scholarly journals Emotional Modulation of Frontal Alpha Asymmetry - a Novel Biomarker of Mild Traumatic Brain Injury

2021 ◽  
Vol 15 ◽  
Author(s):  
Venla Kuusinen ◽  
Jari Peräkylä ◽  
Lihua Sun ◽  
Keith H. Ogawa ◽  
Kaisa M. Hartikainen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls ◽  
Subjective Symptoms ◽  
Emotional Modulation ◽  
Brain Physiology ◽  
Alpha Asymmetry ◽  
Frontal Alpha Asymmetry ◽  
Frontal Activity

Objective findings of brain injury or dysfunction are typically lacking in mild traumatic brain injury (MTBI) despite prolonged post-concussion symptoms in some patients. Thus, there is a need for objective biomarkers of MTBI that reflect altered brain physiology underlying subjective symptoms. We have previously reported increased attention to threat-related stimuli in subjects with MTBI, suggesting a physiological vulnerability to depression. Vulnerability to depression has been linked with relatively greater activity of the right than left frontal cortex reflected in inverse pattern in frontal alpha with greater power on the left than right. We investigated whether patients with previous MTBI show this pattern of frontal activity reflected in more negative frontal alpha asymmetry (FAA) scores. Furthermore, in search for potential biomarkers of MTBI, we created a novel index, emotional modulation of FAA (eFAA) and investigated whether it correlates with subjective symptoms. EEG was recorded while subjects with previous MTBI and controls performed a computer-based reaction time task integrating different cognitive executive functions and containing either threat-related or emotionally neutral visual stimuli. Post-concussion symptoms and depression were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Beck’s depression inventory (BDI). Task-induced FAA was assessed and eFAA calculated by subtracting FAA in the context of neutral stimuli from FAA in the context of emotional stimuli. The MTBI group showed FAA scores reflecting relatively greater right-sided frontal activity compared to healthy controls. eFAA differentiated the symptomatic MTBI from non-symptomatic MTBI group and from healthy controls. eFAA also correlated with RPQ and BDI scores. In conclusion, FAA pattern previously linked with vulnerability to depression, was observed in patients with previous MTBI. Furthermore, eFAA has potential as a biomarker of altered affective brain functions in MTBI.

Exploring persistent complaints of imbalance after mTBI: Oculomotor, peripheral vestibular and central sensory integration function

2021 ◽  
pp. 1-12
Author(s):  
Kody R. Campbell ◽  
Lucy Parrington ◽  
Robert J. Peterka ◽  
Douglas N. Martini ◽  
Timothy E. Hullar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sensory Integration ◽  
Balance Control ◽  
Vestibular Function ◽  
Healthy Controls ◽  
Subjective Symptoms ◽  
Central Function ◽  
Validated Questionnaires ◽  
Sensory Integration Dysfunction

BACKGROUND: Little is known on the peripheral and central sensory contributions to persistent dizziness and imbalance following mild traumatic brain injury (mTBI). OBJECTIVE: To identify peripheral vestibular, central integrative, and oculomotor causes for chronic symptoms following mTBI. METHODS: Individuals with chronic mTBI symptoms and healthy controls (HC) completed a battery of oculomotor, peripheral vestibular and instrumented posturography evaluations and rated subjective symptoms on validated questionnaires. We defined abnormal oculomotor, peripheral vestibular, and central sensory integration for balance measures among mTBI participants as falling outside a 10-percentile cutoff determined from HC data. A X-squared test associated the proportion of normal and abnormal responses in each group. Partial Spearman’s rank correlations evaluated the relationships between chronic symptoms and measures of oculomotor, peripheral vestibular, and central function for balance control. RESULTS: The mTBI group (n = 58) had more abnormal measures of central sensory integration for balance than the HC (n = 61) group (mTBI: 41% –61%; HC: 10%, p’s <  0.001), but no differences on oculomotor and peripheral vestibular function (p >  0.113). Symptom severities were negatively correlated with central sensory integration for balance scores (p’s <  0.048). CONCLUSIONS: Ongoing balance complaints in people with chronic mTBI are explained more by central sensory integration dysfunction rather than peripheral vestibular or oculomotor dysfunction.

