@article{ref1,
title="Cortical excitability after pediatric mild traumatic brain injury",
journal="Brain stimulation",
year="2016",
author="Seeger, Trevor A. and Kirton, Adam and Esser, Michael J. and Gallagher, Clare and Dunn, Jeff and Zewdie, Ephrem and Damji, Omar and Ciechanski, Patrick and Barlow, Karen M.",
volume="10",
number="2",
pages="305-314",
abstract="INTRODUCTION: Mild traumatic brain injury (mTBI) outcomes are variable, and 10-15% may suffer from prolonged symptoms beyond 3 months that impair the child's return to normal activities. Neurophysiological mechanisms of mTBI are incompletely understood, particularly in children, but alterations in cortical excitability have been proposed to underlie post-concussion syndrome. Improved understanding is required to advance interventions and improve outcomes. <br><br>OBJECTIVE/HYPOTHESIS: To determine if cortical excitability is altered in children with mTBI, and its association with clinical symptoms. <br><br>METHODS: This was a cross-sectional controlled cohort study. School-aged children (8-18 years) with mTBI were compared to healthy controls. Cortical excitability was measured using multiple TMS paradigms in children with (symptomatic) and without (recovered) persistent symptoms one-month post-injury. Primary outcome was the cortical silent period (cSP), a potential neurophysiological biomarker of GABAergic inhibition. Secondary outcomes included additional TMS neurophysiology, safety and tolerability. Associations between neurophysiology parameters and clinical symptoms were evaluated. <br><br>RESULTS: Fifty-three children with mTBI (55% male; mean age 14.1 SD: 2.4 years; 35 symptomatic and 27 asymptomatic participants) and 28 controls (46% male; mean age 14.3 SD: 3.1 years) were enrolled. cSP duration was similar between groups (F (2, 73) = 0.55, p = 0.582). Log10 long interval intracortical inhibition (LICI) was reduced in symptomatic participants compared to healthy controls (F (2, 59) = 3.83, p = 0.027). Procedures were well tolerated with no serious adverse events. <br><br>CONCLUSIONS: TMS measures of cortical excitability are altered at one month in children with mTBI. Long interval cortical inhibition is decreased in children who remain symptomatic at one month post-injury.<br><br>Copyright © 2016 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1935-861X",
doi="10.1016/j.brs.2016.11.011",
url="http://dx.doi.org/10.1016/j.brs.2016.11.011"
}