Examining Microstructural White Matter Differences between Children with Typical and Those with Delayed Recovery Two Weeks Post-Concussion

Abstract

Delayed recovery from concussion can dramatically affect a child's social, emotional, and educational development, yet little is known about what causes some children to recover faster than others. The contribution of white matter disruption in children with delayed recovery has been hypothesized, but findings are limited by methodological issues such as: small heterogeneous samples, bias toward children with delayed recovery, and inconsistencies in timing of brain imaging, both within and between studies. The aim of the present study was to assess diffusion neuroimaging correlates of delayed recovery post-concussion in children. A prospective, longitudinal, observational cohort study was conducted at a statewide tertiary pediatric hospital. Forty-three children who presented to the emergency department (ED) with concussion (defined according to the Zurich/Berlin Consensus Statement on Concussion in Sport) underwent magnetic resonance imaging (MRI) at a 2 weeks post-injury and were classified as either normally recovering (n = 26) or delayed recovering (n = 17). Diffusion imaging comparison using voxelwise tract-based spatial statistics (TBSS) analysis found no difference between the groups in fractional anisotropy, axial diffusion, radial diffusion, or mean diffusivity metrics ( p > 0.05 threshold-free cluster enhancement [TFCE] corrected). Post-hoc tract-based Bayesian analysis found evidence for the null in 11 unique white matter tracts (Bayes factor >3). These findings indicate that delayed recovery from post-concussive symptoms in children is unlikely to be caused by white matter microstructural damage.

Examining post-concussion white matter change in a pediatric sample

“…These results are consistent with our previous work which did not show a difference between normally-recovering children and children with delayed recovery from concussion using a diffusion model ( Shapiro et al, 2020 , 2021). In addition, in their longitudinal study, King and colleagues did not find a difference between symptomatic and non-symptomatic children in terms of their region of interest diffusion tractography analyses of their corpus callosum, uncinate fasciculi, and corticospinal tracts ( King et al, 2019 ).…”

“…This includes the diagnosis of concussion (i.e., differentiating between concussed and non-concussed), monitoring recovery from concussion (i.e., improvement over time), predicting slow or poor recovery, and identifying long-term structural injury ( Rausa et al, 2020 ). However, currently, DWI findings in pediatric concussion are mixed, with some identifying significant increases in DWI metrics (i.e., FA) relative to controls ( Babcock et al, 2015 , Bartnik-Olson et al, 2014 , Manning et al, 2017 , Mayer et al, 2015 , Van Beek et al, 2015 , Wilde et al, 2008 , Yallampalli et al, 2013 ), some finding a decrease in DWI metrics ( King et al, 2019 , Lancaster et al, 2016 , MacDonald and Duerson, 2015 ) and others reporting no changes ( Maugans et al, 2012 , Shapiro et al, 2020 ). Previously, our research group utilized diffusion imaging and voxelwise tract-based spatial statistics (TBSS) to assess diffusion neuroimaging correlates of delayed recovery post-concussion in children ( Shapiro et al, 2020 ).…”

“…However, currently, DWI findings in pediatric concussion are mixed, with some identifying significant increases in DWI metrics (i.e., FA) relative to controls ( Babcock et al, 2015 , Bartnik-Olson et al, 2014 , Manning et al, 2017 , Mayer et al, 2015 , Van Beek et al, 2015 , Wilde et al, 2008 , Yallampalli et al, 2013 ), some finding a decrease in DWI metrics ( King et al, 2019 , Lancaster et al, 2016 , MacDonald and Duerson, 2015 ) and others reporting no changes ( Maugans et al, 2012 , Shapiro et al, 2020 ). Previously, our research group utilized diffusion imaging and voxelwise tract-based spatial statistics (TBSS) to assess diffusion neuroimaging correlates of delayed recovery post-concussion in children ( Shapiro et al, 2020 ). Forty-three children underwent magnetic resonance imaging (MRI) at 2 weeks post-injury and were classified (based on parent and child reported symptoms) as either normally recovering ( n = 26) or delayed recovering ( n = 17).…”

Injury Biomechanics of a Child’s Head: Problems, Challenges and Possibilities with a New aHEAD Finite Element Model

“…TBI can cause a serious burden to a child's life and even in cases of good recovery, long-lasting behavioural problems after paediatric TBI can be found in up to 33% of the survivors [3,10,11]. It is not always evident if these long-lasting posttraumatic changes are related to brain contusions or rather microinjuries to white matter structure [12,13]. TBI also comes with higher treatment costs than any other kind of trauma, and typically requires a longer time of treatment and rehabilitation.…”