Prolonged Postconcussive Symptoms

Quinn, Davin K.; Mayer, Andrew R.; Master, Christina L.; Fann, Jesse R.

doi:10.1176/appi.ajp.2017.17020235

Cited by 68 publications

(45 citation statements)

References 96 publications

(110 reference statements)

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“…However, both of those exclusion criteria have been shown to represent potential risk factors for prolonged recovery. 50 A longstanding debate exists in the TBI literature on whether brain injury results in greater deficits (early vulnerability) or better recovery (early plasticity) as a function of ageat-injury. 51 Although chronological age accounted for significant decreases/increases in both ReHo and fALFF across several cortical, subcortical, and cerebellar regions, no significant ageat-injury interactions were observed with either ReHo or fALFF data in relationship to diagnostic status.…”

Section: Discussionmentioning

confidence: 99%

Resting‐State Power and Regional Connectivity After Pediatric Mild Traumatic Brain Injury

Stephenson

Meier

Reddy

et al. 2020

Magnetic Resonance Imaging

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Background: Physiological recovery from pediatric mild traumatic brain injury (pmTBI) as a function of age remains actively debated, with the majority of studies relying on subjective symptom report rather than objective markers of brain physiology. Purpose: To examine potential abnormalities in fractional amplitude of low-frequency fluctuations (fALFF) or regional homogeniety (ReHo) during resting-state fMRI following pmTBI. Study Type: Prospective cohort. Population: Consecutively recruited pmTBI (N = 105; 8-18 years old) and age-and sex-matched healthy controls (HC; N = 113). Field Strength/Sequence: 3T multiecho gradient T 1-weighted and single-shot gradient-echo echo-planar imaging. Assessment: All pmTBI participants were assessed 1 week and 4 months postinjury (HC assessed at equivalent timepoints after the first visit). Comprehensive demographic, clinical, and cognitive batteries were performed in addition to primary investigation of fALFF and ReHo. All pmTBI were classified as "persistent" or "recovered" based on both assessment periods. Statistical Tests: Chi-square, nonparametric, and generalized linear models for demographic data. Generalized estimating equations for clinical and cognitive data. Voxelwise general linear models (AFNI's 3dMVM) for fALFF and ReHo assessment. Results: Evidence of recovery was observed for some, but not all, clinical and cognitive measures at 4 months postinjury. fALFF was increased in the left striatum for pmTBI relative to HC both at 1 week and 4 months postinjury; whereas no significant group differences (P > 0.001) were observed for ReHo. Age-at-injury did not moderate either resting-state metric across groups. In contrast to analyses of pmTBI as a whole, there were no significant (P > 0.001) differences in either fALFF or ReHo in patients with persistent postconcussive symptoms compared to recovered patients and controls at 4 months postinjury. Data Conclusions: Our findings suggest prolonged clinical recovery and alterations in the relative amplitude of restingstate fluctuations up to 4 months postinjury, but no clear relationship with age-at-injury or subjective symptom report. Level of Evidence: 1 Technical Efficacy: 2

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Section: Discussionmentioning

confidence: 99%

Resting‐State Power and Regional Connectivity After Pediatric Mild Traumatic Brain Injury

Stephenson

Meier

Reddy

et al. 2020

Magnetic Resonance Imaging

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“…Subjects qualified for enrollment in the study if they met the following inclusion criteria: (1) age 18-59; (2) have suffered a mild or moderate TBI ["mild" defined as having had loss of consciousness (LOC) <30 min, received a Glasgow coma scale (GCS) score of between 13 and 15 upon ED evaluation (if available), and experienced <24 h of post-traumatic amnesia (PTA); moderate defined as LOC between 30 min and 24 h, GCS between 9 and 12, and PTA between 24 h and 7 days]; (3) were injured between 3 months and 15 years ago; (4) report at least 1 out of 4 cognitive symptoms on the Neurobehavioral Symptom Inventory (NSI). Potential participants were excluded from participation in this study for: (1) a history of other neurological disease, seizures, or psychosis; (2) history of recent (within 2 years) substance/alcohol dependence; (3) any discontinuity in skull electrical conductivity; (4) any implanted electrical device (e.g., pacemaker); (5) medical admission or hospital visit within the last 3 weeks; (6) change in any psychotropic medications in the previous 2 months; (7) inability to complete the protocol; (8) appointment of a legal representative, as assessed via direct inquiry of the subject or a designated trusted other; (10) inability to provide informed consent; (11) pregnancy, current incarceration, or limited English proficiency.…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…Historically these were thought to be due to poor coping with stress, or malingering (4,5). However, advanced imaging has contributed significantly to our current understanding of the acute and chronic sequelae of mTBI, and expanded the possible etiologies of PPS to not only include psychological phenomena but also neurological factors (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Cerebral Perfusion Effects of Cognitive Training and Transcranial Direct Current Stimulation in Mild-Moderate TBI

