dysmorphology, Rady Children’s Hospital - San Diego, San Diego, CA USA
| | - Martin M. Monti
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Deptment of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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Frohlich J, Chiang JN, Mediano PAM, Nespeca M, Saravanapandian V, Toker D, Dell’Italia J, Hipp JF, Jeste SS, Chu CJ, Bird LM, Monti MM. Author Correction: Neural complexity is a common denominator of human consciousness across diverse regimes of cortical dynamics. Commun Biol 2023; 6:24. [PMID: 36627373 PMCID: PMC9832133 DOI: 10.1038/s42003-023-04418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Joel Frohlich
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA ,grid.10392.390000 0001 2190 1447Present Address: Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Jeffrey N. Chiang
- grid.19006.3e0000 0000 9632 6718Department of Computational Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Pedro A. M. Mediano
- grid.7445.20000 0001 2113 8111Department of Computing, Imperial College London, London, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Mark Nespeca
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA ,grid.286440.c0000 0004 0383 2910Department of Neurology, Rady Children’s Hospital San Diego, San Diego, CA USA
| | - Vidya Saravanapandian
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA USA
| | - Daniel Toker
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA
| | - John Dell’Italia
- Institute for Advanced Consciousness Studies, Santa Monica, CA USA
| | - Joerg F. Hipp
- grid.417570.00000 0004 0374 1269Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Shafali S. Jeste
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles, Semel Institute for Neuroscience, Los Angeles, CA USA ,grid.239546.f0000 0001 2153 6013Present Address: Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Catherine J. Chu
- grid.38142.3c000000041936754XDepartment of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Lynne M. Bird
- grid.266100.30000 0001 2107 4242Department of Pediatrics, University of California San Diego, San Diego, CA USA ,grid.286440.c0000 0004 0383 2910Division of Genetics/Dysmorphology, Rady Children’s Hospital - San Diego, San Diego, CA USA
| | - Martin M. Monti
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California Los Angeles, 90095 Pritzker Hall, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Deptment of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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9
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Coetzee JP, Johnson MA, Lee Y, Wu AD, Iacoboni M, Monti MM. Dissociating Language and Thought in Human Reasoning. Brain Sci 2022; 13:brainsci13010067. [PMID: 36672048 PMCID: PMC9856203 DOI: 10.3390/brainsci13010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
What is the relationship between language and complex thought? In the context of deductive reasoning there are two main views. Under the first, which we label here the language-centric view, language is central to the syntax-like combinatorial operations of complex reasoning. Under the second, which we label here the language-independent view, these operations are dissociable from the mechanisms of natural language. We applied continuous theta burst stimulation (cTBS), a form of noninvasive neuromodulation, to healthy adult participants to transiently inhibit a subregion of Broca's area (left BA44) associated in prior work with parsing the syntactic relations of natural language. We similarly inhibited a subregion of dorsomedial frontal cortex (left medial BA8) which has been associated with core features of logical reasoning. There was a significant interaction between task and stimulation site. Post hoc tests revealed that performance on a linguistic reasoning task, but not deductive reasoning task, was significantly impaired after inhibition of left BA44, and performance on a deductive reasoning task, but not linguistic reasoning task, was decreased after inhibition of left medial BA8 (however not significantly). Subsequent linear contrasts supported this pattern. These novel results suggest that deductive reasoning may be dissociable from linguistic processes in the adult human brain, consistent with the language-independent view.
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Affiliation(s)
- John P. Coetzee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- VA Palo Alto Health Care System, Polytrauma Division, 3801 Miranda Avenue, Palo Alto, CA 94304, USA
| | - Micah A. Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Youngzie Lee
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Allan D. Wu
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute (BRI), University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Marco Iacoboni
- Brain Research Institute (BRI), University of California Los Angeles, Los Angeles, CA 90095, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute (BRI), University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-825-8546
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10
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Cain JA, Visagan S, Monti MM. S.M.A.R.T. F.U.S: Surrogate Model of Attenuation and Refraction in Transcranial Focused Ultrasound. PLoS One 2022; 17:e0264101. [PMID: 36302034 PMCID: PMC9612531 DOI: 10.1371/journal.pone.0264101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Low-intensity focused ultrasound (LIFU) is an increasingly applied method for achieving non-invasive brain stimulation. However, transmission of ultrasound through the human skull can substantially affect focal point characteristics of LIFU, including dramatic attenuation in intensity and refraction of focal point location. These effects depend on a high-dimensional parameter space, making these effects difficult to estimate from previous work. Instead, focal point properties of LIFU experiments are often estimated using numerical simulation of LIFU sonication through skull. However, this procedure presents many entry barriers to even computationally savvy investigators and often requires expensive computational hardware, impeding LIFU research. We present a novel MATLAB toolbox (data: doi:10.5068/D1QD60; Matlab Scripts: https://doi.org/10.5281/zenodo.5811122) for rapidly estimating beam properties of LIFU transmitted through bone. Users provide specific values for frequency of LIFU, bone thickness, angle at which LIFU is applied, depth of the LIFU focal point, and diameter of the transducer used and receive an estimation of the degree of refraction/attenuation expected for the given parameters.
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Affiliation(s)
- Joshua A. Cain
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Shakthi Visagan
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
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11
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Zheng ZS, Monti MM. Cortical and thalamic connections of the human globus pallidus: Implications for disorders of consciousness. Front Neuroanat 2022; 16:960439. [PMID: 36093291 PMCID: PMC9453545 DOI: 10.3389/fnana.2022.960439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
A dominant framework for understanding loss and recovery of consciousness in the context of severe brain injury, the mesocircuit hypothesis, focuses on the role of cortico-subcortical recurrent interactions, with a strong emphasis on excitatory thalamofugal projections. According to this view, excess inhibition from the internal globus pallidus (GPi) on central thalamic nuclei is key to understanding prolonged disorders of consciousness (DOC) and their characteristic, brain-wide metabolic depression. Recent work in healthy volunteers and patients, however, suggests a previously unappreciated role for the external globus pallidus (GPe) in maintaining a state of consciousness. This view is consistent with empirical findings demonstrating the existence of “direct” (i.e., not mediated by GPi/substantia nigra pars reticulata) GPe connections with cortex and thalamus in animal models, as well as their involvement in modulating arousal and sleep, and with theoretical work underscoring the role of GABA dysfunction in prolonged DOC. Leveraging 50 healthy subjects' high angular resolution diffusion imaging (HARDI) dataset from the Human Connectome Project, which provides a more accurate representation of intravoxel water diffusion than conventional diffusion tensor imaging approaches, we ran probabilistic tractography using extensive a priori exclusion criteria to limit the influence of indirect connections in order to better characterize “direct” pallidal connections. We report the first in vivo evidence of highly probable “direct” GPe connections with prefrontal cortex (PFC) and central thalamic nuclei. Conversely, we find direct connections between the GPi and PFC to be sparse (i.e., less likely indicative of true “direct” connectivity) and restricted to the posterior border of PFC, thus reflecting an extension from the cortical motor zones (i.e., motor association areas). Consistent with GPi's preferential connections with sensorimotor cortices, the GPi appears to predominantly connect with the sensorimotor subregions of the thalamus. These findings are validated against existing animal tracer studies. These findings suggest that contemporary mechanistic models of loss and recovery of consciousness following brain injury must be updated to include the GPe and reflect the actual patterns of GPe and GPi connectivity within large-scale cortico-thalamo-cortical circuits.
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Affiliation(s)
- Zhong S. Zheng
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
- *Correspondence: Zhong S. Zheng
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Weiler M, Casseb RF, de Campos BM, Crone JS, Lutkenhoff ES, Vespa PM, Monti MM. Evaluating denoising strategies in resting-state functional magnetic resonance in traumatic brain injury (EpiBioS4Rx). Hum Brain Mapp 2022; 43:4640-4649. [PMID: 35723510 PMCID: PMC9491287 DOI: 10.1002/hbm.25979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022] Open
Abstract
Resting-state functional MRI is increasingly used in the clinical setting and is now included in some diagnostic guidelines for severe brain injury patients. However, to ensure high-quality data, one should mitigate fMRI-related noise typical of this population. Therefore, we aimed to evaluate the ability of different preprocessing strategies to mitigate noise-related signal (i.e., in-scanner movement and physiological noise) in functional connectivity (FC) of traumatic brain injury (TBI) patients. We applied nine commonly used denoising strategies, combined into 17 pipelines, to 88 TBI patients from the Epilepsy Bioinformatics Study for Anti-epileptogenic Therapy clinical trial. Pipelines were evaluated by three quality control (QC) metrics across three exclusion regimes based on the participant's head movement profile. While no pipeline eliminated noise effects on FC, some pipelines exhibited relatively high effectiveness depending on the exclusion regime. Once high-motion participants were excluded, the choice of denoising pipeline becomes secondary - although this strategy leads to substantial data loss. Pipelines combining spike regression with physiological regressors were the best performers, whereas pipelines that used automated data-driven methods performed comparatively worse. In this study, we report the first large-scale evaluation of denoising pipelines aimed at reducing noise-related FC in a clinical population known to be highly susceptible to in-scanner motion and significant anatomical abnormalities. If resting-state functional magnetic resonance is to be a successful clinical technique, it is crucial that procedures mitigating the effect of noise be systematically evaluated in the most challenging populations, such as TBI datasets.
