Enhanced pre-frontal functional-structural networks to support behavioural deficits after traumatic brain injury

Abstract

Traumatic brain injury (TBI) affects its structural connectivity, triggering the re-organization of structural-functional circuits in a manner that remains poorly understood. We studied the re-organization of brain networks after TBI, taking advantage of a computational method based on magnetic resonance imaging (MRI) including diffusion-weighted imaging in combination with functional resting state data obtained from the blood-oxygenation-level-dependent T2* signal. We enrolled young participants who had suffered moderate to severe TBI (N=14, age 13.14 {+/-} 3.25 years), comparing them to young typically developing control participants (N=27, age 15.04 {+/-} 2.26 years). We found increased functional and structural connectivity within a cortico-subcortical network in TBI patients brains that involved prefrontal cortex, anterior cingulate gyrus, orbital gyrus and caudate nucleus. In comparison to control participants, TBI patients increased functional connectivity from prefrontal regions towards two different networks: 1) a subcortical network including part of the motor network, basal ganglia, cerebellum, hippocampus, amygdala, posterior cingulum and precuneus; and 2) a task-positive network, involving regions of the dorsal attention system together with the dorsolateral and ventrolateral prefrontal regions. We also found the increased prefrontal activation in TBI patients was correlated with some behavioural indices, such as the amount of body sway, whereby patients with worse balance activated frontal regions more strongly. The enhanced prefrontal activation found in TBI patients may provide the structural scaffold for stronger cognitive control of certain behavioural functions, consistent with the observation that various motor tasks are performed less automatically following TBI and that more cognitive control is associated with such actions.