TY  - JOUR
PY  - 2023//
TI  - Altered longitudinal structural connectome in paediatric mild traumatic brain injury: an Advancing Concussion Assessment in Paediatrics study
JO  - Brain communications
A1  - Ware, Ashley L.
A1  - Onicas, Adrian I.
A1  - Abdeen, Nishard
A1  - Beauchamp, Miriam H.
A1  - Beaulieu, Christian
A1  - Bjornson, Bruce H.
A1  - Craig, William
A1  - Dehaes, Mathieu
A1  - Deschenes, Sylvain
A1  - Doan, Quynh
A1  - Freedman, Stephen B.
A1  - Goodyear, Bradley G.
A1  - Gravel, Jocelyn
A1  - Ledoux, Andrée-Anne
A1  - Zemek, Roger
A1  - Yeates, Keith Owen
A1  - Lebel, Catherine
SP  - fcad173
EP  - fcad173
VL  - 5
IS  - 3
N2  - Advanced diffusion-weighted imaging techniques have increased understanding of the neuropathology of paediatric mild traumatic brain injury (i.e. concussion). Most studies have examined discrete white-matter pathways, which may not capture the characteristically subtle, diffuse and heterogenous effects of paediatric concussion on brain microstructure. This study compared the structural connectome of children with concussion to those with mild orthopaedic injury to determine whether network metrics and their trajectories across time post-injury differentiate paediatric concussion from mild traumatic injury more generally. Data were drawn from of a large study of outcomes in paediatric concussion. Children aged 8-16.99 years were recruited from five paediatric emergency departments within 48 h of sustaining a concussion (n = 360; 56% male) or mild orthopaedic injury (n = 196; 62% male). A reliable change score was used to classify children with concussion into two groups: concussion with or without persistent symptoms. Children completed 3 T MRI at post-acute (2-33 days) and/or chronic (3 or 6 months, via random assignment) post-injury follow-ups. Diffusion-weighted images were used to calculate the diffusion tensor, conduct deterministic whole-brain fibre tractography and compute connectivity matrices in native (diffusion) space for 90 supratentorial regions. Weighted adjacency matrices were constructed using average fractional anisotropy and used to calculate global and local (regional) graph theory metrics. Linear mixed effects modelling was performed to compare groups, correcting for multiple comparisons. Groups did not differ in global network metrics. However, the clustering coefficient, betweenness centrality and efficiency of the insula, cingulate, parietal, occipital and subcortical regions differed among groups, with differences moderated by time (days) post-injury, biological sex and age at time of injury. Post-acute differences were minimal, whereas more robust alterations emerged at 3 and especially 6 months in children with concussion with persistent symptoms, albeit differently by sex and age. In the largest neuroimaging study to date, post-acute regional network metrics distinguished concussion from mild orthopaedic injury and predicted symptom recovery 1-month post-injury. Regional network parameters alterations were more robust and widespread at chronic timepoints than post-acutely after concussion. <br><br>RESULTS suggest that increased regional and local subnetwork segregation (modularity) and inefficiency occurs across time after concussion, emerging after post-concussive symptom resolve in most children. These differences persist up to 6 months after concussion, especially in children who showed persistent symptoms. While prognostic, the small to modest effect size of group differences and the moderating effects of sex likely would preclude effective clinical application in individual patients.<p />  <p>Language: en</p>
LA  - en
SN  - 2632-1297
UR  - http://dx.doi.org/10.1093/braincomms/fcad173
ID  - ref1
ER  -