基于表面的儿童创伤性脑损伤执行额眶皮质回路异常。

Surface-based abnormalities of the executive frontostriatial circuit in pediatric TBI.

机构信息

Department of Psychology, Brigham Young University, Provo, UT, United States.

Neuroscience Center, Brigham Young University, Provo, UT, United States.

出版信息

Neuroimage Clin. 2022;35:103136. doi: 10.1016/j.nicl.2022.103136. Epub 2022 Jul 29.

Abstract

Childhood traumatic brain injury (TBI) is one of the most common causes of acquired disability and has significant implications for executive functions (EF), such as impaired attention, planning, and initiation that are predictive of everyday functioning. Evidence has suggested attentional features of executive functioning require behavioral flexibility that is dependent on frontostriatial circuitry. The purpose of this study was to evaluate surface-based deformation of a specific frontostriatial circuit in pediatric TBI and its role in EF. Regions of interest included: the dorsolateral prefrontal cortex (DLPFC), caudate nucleus, globus pallidus, and the mediodorsal nucleus of the thalamus (MD). T1-weighted magnetic resonance images were obtained in a sample of children ages 8-13 with complicated mild, moderate, or severe TBI (n = 32) and a group of comparison children with orthopedic injury (OI; n = 30). Brain regions were characterized using high-dimensional surface-based brain mapping procedures. Aspects of EF were assessed using select subtests from the Test of Everyday Attention for Children (TEA-Ch). General linear models tested group and hemisphere differences in DLPFC cortical thickness and subcortical shape of deep-brain regions; Pearson correlations tested relationships with EF. Main effects for group were found in both cortical thickness of the DLPFC (F = 4.30, p = 0.042) and MD mean deformation (F = 6.50, p = 0.01) all with lower values in the TBI group. Statistical surface maps revealed significant inward deformation on ventral-medial aspects of the caudate in TBI relative to OI, but null results in the globus pallidus. No significant relationships between EF and any region of interest were observed. Overall, findings revealed abnormalities in multiple aspects of a frontostriatial circuit in pediatric TBI, which may reflect broader pathophysiological mechanisms. Increased consideration for the role of deep-brain structures in pediatric TBI can aid in the clinical characterization of anticipated long-term developmental effects of these individuals.

摘要

儿童创伤性脑损伤 (TBI) 是后天残疾的最常见原因之一,对执行功能 (EF) 有重大影响,例如注意力、计划和启动受损,这些都是日常功能的预测因素。有证据表明,执行功能的注意力特征需要依赖额纹状体回路的行为灵活性。本研究旨在评估儿科 TBI 特定额纹状体回路的表面变形及其在 EF 中的作用。感兴趣的区域包括:背外侧前额叶皮层 (DLPFC)、尾状核、苍白球和丘脑内背侧核 (MD)。对年龄在 8-13 岁的患有复杂轻度、中度或重度 TBI 的儿童 (n=32) 和一组伴有骨科损伤的对照组儿童 (n=30) 进行 T1 加权磁共振成像。使用高维表面脑图绘制程序对大脑区域进行特征描述。使用儿童日常注意力测试 (TEA-Ch) 的特定子测试评估 EF 方面。一般线性模型测试了组和大脑半球对 DLPFC 皮质厚度和深部脑区皮质下形状的差异;Pearson 相关性测试了与 EF 的关系。在 DLPFC 皮质厚度 (F=4.30, p=0.042) 和 MD 平均变形 (F=6.50, p=0.01) 方面均发现了组的主要效应,而 TBI 组的数值较低。在 TBI 中,与 OI 相比,尾状核的腹内侧表面出现了明显的向内变形,但苍白球的结果为零。未观察到 EF 与任何感兴趣区域之间存在显著关系。总体而言,研究结果表明,儿科 TBI 中的多个额纹状体回路存在异常,这可能反映了更广泛的病理生理机制。增加对深部脑结构在儿科 TBI 中的作用的考虑,可以帮助临床表征这些个体的预期长期发育影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c092/9421496/faefa54fe44a/gr1.jpg

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