TBI Could Reduce Cerebellic Volume in Children and Adolescents
Traumatic brain injury (TBI) in children and adolescents was shown to decrease cerebellum volume, especially in the posterior lobe, according to a retrospective cohort study published in JAMA Network Open.
“Longitudinal cerebellum changes were associated with baseline diffusion tensor MRI metrics, suggesting secondary cerebellar atrophy,” authors noted. “These results provide further understanding of secondary injury mechanisms and may point to new opportunities for intervention.”
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Researchers gathered data, collected between 2006 and 2020, from 9 sites in the Enhancing Neuroimaging Genetics Through Meta-Analysis Consortium Pediatric TBI working group. Participants with TBI and healthy controls were recruited from various trauma centers, clinics, and registries, with some individuals followed longitudinally for up to 1.9 years. Data analysis was conducted from October to December 2022. The main exposure was accidental mild complicated-severe TBI (msTBI) for individuals in the TBI group, while some controls had orthopedic injury diagnoses.
Primary outcomes included the volume of 18 cerebellar lobules and vermal regions estimated from 3-dimensional T1-weighted magnetic resonance imaging (MRI) scans, assessment of white matter organization in 28 regions of interest using diffusion tensor MRI, and measurement of executive function via parent-reported scores from the Behavior Rating Inventory of Executive Functioning.
A total of 598 children and adolescents participated in the study. Participants were 35.5% female and had a mean age of 14. There were 314 participants in the msTBI group and 284 participants in the non-TBI group. Significantly smaller total cerebellum volume (d = −0.37; 95% CI, −0.52 to −0.22; P < .001) and subregional cerebellum volumes (eg, corpus medullare; d = −0.43; 95% CI, −0.58 to −0.28; P < .001) were observed in the msTBI group, particularly in patients 6 months post-injury (total cerebellar volume, d = −0.55; 95% CI, −0.75 to −0.35; P < .001). Participants with higher scores on the Behavior Rating Inventory of Executive Functioning Global Executive Composite were found to have smaller cerebellum volumes (β = −208.9 mm3; 95% CI, −319.0 to −98.0 mm3; P = .008). Poorer white matter organization in the first months following the injury was associated with decreases in cerebellum volume over time (β=0.52 mm3; 95% CI, 0.19 to 0.84 mm3; P = .005).
“Future research incorporating lesion mapping and structural connectivity will help understand the mechanisms of spreading disruption and potentially identify additional opportunities for intervention that may leverage developmental neuroplasticity,” researchers concluded.