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Affiliation(s)
- Marina Weiler
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Raphael F Casseb
- Neuroimaging Laboratory, University of Campinas, Campinas, São Paulo, Brazil
| | - Brunno M de Campos
- Neuroimaging Laboratory, University of Campinas, Campinas, São Paulo, Brazil
| | - Julia S Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Paul M Vespa
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA.,Department of Neurosurgery, Brain Injury Research Center, University of California Los Angeles, Los Angeles, California, USA
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13
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Lutkenhoff ES, Nigri A, Rossi Sebastiano D, Sattin D, Visani E, Rosazza C, D'Incerti L, Bruzzone MG, Franceschetti S, Leonardi M, Ferraro S, Monti MM. EEG Power spectra and subcortical pathology in chronic disorders of consciousness. Psychol Med 2022; 52:1491-1500. [PMID: 32962777 DOI: 10.1017/s003329172000330x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite a growing understanding of disorders of consciousness following severe brain injury, the association between long-term impairment of consciousness, spontaneous brain oscillations, and underlying subcortical damage, and the ability of such information to aid patient diagnosis, remains incomplete. METHODS Cross-sectional observational sample of 116 patients with a disorder of consciousness secondary to brain injury, collected prospectively at a tertiary center between 2011 and 2013. Multimodal analyses relating clinical measures of impairment, electroencephalographic measures of spontaneous brain activity, and magnetic resonance imaging data of subcortical atrophy were conducted in 2018. RESULTS In the final analyzed sample of 61 patients, systematic associations were found between electroencephalographic power spectra and subcortical damage. Specifically, the ratio of beta-to-delta relative power was negatively associated with greater atrophy in regions of the bilateral thalamus and globus pallidus (both left > right) previously shown to be preferentially atrophied in chronic disorders of consciousness. Power spectrum total density was also negatively associated with widespread atrophy in regions of the left globus pallidus, right caudate, and in the brainstem. Furthermore, we showed that the combination of demographics, encephalographic, and imaging data in an analytic framework can be employed to aid behavioral diagnosis. CONCLUSIONS These results ground, for the first time, electroencephalographic presentation detected with routine clinical techniques in the underlying brain pathology of disorders of consciousness and demonstrate how multimodal combination of clinical, electroencephalographic, and imaging data can be employed in potentially mitigating the high rates of misdiagnosis typical of this patient cohort.
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Affiliation(s)
- Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Davide Rossi Sebastiano
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Davide Sattin
- Neurology, Public Health, Disability Unit and Coma Research Centre, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Elisa Visani
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Cristina Rosazza
- Scientific Direction, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Ludovico D'Incerti
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Silvana Franceschetti
- Department of Neurophysiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research Centre, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Stefania Ferraro
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
- School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China: On the behalf of the Coma Research Center, Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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14
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Dell'Italia J, Sanguinetti JL, Monti MM, Bystritsky A, Reggente N. Current State of Potential Mechanisms Supporting Low Intensity Focused Ultrasound for Neuromodulation. Front Hum Neurosci 2022; 16:872639. [PMID: 35547195 PMCID: PMC9081930 DOI: 10.3389/fnhum.2022.872639] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 01/07/2023] Open
Abstract
Low intensity focused ultrasound (LIFU) has been gaining traction as a non-invasive neuromodulation technology due to its superior spatial specificity relative to transcranial electrical/magnetic stimulation. Despite a growing literature of LIFU-induced behavioral modifications, the mechanisms of action supporting LIFU's parameter-dependent excitatory and suppressive effects are not fully understood. This review provides a comprehensive introduction to the underlying mechanics of both acoustic energy and neuronal membranes, defining the primary variables for a subsequent review of the field's proposed mechanisms supporting LIFU's neuromodulatory effects. An exhaustive review of the empirical literature was also conducted and studies were grouped based on the sonication parameters used and behavioral effects observed, with the goal of linking empirical findings to the proposed theoretical mechanisms and evaluating which model best fits the existing data. A neuronal intramembrane cavitation excitation model, which accounts for differential effects as a function of cell-type, emerged as a possible explanation for the range of excitatory effects found in the literature. The suppressive and other findings need additional theoretical mechanisms and these theoretical mechanisms need to have established relationships to sonication parameters.
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Affiliation(s)
- John Dell'Italia
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- *Correspondence: John Dell'Italia
| | - Joseph L. Sanguinetti
- Department of Psychology, University of Arizona, Tuscon, AZ, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Martin M. Monti
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexander Bystritsky
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Tiny Blue Dot Foundation, Santa Monica, CA, United States
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Tiny Blue Dot Foundation, Santa Monica, CA, United States
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15
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Luppi AI, Cain J, Spindler LRB, Górska UJ, Toker D, Hudson AE, Brown EN, Diringer MN, Stevens RD, Massimini M, Monti MM, Stamatakis EA, Boly M. Correction: Mechanisms Underlying Disorders of Consciousness: Bridging Gaps to Move Toward an Integrated Translational Science. Neurocrit Care 2022; 36:1080. [PMID: 35359223 PMCID: PMC9110433 DOI: 10.1007/s12028-022-01488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Joshua Cain
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Lennart R B Spindler
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Urszula J Górska
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
| | - Daniel Toker
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrew E Hudson
- Department of Anesthesia and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emery N Brown
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael N Diringer
- Department of Neurology and Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery, and Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università Degli Studi Di Milano, Milan, Italy.,Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.,Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Melanie Boly
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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16
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Cain JA, Spivak NM, Coetzee JP, Crone JS, Johnson MA, Lutkenhoff ES, Real C, Buitrago-Blanco M, Vespa PM, Schnakers C, Monti MM. Ultrasonic Deep Brain Neuromodulation in Acute Disorders of Consciousness: A Proof-of-Concept. Brain Sci 2022; 12:brainsci12040428. [PMID: 35447960 PMCID: PMC9032970 DOI: 10.3390/brainsci12040428] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 02/04/2023] Open
Abstract
The promotion of recovery in patients who have entered a disorder of consciousness (DOC; e.g., coma or vegetative states) following severe brain injury remains an enduring medical challenge despite an ever-growing scientific understanding of these conditions. Indeed, recent work has consistently implicated altered cortical modulation by deep brain structures (e.g., the thalamus and the basal ganglia) following brain damage in the arising of, and recovery from, DOCs. The (re)emergence of low-intensity focused ultrasound (LIFU) neuromodulation may provide a means to selectively modulate the activity of deep brain structures noninvasively for the study and treatment of DOCs. This technique is unique in its combination of relatively high spatial precision and noninvasive implementation. Given the consistent implication of the thalamus in DOCs and prior results inducing behavioral recovery through invasive thalamic stimulation, here we applied ultrasound to the central thalamus in 11 acute DOC patients, measured behavioral responsiveness before and after sonication, and applied functional MRI during sonication. With respect to behavioral responsiveness, we observed significant recovery in the week following thalamic LIFU compared with baseline. With respect to functional imaging, we found decreased BOLD signals in the frontal cortex and basal ganglia during LIFU compared with baseline. In addition, we also found a relationship between altered connectivity of the sonicated thalamus and the degree of recovery observed post-LIFU.
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Affiliation(s)
- Josh A. Cain
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Correspondence: (J.A.C.); (M.M.M.)
| | - Norman M. Spivak
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- UCLA-Caltech Medical Scientist Training Program, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - John P. Coetzee
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA 94304, USA
- Palo Alto VA Medical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Julia S. Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Micah A. Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Evan S. Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
| | - Courtney Real
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
| | - Manuel Buitrago-Blanco
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M. Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA;
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; (J.P.C.); (J.S.C.); (M.A.J.); (E.S.L.)
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; (N.M.S.); (C.R.); (M.B.-B.); (P.M.V.)
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
- Correspondence: (J.A.C.); (M.M.M.)
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Toker D, Pappas I, Lendner JD, Frohlich J, Mateos DM, Muthukumaraswamy S, Carhart-Harris R, Paff M, Vespa PM, Monti MM, Sommer FT, Knight RT, D'Esposito M. Consciousness is supported by near-critical slow cortical electrodynamics. Proc Natl Acad Sci U S A 2022; 119:e2024455119. [PMID: 35145021 PMCID: PMC8851554 DOI: 10.1073/pnas.2024455119] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Mounting evidence suggests that during conscious states, the electrodynamics of the cortex are poised near a critical point or phase transition and that this near-critical behavior supports the vast flow of information through cortical networks during conscious states. Here, we empirically identify a mathematically specific critical point near which waking cortical oscillatory dynamics operate, which is known as the edge-of-chaos critical point, or the boundary between stability and chaos. We do so by applying the recently developed modified 0-1 chaos test to electrocorticography (ECoG) and magnetoencephalography (MEG) recordings from the cortices of humans and macaques across normal waking, generalized seizure, anesthesia, and psychedelic states. Our evidence suggests that cortical information processing is disrupted during unconscious states because of a transition of low-frequency cortical electric oscillations away from this critical point; conversely, we show that psychedelics may increase the information richness of cortical activity by tuning low-frequency cortical oscillations closer to this critical point. Finally, we analyze clinical electroencephalography (EEG) recordings from patients with disorders of consciousness (DOC) and show that assessing the proximity of slow cortical oscillatory electrodynamics to the edge-of-chaos critical point may be useful as an index of consciousness in the clinical setting.
