Elsevier

Biological Psychiatry

Volume 55, Issue 3, 1 February 2004, Pages 208-216
Biological Psychiatry

Original article
Neuroimaging correlates of anxiety after pediatric traumatic brain injury

https://doi.org/10.1016/S0006-3223(03)00708-XGet rights and content

Abstract

Background

Anxiety disorders are common after traumatic brain injury (TBI). Data on the neural correlates of these conditions are lacking. This study examines the relationship between brain damage, particularly to the orbitofrontal cortex (OFC) and temporal lobe, and anxiety symptoms and disorders.

Methods

Ninety-five children and adolescents were followed for one year postinjury. Preinjury and one-year postinjury anxiety status were obtained from the parent. Magnetic resonance imaging was performed to evaluate brain lesions. The primary analysis used regression models to determine relationships between brain lesions and anxiety outcomes. As a secondary analysis, previously reported posttraumatic stress disorder (PTSD) data were reanalyzed using similar methods for purposes of comparison.

Results

The primary analysis showed that greater volume and number of OFC lesions correlated with decreased risk for anxiety, whereas lesions in other brain areas did not correlate with anxiety. Consistent with prior data, the secondary analysis showed an inverse correlation between OFC damage and PTSD; temporal lobe damage was positively correlated with PTSD.

Conclusions

After pediatric TBI, greater damage to the OFC is associated with decreased risk for anxiety outcomes. Similar to adult data, these findings implicate OFC dysfunction in childhood anxiety. Temporal lobe damage did not correlate with anxiety, in contrast to the findings for PTSD.

Section snippets

Design overview

The methods, sample characteristics, and data on prevalence and clinical risk factors of anxiety and PTSD outcomes have been described elsewhere Gerring et al., 2000, Gerring et al., 2002, Vasa et al., 2002. This was a 1-year prospective cohort study that used a parent report to rate the child's behavior at two times: 1) immediately after enrollment to retrospectively assess premorbid anxiety, and 2) 1 year postinjury to obtain current anxiety status. Only parent reports of child anxiety were

Brain lesion characteristics

Table 1 shows the brain lesion characteristics of the sample. Two children descriptors of brain damage, the volume and number of lesions, are presented for five areas.

Anxiety disorders

Nine subjects had a preinjury disorder; seven children had one disorder, and two had 2 disorders. Specific disorders included 5 SP, 3 OCD, 2OAD, and 1 SAD. Twelve subjects had one postinjury disorder; one subject had two disorders. Specific disorders included 6 SP, 5 OAD, 1 SAD, and 1 OCD. Seven children had postinjury PTSD. One

Discussion

This is the first lesion-based study to examine the neural correlates of anxiety after pediatric TBI. The main finding shows that children with more damage to the OFC are less likely to develop anxiety. This finding was significant in the univariate and multivariate regressions when using multiple descriptors of brain damage (i.e., the volume and presence or absence of lesions) and when controlling for preinjury anxiety and damage to other brain regions. These results show that, similar to

Acknowledgements

This research was funded by National Institute of Mental Health Grant No. K20 MH-00997 and National Institutes of Health Grant No. MO-RR00052, which was awarded to the senior author. We thank Laurie Tochterman for her assistance in preparing this manuscript.

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