Citation

Cosgrove ME, Saadon JR, Mikell CB, Stefancin PL, Alkadaa L, Wang Z, Saluja S, Servider J, Razzaq B, Huang C, Mofakham S. Front. Neurol. 2022; 13: e826266.

Copyright

(Copyright © 2022, Frontiers Research Foundation)

DOI

10.3389/fneur.2022.826266

PMID

35250829

PMCID

PMC8895046

Abstract

Recovery of consciousness after traumatic brain injury (TBI) is heterogeneous and difficult to predict. Structures such as the thalamus and prefrontal cortex are thought to be important in facilitating consciousness. We sought to investigate whether the integrity of thalamo-prefrontal circuits, assessed via diffusion tensor imaging (DTI), was associated with the return of goal-directed behavior after severe TBI. We classified a cohort of severe TBI patients (N = 25, 20 males) into Early and Late/Never outcome groups based on their ability to follow commands within 30 days post-injury. We assessed connectivity between whole thalamus, and mediodorsal thalamus (MD), to prefrontal cortex (PFC) subregions including dorsolateral PFC (dlPFC), medial PFC (mPFC), anterior cingulate (ACC), and orbitofrontal (OFC) cortices. We found that the integrity of thalamic projections to PFC subregions (L OFC, L and R ACC, and R mPFC) was significantly associated with Early command-following. This association persisted when the analysis was restricted to prefrontal-mediodorsal (MD) thalamus connectivity. In contrast, dlPFC connectivity to thalamus was not significantly associated with command-following. Using the integrity of thalamo-prefrontal connections, we created a linear regression model that demonstrated 72% accuracy in predicting command-following after a leave-one-out analysis. Together, these data support a role for thalamo-prefrontal connectivity in the return of goal-directed behavior following TBI.

Language: en

Keywords

diffusion-weighted imaging; goal-directed behavior; recovery of consciousness; thalamocortical connectivity; tractography; traumatic brain injury (TBI)