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Affiliation(s)
- Daniel Toker
- Department of Psychology, University of California, Los Angeles, CA 90095;
| | - Ioannis Pappas
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94704
- Department of Psychology, University of California, Berkeley, CA 94704
- Laboratory of Neuro Imaging, Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Janna D Lendner
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94704
- Department of Anesthesiology and Intensive Care, University Medical Center, 72076 Tübingen, Germany
| | - Joel Frohlich
- Department of Psychology, University of California, Los Angeles, CA 90095
| | - Diego M Mateos
- Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, C1425 Buenos Aires, Argentina
- Facultad de Ciencia y Tecnología, Universidad Autónoma de Entre Ríos, E3202 Paraná, Entre Ríos, Argentina
- Grupo de Análisis de Neuroimágenes, Instituo de Matemática Aplicada del Litoral, S3000 Santa Fe, Argentina
| | - Suresh Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, 1010 Auckland, New Zealand
| | - Robin Carhart-Harris
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London SW7 2AZ, United Kingdom
- Centre for Psychedelic Research, Department of Psychiatry, Imperial College London, London SW7 2AZ, United Kingdom
| | - Michelle Paff
- Department of Neurological Surgery, University of California, Irvine, CA 92697
| | - Paul M Vespa
- Brain Injury Research Center, Department of Neurosurgery, University of California, Los Angeles, CA 90095
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, CA 90095
- Brain Injury Research Center, Department of Neurosurgery, University of California, Los Angeles, CA 90095
| | - Friedrich T Sommer
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94704
- Redwood Center for Theoretical Neuroscience, University of California, Berkeley, CA 94704
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94704
- Department of Psychology, University of California, Berkeley, CA 94704
| | - Mark D'Esposito
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94704
- Department of Psychology, University of California, Berkeley, CA 94704
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18
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Spivak NM, Sanguinetti JL, Monti MM. Focusing in on the Future of Focused Ultrasound as a Translational Tool. Brain Sci 2022; 12:brainsci12020158. [PMID: 35203922 PMCID: PMC8870102 DOI: 10.3390/brainsci12020158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 12/22/2022] Open
Abstract
This article summarizes the field of focused ultrasound for use in neuromodulation and discusses different ways of targeting, delivering, and validating focused ultrasound. A discussion is focused on parameter space and different ongoing theories of ultrasonic neuromodulation. Current and future applications of the technique are discussed.
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Affiliation(s)
- Norman M. Spivak
- UCLA—Caltech Medical Scientist Training Program, David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA;
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
- Correspondence:
| | - Joseph L. Sanguinetti
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Martin M. Monti
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA;
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
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Frohlich J, Crone JS, Johnson MA, Lutkenhoff ES, Spivak NM, Dell'Italia J, Hipp JF, Shrestha V, Ruiz Tejeda JE, Real C, Vespa PM, Monti MM. Neural oscillations track recovery of consciousness in acute traumatic brain injury patients. Hum Brain Mapp 2022; 43:1804-1820. [PMID: 35076993 PMCID: PMC8933330 DOI: 10.1002/hbm.25725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022] Open
Abstract
Electroencephalography (EEG), easily deployed at the bedside, is an attractive modality for deriving quantitative biomarkers of prognosis and differential diagnosis in severe brain injury and disorders of consciousness (DOC). Prior work by Schiff has identified four dynamic regimes of progressive recovery of consciousness defined by the presence or absence of thalamically‐driven EEG oscillations. These four predefined categories (ABCD model) relate, on a theoretical level, to thalamocortical integrity and, on an empirical level, to behavioral outcome in patients with cardiac arrest coma etiologies. However, whether this theory‐based stratification of patients might be useful as a diagnostic biomarker in DOC and measurably linked to thalamocortical dysfunction remains unknown. In this work, we relate the reemergence of thalamically‐driven EEG oscillations to behavioral recovery from traumatic brain injury (TBI) in a cohort of N = 38 acute patients with moderate‐to‐severe TBI and an average of 1 week of EEG recorded per patient. We analyzed an average of 3.4 hr of EEG per patient, sampled to coincide with 30‐min periods of maximal behavioral arousal. Our work tests and supports the ABCD model, showing that it outperforms a data‐driven clustering approach and may perform equally well compared to a more parsimonious categorization. Additionally, in a subset of patients (N = 11), we correlated EEG findings with functional magnetic resonance imaging (fMRI) connectivity between nodes in the mesocircuit—which has been theoretically implicated by Schiff in DOC—and report a trend‐level relationship that warrants further investigation in larger studies.
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Affiliation(s)
- Joel Frohlich
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Julia S. Crone
- Department of Psychology University of California Los Angeles Los Angeles California USA
- Vienna Cognitive Science Hub University of Vienna Vienna Austria
| | - Micah A. Johnson
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Evan S. Lutkenhoff
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Norman M. Spivak
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
| | - John Dell'Italia
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Joerg F. Hipp
- Roche Pharma Research and Early Development Roche Innovation Center Basel Basel Switzerland
| | - Vikesh Shrestha
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
| | - Jesús E. Ruiz Tejeda
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
| | - Courtney Real
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
| | - Paul M. Vespa
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
| | - Martin M. Monti
- Department of Psychology University of California Los Angeles Los Angeles California USA
- Department of Neurosurgery UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles California USA
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20
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Frohlich J, Johnson MA, McArthur DL, Lutkenhoff ES, Dell'Italia J, Real C, Shrestha V, Spivak NM, Ruiz Tejeda JE, Vespa PM, Monti MM. Sedation-Induced Burst Suppression Predicts Positive Outcome Following Traumatic Brain Injury. Front Neurol 2022; 12:750667. [PMID: 35002918 PMCID: PMC8727767 DOI: 10.3389/fneur.2021.750667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/31/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
While electroencephalogram (EEG) burst-suppression is often induced therapeutically using sedatives in the intensive care unit (ICU), there is hitherto no evidence with respect to its association to outcome in moderate-to-severe neurological patients. We examined the relationship between sedation-induced burst-suppression (SIBS) and outcome at hospital discharge and at 6-month follow up in patients surviving moderate-to-severe traumatic brain injury (TBI). For each of 32 patients recovering from coma after moderate-to-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS). The maximum BSR was then used to predict the Glasgow Outcome Scale extended (GOSe) at discharge and at 6 months post-injury. A multi-model inference approach was used to assess the combination of predictors that best fit the outcome data. We found that BSR was positively associated with outcomes at 6 months (P = 0.022) but did not predict outcomes at discharge. A mediation analysis found no evidence that BSR mediates the effects of barbiturates or propofol on outcomes. Our results provide initial observational evidence that burst suppression may be neuroprotective in acute patients with TBI etiologies. SIBS may thus be useful in the ICU as a prognostic biomarker.
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Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Micah A Johnson
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David L McArthur
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Evan S Lutkenhoff
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - John Dell'Italia
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Courtney Real
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vikesh Shrestha
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Norman M Spivak
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jesús E Ruiz Tejeda
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M Vespa
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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21
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Claassen J, Akbari Y, Alexander S, Bader MK, Bell K, Bleck TP, Boly M, Brown J, Chou SHY, Diringer MN, Edlow BL, Foreman B, Giacino JT, Gosseries O, Green T, Greer DM, Hanley DF, Hartings JA, Helbok R, Hemphill JC, Hinson HE, Hirsch K, Human T, James ML, Ko N, Kondziella D, Livesay S, Madden LK, Mainali S, Mayer SA, McCredie V, McNett MM, Meyfroidt G, Monti MM, Muehlschlegel S, Murthy S, Nyquist P, Olson DM, Provencio JJ, Rosenthal E, Sampaio Silva G, Sarasso S, Schiff ND, Sharshar T, Shutter L, Stevens RD, Vespa P, Videtta W, Wagner A, Ziai W, Whyte J, Zink E, Suarez JI. Proceedings of the First Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness. Neurocrit Care 2021; 35:4-23. [PMID: 34236619 PMCID: PMC8264966 DOI: 10.1007/s12028-021-01260-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
Coma and disorders of consciousness (DoC) are highly prevalent and constitute a burden for patients, families, and society worldwide. As part of the Curing Coma Campaign, the Neurocritical Care Society partnered with the National Institutes of Health to organize a symposium bringing together experts from all over the world to develop research targets for DoC. The conference was structured along six domains: (1) defining endotype/phenotypes, (2) biomarkers, (3) proof-of-concept clinical trials, (4) neuroprognostication, (5) long-term recovery, and (6) large datasets. This proceedings paper presents actionable research targets based on the presentations and discussions that occurred at the conference. We summarize the background, main research gaps, overall goals, the panel discussion of the approach, limitations and challenges, and deliverables that were identified.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Columbia University and New York-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York City, NY, 10032, USA.
| | - Yama Akbari
- Departments of Neurology, Neurological Surgery, and Anatomy & Neurobiology and Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
| | - Sheila Alexander
- Acute and Tertiary Care, School of Nursing and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas P Bleck
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melanie Boly
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeremy Brown
- Office of Emergency Care Research, Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sherry H-Y Chou
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael N Diringer
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, USA
| | - Brandon Foreman
- Departments of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Olivia Gosseries
- GIGA Consciousness After Coma Science Group, University of Liege, Liege, Belgium
| | - Theresa Green
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - David M Greer
- Department of Neurology, School of Medicine, Boston University, Boston, MA, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jed A Hartings
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Raimund Helbok
- Neurocritical Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Claude Hemphill
- Department of Neurology, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - H E Hinson
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Karen Hirsch
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Theresa Human
- Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Michael L James
- Departments of Anesthesiology and Neurology, Duke University, Durham, NC, USA
| | - Nerissa Ko
- Department of Neurology, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Kondziella
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah Livesay
- College of Nursing, Rush University, Chicago, IL, USA
| | - Lori K Madden
- Center for Nursing Science, University of California, Davis, Sacramento, CA, USA
| | - Shraddha Mainali
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College, Valhalla, NY, USA
| | - Victoria McCredie
- Interdepartmental Division of Critical Care, Department of Respirology, University of Toronto, Toronto, ON, Canada
| | - Molly M McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven and University of Leuven, Leuven, Belgium
| | - Martin M Monti
- Departments of Neurosurgery and Psychology, Brain Injury Research Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesiology/Critical Care, and Surgery, Medical School, University of Massachusetts, Worcester, MA, USA
| | - Santosh Murthy
- Department of Neurology, Weill Cornell Medical College, New York City, NY, USA
| | - Paul Nyquist
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - DaiWai M Olson
- Departments of Neurology and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Javier Provencio
- Departments of Neurology and Neuroscience, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Eric Rosenthal
- Department of Neurology, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gisele Sampaio Silva
- Department of Neurology, Albert Einstein Israelite Hospital and Universidade Federal de São Paulo, São Paulo, Brazil
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Nicholas D Schiff
- Department of Neurology and Brain Mind Research Institute, Weill Cornell Medicine, Cornell University, New York City, NY, USA
| | - Tarek Sharshar
- Department of Intensive Care, Paris Descartes University, Paris, France
| | - Lori Shutter
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert D Stevens
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Vespa
- Departments of Neurosurgery and Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Walter Videtta
- National Hospital Alejandro Posadas, Buenos Aires, Argentina
| | - Amy Wagner
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Ziai
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Elizabeth Zink
- Division of Neurosciences Critical Care, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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22
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Stern JM, Spivak NM, Becerra SA, Kuhn TP, Korb AS, Kronemyer D, Khanlou N, Reyes SD, Monti MM, Schnakers C, Walshaw P, Keselman I, Cohen MS, Yong W, Fried I, Jordan SE, Schafer ME, Engel J, Bystritsky A. Safety of focused ultrasound neuromodulation in humans with temporal lobe epilepsy. Brain Stimul 2021; 14:1022-1031. [PMID: 34198105 DOI: 10.1016/j.brs.2021.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing. METHODS Neuropsychological functions were assessed in eight patients before and after focused ultrasound sonication of the temporal lobe at intensities up to 5760 mW/cm2. Using the BrainSonix Pulsar 1002, tFUS was delivered under MR guidance, using the Siemens Magnetom 3T Prisma scanner. Neuropsychological changes were assessed using various batteries. Histological changes were assessed using hematoxylin and eosin staining, among others. RESULTS With respect to safety, the histological analysis did not reveal any detectable damage to the tissue, except for one subject for whom the histology findings were inconclusive. In addition, neuropsychological testing did not show any statistically significant changes in any test, except for a slight decrease in performance on one of the tests after tFUS. SIGNIFICANCE This study supports the hypothesis that low-intensity Transcranial Focused Ultrasound (tFUS) used for neuromodulation of brain circuits at intensities up to 5760 mW/cm2 may be safe for use in human research. However, due to methodological limitations in this study and inconclusive findings, more work is warranted to establish the safety. Future directions include greater number of sonications as well as longer exposure at higher intensity levels to further assess the safety of tFUS for modulation of neuronal circuits.
