Serum Neurosteroid Levels Are Associated With Cortical Thickness in Individuals Diagnosed With Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury,Clinical EEG and Neuroscience

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Serum Neurosteroid Levels Are Associated With Cortical Thickness in Individuals Diagnosed With Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury
Clinical EEG and Neuroscience ( IF 1.6 ) Pub Date : 2020-03-18 , DOI: 10.1177/1550059420909676
Philipp Kinzel _{1,

2} , Christine E Marx _{3,

4} , Nico Sollmann _{1,

2,

5,

6} , Elisabeth Hartl _{1,

2,

7} , Jeffrey P Guenette _{1,

8} , David Kaufmann _{1,

2,

9} , Sylvain Bouix ₁ , Ofer Pasternak _{1,

8} , Yogesh Rathi ₁ , Michael J Coleman ₁ , Andre van der Kouwe _{10,

11} , Karl Helmer _{10,

11} , Jason D Kilts _{3,

4} , Jennifer C Naylor _{3,

4} , Rajendra A Morey _{3,

4,

12} , Lori Shutter ₁₃ , Norberto Andaluz _{14,

15} , Raul Coimbra ₁₆ , Ariel J Lang _{17,

18,

19} , Mark S George _{20,

21} , Thomas W McAllister ₂₂ , Ross Zafonte _{23,

24} , Murray B Stein _{17,

18,

19} , Martha E Shenton _{1,

8,

25} , Inga K Koerte _{1,

2,

26,

27}

Affiliation

Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC, USA.
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Department of Neurology, Epilepsy Center, University Hospital Munich, Munich, Germany.
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Charité Universitätsmedizin, Berlin, Germany.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
Departments of Critical Care Medicine, Neurology and Neurosurgery, UPMC Health System/University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Mayfield Brain & Spine, Cincinnati, OH, USA.
Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
Psychiatry Department, Medical University of South Carolina, Charleston, SC, USA.
Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
Department of Psychiatry, Indiana School of Medicine, Indianapolis, IN, USA.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.
Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
VA Boston Healthcare System, Brockton Division, Brockton, MA, USA.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany.

Posttraumatic stress disorder (PTSD) co-occurring with mild traumatic brain injury (mTBI) is common in veterans. Worse clinical outcome in those with PTSD has been associated with decreased serum neurosteroid levels. Furthermore, decreased cortical thickness has been associated with both PTSD and mTBI. However, it is not known whether decreased neurosteroids are associated with decreased cortical thickness in PTSD co-occurring with mTBI. This study included 141 individuals divided into the following groups: (a) mTBI group (n = 32 [10 female, 22 male] veterans with a history of mTBI); (b) PTSD + mTBI group (n = 41 [6 female, 35 male] veterans with current PTSD with a history of mTBI); and (c) control group (n = 68 [35 female, 33 male] control participants), which were acquired through the Injury and Traumatic Stress (INTRuST) Clinical Consortium. Subjects underwent clinical assessment, magnetic resonance imaging at 3 T, and serum neurosteroid quantifications of allopregnanolone (ALLO) and pregnenolone (PREGN). Group differences in cortical thickness and associations between serum neurosteroid levels and cortical thickness were investigated. Cortical thickness was decreased in the PTSD + mTBI group compared with the other groups. In the PTSD + mTBI group, decreased cortical thickness was also associated with lower serum ALLO (right superior frontal cortex) and lower serum PREGN (left middle temporal and right orbitofrontal cortex). Cortical thickness in the middle temporal and orbitofrontal cortex was associated with PTSD symptom severity. There were no significant associations between neurosteroids and cortical thickness in the mTBI or control groups. Decreased cortical thickness in individuals with PTSD + mTBI is associated with decreased serum neurosteroid levels and greater PTSD symptom severity. Causality is unclear. However, future studies might investigate whether treatment with neurosteroids could counteract stress-induced neural atrophy in PTSD + mTBI by potentially preserving cortical thickness.

中文翻译：

血清神经类固醇水平与诊断为创伤后应激障碍和轻度创伤性脑损伤病史的个体的皮质厚度相关

与轻度创伤性脑损伤 (mTBI) 并存的创伤后应激障碍 (PTSD) 在退伍军人中很常见。PTSD 患者更糟糕的临床结果与血清神经类固醇水平降低有关。此外，减少的皮质厚度与 PTSD 和 mTBI 都有关。然而，尚不清楚神经类固醇的减少是否与 mTBI 共同发生的 PTSD 中皮质厚度的减少有关。这项研究包括 141 个人，分为以下几组： (a) mTBI 组（n = 32 [10 名女性，22 名男性] 有 mTBI 病史的退伍军人）；(b) PTSD + mTBI 组（n = 41 [6 名女性，35 名男性] 具有 mTBI 病史的当前 PTSD 退伍军人）；(c) 对照组（n = 68 [35 名女性，33 名男性] 对照组参与者），它们是通过伤害和创伤压力 (INTRuST) 临床联盟获得的。受试者接受了临床评估、3 T 磁共振成像以及别孕烯醇酮 (ALLO) 和孕烯醇酮 (PREGN) 的血清神经类固醇定量。研究了皮质厚度的组差异以及血清神经类固醇水平和皮质厚度之间的关联。与其他组相比，PTSD + mTBI 组的皮质厚度减少。在 PTSD + mTBI 组中，皮质厚度降低也与血清 ALLO（右上额叶皮层）和血清 PREGN（左中颞叶和右眶额叶皮层）降低有关。中颞叶和眶额皮质的皮质厚度与 PTSD 症状严重程度相关。在 mTBI 或对照组中，神经类固醇与皮质厚度之间没有显着关联。PTSD + mTBI 患者皮质厚度减少与血清神经类固醇水平降低和 PTSD 症状严重程度有关。因果关系不清楚。然而，未来的研究可能会调查用神经类固醇治疗是否可以通过潜在地保持皮质厚度来抵消 PTSD + mTBI 中压力引起的神经萎缩。

更新日期：2020-03-18

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