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Published on: January 20, 2023
Longitudinal white matter microstructural changes in pediatric mild traumatic brain injury: An A-CAP study
Ashley L Ware1,2, Keith Owen Yeates1, Ken Tang3
1Department of Psychology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Insights
Pediatric mild traumatic brain injury (mTBI) can cause chronic white matter changes, particularly in younger children with persistent symptoms. White matter microstructure appears more organized in children without persistent symptoms, correlating with better outcomes.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Radiology
Background:
- Pediatric mild traumatic brain injury (mTBI) is common, but its long-term effects on white matter microstructure are not fully understood.
- Persistent symptoms after mTBI in children can impact neurodevelopment and quality of life.
Purpose of the Study:
- To investigate white matter microstructural trajectories in children after mTBI.
- To examine the relationship between white matter changes and persistent symptoms in pediatric mTBI.
Main Methods:
- A prospective, longitudinal cohort study involving children aged 8-16.99 years with mTBI or orthopedic injury (OI).
- Diffusion-weighted imaging (DWI) was used to assess white matter microstructure (mean diffusivity and fractional anisotropy) at post-acute and chronic time points.
- Children were classified as mTBI with or without persistent symptoms based on pre-injury and 1-month post-injury symptom ratings.
Main Results:
- Children with mTBI without persistent symptoms showed higher fractional anisotropy in the superior longitudinal fasciculus compared to OI.
- Younger children with mTBI and persistent symptoms exhibited higher mean diffusivity in the anterior thalamic radiations.
- Lower mean diffusivity in the arcuate fasciculus and superior longitudinal fasciculus was observed in mTBI without persistent symptoms compared to OI at 6 months post-injury.
Conclusions:
- White matter microstructural changes, potentially indicating neuroinflammation and axonal swelling, persist for at least 6 months post-injury in children with mTBI.
- These changes are more pronounced in younger children experiencing persistent symptoms after mTBI.
- More organized white matter microstructure is associated with better clinical outcomes in children recovering from mTBI.
Abstract:
In the largest sample studied to date, white matter microstructural trajectories and their relation to persistent symptoms were examined after pediatric mild traumatic brain injury (mTBI). This prospective, longitudinal cohort study recruited children aged 8-16.99 years with mTBI or mild orthopedic injury (OI) from five pediatric emergency departments. Children's pre-injury and 1-month post-injury symptom ratings were used to classify mTBI with or without persistent symptoms. Children completed diffusion-weighted imaging at post-acute (2-33 days post-injury) and chronic (3 or 6 months via random assignment) post-injury assessments. Mean diffusivity (MD) and fractional anisotropy (FA) were derived for 18 white matter tracts in 560 children (362 mTBI/198 OI), 407 with longitudinal data. Superior longitudinal fasciculus FA was higher in mTBI without persistent symptoms relative to OI, d (95% confidence interval) = 0.31 to 0.37 (0.02, 0.68), across time. In younger children, MD of the anterior thalamic radiations was higher in mTBI with persistent symptoms relative to both mTBI without persistent symptoms, 1.43 (0.59, 2.27), and OI, 1.94 (1.07, 2.81). MD of the arcuate fasciculus, -0.58 (-1.04, -0.11), and superior longitudinal fasciculus, -0.49 (-0.90, -0.09) was lower in mTBI without persistent symptoms relative to OI at 6 months post-injury. White matter microstructural changes suggesting neuroinflammation and axonal swelling occurred chronically and continued 6 months post injury in children with mTBI, especially in younger children with persistent symptoms, relative to OI. White matter microstructure appears more organized in children without persistent symptoms, consistent with their better clinical outcomes.
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