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Affiliation(s)
- John M Stern
- Department of Neurology, UCLA School of Medicine, USA
| | - Norman M Spivak
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA
| | - Sergio A Becerra
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Alexander S Korb
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA
| | - David Kronemyer
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Négar Khanlou
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Samuel D Reyes
- Department of Neurosurgery, UCLA School of Medicine, USA
| | - Martin M Monti
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurosurgery, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Brain Research Institute, UCLA, USA
| | | | - Patricia Walshaw
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA
| | - Inna Keselman
- Department of Neurology, UCLA School of Medicine, USA
| | - Mark S Cohen
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Psychology, UCLA College of Letters and Science, USA; Department of Radiology, UCLA School of Medicine, USA; Department of Biomedical Physics, UCLA School of Medicine, USA; Department of Bioengineering, UCLA School of Engineering, USA; California Nanosystems Institute, UCLA, USA; Brain Research Institute, UCLA, USA
| | - William Yong
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, USA
| | - Itzhak Fried
- Department of Neurosurgery, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Sheldon E Jordan
- Neurology Management Associates- Los Angeles, Santa Monica, CA, USA
| | - Mark E Schafer
- BrainSonix Inc., Los Angeles, CA, USA; School of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
| | - Jerome Engel
- Department of Neurology, UCLA School of Medicine, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; Department of Neurobiology, UCLA School of Medicine, USA; Brain Research Institute, UCLA, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, USA; BrainSonix Inc., Los Angeles, CA, USA.
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Olsen A, Babikian T, Bigler ED, Caeyenberghs K, Conde V, Dams-O'Connor K, Dobryakova E, Genova H, Grafman J, Håberg AK, Heggland I, Hellstrøm T, Hodges CB, Irimia A, Jha RM, Johnson PK, Koliatsos VE, Levin H, Li LM, Lindsey HM, Livny A, Løvstad M, Medaglia J, Menon DK, Mondello S, Monti MM, Newcombe VFJ, Petroni A, Ponsford J, Sharp D, Spitz G, Westlye LT, Thompson PM, Dennis EL, Tate DF, Wilde EA, Hillary FG. Toward a global and reproducible science for brain imaging in neurotrauma: the ENIGMA adult moderate/severe traumatic brain injury working group. Brain Imaging Behav 2021; 15:526-554. [PMID: 32797398 PMCID: PMC8032647 DOI: 10.1007/s11682-020-00313-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The global burden of mortality and morbidity caused by traumatic brain injury (TBI) is significant, and the heterogeneity of TBI patients and the relatively small sample sizes of most current neuroimaging studies is a major challenge for scientific advances and clinical translation. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Adult moderate/severe TBI (AMS-TBI) working group aims to be a driving force for new discoveries in AMS-TBI by providing researchers world-wide with an effective framework and platform for large-scale cross-border collaboration and data sharing. Based on the principles of transparency, rigor, reproducibility and collaboration, we will facilitate the development and dissemination of multiscale and big data analysis pipelines for harmonized analyses in AMS-TBI using structural and functional neuroimaging in combination with non-imaging biomarkers, genetics, as well as clinical and behavioral measures. Ultimately, we will offer investigators an unprecedented opportunity to test important hypotheses about recovery and morbidity in AMS-TBI by taking advantage of our robust methods for large-scale neuroimaging data analysis. In this consensus statement we outline the working group's short-term, intermediate, and long-term goals.
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Affiliation(s)
- Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Australia
| | - Virginia Conde
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen Genova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Neurology, Department of Psychiatry & Department of Psychology, Cognitive Neurology and Alzheimer's, Center, Feinberg School of Medicine, Weinberg, Chicago, IL, USA
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hopsital, Trondheim University Hospital, Trondheim, Norway
| | - Ingrid Heggland
- Section for Collections and Digital Services, NTNU University Library, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Ruchira M Jha
- Departments of Critical Care Medicine, Neurology, Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
| | - Paula K Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Vassilis E Koliatsos
- Departments of Pathology(Neuropathology), Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Neuropsychiatry Program, Sheppard and Enoch Pratt Hospital, Baltimore, MD, USA
| | - Harvey Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lucia M Li
- C3NL, Imperial College London, London, UK
- UK DRI Centre for Health Care and Technology, Imperial College London, London, UK
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - John Medaglia
- Department of Psychology, Drexel University, Philadelphia, PA, USA
- Department of Neurology, Drexel University, Philadelphia, PA, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA, Los Angeles, CA, USA
| | | | - Agustin Petroni
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway
- Department of Computer Science, Faculty of Exact & Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina
- National Scientific & Technical Research Council, Institute of Research in Computer Science, Buenos Aires, Argentina
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - David Sharp
- Department of Brain Sciences, Imperial College London, London, UK
- Care Research & Technology Centre, UK Dementia Research Institute, London, UK
| | - Gershon Spitz
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Frank G Hillary
- Department of Neurology, Hershey Medical Center, State College, PA, USA.
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Frohlich J, Toker D, Monti MM. Consciousness among delta waves: a paradox? Brain 2021; 144:2257-2277. [PMID: 33693596 DOI: 10.1093/brain/awab095] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 01/29/2023] Open
Abstract
A common observation in EEG research is that consciousness vanishes with the appearance of delta (1 - 4 Hz) waves, particularly when those waves are high amplitude. High amplitude delta oscillations are very frequently observed in states of diminished consciousness, including slow wave sleep, anaesthesia, generalised epileptic seizures, and disorders of consciousness such as coma and vegetative state. This strong correlation between loss of consciousness and high amplitude delta oscillations is thought to stem from the widespread cortical deactivation that occurs during the "down states" or troughs of these slow oscillations. Recently, however, many studies have reported the presence of prominent delta activity during conscious states, which casts doubt on the hypothesis that high amplitude delta oscillations are an indicator of unconsciousness. These studies include work in Angelman syndrome, epilepsy, behavioural responsiveness during propofol anaesthesia, postoperative delirium, and states of dissociation from the environment such as dreaming and powerful psychedelic states. The foregoing studies complement an older, yet largely unacknowledged, body of literature that has documented awake, conscious patients with high amplitude delta oscillations in clinical reports from Rett syndrome, Lennox-Gastaut syndrome, schizophrenia, mitochondrial diseases, hepatic encephalopathy, and nonconvulsive status epilepticus. At the same time, a largely parallel body of recent work has reported convincing evidence that the complexity or entropy of EEG and magnetoencephalogram or MEG signals strongly relates to an individual's level of consciousness. Having reviewed this literature, we discuss plausible mechanisms that would resolve the seeming contradiction between high amplitude delta oscillations and consciousness. We also consider implications concerning theories of consciousness, such as integrated information theory and the entropic brain hypothesis. Finally, we conclude that false inferences of unconscious states can be best avoided by examining measures of electrophysiological complexity in addition to spectral power.
