Traumatic Brain Injury Results in Altered Physiologic, But Not Subjective, Responses to Emotional Stimuli

Amorapanth, Prin; Raghavan, Preeti; Aluru, Viswanath; Lu, Ying; Cox, Sarah; Tang, Alvin; Bilaloglu, Seda

doi:10.1016/j.apmr.2016.09.081

Cited by 2 publications

(11 citation statements)

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“…In the acute setting, autonomic dysfunction presenting as paroxysmal sympathetic hyperactivity is well documented after msTBI, and also has been repeatedly shown to correlate with worse mid-long term functional outcomes 7 . There is some suggestion, from studies assessing heart rate variability in small groups of TBI patients, that cardiovascular autonomic dysfunction persists in chronic TBI, and can manifest as clinically relevant symptoms [2][3][4] . Our retrospective cohort presented with mild autonomic cardiovascular dysfunction within the spectrum of intermittent autonomic dysfunction, and in particular either new onset vasovagal syncope or postural tachycardia syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these symptoms are suggestive of autonomic nervous system dysfunction 12 . Changes in heart rate variability, an experimentally used measure of cardiovascular autonomic nervous system (ANS) function, has been found in a number of studies of concussion and mild TBI, with one study reporting a positive correlation between TBI severity and degree of both sympathetic parasympathetic impairment [3][4][5][6] . Paroxysmal sympathetic hyperactivity, manifesting as episodic surges in heart rate and blood pressure, temperature, sweating, respiratory rate, sometimes associated with abnormal posturing, mostly frequently observed in acute cases of severe TBI, is thought to represent autonomic dysfunction and relates to worse clinical outcomes 7 .…”

Section: Introductionmentioning

confidence: 99%

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Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

Vichayanrat

Giovane

et al. 2021

Preprint

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Background and Objective: Survivors of moderate-severe traumatic brain injury (msTBI) frequently experience chronic, debilitating somatic symptoms, which are largely unexplained. The phenomenon of paroxysmal sympathetic hyperactivity, reflecting hyperacute autonomic dysfunction, is well-documented after msTBI. Limited animal and human studies, using experimental measures, have found evidence for autonomic dysfunction after msTBI. However, no studies have investigated the range and type of autonomic symptoms and autonomic dysfunction existing in msTBI. We set out to investigate the presence and type of subjective and objective autonomic dysfunction in msTBI. Methods: We conducted two cohort studies. Cohort 1 comprises msTBI patients prospectively recruited from a regional TBI outpatient clinic, in whom we assessed burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) autonomic symptom questionnaire. Cohort 2 comprises msTBI patients who had standard clinical autonomic function testing (supine/tilted catecholamine levels, head-up tilt, Valsalva manoeuvre, respiratory sinus arrhythmia assessment), retrospectively identified from the database of a regional clinical autonomic unit. Results: Cohort 1 comprises 29 msTBI patients (6 females, median age 40 years, range 19-76), with a median time since injury of 19 months (range 4-105). There was multi-domain symptom burden, with all but 3 patients reporting symptoms on the COMPASS31 questionnaire, and 17/29 reporting symptoms in 3+ domains. The most commonly reported symptoms were gastrointestinal (22/29), followed by orthostatic (17/19), pupillomotor (14/29), secretomotor (14/29), bladder (12/29) and, least commonly, vasomotor (6/29). Cohort 2 comprises 19 msTBI patients (7 females, median age 44 years, range 21-64), with a median time between injury and testing of 65 months (range: 2-416). The majority of patients (16/19) had orthostatic symptoms as part of the reason for referral. Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction: 4/19 had evidence of sympathetic dysfunction, 10/19 had evidence of parasympathetic dysfunction, of which 6 had evidence of mixed dysfunction. Discussion: Our results provide evidence for clinically relevant autonomic dysfunction after moderate-severe TBI, even at the chronic stage. Our study advocates for routine enquiry about potential autonomic symptoms in this population, and the utility of formal clinical autonomic testing in providing diagnoses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