et al. 2020

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Background: Persistent post-traumatic symptoms (PPS) after traumatic brain injury (TBI) can lead to significant chronic functional impairment. Pseudocontinuous arterial spin labeling (pCASL) has been used in multiple studies to explore changes in cerebral blood flow (CBF) that may result in acute and chronic TBI, and is a promising neuroimaging modality for assessing response to therapies. Methods: Twenty-four subjects with chronic mild-moderate TBI (mmTBI) were enrolled in a pilot study of 10 days of computerized executive function training combined with active or sham anodal transcranial direct current stimulation (tDCS) for treatment of cognitive PPS. Behavioral surveys, neuropsychological testing, and magnetic resonance imaging (MRI) with pCASL sequences to assess global and regional CBF were obtained before and after the training protocol. Results: Robust improvements in depression, anxiety, complex attention, and executive function were seen in both active and sham groups between the baseline and post-treatment visits. Global CBF decreased over time, with differences in regional CBF noted in the right inferior frontal gyrus (IFG). Active stimulation was associated with static or increased CBF in the right IFG, whereas sham was associated with reduced CBF. Neuropsychological performance and behavioral symptoms were not associated with changes in CBF. Discussion: The current study suggests a complex picture between mmTBI, cerebral perfusion, and recovery. Changes in CBF may result from physiologic effect of the intervention, compensatory neural mechanisms, or confounding factors. Limitations include a small sample size and heterogenous injury sample, but these findings suggest promising directions for future studies of cognitive training paradigms in mmTBI.

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“…However, the Glasgow Outcome Scale Extended is widely used internationally for studying outcome after mTBI, and for the development of prediction models (Nelson et al, ; van der Naalt et al, ). Other outcome measures such as (persistent) posttraumatic symptoms have proven less reliable, because patients with symptoms may still resume their daily activities, symptoms are only partly specific for mTBI, and definitions of persistent symptoms vary (de Koning et al, ; Quinn, Mayer, Master, & Fann, ; Voormolen et al, ).…”

Section: Discussionmentioning

confidence: 99%

Functional outcome is tied to dynamic brain states after mild to moderate traumatic brain injury

Horn

Vergara

Espinoza

et al. 2019

Human Brain Mapping

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The current study set out to investigate the dynamic functional connectome in relation to long-term recovery after mild to moderate traumatic brain injury (TBI). Longitudinal resting-state functional MRI data were collected (at 1 and 3 months postinjury) from a prospectively enrolled cohort consisting of 68 patients with TBI (92% mild TBI) and 20 healthy subjects. Patients underwent a neuropsychological assessment at 3 months postinjury. Outcome was measured using the Glasgow Outcome Scale Extended (GOS-E) at 6 months postinjury. The 57 patients who completed the GOS-E were classified as recovered completely (GOS-E = 8; n = 37) or incompletely (GOS-E < 8; n = 20). Neuropsychological test scores were similar for all groups. Patients with incomplete recovery spent less time in a segregated brain state compared to recovered patients during the second visit. Also, these patients moved less frequently from one meta-state to another as compared to healthy controls and recovered patients. Furthermore, incomplete recovery was associated with disruptions in cyclic state transition patterns, called attractors, during both visits. This study demonstrates that poor long-term functional recovery is associated with alterations in dynamics between brain networks, which becomes more marked as a function of time. These results could be related to psychological processes rather than injury-effects, which is an interesting area for further work.Another natural progression of the current study is to examine whether these dynamic measures can be used to monitor treatment effects. K E Y W O R D S brain dynamics, fMRI, functional connectivity, mild traumatic brain injury, networks, outcome, recovery

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Prolonged Postconcussive Symptoms

Cited by 68 publications

References 96 publications

Resting‐State Power and Regional Connectivity After Pediatric Mild Traumatic Brain Injury

Resting‐State Power and Regional Connectivity After Pediatric Mild Traumatic Brain Injury

Cerebral Perfusion Effects of Cognitive Training and Transcranial Direct Current Stimulation in Mild-Moderate TBI

Functional outcome is tied to dynamic brain states after mild to moderate traumatic brain injury

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