Articles: traumatic-brain-injuries.
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Journal of neurotrauma · Jul 2024
Characterizing diffusion from microdialysis catheters in the human brain: a magnetic resonance imaging study with gadobutrol.
Cerebral microdialysis (CMD) catheters allow continuous monitoring of patients' cerebral metabolism in severe traumatic brain injury (TBI). The catheters consist of a terminal semi-permeable membrane that is inserted into the brain's interstitium to allow perfusion fluid to equalize with the surrounding cerebral extracellular environment before being recovered through a central non-porous channel. However, it is unclear how far recovered fluid and suspended metabolites have diffused from within the brain, and therefore what volume or region of brain tissue the analyses of metabolism represent. ⋯ Cerebral microdialysis allows continuous monitoring of regional cerebral metabolism-the volume of which is now clearer from this study. It also has the potential to deliver small molecule therapies to focal pathologies of the human brain. This study provides a platform for future development of new catheters optimally designed to treat such conditions.
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Journal of neurotrauma · Jul 2024
DREADD-mediated activation of the periaqueductal gray restores nociceptive descending inhibition after traumatic brain injury in rats.
Traumatic brain injury (TBI) patients frequently experience chronic pain that can enhance their suffering and significantly impair rehabilitative efforts. Clinical studies suggest that damage to the periaqueductal gray matter (PAG) following TBI, a principal center involved in endogenous pain control, may underlie the development of chronic pain. We hypothesized that TBI would diminish the usual pain control functions of the PAG, but that directly stimulating this center using a chemogenetic approach would restore descending pain modulation. ⋯ Descending pain control originating in the PAG is mediated through opioid receptors in uninjured rats. TBI, however, fundamentally alters the descending nociceptive control circuitry such that serotonergic influences predominate, and those are mediated by the 5-HT2A receptor. These results provide further evidence that the PAG is a key target for anti-nociception after TBI.
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Journal of neurotrauma · Jul 2024
Behavioral interventions can improve brain injury-induced deficits in behavioral flexibility and impulsivity linked to impaired reward-feedback beta oscillations.
Traumatic brain injury (TBI) affects a large population, resulting in severe cognitive impairments. Although cognitive rehabilitation is an accepted treatment for some deficits, studies in patients are limited in ability to probe physiological and behavioral mechanisms. Therefore, animal models are needed to optimize strategies. ⋯ The behavioral intervention improved flexibility and increased OFC activity. Intervention also reduced impulsivity, even after cues were decoupled, which was partially mediated by improvements in timing behavior. The current study established a platform to begin investigating cognitive rehabilitation in rats and identified a strong role for dysfunctional OFC signaling in probabilistic learning after frontal TBI.
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Journal of neurotrauma · Jul 2024
ReviewEffectiveness of non-pharmacological therapy on physical symptoms in patients with persistent concussion symptoms: A Systematic Review.
This systematic review provides a comprehensive overview on the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. PubMed, MEDLINE®, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical post-concussion symptoms. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. ⋯ Finally, in a pediatric population, the use of melatonin did not produce any changes in physical persistent concussion symptoms as compared with placebo. Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, the results need to be interpreted with caution.
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Journal of neurotrauma · Jul 2024
Multicenter StudyVisualization of the intracranial pressure and time burden in childhood brain trauma: What we have learnt one decade on with KidsBrainIT.
To validate the intracranial pressure (ICP) dose-response visualization plot for the first time in a novel prospectively collected pediatric traumatic brain injury (pTBI) data set from the multi-center, multi-national KidsBrainIT consortium. Prospectively collected minute-by-minute ICP and mean arterial blood pressure time series of 104 pTBI patients were categorized in ICP intensity-duration episodes. These episodes were correlated with the 6-month Glasgow Outcome Score (GOS) and displayed in a color-coded ICP dose-response plot. ⋯ The ICP dose-response plot was reproduced in a novel and independent pTBI data set. ICP above 20 mm Hg and CPP below 50 mm Hg for any duration in time were associated with worse outcome. This highlighted a pressing need to reduce pediatric ICP therapeutic thresholds used at the bedside.