scholarly journals A pilot study exploring pupil response measurement in mild traumatic brain injury

2015 ◽  
Vol 42 (S1) ◽  
pp. S40-S40
Author(s):  
W Ting ◽  
J Topolovec-Vranic ◽  
M McGowan ◽  
MD Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls ◽  
Response Dynamics ◽  
Post Injury ◽  
Response Measurement ◽  
Pupil Response ◽  
Post Traumatic ◽  
Traumatic Symptoms

Background: Pupillometry, the measurement of pupil response dynamics via the pupillary light reflex, is seldom used in the assessment of mild traumatic brain injury (mTBI). We hypothesized that there would be quantifiable differences in detailed pupil response measurements in patients with acute and chronic mTBI. Methods: We conducted 49 bilateral pupillometry measurements, in acute mTBI patients at 1-week (N=11), 2-4w (N=9), and 3-7mo post-injury (N=3); 14 patients with persistent post-traumatic symptoms (PTS) once, and healthy controls across a first visit (N=7) and second visit 2-4w later (N=5). Results: The percentage of left pupil diameter change was significantly greater in the acute mTBI group at second visit (mean=36.3% (2.96)), compared to controls at second visit (mean=31.6% (4.39)) (F=5.87, p=0.0321). We did not identify significant differences between acute mTBI patients and controls at first visit, PTS patients versus controls, and within the acute mTBI group across three longitudinal visits. Conclusion: While these preliminary data suggest that pupillometry under these conditions does not distinguish between patients who had a recent mTBI or those with PTS and healthy controls, further research is warranted investigating pupil behavior and its clinical utility in mTBI.

scholarly journals Validation of a velocity-based algorithm to quantify saccades during walking and turning in mild traumatic brain injury and healthy controls

2019 ◽  
Vol 40 (4) ◽  
pp. 044006 ◽  
Author(s):  
Samuel Stuart ◽  
Lucy Parrington ◽  
Douglas Martini ◽  
Bryana Popa ◽  
Peter C Fino ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls

scholarly journals 0014 Reduced Cortical Thickness as a Biomarker of Daytime Sleepiness in Mild Traumatic Brain Injury

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A5-A6
Author(s):  
N S Dailey ◽  
A C Raikes ◽  
A Alkozei ◽  
M A Grandner ◽  
W D Killgore
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Cortical Thickness ◽  
Daytime Sleepiness ◽  
Healthy Controls ◽  
Inferior Parietal Lobule ◽  
Post Injury ◽  
Attention Network ◽  
Parietal Lobule

Abstract Introduction Sleep disruptions, including the increase of daytime sleepiness, are reported in roughly 70% of all individuals who have suffered a mild traumatic brain injury (mTBI). Prior research using magnetic resonance imaging (MRI) has identified associations between functional brain changes and daytime sleepiness following mTBI. In the present study, we aimed to identify whether structural differences in cortical thickness are associated with increased daytime sleepiness in adults with mTBI. Methods A total of 58 adults between 18 and 45 years of age (M=23.58±5.31) participated in the study, including 19 healthy controls and 39 individuals with a documented mTBI. Individuals with mTBI were further divided based on time-since-injury into a sub-acute (n=22) or chronic (n=17) group. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) and cortical thickness was measured using high-resolution T1-weighted structural MRI. Whole-brain vertex-wise estimations of cortical thickness were calculated using FreeSurfer (v.6.0) and entered into a GLM to identify between-group differences in cortical thickness and the association with ESS. Results Significant differences in cortical thickness were found between the two mTBI groups (cluster-forming threshold p&lt;.01; cluster-wise threshold p&lt;.05; two-tailed; FWE-corrected). Specifically, lower cortical thickness in the left hemisphere was found in the inferior parietal lobule (p=.01), precuneus (p=.03), and pars triangularis (p=.04) for the sub-acute, compared to chronic group. Furthermore, a significant negative correlation was found between ESS and cortical thickness in the inferior parietal lobule (r=-.55, p=.009) for the sub-acute mTBI group. Conclusion More daytime sleepiness was associated with reduced inferior parietal cortical thickness in those 2 to 12-weeks post-injury, an association not observed in those 6 to 12-months post-injury or healthy controls. The inferior parietal lobule is part of the frontoparietal attention network and has been associated with vulnerability to sleep loss. Our findings suggest structural damage to the attention network following mTBI may be one factor affecting daytime sleepiness in mTBI. These findings may reflect a potential biomarker of sleep disturbances in mTBI. Support USAMRMC grant (W81XWH-12–0386).