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Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA
| | - Daniel Toker
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, California 90095, USA.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA
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Schnakers C, Divine J, Johnson MA, Lutkenhoff E, Monti MM, Keil KM, Guthrie J, Pouratian N, Patterson D, Jensen G, Morales VC, Weaver KF, Rosario ER. Longitudinal changes in blood-based biomarkers in chronic moderate to severe traumatic brain injury: preliminary findings. Brain Inj 2021; 35:285-291. [PMID: 33461331 DOI: 10.1080/02699052.2020.1858345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: This longitudinal study aims at 1) providing preliminary evidence of changes in blood-based biomarkers across time in chronic TBI and 2) relating these changes to outcome measures and cerebral structure and activity.Methods: Eight patients with moderate-to-severe TBI (7 males, 35 ± 7.6 years old, 5 severe TBI, 17.52 ± 3.84 months post-injury) were evaluated at monthly intervals across 6 time-points using: a) Blood-based biomarkers (GFAP, NSE, S100A12, SDBP145, UCH-L1, T-tau, P-tau, P-tau/T-tau ratio); b) Magnetic Resonance Imaging to evaluate changes in brain structure; c) Resting-state electroencephalograms to evaluate changes in brain function; and d) Outcome measures to assess cognition, emotion, and functional recovery (MOCA, RBANS, BDI-II, and DRS).Results: Changes in P-tau levels were found across time [p = .007]. P-tau was positively related to functional [p < .001] and cognitive [p = .006] outcomes, and negatively related to the severity of depression, 6 months later [R = -0.901; p =.006]. P-tau and P-tau/T-tau ratio were also positively correlated to shape change in subcortical areas such as brainstem [T(7) = 4.71, p = .008] and putamen [T(7) = 3.25, p = .012].Conclusions: Our study provides preliminary findings that suggest a positive relationship between P-tau and the recovery of patients with chronic TBI.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - James Divine
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Evan Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Katrina M Keil
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - John Guthrie
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California Los Angeles, California, Los Angeles, USA
| | - David Patterson
- Transition Living Center, Casa Colina Hospital and Centers for Healthcare, California, Pomona, USA
| | - Gary Jensen
- Diagnostics Imaging Center, University of California Los Angeles, California, Los Angeles, USA
| | - Vanessa C Morales
- Grant Evaluation & Statistical Support, Loyola Marymount University, California, Los Angeles, USA
| | - Kathleen F Weaver
- Professional Development and Online Learning, Loyola Marymount University, California, Los Angeles, USA
| | - Emily R Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
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26
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Cain JA, Spivak NM, Coetzee JP, Crone JS, Johnson MA, Lutkenhoff ES, Real C, Buitrago-Blanco M, Vespa PM, Schnakers C, Monti MM. Ultrasonic thalamic stimulation in chronic disorders of consciousness. Brain Stimul 2021; 14:301-303. [PMID: 33465497 DOI: 10.1016/j.brs.2021.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joshua A Cain
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Norman M Spivak
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - John P Coetzee
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA; Department of Psychiatry, Stanford School of Medicine, Palo Alto, CA, 94304, USA; VA Palo Alto, Palo Alto, CA, 94304, USA
| | - Julia S Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Courtney Real
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA
| | - Manuel Buitrago-Blanco
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, 91767, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA; Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, CA, 90095, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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27
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Rosenberg BM, Mennigen E, Monti MM, Kaiser RH. Functional Segregation of Human Brain Networks Across the Lifespan: An Exploratory Analysis of Static and Dynamic Resting-State Functional Connectivity. Front Neurosci 2020; 14:561594. [PMID: 33363450 PMCID: PMC7752769 DOI: 10.3389/fnins.2020.561594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Prior research has shown that during development, there is increased segregation between, and increased integration within, prototypical resting-state functional brain networks. Functional networks are typically defined by static functional connectivity over extended periods of rest. However, little is known about how time-varying properties of functional networks change with age. Likewise, a comparison of standard approaches to functional connectivity may provide a nuanced view of how network integration and segregation are reflected across the lifespan. Therefore, this exploratory study evaluated common approaches to static and dynamic functional network connectivity in a publicly available dataset of subjects ranging from 8 to 75 years of age. Analyses evaluated relationships between age and static resting-state functional connectivity, variability (standard deviation) of connectivity, and mean dwell time of functional network states defined by recurring patterns of whole-brain connectivity. Results showed that older age was associated with decreased static connectivity between nodes of different canonical networks, particularly between the visual system and nodes in other networks. Age was not significantly related to variability of connectivity. Mean dwell time of a network state reflecting high connectivity between visual regions decreased with age, but older age was also associated with increased mean dwell time of a network state reflecting high connectivity within and between canonical sensorimotor and visual networks. Results support a model of increased network segregation over the lifespan and also highlight potential pathways of top-down regulation among networks.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eva Mennigen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roselinde H Kaiser
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
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28
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La Rocca M, Garner R, Amoroso N, Lutkenhoff ES, Monti MM, Vespa P, Toga AW, Duncan D. Multiplex Networks to Characterize Seizure Development in Traumatic Brain Injury Patients. Front Neurosci 2020; 14:591662. [PMID: 33328863 PMCID: PMC7734183 DOI: 10.3389/fnins.2020.591662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 01/11/2023] Open
Abstract
Traumatic brain injury (TBI) may cause secondary debilitating problems, such as post-traumatic epilepsy (PTE), which occurs with unprovoked recurrent seizures, months or even years after TBI. Currently, the Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) has been enrolling moderate-severe TBI patients with the goal to identify biomarkers of epileptogenesis that may help to prevent seizure occurrence and better understand the mechanism underlying PTE. In this work, we used a novel complex network approach based on segmenting T1-weighted Magnetic Resonance Imaging (MRI) scans in patches of the same dimension (network nodes) and measured pairwise patch similarities using Pearson's correlation (network connections). This network model allowed us to obtain a series of single and multiplex network metrics to comprehensively analyze the different interactions between brain components and capture structural MRI alterations related to seizure development. We used these complex network features to train a Random Forest (RF) classifier and predict, with an accuracy of 70 and a 95% confidence interval of [67, 73%], which subjects from EpiBioS4Rx have had at least one seizure after a TBI. This complex network approach also allowed the identification of the most informative scales and brain areas for the discrimination between the two clinical groups: seizure-free and seizure-affected subjects, demonstrating to be a promising pilot study which, in the future, may serve to identify and validate biomarkers of PTE.
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Affiliation(s)
- Marianna La Rocca
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Rachael Garner
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nicola Amoroso
- Dipartimento di Farmacia - Scienze del Farmaco, Università degli Studi di Bari “A. Moro”, Bari, Italy
| | - Evan S. Lutkenhoff
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul Vespa
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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29
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Lutkenhoff ES, Shrestha V, Ruiz Tejeda J, Real C, McArthur DL, Duncan D, La Rocca M, Garner R, Toga AW, Vespa PM, Monti MM. Early brain biomarkers of post-traumatic seizures: initial report of the multicentre epilepsy bioinformatics study for antiepileptogenic therapy (EpiBioS4Rx) prospective study. J Neurol Neurosurg Psychiatry 2020; 91:1154-1157. [PMID: 32848013 PMCID: PMC7572686 DOI: 10.1136/jnnp-2020-322780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) causes early seizures and is the leading cause of post-traumatic epilepsy. We prospectively assessed structural imaging biomarkers differentiating patients who develop seizures secondary to TBI from patients who do not. DESIGN Multicentre prospective cohort study starting in 2018. Imaging data are acquired around day 14 post-injury, detection of seizure events occurred early (within 1 week) and late (up to 90 days post-TBI). RESULTS From a sample of 96 patients surviving moderate-to-severe TBI, we performed shape analysis of local volume deficits in subcortical areas (analysable sample: 57 patients; 35 no seizure, 14 early, 8 late) and cortical ribbon thinning (analysable sample: 46 patients; 29 no seizure, 10 early, 7 late). Right hippocampal volume deficit and inferior temporal cortex thinning demonstrated a significant effect across groups. Additionally, the degree of left frontal and temporal pole thinning, and clinical score at the time of the MRI, could differentiate patients experiencing early seizures from patients not experiencing them with 89% accuracy. CONCLUSIONS AND RELEVANCE Although this is an initial report, these data show that specific areas of localised volume deficit, as visible on routine imaging data, are associated with the emergence of seizures after TBI.
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Affiliation(s)
- Evan S Lutkenhoff
- Psychology, University of California Los Angeles, Los Angeles, California, USA.,Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Vikesh Shrestha
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jesus Ruiz Tejeda
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Courtney Real
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - David L McArthur
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Marianna La Rocca
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Rachael Garner
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Martin M Monti
- Psychology, University of California Los Angeles, Los Angeles, California, USA .,Brain Injury Research Center (BIRC), Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
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30
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Wright MJ, Monti MM, Lutkenhoff ES, Hardy DJ, Litvin PY, Kelly DF, Guskiewicz K, Cantu RC, Vespa PM, Hovda DA, Lopez WD, Wang C, Swerdloff R, Fuster JM. Memory in repeat sports-related concussive injury and single-impact traumatic brain injury. Brain Inj 2020; 34:1666-1673. [PMID: 32990043 DOI: 10.1080/02699052.2020.1825806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Repeat sports-related concussive/subconcussive injury (RC/SCI) is related to memory impairment. Objective & Methods: We sought to determine memory differences between persons with RC/SCI, moderate-to-severe single-impact traumatic brain injury (SI-TBI), and healthy controls. MRI scans from a subsample of participants with SI-TBI were used to identify the neuroanatomical correlates of observed memory process differences between the brain injury groups. Results: Both brain injury groups evidenced worse learning and recall in contrast to controls, although SI-TBI group had poorer memory than the RC/SCI group. Regarding memory process differences, in contrast to controls, the SI-TBI group evidenced difficulties with encoding, consolidation, and retrieval, while the RC/SCI group showed deficits in consolidation and retrieval. Delayed recall was predicted by encoding, with consolidation as a secondary predictor in the SI-TBI group. In the RC/SCI group, delayed recall was only predicted by consolidation. MRI data showed that the consolidation index we used mapped onto hippocampal atrophy. Conclusions: RC/SCI is primarily associated with consolidation deficits, which differs from SI-TBI. Given the role of the hippocampus in memory consolidation and the fact that hyperphosphorylated tau tends to accumulate in the medial temporal lobe in RC/SCI, consolidation deficits may be a cognitive marker of chronic traumatic encephalopathy in athletes.
