Rier, Lukas
(2022)
Magnetoencephalography for the investigation and diagnosis of Mild Traumatic Brain Injury.
PhD thesis, University of Nottingham.
Abstract
Mild Traumatic Brain Injury (mTBI), (or concussion), is the most common type of brain injury. Despite this, it often goes undiagnosed and can cause long term disability—most likely caused by the disruption of axonal connections in the brain. Objective methods for diagnosis and prognosis are needed but clinically available neuroimaging modalities rarely show structural abnormalities, even when patients suffer persisting functional deficits. In the past three decades, new powerful techniques to image brain structure and function have shown promise in detecting mTBI related changes. Magnetoencephalography (MEG), which measures electrical brain activity by detecting magnetic fields outside the head generated by neural currents, is particularly sensitive and has therefore gained interest from researchers. Numerous studies are proposing abnormal low-frequency neural oscillations and functional connectivity—the statistical interdependency of signals from separate brain regions—as potential biomarkers for mTBI. However, typically small sample sizes, the lack of replication between groups, the heterogeneity of the cohorts studied, and the lack of longitudinal studies impedes the adoption of MEG as a clinical tool in mTBI management. In particular, little is known about the acute phase of mTBI.
In this thesis, some of these gaps will be addressed by analysing MEG data from individuals with mTBI, using novel as well as conventional methods. The potential future of MEG in mTBI research will also be addressed by testing the capabilities of a wearable MEG system based on optically pumped magnetometers (OPMs).
The thesis contains three main experimental studies. In study 1, we investigated the signal dynamics underlying MEG abnormalities, found in a cohort of subjects scanned within three months of an mTBI, using a Hidden Markov Model (HMM), as growing evidence suggests that neural dynamics are (in part) driven by transient bursting events. Applying the HMM to resting-state data, we show that previously reported findings of diminished intrinsic beta amplitude and connectivity in individuals with mTBI (compared to healthy controls) can be explained by a reduction in the beta-band content of pan-spectral bursts and a loss in the temporal coincidence of bursts respectively. Using machine learning, we find the functional connections driving group differences and achieve classification accuracies of 98%. In a motor task, mTBI resulted in reduced burst amplitude, altered modulation of burst probability during movement and decreased connectivity in the motor network.
In study 2, we further test our HMM-based method in a cohort of subjects with mTBI and non-head trauma—scanned within two weeks of injury—to ensure specificity of any observed effects to mTBI and replicate our previous finding of reduced connectivity and high classification accuracy, although not the reduction in burst amplitude. Burst statistics were stable over both studies—despite data being acquired at different sites, using different scanners. In the same cohort, we applied a more conventional analysis of delta-band power. Although excess low-frequency power appears to be a promising candidate marker for persistently symptomatic mTBI, insufficient data exist to confirm this pattern in acute mTBI. We found abnormally high delta power to be a sensitive measure for discriminating mTBI subjects from healthy controls, however, similarly elevated delta amplitude was found in the cohort with non-head trauma, suggesting that excess delta may not be specific to mTBI, at least in the acute stage of injury.
Our work highlights the need for longitudinal assessment of mTBI. In addition, there appears to be a need to investigate naturalistic paradigms which can be tailored to induce activity in symptom-relevant brain networks and consequently are likely to be more sensitive biomarkers than the resting state scans used to date. Wearable OPM-MEG makes naturalistic scanning possible and may offer a cheaper and more accessible alternative to cryogenic MEG, however, before deploying OPMs clinically, or in pitch-side assessment for athletes, for example, the reliability of OPM-derived measures needs to be verified. In the third and final study, we performed a repeatability study using a novel motor task, estimating a series of common MEG measures and quantifying the reliability of both activity and connectivity derived from OPM-MEG data. These initial findings—presently limited to a small sample of healthy controls—demonstrate the utility of OPM-MEG and pave the way for this technology to be deployed on patients with mTBI.
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