Early Parosmia Signs and Affective States Predict Depression and Anxiety Symptoms 6 Months After a Mild Traumatic Brain Injury

2020 ◽  
Vol 45 (6) ◽  
pp. 483-490 ◽  
Author(s):  
Fanny Lecuyer Giguere ◽  
Benoit Jobin ◽  
Joëlle Robert ◽  
Laurianne Bastien ◽  
Jean-François Giguère ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Affective State ◽  
Healthy Controls ◽  
Depression And Anxiety ◽  
Affective States ◽  
Symptoms Of Depression ◽  
Olfactory Impairment

Abstract This longitudinal study aimed to evaluate qualitative (parosmia) and quantitative (hyposmia/anosmia) olfaction 2–4 weeks (baseline) and 6 months (follow-up) after a mild traumatic brain injury (mTBI). We further evaluated the predictive value of baseline depression, anxiety, and olfaction scores on depression and anxiety at follow-up. At baseline, olfactory function and affective state were assessed in 107 participants (53 patients with mTBI; 54 healthy controls). At follow-up, data were collected on 71 participants (32 patients and 39 controls). Both at baseline and follow-up, patients with mTBI showed more signs of parosmia, depression, and anxiety compared with controls. However, patients did not, neither at baseline nor follow-up, show quantitative olfactory impairment. Moreover, although baseline scores of depression and anxiety helped predict the development of symptoms of depression and anxiety at follow-up, adding parosmia scores to the prediction model significantly increased the amount of explained variances. Clinicians should implement affective and olfactory evaluation to predict patients’ affective outcome.

scholarly journals Free-living Turning Rather Than Gait Differentiates People with Chronic Mild Traumatic Brain Injury from Controls

2021 ◽  
Author(s):  
Dylan Powell ◽  
Alan Godfrey ◽  
Lucy Parrington ◽  
Kody R. Campbell ◽  
Laurie A. King ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Physical Function ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls ◽  
Post Injury ◽  
Free Living ◽  
Sensitive Measure ◽  
Gait Characteristics

Abstract Background: Physical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to subtle deficits post-injury, which can impact quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an objective alternative for measuring physical function of gait and turning and can be used in any environment. Our recent work has found that turning quality is more sensitive than the quantity of physical activity when comparing chronic mTBI and healthy controls. However, no studies have compared the quality of free-living gait and turning characteristics concurrently in chronic mTBI and healthy controls. This study aimed to determine whether free-living gait or turning is more sensitive in differentiating chronic mTBI from controls.Methods: Thirty-two people with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~7 days using a single IMU at the waist on a belt. Free-living gait and turning characteristics were evaluated for chronic mTBI and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI.Results: Free-living gait characteristics were not different in chronic mTBI and controls (all p>0.05). In contrast, all but two (number of turns and average velocity CV) free-living turning characteristics were significantly different between chronic mTBI and controls, whilst controlling for age and sex (Bonferroni adjusted p<0.002). The chronic mTBI group had larger turn angles and longer turn durations compared to controls. ROC and AUC analysis showed turn duration (AUC = 0.92) was the most sensitive measure for differentiating chronic mTBI from controls. Conclusions: Results show that turning rather than gait characteristics were significantly different between chronic mTBI and controls, with turn duration being the most sensitive measure. These results suggest turning is a suitable surrogate biomarker to assess and monitor chronic mTBI.

scholarly journals Towards the Development of an Integrative, Evidence-Based Suite of Indicators for the Prediction of Outcome Following Mild Traumatic Brain Injury: Results from a Pilot Study