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Affiliation(s)
- Matthew J Wright
- Lundquist Institute at Harbor-UCLA Medical Center , Torrance, California, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine , Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, UCLA , Los Angeles, California, USA.,Department of Neurosurgery, UCLA School of Medicine , Los Angeles, California, USA
| | - Evan S Lutkenhoff
- Department of Psychology, UCLA , Los Angeles, California, USA.,Department of Neurosurgery, UCLA School of Medicine , Los Angeles, California, USA
| | - David J Hardy
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine , Los Angeles, California, USA.,Department of Psychology, Loyola Marymount University , Los Angeles, California, USA
| | - Pavel Y Litvin
- Lundquist Institute at Harbor-UCLA Medical Center , Torrance, California, USA
| | - Daniel F Kelly
- Department of Neurosurgery, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center , Santa Monica, California, USA
| | - Kevin Guskiewicz
- Department of Exercise & Sports Science, Center for the Study of Retired Athletes at the University of North Carolina , Chapel Hill, North Carolina, USA
| | - Robert C Cantu
- Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts, USA
| | - Paul M Vespa
- Department of Neurosurgery, UCLA School of Medicine , Los Angeles, California, USA.,Department of Neurology, UCLA School of Medicine , Los Angeles, California, USA
| | - David A Hovda
- Department of Neurosurgery, UCLA School of Medicine , Los Angeles, California, USA
| | - Walter D Lopez
- Lundquist Institute at Harbor-UCLA Medical Center , Torrance, California, USA
| | - Christina Wang
- Lundquist Institute at Harbor-UCLA Medical Center , Torrance, California, USA
| | - Ronald Swerdloff
- Lundquist Institute at Harbor-UCLA Medical Center , Torrance, California, USA
| | - Joaquín M Fuster
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine , Los Angeles, California, USA
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Frohlich J, Bird LM, Dell'Italia J, Johnson MA, Hipp JF, Monti MM. Erratum: High-voltage, diffuse delta rhythms coincide with wakeful consciousness and complexity in Angelman syndrome. Neurosci Conscious 2020; 2020:niaa021. [PMID: 33042582 PMCID: PMC7533426 DOI: 10.1093/nc/niaa021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California, San Diego, CA, USA.,Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - John Dell'Italia
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Joerg F Hipp
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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32
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Lutkenhoff ES, Wright MJ, Shrestha V, Real C, McArthur DL, Buitrago-Blanco M, Vespa PM, Monti MM. The subcortical basis of outcome and cognitive impairment in TBI: A longitudinal cohort study. Neurology 2020; 95:e2398-e2408. [PMID: 32907958 DOI: 10.1212/wnl.0000000000010825] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/02/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury. METHODS For this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale-extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory. RESULTS In the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy. CONCLUSION Despite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.
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Affiliation(s)
- Evan S Lutkenhoff
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Matthew J Wright
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Vikesh Shrestha
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Courtney Real
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - David L McArthur
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Manuel Buitrago-Blanco
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Paul M Vespa
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA
| | - Martin M Monti
- From the Department of Psychology (E.S.L., M.M.M.) and Department of Psychiatry and Biobehavioral Sciences (M.J.W.), University of California Los Angeles; Brain Injury Research Center (E.S.L., M.J.W., V.S., C.R., D.L.M., M.B.-B., P.M.V., M.M.M.), Department of Neurosurgery, and Department of Neurology (M.B.-B, P.M.V., M.M.M.), David Geffen School of Medicine at UCLA; and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (M.J.W.), Torrance, CA.
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Abstract
Relational integration is required when multiple explicit representations of relations between entities must be jointly considered to make inferences. We provide an overview of the neural substrate of relational integration in humans and the processes that support it, focusing on work on analogical and deductive reasoning. In addition to neural evidence, we consider behavioral and computational work that has informed neural investigations of the representations of individual relations and of relational integration. In very general terms, evidence from neuroimaging, neuropsychological, and neuromodulatory studies points to a small set of regions (generally left lateralized) that appear to constitute key substrates for component processes of relational integration. These include posterior parietal cortex, implicated in the representation of first-order relations (e.g., A:B); rostrolateral pFC, apparently central in integrating first-order relations so as to generate and/or evaluate higher-order relations (e.g., A:B::C:D); dorsolateral pFC, involved in maintaining relations in working memory; and ventrolateral pFC, implicated in interference control (e.g., inhibiting salient information that competes with relevant relations). Recent work has begun to link computational models of relational representation and reasoning with patterns of neural activity within these brain areas.
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34
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Chiang JN, Peng Y, Lu H, Holyoak KJ, Monti MM. Distributed Code for Semantic Relations Predicts Neural Similarity during Analogical Reasoning. J Cogn Neurosci 2020; 33:377-389. [PMID: 32762520 DOI: 10.1162/jocn_a_01620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The ability to generate and process semantic relations is central to many aspects of human cognition. Theorists have long debated whether such relations are coarsely coded as links in a semantic network or finely coded as distributed patterns over some core set of abstract relations. The form and content of the conceptual and neural representations of semantic relations are yet to be empirically established. Using sequential presentation of verbal analogies, we compared neural activities in making analogy judgments with predictions derived from alternative computational models of relational dissimilarity to adjudicate among rival accounts of how semantic relations are coded and compared in the brain. We found that a frontoparietal network encodes the three relation types included in the design. A computational model based on semantic relations coded as distributed representations over a pool of abstract relations predicted neural activities for individual relations within the left superior parietal cortex and for second-order comparisons of relations within a broader left-lateralized network.
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35
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Dell'Italia J, Johnson MA, Vespa PM, Monti MM. Accounting for Changing Structure in Functional Network Analysis of TBI Patients. Front Syst Neurosci 2020; 14:42. [PMID: 32848638 PMCID: PMC7427444 DOI: 10.3389/fnsys.2020.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 06/05/2020] [Indexed: 12/05/2022] Open
Abstract
Over the last 15 years, network analysis approaches based on MR data have allowed a renewed understanding of the relationship between brain function architecture and consciousness. Application of this approach to Disorders of Consciousness (DOC) highlights the relationship between specific aspects of network topology and levels of consciousness. Nonetheless, such applications do not acknowledge that DOC patients present with a dramatic level of heterogeneity in structural connectivity (SC) across groups (e.g., etiology, diagnostic categories) and within individual patients (e.g., over time), which possibly affects the level and quality of functional connectivity (FC) patterns that can be expressed. In addition, it is rarely acknowledged that the most frequently employed outcome metrics in the study of brain connectivity (e.g., degree distribution, inter- or intra-resting state network connectivity, and clustering coefficient) are interrelated and cannot be assumed to be independent of each other. We present empirical data showing that, when the two points above are not taken into consideration with an appropriate analytic model, it can lead to a misinterpretation of the role of each outcome metric in the graph's structure and thus misinterpretation of FC results. We show that failing to account for either SC or the inter-relation between outcome measures can lead to inflated false positives (FP) and/or false negatives (FN) in inter- or intra-resting state network connectivity results (defined, respectively, as a positive or negative result in network connectivity that is present when not accounting for SC and/or outcome measure inter-relation, but becomes not significant when accounting for all variables). Overall, we find that unconscious patients have lower rates of FP and FN for within cortical connectivity, lower rates of FN for cortico-subcortical connectivity, and lower rates of FP for within subcortical connectivity. These lower rates in unconscious patients may reflect differences in their triadic closure and SC metrics, which bias the interpretations of the inter- or intra-resting state network connectivity if the SC metrics and triadic closure are not modeled. We suggest that future studies of functional connectivity in DOC patients (i) incorporate where possible SC metrics and (ii) properly account for the intercorrelated nature of outcome variables.
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Affiliation(s)
- John Dell'Italia
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Micah A. Johnson
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M. Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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36
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Provencio JJ, Hemphill JC, Claassen J, Edlow BL, Helbok R, Vespa PM, Diringer MN, Polizzotto L, Shutter L, Suarez JI, Stevens RD, Hanley DF, Akbari Y, Bleck TP, Boly M, Foreman B, Giacino JT, Hartings JA, Human T, Kondziella D, Ling GSF, Mayer SA, McNett M, Menon DK, Meyfroidt G, Monti MM, Park S, Pouratian N, Puybasset L, Rohaut B, Rosenthal ES, Schiff ND, Sharshar T, Wagner A, Whyte J, Olson DM. The Curing Coma Campaign: Framing Initial Scientific Challenges-Proceedings of the First Curing Coma Campaign Scientific Advisory Council Meeting. Neurocrit Care 2020; 33:1-12. [PMID: 32578124 PMCID: PMC7392933 DOI: 10.1007/s12028-020-01028-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the "grand challenge" of improving the management of patients with coma and decreased consciousness. One of the first steps was to bring together a Scientific Advisory Council including coma scientists, neurointensivists, neurorehabilitationists, and implementation experts in order to address the current scientific landscape and begin to develop a framework on how to move forward. This manuscript describes the proceedings of the first Curing Coma Campaign Scientific Advisory Council meeting which occurred in conjunction with the NCS Annual Meeting in October 2019 in Vancouver. Specifically, three major pillars were identified which should be considered: endotyping of coma and disorders of consciousness, biomarkers, and proof-of-concept clinical trials. Each is summarized with regard to current approach, benefits to the patient, family, and clinicians, and next steps. Integration of these three pillars will be essential to the success of the Curing Coma Campaign as will expanding the "curing coma community" to ensure broad participation of clinicians, scientists, and patient advocates with the goal of identifying and implementing treatments to fundamentally improve the outcome of patients.
