Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome

Sterr, Annette; Herron, Katherine; Hayward, Chantal; Montaldi, Daniela

doi:10.1186/1471-2377-6-7

Cited by 164 publications

(127 citation statements)

References 51 publications

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“…Results of this study were consistent with the previous neuropsychological studies and the integrated neuropsychological and imaging approach utilized in the Lewine and colleagues study. [14][15][16]28 These results support our hypotheses that neuropsychological differences would be found between a group with lasting PCS post-mTBI and that significant correlations would be found between neuropsychological measures that display significance between the two groups and MEG slowwave activity relational to specific neural coordinates associated with the neuropsychological measures utilized.…”

Section: Discussionsupporting

confidence: 77%

“…Various studies that included neuropsychological testing have reported reduced cognitive efficiency, especially on tests measuring executive functioning, processing speed, attention, and memory in patients with mTBI and persistent PCS. [14][15][16] However, others have suggested that the observed impairments on neuropsychological tests are of insufficient severity to be clinically significant. 17,18 In addition, controversy exists as to whether the persistent symptoms and cognitive impairments reported in some studies are evidence of residual neuropathological effects of the injury or are owing to motivational issues (i.e., secondary gain) or psychological factors.…”

mentioning

confidence: 99%

“…Results of this study were consistent with findings from a number of previous studies of mTBI and support our hypothesis that mTBI can contribute to persistent PCS and that subtle neurophysiological changes observed using MEG may provide a biological marker to improve diagnostic accuracy of mTBI. [14][15][16]28 Finally, these results could be used to develop evidence-based treatment guidelines to address the subtle functional declines that occur in some individuals after a single uncomplicated mTBI. Future studies will need to include subjects with mTBI without PCS in order to further understand the effects of abnormal slow-wave activity on MEG.…”

mentioning

confidence: 99%

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Magnetoencephalography Slow-Wave Detection in Patients with Mild Traumatic Brain Injury and Ongoing Symptoms Correlated with Long-Term Neuropsychological Outcome

Swan

Nichols

Drake

et al. 2015

Journal of Neurotrauma

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Mild traumatic brain injury (mTBI) is common in the United States, accounting for as many as 75-80% of all TBIs. It is recognized as a significant public health concern, but there are ongoing controversies regarding the etiology of persistent symptoms post-mTBI. This constellation of nonspecific symptoms is referred to as postconcussive syndrome (PCS). The present study combined results from magnetoencephalography (MEG) and cognitive assessment to examine group differences and relationships between brain activity and cognitive performance in 31 military and civilian individuals with a history of mTBI + PCS and 33 matched healthy control subjects. An operator-free analysis was used for MEG data to increase reliability of the technique. Subjects completed a comprehensive neuropsychological assessment, and measures of abnormal slow-wave activity from MEG were collected. Results demonstrated significant group differences on measures of executive functioning and processing speed. In addition, significant correlations between slow-wave activity on MEG and patterns of cognitive functioning were found in cortical areas, consistent with cognitive impairments on exams. Results provide more objective evidence that there may be subtle changes to the neurobiological integrity of the brain that can be detected by MEG. Further, these findings suggest that these abnormalities are associated with cognitive outcomes and may account, at least in part, for long-term PCS in those who have sustained an mTBI.

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Section: Discussionsupporting

confidence: 77%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Magnetoencephalography Slow-Wave Detection in Patients with Mild Traumatic Brain Injury and Ongoing Symptoms Correlated with Long-Term Neuropsychological Outcome

Swan

Nichols

Drake

et al. 2015

Journal of Neurotrauma

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“…Concussions are not typically associated with gross gray matter damage, 39,40 but have recently been shown to cause diffused axonal injury as detected by DTI. For example, mild TBI patients have reduced FA values in both the genu and splenium of the corpus callosum, the internal and external capsule, the left superior cerebellar peduncle, the cingulum, the hippocampus, the thalamus, the dorsolateral prefrontal cortex, and other brain regions.…”

Section: Discussionmentioning

confidence: 99%

Behavioral and Histopathological Alterations Resulting from Mild Fluid Percussion Injury

Hylin

Orsi

Zhao

et al. 2013

Journal of Neurotrauma

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The majority of people who sustain a traumatic brain injury (TBI) have an injury that can be classified as mild (often referred to as concussion). Although head CT scans for most subjects who have sustained a mild TBI (mTBI) are negative, these persons may still suffer from neurocognitive and neurobehavioral deficits. In order to expedite pre-clinical research and develop therapies, there is a need for well-characterized animal models of mTBI that reflect the neurological, neurocognitive, and pathological changes seen in human patients. In the present study, we examined the motor, cognitive, and histopathological changes resulting from 1.0 and 1.5 atmosphere (atm) overpressure fluid percussion injury (FPI). Both 1.0 and 1.5 atm FPI injury caused transient suppression of acute neurological functions, but did not result in visible brain contusion. Animals injured with 1.0 atm FPI did not show significant motor, vestibulomotor, or learning and memory deficits. In contrast, 1.5 atm injury caused transient motor disturbances, and resulted in a significant impairment of spatial learning and short-term memory. In addition, 1.5 atm FPI caused a marked reduction in cerebral perfusion at the site of injury that lasted for several hours. Consistent with previous studies, 1.5 atm FPI did not cause visible neuronal loss in the hippocampus or in the neocortex. However, a robust inflammatory response (as indicated by enhanced GFAP and Iba1 immunoreactivity) in the corpus callosum and the thalamus was observed. Examination of fractional anisotropy color maps after diffusion tensor imaging (DTI) revealed a significant decrease of FA values in the cingulum, an area found to have increased silver impregnation, suggesting axonal injury. Increased silver impregnation was also observed in the corpus callosum, and internal and external capsules. These findings are consistent with the deficits and pathologies associated with mild TBI in humans, and support the use of mild FPI as a model to evaluate putative therapeutic options.

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“…Plainly, presence of litigation is a major confound in research in mTBI and its presence in research studies has likely obscured the true effects of concussion, including PPCS. Also, whenever analyzing group data, if all subjects with concussion are examined at a particular time period, the effects on individual subjects who may be symptomatic get washed out by the total group effects (Iverson et al, 2006a;Kent, 2007;McHugh et al, 2006;Sterr et al, 2006). This is a very important point, because few studies compare symptomatic versus non-symptomatic subjects who have been concussed and those who do, find those who are symptomatic to have greater neuropsychological impairment (Collie et al, 2006;Iverson et al, 2004;Sterr et al, 2006).…”

Section: Limitations Of Neuropsychological Research To Advance the Fimentioning

confidence: 99%

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Bigler

2007

J Int Neuropsychol Soc

355

242

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On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion. (JINS, 2008, 14, 1-22.)

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Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome

Cited by 164 publications

References 51 publications

Magnetoencephalography Slow-Wave Detection in Patients with Mild Traumatic Brain Injury and Ongoing Symptoms Correlated with Long-Term Neuropsychological Outcome

Magnetoencephalography Slow-Wave Detection in Patients with Mild Traumatic Brain Injury and Ongoing Symptoms Correlated with Long-Term Neuropsychological Outcome

Behavioral and Histopathological Alterations Resulting from Mild Fluid Percussion Injury

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

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