2020 ◽  
Vol 10 (1) ◽  
pp. 23 ◽  
Author(s):  
Aleksandra Gozt ◽  
Melissa Licari ◽  
Alison Halstrom ◽  
Hannah Milbourn ◽  
Stephen Lydiard ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glial Fibrillary Acidic Protein ◽  
Mild Traumatic Brain Injury ◽  
Diffusion Tensor ◽  
Neuron Specific Enolase ◽  
Mean Diffusivity ◽  
Small Sample ◽  
Acidic Protein ◽  
Healthy Controls

Background: Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI; concussion) beyond the timeframe that it typically takes to recover. Currently, there is no way of knowing which individuals may develop this condition. Method: Patients presenting to a hospital emergency department (ED) within 48 h of sustaining a mTBI underwent neuropsychological assessment and demographic, injury-related information and blood samples were collected. Concentrations of blood-based biomarkers neuron specific enolase, neurofilament protein-light, and glial fibrillary acidic protein were assessed, and a subset of patients also underwent diffusion tensor–magnetic resonance imaging; both relative to healthy controls. Individuals were classified as having PPCS if they reported a score of 25 or higher on the Rivermead Postconcussion Symptoms Questionnaire at ~28 days post-injury. Univariate exact logistic regression was performed to identify measures that may be predictive of PPCS. Neuroimaging data were examined for differences in fractional anisotropy (FA) and mean diffusivity in regions of interest. Results: Of n = 36 individuals, three (8.33%) were classified as having PPCS. Increased performance on the Repeatable Battery for the Assessment of Neuropsychological Status Update Total Score (OR = 0.81, 95% CI: 0.61–0.95, p = 0.004), Immediate Memory (OR = 0.79, 95% CI: 0.56–0.94, p = 0.001), and Attention (OR = 0.86, 95% CI: 0.71–0.97, p = 0.007) indices, as well as faster completion of the Trails Making Test B (OR = 1.06, 95% CI: 1.00–1.12, p = 0.032) at ED presentation were associated with a statistically significant decreased odds of an individual being classified as having PPCS. There was no significant association between blood-based biomarkers and PPCS in this small sample, although glial fibrillary acidic protein (GFAP) was significantly increased in individuals with mTBI relative to healthy controls. Furthermore, relative to healthy age and sex-matched controls (n = 8), individuals with mTBI (n = 14) had higher levels of FA within the left inferior frontal occipital fasciculus (t (18.06) = −3.01, p = 0.008). Conclusion: Performance on neuropsychological measures may be useful for predicting PPCS, but further investigation is required to elucidate the utility of this and other potential predictors.

Low plasma levels of calcitonin gene-related peptide in persistent post-traumatic headache attributed to mild traumatic brain injury

Cephalalgia ◽  
2020 ◽  
Vol 40 (12) ◽  
pp. 1276-1282 ◽  
Author(s):  
Håkan Ashina ◽  
Haidar Muhsen Al-Khazali ◽  
Afrim Iljazi ◽  
Sait Ashina ◽  
Niklas Rye Jørgensen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Plasma Levels ◽  
Healthy Controls ◽  
Age And Gender ◽  
Calcitonin Gene ◽  
Post Traumatic ◽  
And Gender ◽  
Plasma Measurements

Objective To investigate the role of calcitonin gene-related peptide (CGRP) in persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (TBI). Methods A total of 100 individuals with persistent PTH attributed to mild TBI and 100 age- and gender-matched healthy controls were enrolled between July 2018 and June 2019. Blood was drawn from the antecubital vein and subsequently analyzed using a validated radioimmunoassay for human CGRP. Measurements were performed on coded samples by a board-certified laboratory technician who was blind to clinical information. Results CGRP plasma levels were lower in subjects with persistent PTH (mean, 75.8 pmol/L; SD, 26.4 pmol/L), compared with age- and gender-matched healthy controls (mean, 88.0 pmol/L; SD, 34.1 pmol/L) ( p = 0.04). No correlation was found of CGRP plasma levels with monthly headache days ( r = −0.11; p = 0.27), monthly migraine-like days ( r = 0.15; p = 0.13), headache quality ( r = −0.14; p = 0.15), or a chronic migraine-like headache phenotype ( r = −0.02; p = 0.85). Conclusions CGRP plasma measurements are unlikely a feasible blood-based biomarker of persistent PTH. Future studies should assess whether CGRP plasma measurements can be used to predict development of persistent PTH.

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