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Affiliation(s)
- J Javier Provencio
- Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA
| | - J Claude Hemphill
- Department of Neurology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raimund Helbok
- Department of Neurology, Neurocritical Care, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul M Vespa
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael N Diringer
- Department of Neurology, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Len Polizzotto
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Lori Shutter
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh/UPMC Health System, Pittsburgh, PA, USA
| | - Jose I Suarez
- Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | - Yama Akbari
- Departments of Neurology, Neurosurgery and the Beckman Laser Institute, University of California-Irvine, Irvine, CA, USA
| | - Thomas P Bleck
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Theresa Human
- Departments of Neurology and Neurosurgery, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geoffrey S F Ling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Louis Puybasset
- Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Benjamin Rohaut
- Department of Neurology, Neuro-ICU, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas D Schiff
- Departments of Neurology, Neuroscience, and Medical Ethics, Weill Cornell Medicine, New York, NY, USA
| | - Tarek Sharshar
- Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
- Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - Amy Wagner
- Department of Physical Medicine and Rehabilitation, Department of Neuroscience, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - DaiWai M Olson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
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37
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Crone JS, Lutkenhoff ES, Vespa PM, Monti MM. A systematic investigation of the association between network dynamics in the human brain and the state of consciousness. Neurosci Conscious 2020; 2020:niaa008. [PMID: 32551138 PMCID: PMC7293819 DOI: 10.1093/nc/niaa008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/17/2020] [Accepted: 03/09/2020] [Indexed: 12/29/2022] Open
Abstract
An increasing amount of studies suggest that brain dynamics measured with resting-state functional magnetic resonance imaging (fMRI) are related to the state of consciousness. However, the challenge of investigating neuronal correlates of consciousness is the confounding interference between (recovery of) consciousness and behavioral responsiveness. To address this issue, and validate the interpretation of prior work linking brain dynamics and consciousness, we performed a longitudinal fMRI study in patients recovering from coma. Patients were assessed twice, 6 months apart, and assigned to one of two groups. One group included patients who were unconscious at the first assessment but regained consciousness and improved behavioral responsiveness by the second assessment. The other group included patients who were already conscious and improved only behavioral responsiveness. While the two groups were matched in terms of the average increase in behavioral responsiveness, only one group experienced a categorical change in their state of consciousness allowing us to partially dissociate consciousness and behavioral responsiveness. We find the variance in network metrics to be systematically different across states of consciousness, both within and across groups. Specifically, at the first assessment, conscious patients exhibited significantly greater variance in network metrics than unconscious patients, a difference that disappeared once all patients had recovered consciousness. Furthermore, we find a significant increase in dynamics for patients who regained consciousness over time, but not for patients who only improved responsiveness. These findings suggest that changes in brain dynamics are indeed linked to the state of consciousness and not just to a general level of behavioral responsiveness.
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Affiliation(s)
- Julia S Crone
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Vespa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA.,Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
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38
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Frohlich J, Bird LM, Dell'Italia J, Johnson MA, Hipp JF, Monti MM. High-voltage, diffuse delta rhythms coincide with wakeful consciousness and complexity in Angelman syndrome. Neurosci Conscious 2020; 2020:niaa005. [PMID: 32551137 PMCID: PMC7293820 DOI: 10.1093/nc/niaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022] Open
Abstract
Abundant evidence from slow wave sleep, anesthesia, coma, and epileptic seizures links high-voltage, slow electroencephalogram (EEG) activity to loss of consciousness. This well-established correlation is challenged by the observation that children with Angelman syndrome (AS), while fully awake and displaying volitional behavior, display a hypersynchronous delta (1–4 Hz) frequency EEG phenotype typical of unconsciousness. Because the trough of the delta oscillation is associated with down-states in which cortical neurons are silenced, the presence of volitional behavior and wakefulness in AS amidst diffuse delta rhythms presents a paradox. Moreover, high-voltage, slow EEG activity is generally assumed to lack complexity, yet many theories view functional brain complexity as necessary for consciousness. Here, we use abnormal cortical dynamics in AS to assess whether EEG complexity may scale with the relative level of consciousness despite a background of hypersynchronous delta activity. As characterized by multiscale metrics, EEGs from 35 children with AS feature significantly greater complexity during wakefulness compared with sleep, even when comparing the most pathological segments of wakeful EEG to the segments of sleep EEG least likely to contain conscious mentation and when factoring out delta power differences across states. These findings (i) warn against reverse inferring an absence of consciousness solely on the basis of high-amplitude EEG delta oscillations, (ii) corroborate rare observations of preserved consciousness under hypersynchronization in other conditions, (iii) identify biomarkers of consciousness that have been validated under conditions of abnormal cortical dynamics, and (iv) lend credence to theories linking consciousness with complexity.
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Affiliation(s)
- Joel Frohlich
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California, San Diego, CA, USA.,Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - John Dell'Italia
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Micah A Johnson
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA
| | - Joerg F Hipp
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, 3423 Franz Hall, Los Angeles, CA, USA.,Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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39
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Garner R, La Rocca M, Vespa P, Jones N, Monti MM, Toga AW, Duncan D. Imaging biomarkers of posttraumatic epileptogenesis. Epilepsia 2019; 60:2151-2162. [PMID: 31595501 PMCID: PMC6842410 DOI: 10.1111/epi.16357] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) affects 2.5 million people annually within the United States alone, with over 300 000 severe injuries resulting in emergency room visits and hospital admissions. Severe TBI can result in long-term disability. Posttraumatic epilepsy (PTE) is one of the most debilitating consequences of TBI, with an estimated incidence that ranges from 2% to 50% based on severity of injury. Conducting studies of PTE poses many challenges, because many subjects with TBI never develop epilepsy, and it can be more than 10 years after TBI before seizures begin. One of the unmet needs in the study of PTE is an accurate biomarker of epileptogenesis, or a panel of biomarkers, which could provide early insights into which TBI patients are most susceptible to PTE, providing an opportunity for prophylactic anticonvulsant therapy and enabling more efficient large-scale PTE studies. Several recent reviews have provided a comprehensive overview of this subject (Neurobiol Dis, 123, 2019, 3; Neurotherapeutics, 11, 2014, 231). In this review, we describe acute and chronic imaging methods that detect biomarkers for PTE and potential mechanisms of epileptogenesis. We also describe shortcomings in current acquisition methods, analysis, and interpretation that limit ongoing investigations that may be mitigated with advancements in imaging techniques and analysis.
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Affiliation(s)
- Rachael Garner
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Marianna La Rocca
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Paul Vespa
- Division of Neurosurgery, Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, United States
| | - Nigel Jones
- Van Cleef Centre for Nervous Diseases, Department of Neuroscience, Monash University, Clayton, VIC, Australia
| | - Martin M. Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Dominique Duncan
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
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Schnakers C, Lutkenhoff ES, Bio BJ, McArthur DL, Vespa PM, Monti MM. Acute EEG spectra characteristics predict thalamic atrophy after severe TBI. J Neurol Neurosurg Psychiatry 2019; 90:617-619. [PMID: 29954872 PMCID: PMC6310668 DOI: 10.1136/jnnp-2017-317829] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Evan S Lutkenhoff
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Branden J Bio
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychology, Princeton University, Princeton, New Jersey, USA
| | - David L McArthur
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.,Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA .,Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
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41
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Ellingson BM, Yao J, Raymond C, Chakhoyan A, Khatibi K, Salamon N, Villablanca JP, Wanner I, Real CR, Laiwalla A, McArthur DL, Monti MM, Hovda DA, Vespa PM. pH-weighted molecular MRI in human traumatic brain injury (TBI) using amine proton chemical exchange saturation transfer echoplanar imaging (CEST EPI). Neuroimage Clin 2019; 22:101736. [PMID: 30826686 PMCID: PMC6396390 DOI: 10.1016/j.nicl.2019.101736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/09/2019] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
Abstract
Cerebral acidosis is a consequence of secondary injury mechanisms following traumatic brain injury (TBI), including excitotoxicity and ischemia, with potentially significant clinical implications. However, there remains an unmet clinical need for technology for non-invasive, high resolution pH imaging of human TBI for studying metabolic changes following injury. The current study examined 17 patients with TBI and 20 healthy controls using amine chemical exchange saturation transfer echoplanar imaging (CEST EPI), a novel pH-weighted molecular MR imaging technique, on a clinical 3T MR scanner. Results showed significantly elevated pH-weighted image contrast (MTRasym at 3 ppm) in areas of T2 hyperintensity or edema (P < 0.0001), and a strong negative correlation with Glasgow Coma Scale (GCS) at the time of the MRI exam (R2 = 0.4777, P = 0.0021), Glasgow Outcome Scale - Extended (GOSE) at 6 months from injury (R2 = 0.5334, P = 0.0107), and a non-linear correlation with the time from injury to MRI exam (R2 = 0.6317, P = 0.0004). This evidence suggests clinical feasibility and potential value of pH-weighted amine CEST EPI as a high-resolution imaging tool for identifying tissue most at risk for long-term damage due to cerebral acidosis.
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Affiliation(s)
- Benjamin M Ellingson
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Jingwen Yao
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Dept. of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ararat Chakhoyan
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kasra Khatibi
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - J Pablo Villablanca
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ina Wanner
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Courtney R Real
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Azim Laiwalla
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David L McArthur
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Martin M Monti
- Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - David A Hovda
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul M Vespa
- Dept. of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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42
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Cheng L, Cortese D, Monti MM, Wang F, Riganello F, Arcuri F, Di H, Schnakers C. Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery? Front Neurol 2018; 9:826. [PMID: 30333789 PMCID: PMC6176776 DOI: 10.3389/fneur.2018.00826] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state-VS and minimally conscious state-MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions.
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Affiliation(s)
- Lijuan Cheng
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Daniela Cortese
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Fuyan Wang
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | | | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Haibo Di
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
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43
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Chiang JN, Rosenberg MH, Bufford CA, Stephens D, Lysy A, Monti MM. The language of music: Common neural codes for structured sequences in music and natural language. Brain Lang 2018; 185:30-37. [PMID: 30086421 DOI: 10.1016/j.bandl.2018.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 07/04/2018] [Accepted: 07/15/2018] [Indexed: 06/08/2023]
Abstract
The ability to process structured sequences is a central feature of natural language but also characterizes many other domains of human cognition. In this fMRI study, we measured brain metabolic response in musicians as they generated structured and non-structured sequences in language and music. We employed a univariate and multivariate cross-classification approach to provide evidence that a common neural code underlies the production of structured sequences across the two domains. Crucially, the common substrate includes Broca's area, a region well known for processing structured sequences in language. These findings have several implications. First, they directly support the hypothesis that language and music share syntactic integration mechanisms. Second, they show that Broca's area is capable of operating supramodally across these two domains. Finally, these results dismiss the recent hypothesis that domain general processes of neighboring neural substrates explain the previously observed "overlap" between neuroimaging activations across the two domains.