Vichayanrat

Giovane

et al. 2021

Preprint

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“…The patient sample included 290 men (74.17%) and 101 women (25.83%), and the control sample included 285 men (6.13%) and 146 Concerning the injury severity, 15 studies included only moderate to severe TBI (Soussignan et al, 2005;Saunders et al, 2006;de Sousa et al, 2010de Sousa et al, , 2011de Sousa et al, , 2012Krpan et al, 2011;McDonald et al, 2011;Williams and Wood, 2012;Rushby et al, 2013aRushby et al, , 2013bRushby et al, , 2016Fisher et al, 2015;Francis et al, 2016;Kelly et al, 2017;Osborne-Crowley et al, 2020), one study included mild to severe TBI (Aboulafia-Brakha et al, 2016). Sánchez-Navarro et al (2005) included patients with frontal brain damage, and Amorapanth et al (2016) included patients with TBI with cognitive or emotional disorders, but these two studies did not specify the severity of brain injuries. Finally, the mean time post-injury was 10.42 years, the shortest post-injury period was 3 months (Aboulafia-Brakha et al, 2016) and the longest was 40 years (de Sousa et al, 2012).…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…The most commonly used measure was EDA in 14 studies (Soussignan et al, 2005;de Sousa et al, 2010de Sousa et al, , 2011de Sousa et al, , 2012Krpan et al, 2011;McDonald et al, 2011;Rushby et al, 2013aRushby et al, , 2013bRushby et al, , 2016Fisher et al, 2015;Aboulafia-Brakha et al, 2016;Kelly et al, 2017;Osborne-Crowley et al, 2020), followed by cardiac activity in 7 studies (Sánchez-Navarro et al, 2005;Soussignan et al, 2005;Krpan et al, 2011;McDonald et al, 2011;Rushby et al, 2013b;Amorapanth et al, 2016;Francis et al, 2016), and facial EMG in 8 studies (Sánchez-Navarro et al, 2005;Soussignan et al, 2005;Saunders et al, 2006;de Sousa et al, 2010de Sousa et al, , 2011de Sousa et al, , 2012Williams and Wood, 2012;Rushby et al, 2013b). Krpan et al (2011) measured cortisol levels, and Amorapanth et al (2016) recorded the respiratory rate. As this respiratory measurement is used in combination with cardiac data to calculate the respiratory sinus arrhythmia (RSA), the last study will be discussed in Section 3.…”

Section: Physiological Measuresmentioning

confidence: 99%

“…Three studies were extracted from famous movies (de Sousa et al, 2012;Rushby et al, 2013b;Amorapanth et al, 2016), two asked participants to report an event (Aboulafia-Brakha et al, 2016;Osborne-Crowley et al, 2020), two simulated social stress situations (Krpan et al, 2011;Kelly et al, 2017), three contained acoustic startle probes (Sánchez-Navarro et al, 2005;Saunders et al, 2006;Williams and Wood, 2012), and one used odor (Soussignan et al, 2005). Five studies included different types of stimuli (Sánchez-Navarro et al, 2005;Soussignan et al, 2005;Saunders et al, 2006;Williams and Wood, 2012;Aboulafia-Brakha et al, 2016), whereas the remaining studies included only one type of stimulus (de Sousa et al, 2010(de Sousa et al, , 2011(de Sousa et al, , 2012Krpan et al, 2011;McDonald et al, 2011;Rushby et al, 2013aRushby et al, , 2013bRushby et al, , 2016Fisher et al, 2015;Amorapanth et al, 2016;Francis et al, 2016;Kelly et al, 2017;Osborne-Crowley et al, 2020). Finally, three studies used measures at rest as the main measure (Rushby et al, 2013a(Rushby et al, , 2016Francis et al, 2016) and seven others reported physiological data during the baseline (Sánchez-Navarro et al, 2005;Krpan et al, 2011;McDonald et al, 2011;Rushby et al, 2013b;Fisher et al, 2015;…”

Section: Stimulimentioning

confidence: 99%

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Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review

Bodart

Invernizzi²,

Lefèbvre³

et al. 2023

Front. Psychol.

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Numerous studies have shown that alterations in physiological reactivity (PR) after traumatic brain injury (TBI) are possibly associated with emotional deficits. We conducted a systematic review of these studies that evaluated PR in adults with moderate-to-severe TBI, either at rest or in response to emotional, stressful, or social stimuli. We focused on the most common measures of physiological response, including heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), salivary cortisol, facial electromyography (EMG), and blink reflex.MethodsA systematic literature search was conducted across six databases (PsycINFO, Psycarticles, SciencDirect, Cochrane Library, PubMed, and Scopus). The search returned 286 articles and 18 studies met the inclusion criteria.ResultsDiscrepancies were observed according to the type of physiological measure. Reduced physiological responses in patients with TBI have been reported in most EDA studies, which were also overrepresented in the review. In terms of facial EMG, patients with TBI appear to exhibit reduced activity of the corrugator muscle and diminished blink reflex, while in most studies, zygomaticus contraction did not show significant differences between TBI and controls. Interestingly, most studies measuring cardiac activity did not find significant differences between TBI and controls. Finally, one study measured salivary cortisol levels and reported no difference between patients with TBI and controls.ConclusionAlthough disturbed EDA responses were frequently reported in patients with TBI, other measures did not consistently indicate an impairment in PR. These discrepancies could be due to the lesion pattern resulting from TBI, which could affect the PR to aversive stimuli. In addition, methodological differences concerning the measurements and their standardization as well as the characteristics of the patients may also be involved in these discrepancies. We propose methodological recommendations for the use of multiple and simultaneous PR measurements and standardization. Future research should converge toward a common methodology in terms of physiological data analysis to improve inter-study comparisons.

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Traumatic Brain Injury Results in Altered Physiologic, But Not Subjective, Responses to Emotional Stimuli

Cited by 2 publications

References 0 publications

Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review

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