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Affiliation(s)
- Jeffrey N Chiang
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew H Rosenberg
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Carolyn A Bufford
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel Stephens
- Department of Music, UCLA Herb Alpert School of Music, University of California Los Angeles, Los Angeles, CA, USA
| | - Antonio Lysy
- Department of Music, UCLA Herb Alpert School of Music, University of California Los Angeles, Los Angeles, CA, USA
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
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44
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Dell'Italia J, Johnson MA, Vespa PM, Monti MM. Network Analysis in Disorders of Consciousness: Four Problems and One Proposed Solution (Exponential Random Graph Models). Front Neurol 2018; 9:439. [PMID: 29946293 PMCID: PMC6005847 DOI: 10.3389/fneur.2018.00439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/12/2018] [Accepted: 05/24/2018] [Indexed: 12/24/2022] Open
Abstract
In recent years, the study of the neural basis of consciousness, particularly in the context of patients recovering from severe brain injury, has greatly benefited from the application of sophisticated network analysis techniques to functional brain data. Yet, current graph theoretic approaches, as employed in the neuroimaging literature, suffer from four important shortcomings. First, they require arbitrary fixing of the number of connections (i.e., density) across networks which are likely to have different "natural" (i.e., stable) density (e.g., patients vs. controls, vegetative state vs. minimally conscious state patients). Second, when describing networks, they do not control for the fact that many characteristics are interrelated, particularly some of the most popular metrics employed (e.g., nodal degree, clustering coefficient)-which can lead to spurious results. Third, in the clinical domain of disorders of consciousness, there currently are no methods for incorporating structural connectivity in the characterization of functional networks which clouds the interpretation of functional differences across groups with different underlying pathology as well as in longitudinal approaches where structural reorganization processes might be operating. Finally, current methods do not allow assessing the dynamics of network change over time. We present a different framework for network analysis, based on Exponential Random Graph Models, which overcomes the above limitations and is thus particularly well suited for clinical populations with disorders of consciousness. We demonstrate this approach in the context of the longitudinal study of recovery from coma. First, our data show that throughout recovery from coma, brain graphs vary in their natural level of connectivity (from 10.4 to 14.5%), which conflicts with the standard approach of imposing arbitrary and equal density thresholds across networks (e.g., time-points, subjects, groups). Second, we show that failure to consider the interrelation between network measures does lead to spurious characterization of both inter- and intra-regional brain connectivity. Finally, we show that Separable Temporal ERGM can be employed to describe network dynamics over time revealing the specific pattern of formation and dissolution of connectivity that accompany recovery from coma.
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Affiliation(s)
- John Dell'Italia
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Micah A. Johnson
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M. Vespa
- Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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45
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Tashjian SM, Goldenberg D, Monti MM, Galván A. Sleep quality and adolescent default mode network connectivity. Soc Cogn Affect Neurosci 2018; 13:290-299. [PMID: 29432569 PMCID: PMC5836271 DOI: 10.1093/scan/nsy009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
Sleep suffers during adolescence and is related to academic, emotional and social behaviors. How this normative change relates to ongoing brain development remains unresolved. The default mode network (DMN), a large-scale brain network important for complex cognition and socioemotional processing, undergoes intra-network integration and inter-network segregation during adolescence. Using resting state functional connectivity and actigraphy over 14 days, we examined correlates of naturalistic individual differences in sleep duration and quality in the DMN at rest in 45 human adolescents (ages 14-18). Variation in sleep quality, but not duration, was related to weaker intrinsic DMN connectivity, such that those with worse quality sleep evinced weaker intra-network connectivity at rest. These novel findings suggest sleep quality, a relatively unexplored sleep index, is related to adolescent brain function in a network that contributes to behavioral maturation and undergoes development during adolescence.
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Affiliation(s)
- Sarah M Tashjian
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Diane Goldenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Adriana Galván
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
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46
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Coetzee JP, Monti MM. At the core of reasoning: Dissociating deductive and non-deductive load. Hum Brain Mapp 2018; 39:1850-1861. [PMID: 29341386 DOI: 10.1002/hbm.23979] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022] Open
Abstract
In recent years, neuroimaging methods have been used to investigate how the human mind carries out deductive reasoning. According to some, the neural substrate of language is integral to deductive reasoning. According to others, deductive reasoning is supported by a language-independent distributed network including left frontopolar and frontomedial cortices. However, it has been suggested that activity in these frontal regions might instead reflect non-deductive factors such as working memory load and general cognitive difficulty. To address this issue, 20 healthy volunteers participated in an fMRI experiment in which they evaluated matched simple and complex deductive and non-deductive arguments in a 2 × 2 design. The contrast of complex versus simple deductive trials resulted in a pattern of activation closely matching previous work, including frontopolar and frontomedial "core" areas of deduction as well as other "cognitive support" areas in frontoparietal cortices. Conversely, the contrast of complex and simple non-deductive trials resulted in a pattern of activation that does not include any of the aforementioned "core" areas. Direct comparison of the load effect across deductive and non-deductive trials further supports the view that activity in the regions previously interpreted as "core" to deductive reasoning cannot merely reflect non-deductive load, but instead might reflect processes specific to the deductive calculus. Finally, consistent with previous reports, the classical language areas in left inferior frontal gyrus and posterior temporal cortex do not appear to participate in deductive inference beyond their role in encoding stimuli presented in linguistic format.
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Affiliation(s)
- John P Coetzee
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California.,Brain Injury Research Center (BIRC), Department of Neurosurgery, Geffen School of Medicine at UCLA, Los Angeles, California
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47
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Crone JS, Bio BJ, Vespa PM, Lutkenhoff ES, Monti MM. Restoration of thalamo-cortical connectivity after brain injury: recovery of consciousness, complex behavior, or passage of time? J Neurosci Res 2017; 96:671-687. [DOI: 10.1002/jnr.24115] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/12/2017] [Accepted: 06/19/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Julia S. Crone
- Department of Psychology; University of California Los Angeles; Los Angeles CA 90095 USA
| | - Branden J. Bio
- Department of Psychology; University of California Los Angeles; Los Angeles CA 90095 USA
- Department of Psychology; Princeton University; Princeton NJ 08540 USA
| | - Paul M. Vespa
- Brain Injury Research Center (BIRC); Department of Neurosurgery, Geffen School of Medicine at UCLA; Los Angeles CA 90095 USA
- Department of Neurology; Geffen School of Medicine at UCLA; Los Angeles CA 90095 USA
| | - Evan S. Lutkenhoff
- Department of Psychology; University of California Los Angeles; Los Angeles CA 90095 USA
| | - Martin M. Monti
- Department of Psychology; University of California Los Angeles; Los Angeles CA 90095 USA
- Brain Injury Research Center (BIRC); Department of Neurosurgery, Geffen School of Medicine at UCLA; Los Angeles CA 90095 USA
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48
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DeWolf M, Chiang JN, Bassok M, Holyoak KJ, Monti MM. Neural representations of magnitude for natural and rational numbers. Neuroimage 2016; 141:304-312. [DOI: 10.1016/j.neuroimage.2016.07.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022] Open
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49
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Zheng ZS, Reggente N, Lutkenhoff E, Owen AM, Monti MM. Disentangling disorders of consciousness: Insights from diffusion tensor imaging and machine learning. Hum Brain Mapp 2016; 38:431-443. [PMID: 27622575 DOI: 10.1002/hbm.23370] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/27/2016] [Accepted: 08/25/2016] [Indexed: 11/07/2022] Open
Abstract
Previous studies have suggested that disorders of consciousness (DOC) after severe brain injury may result from disconnections of the thalamo-cortical system. However, thalamo-cortical connectivity differences between vegetative state (VS), minimally conscious state minus (MCS-, i.e., low-level behavior such as visual pursuit), and minimally conscious state plus (MCS+, i.e., high-level behavior such as language processing) remain unclear. Probabilistic tractography in a sample of 25 DOC patients was employed to assess whether structural connectivity in various thalamo-cortical circuits could differentiate between VS, MCS-, and MCS+ patients. First, the thalamus was individually segmented into seven clusters based on patterns of cortical connectivity and tested for univariate differences across groups. Second, reconstructed whole-brain thalamic tracks were used as features in a multivariate searchlight analysis to identify regions along the tracks that were most informative in distinguishing among groups. At the univariate level, it was found that VS patients displayed reduced connectivity in most thalamo-cortical circuits of interest, including frontal, temporal, and sensorimotor connections, as compared with MCS+, but showed more pulvinar-occipital connections when compared with MCS-. Moreover, MCS- exhibited significantly less thalamo-premotor and thalamo-temporal connectivity than MCS+. At the multivariate level, it was found that thalamic tracks reaching frontal, parietal, and sensorimotor regions, could discriminate, up to 100% accuracy, across each pairwise group comparison. Together, these findings highlight the role of thalamo-cortical connections in patients' behavioral profile and level of consciousness. Diffusion tensor imaging combined with machine learning algorithms could thus potentially facilitate diagnostic distinctions in DOC and shed light on the neural correlates of consciousness. Hum Brain Mapp 38:431-443, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zhong S Zheng
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Nicco Reggente
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Evan Lutkenhoff
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Adrian M Owen
- The Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, California.,Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
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50
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Monti MM, Schnakers C, Korb AS, Bystritsky A, Vespa PM. Non-Invasive Ultrasonic Thalamic Stimulation in Disorders of Consciousness after Severe Brain Injury: A First-in-Man Report. Brain Stimul 2016; 9:940-941. [PMID: 27567470 DOI: 10.1016/j.brs.2016.07.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA; Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA.
| | - Caroline Schnakers
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alexander S Korb
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
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